Alice in Wonderland and Sleep Apnea

An interesting review in the Oxford University Press blog by Edward Shorter, MD, Professor in the History of Medicine and Professor of Psychiatry, University of Toronto and Susan Bélanger, Research Coordinator with the History of Medicine Program discusses “Alice in Wonderland in Psychiatry and Medicine.”

The authors describe that since Lewis Carroll published Alice’s Adventures in Wonderland on the 4th of July, 1865, medical and psychiatric writers and researchers over the last century and a half have used the story of Alice to elucidate various medical and psychiatric conditions. These include migraines, Todd syndrome (also termed Alice in Wonderland Syndrome) where an individual perceives size distortions, psychotic states and the use of hallucinogenic drugs.

According to Shorter and Bélanger, one of the most interesting and humorous medical reviews of Alice in Wonderland, however, occurred in an essay titled “Sleep of the Great,” published in 2000 in the Journal Respiratory Physiology. Whitelaw and colleagues of the University of Calgary identified the Mad Hatter’s Tea Party as an early report of obstructive sleep apnea and its treatment. “You might just as well say… that ‘I breathe when I sleep’ is the same thing as ‘I sleep when I breathe’” says the Dormouse (“which seemed to be talking in its sleep”), to which the Hatter replies “It is the same thing with you.” Whitelaw and Black interpret the Dormouse’s “severe daytime somnolence” as “a cardinal symptom of obstructive sleep apnea…. The dormouse cannot breathe and sleep at the same time because… his pharynx falls closed the moment he falls asleep.” The episode ends with Alice walking off in disgust (“It’s the stupidest tea-party I ever was at in all my life!”) as the Hare and the Hatter stuff the Dormouse head first into a teapot. Whitelaw and colleagues explain that the teapot “fits tightly around his neck, thus compressing the air in the pot and producing continuous positive airway pressure, which is the best treatment for obstructive sleep apnea.”

Oxford University Press

A Historical Dictionary of Psychiatry
Edward Shorter, MD