Sleep Medicine 16 (2015) 1295–1300

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Historical Issues in Sleep Medicine

Elliot D. Weitzman MD and early sleep research and sleep medicine in New York Michael Thorpy * Sleep-Wake Disorders Center, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA

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Article history: Received 27 April 2015 Received in revised form 14 May 2015 Accepted 29 May 2015 Available online 23 June 2015 Keywords: Weitzman Sleep New York History Research Montefiore

Elliot Weitzman, past Professor of Neurology and Chairman of the Department of Neurology at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, NY, USA, had an illustrious career and was a true pioneer of sleep research and sleep medicine in New York in the 1960s, 1970s, and early 1980s. He created the clinical sleep center at Montefiore Medical Center in New York on 27 April 1977, which was the first sleep center in the United States to be accredited by the American Academy of Sleep Medicine (AASM) (formerly the Association of Sleep Disorders Centers (ASDC)). The center was modeled in part on the first sleep clinic in the country, a clinic dedicated to the diagnosis, research, and treatment of narcolepsy that was developed by William Dement at Stanford University in California in 1964. Weitzman, who was born in Newark, NJ, USA, in 1929, was originally interested in journalism and joined Iowa State University, but soon transferred to, and graduated from, the University of Iowa with a BA in zoology in 1950. He then went to medical school at the University of Chicago and was in the same class as William Dement. At that time, Weitzman already had an interest in neurology and in 1951 he became an instructor in neuroanatomy (Fig. 1).

With contributions from Roger Broughton Charles Czeisler William Dement Christian Guilleminault Daniel Kripke Wallace Mendelson Merrill Mitler Mark Pressman Howard Roffwarg Thomas Roth and Jon Sassin. However any factual errors are solely the responsibility of the author. * Sleep-Wake Disorders Center, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA. Tel.: +1 718 920 4841; fax: 718 798 4352. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.sleep.2015.05.017 1389-9457/© 2015 Elsevier B.V. All rights reserved.

Weitzman and Dement stayed in contact after their graduation with an MD degree from the University of Chicago in 1955. Dement studied sleep and dreams in Chicago under the mentorship of Nathaniel Kleitman and moved to New York in 1957 as an intern at the Mount Sinai Hospital, which, at that time, was not yet a medical school, and he worked on sleep with Charles Fisher in the Department of Psychiatry who was performing research on dreams. “I had a sleep laboratory (in my apartment on the West Side!), rent paid for by the NIH. Many of my sleep subjects were recruited from the Radio City Hall dancing Rockettes,” said Bill Dement. Sleep deprivation received a lot of publicity in New York in the 1950s, because of Peter Tripp. He was a Top 40 countdown radio personality from Port Chester, New York. His career peaked with his 1959 record-breaking 201-h wakeathon (working on the radio nonstop without sleep to benefit the March of Dimes). For much of the stunt, he sat in a glass booth in Times Square. After a few days, he began to hallucinate and, for the last 66 h, Louis Jolyon “Jolly” West, a NY psychiatrist who had received a National Institutes of Health (NIH) grant to study sleep deprivation, gave him medication to help him stay awake [1]. Weitzman initially did his internship at Kings County Hospital in Brooklyn, and then his neurology residency from 1956 to 1959 at Columbia University College of Physicians and Surgeons. He was in the U.S. Army Medical Corps, Department of Neurophysiology, at Walter Reed Army Institute of Research in Washington DC from 1959 to 1961, where he performed pain research on rhesus monkeys that was published in the journal Science in 1961 [2]. After that, he joined Albert Einstein College of Medicine in 1961 and continued his pain research on monkeys. Peter MacGregor, BSc, went with

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Fig. 1. Elliot Weitzman.

Weitzman from Columbia University in 1961 and became the lead technologist in the research and clinical labs at Einstein College. He founded the Association of Polysomnographic Technologists (APT) in 1978 and served as its first president. The lab was shared by another young neurologist, named Robert Katzman, who became an international leader of Alzheimer’s research, and they sometimes did stereotaxic monkey surgery together. Howard Roffwarg, who was a research associate with Dement and Fisher at Mount Sinai Hospital in 1961, became an instructor in psychiatry at Columbia University in 1962. He was provided space to create a human sleep research lab at the New York State Psychiatric Institute to further his interest in rapid eye movement (REM) sleep and human ontogeny, which he ran from 1962 until 1966 [3,4]. Weitzman and Dement were very good friends and exchanged research findings. In 1962, Dement and Roffwarg visited Weitzman’s rhesus monkey lab at Einstein College and watched a sleep recording from an electrode-implanted sleeping monkey. “It looked just like a human sleep study,” said Dement. “The ability to visualize the monkey’s eye in sleep could not have been better. We took a movie of typical REMs which was so dramatic, showing binocular synchronization and normal rotational velocity. I have been showing this movie very often until this very day.” In the early 1960s sleep research, particularly research on dreams and REM sleep was being developed by a number of scientists in different parts of New York. Montague Ullman, MD, a psychiatrist at New York University College of Medicine and a Clinical Professor of Psychiatry Emeritus at Albert Einstein College of Medicine, had been studying dreams since 1956 [5]. Ullman, in 1962, after several years of pilot studies in the area of telepathy and dreams, created one of the first sleep research laboratories in the country, the Maimonides Dream Laboratory at Maimonides Medical Center, Brooklyn [6,7]. The lab studied dreams and extrasensory perception (ESP), but was closed in 1978. In 1963, the second annual meeting of the Sleep Research Society was held in New York, which was hosted by Charles Fisher, MD. In addition to his own publications on dreams and some in collaboration with Dement, Fisher, in 1964, performed the first experiments

at Mount Sinai Hospital on penile erections during REM sleep [8,9]. Collaborators of Dement and Fisher at that time were Judith and John Antrobus, both of whom investigated dreams [10,11]. Dement left Mount Sinai Hospital for Stanford University in 1964 and established the first narcolepsy center that was to become the first American full-service sleep disorders center in 1972. Daniel Kripke, at the beginning of his third year of medical school at Columbia University in New York, spent the summer of 1963 in Weitzman’s laboratory in the basement of the Einstein Medical School building. He already had a summer doing sleep research with Joseph Kamiya at the University of California in San Francisco. Kamiya was one of the Chicago founders of the Sleep Research Society, which was initially called the Association for the Psychophysiological Study of Sleep (APSS). The APSS was the world’s first sleep research society and being for many years the only one. Moreover, it was international in membership. Subsequently, the APSS abbreviation was used for the Association of Professional Sleep Societies. Roger Broughton, MD, a neurologist in Ottawa, Canada, who had met Dement and Allan Rechtschaffen in Lyon, France, in 1963 at a sleep meeting hosted by Michel Jouvet, MD, first met Weitzman in 1965 at the fourth APSS meeting in Gainesville, Florida. “I remember Elliot’s aura of intelligence, passion for research and commitment to the new field of sleep research and chronobiology,” said Broughton. “We became good friends, as we were both neurologists.” Broughton subsequently developed his own sleep laboratory in Ottawa in 1968. Daniel Kripke did some monkey sleep research at Columbia University in his second year of medical school, but went on to work with Weitzman at Einstein College. “Elliot was a hard-working and kind mentor who gave me an excellent project,” said Kripke. “Together, we implanted some monkeys with surface and depth EEG electrodes; and then I spent many long nights recording their sleep, while trying to rescore the already-recorded records at the same time. Elliot was generous about sharing the publication of those studies, and he taught me to read the literature deeply.” During the day, Charles Pollak, MD, a neurologist at Einstein College, would use some of the same monkeys for studies of arousal thresholds [12]. Kripke did clinical clerkships in his last two years at Columbia University, but kept in touch with Weitzman for finishing up the data analyses and writing up the papers for publication. In 1965, Kripke did an internship at Bronx Municipal Hospital Center (BMHC), but hardly saw Weitzman in that internship year. After Kripke completed his internship in June 1966, he volunteered for the Air Force in September (all physicians were drafted during the Vietnam War). Weitzman had visited Clyde Kratochvil, MD, PhD, at the Aeromedical Research Laboratory at Holloman Air Force Base in New Mexico, where the Air Force was training chimpanzees for the initial space flights; and he pulled some strings to get Kripke assigned there. Weitzman subsequently hired Kripke to help start a human phase-shifting project run in the Clinical Research Center (CRC) at the Van Etten portion of BMHC. Weitzman had done some pilot studies by sneaking into the bedroom with a flashlight and drawing repeated blood samples for cortisol levels throughout the night using short indwelling catheters. He received a NASA grant and the first project was an investigation of the switching of endocrine effects from daytime to night-shift work. He performed 24-h studies of cortisol using 10-foot catheters, which went through a hole in the soundproofed wall between the polysomnographic equipment area and the bedroom. They were probably the first through-the-wall endocrine sampling studies ever performed. The catheters were made from tubing and Luer-lock couplers with an elaborate setup of an intravenous heparin drip, three-way catheter junctions, and syringes to withdraw the blood and reflush the catheters. In 1966, Weitzman published the initial report on cortisol secretion in sleep using the “long catheter” technique that his team pioneered [13].

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Weitzman’s first publication of sleep research was on auditory evoked potentials during sleep in 1965 [14]. At that time, Pollak worked with Weitzman and Kripke on many sleep-related projects, including studying sleep in the monkey [11]. In 1966, Edward Tauber of the Department of Psychology at Yeshiva University and Roffwarg collaborated with Weitzman to study eye movements during sleep in lizards obtained from the New York Zoo [15]. Roffwarg was recruited to the Psychiatry Department at Einstein’s teaching hospital, Montefiore Medical Center in 1966, and given laboratory space and money for both a human and animal sleep research facility. He had been awarded a National Institute of Mental Health (NIMH) Career Development Award while at Columbia University to pursue brain development in the sleep of kittens. He collaborated with Weitzman in the cortisol and other endocrine studies, and also continued his interest in the ontogeny of sleep revealing that REM sleep generated neuronal activity that helped develop brain maturation in early life [3]. Kripke worked on the cortisol publication while being in the Air Force, which he completed when he returned to Einstein College for his Psychiatry Residency. Weitzman had moved to Montefiore to become Chief of Neurology in 1969. Using the CRC at Montefiore, Weitzman conducted some longer 9-week day-shift/night-shift/ day-shift studies. Kripke, who had met Franz Halberg, the wellknown chronobiologist at Holloman Air Force Base, made several trips to Minneapolis with Weitzman’s data to persuade Halberg to do cosine-fitting “cosinor” analyses of the circadian shift patterns. Weitzman, who collaborated with the endocrinologists at Montefiore (including Leon Hellman and Thomas Gallagher), discovered a major finding that was published in 1971 in the Journal of Clinical Endocrinology and Metabolism. It documented the 24-h pattern of the episodic secretion of cortisol in normal subjects using 20-min sampling [16,17]. At that time, this finding was disputed and viewed skeptically by the endocrine community, which did not believe that cortisol secretion was pulsatile. Jon Sassin, MD, who originally did sleep research with Laverne Johnson in San Diego in 1968, joined the Department of Neurology at Montefiore in 1971 and investigated growth hormone and prolactin secretion during sleep [18,19]. “Of course Elliot was a force of nature,” said Sassin. “He once told me that his grandfather took him on his knee and told him: ‘Elliot, you have to be the smartest man in the world’, and of course he strove for that. There was also one concept that Elliot taught me about academic medicine: never turn down more space.” Sassin moved to the Department of Neurology, University of California, Irvine Medical Center, Orange County, California, in 1980. Sheldon Kapen, MD, was also a neurologist at Montefiore interested in hormone secretion and sleep [20]. Kapen and Sassin published many studies together on hormone secretion and sleep. Kapen started the first sleep center of any Veterans Administration facility, at the Detroit Veterans Affairs Medical Center (VAMC) in Allen Park in 1985. The center was subsequently moved and expanded at the John Dingell VA Hospital and named in his honor. He died in 2012. In 1972, Weitzman and Roffwarg were the co-chairmen of the annual APSS meeting held at Lake Minnewaska in the Hudson Valley, New York. On the day of the meeting, a dump truck took down the power lines to the resort and the premises were cast into darkness and without refrigeration. “The hotel made bologna sandwiches and all the meetings were held by candlelight and oil lamp light. Actually it was a blast!” said Sassin. It rained so hard on the tin roof of the conference center that the audience could not hear and meeting had to be adjourned to another building. At the Lake Minnewaska APSS meeting, Christian Guilleminault gave an oral presentation of data obtained from both Paris and Stanford, related to a study that he had conducted on “sleep apnea

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syndrome.” “The presentation was essentially a ‘miss’, as the audience was not at all interested in the problem; however two individuals came later to ask questions,” said Guilleminault. “One was Peter Hauri PhD and the other was Elliot who wanted to ‘know more’ and took a lot of notes on how the monitoring was done during sleep. He also wanted to know ‘other data’ that I had not presented. I was pleased to meet Elliot as he was a neurologist like myself, and that was at a time when there were few neurologists interested in sleep.” Weitzman’s interest in the 1970s was very much focused on what he called Guilleminault’s “your obstructive sleep apnea syndrome” (OSAS). He visited Dement at Stanford regularly and each time would seek out Guilleminault to gain knowledge about the “new findings” on sleep apnea. However, Guilleminault and Weitzman disagreed on the mechanism of obstructive sleep apnea (OSA). Weitzman believed that the upper-airway collapse during sleep was related to an active contraction of muscles. However, Guilleminault strongly disagreed as his studies and observations showed a decrease in muscle activity with each collapse. A collapse that Guilleminault called “passive” related to the effect of the negative intrathoracic inspiratory pressure on noncontracted muscles. Each time that they met, Weitzman always wanted “more proof” than Guilleminault had. “His continuous ‘nagging’ led me to place wire electrodes in many upper-airway muscles in OSA patients at the time of tracheostomy,” said Guilleminault. The tracheostomy would be temporarily closed during sleep and the raw electromyogram (EMG) activity of the upper-airway muscles was monitored for several nights. The repetitive collapses of the upper airway, while recording as many variables as possible, including EMG muscles, were also filmed through the fiberoptic scope. “These studies were difficult as the more devices placed on the subject, the more sleep was disturbed,” said Guilleminault. He also added, “The investigator had to fight his own sleepiness while ‘hiding’ behind the headboard in order to film the different types of collapses in different sleep stages through the fiberoptic scope.” Michael Hill, MD, an ear, nose, and throat (ENT) fellow, and Guilleminault would spend hours during the night looking down the fiberoptic scope to obtain the data that would convince Weitzman, who, despite the efforts, was always skeptical of the findings. A considerable amount of data was collected during repetitive nights of sleep that included continuous systemic blood pressure, pulmonary artery pressure, and wedge pressure using catheters in different arteries and veins; yet OSAS was still very much ignored in North America. Stanford wanted to host an international conference on the “sleep apnea syndrome,” but interest on the subject was really low. “We could not raise the funds to organize it and proposals for funding were always rejected. But Elliot said to try again,” said Guilleminault. Dement and Weitzman knew Peter Amacher, who was involved with the Krock Foundation in California and, with their combined help, the proposal was accepted for a “small conference” in the Santa Ynez Mountains. It led to the publication of the book “Sleep Apnea Syndromes” in 1978, and many journal articles that finally attracted the attention of pulmonary scientists to sleep apnea. During that conference, Weitzman presented his “active contraction theory”; but he finally changed his mind on the mechanism of the upper-airway collapse, but only after all the data were shown by Hill and Guilleminault. At the Minnewaska meeting, Weitzman’s group presented the first data on treatment of pediatric OSAS with adenotonsillectomy. Weitzman was Chairman of the Department of Neurology at Montefiore from 1971 to 1982. He directed the Sleep-Wake Disorders Center, a diagnosis and treatment facility, at the Montefiore Medical Center in the Bronx and was Professor of Neurology and Neurosciences at the Albert Einstein College of Medicine, also in the Bronx.

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Guilleminault, between 1972 and 1975, wanted to develop a clinical service of “Sleep Medicine” believing that an effort of bringing together many physicians involved in sleep disorders patient care under one specialty would advance the clinical field. However, Dement was interested in congress developing a “National Sleep Research Center” as part of the NIH. There were clear differences between Dement and Anthony Kales, who had moved from University of California, Los Angeles (UCLA) to Hershey, Pennsylvania; these concerned particularly the pharmacological treatment of insomnia, and Kales created his own sleep society that only lasted a short time. The APSS at that time was mainly an association of neuroscientists, mainly PhD researchers, who had little interest in patient care. In very few meetings, often involving only two or three individuals, Dement, Weitzman, and Guilleminault looked at strategies to establish the field. There were only two academic and clinical departments involved: Montefiore and Stanford, and those were not enough to establish a “national” effort. On the one hand, Dement wanted the national sleep research center and on the other hand, Guilleminault was focused on developing clinical sleep medicine. “Elliot was in the middle, raising important objections and questions, bringing a different point of view in order to come out of an impasse,” said Guilleminault. However, everyone agreed that it was mandatory to enlarge the field of participants. Roffwarg, who had collaborated with both Dement and Weitzman, was easily recruited, and Ismet Karacan, Milton Kramer, and Peter Hauri joined the effort. However, most of the work toward establishing the clinical field of sleep medicine was performed with exchanges between Montefiore and Stanford. At the Edinburgh sleep conference in 1975, a group was formed during a lunch meeting organized by Hauri. Discussions continued later that year in Chicago and the group’s leadership included Dement, Weitzman, Roffwarg, Ismet Karacan, Milton Kramer, David Kupfer, and Thomas Roth. They agreed that a new sleep center-oriented organization with a strong medical and research direction should be formed. A meeting held in a Chicago Airport hotel in 1975 resulted in the establishment of ASDC, the first step toward the establishment of the field of Sleep Medicine. The ASDC subsequently became the AASM. Weitzman was very interested in narcolepsy, and was a participant of the first International Congress on Narcolepsy in 1975 held in Montpellier, France. He also became very much involved in “periodic limb movements” (PLMs) during sleep, and asked if he could collaborate in the research at Stanford. Richard Coleman, PhD, carried out similar work on PLMs at Montefiore in New York with Weitzman. He indicated “this is a problem to be solved by neurologists.” “It was always important to pass the scrutiny of Elliot’s brain,” said Guilleminault. Regular meetings were held where Guilleminault would show and discuss new data and appropriately respond to Weitzman’s questions. An abstract was to be presented at the APSS, but Weitzman indicated that it would be much better if submitted to a neurology meeting. The data were published in a rarely read and cited journal, Trans Am Neurol Assoc in 1975 [21]. Weitzman’s interest in circadian rhythms led him to travel widely. In the mid-1970s, his military background led him to develop a research project in Tromso, Norway, with the US and Norwegian military, studying the effect of arctic light on circadian rhythms that was published in 1975 [22]. Around that time, Weitzman learned from Dement that there was a medical student, Charles Czeisler, who was very interested in the investigation of sleep–wake cycles, hormonal secretion, and human circadian rhythms. Czeisler, who had graduated from Harvard College in 1974 with a degree in biochemistry and molecular biology, and received his PhD in neuro- and biobehavioral sciences and subsequently his MD from Stanford University, had interesting ideas on new circadian protocols. His undergraduate thesis was focused on the timing of cortisol release. As a graduate student at Stanford, Czeisler continued his research

Fig. 2. Montefiore Research Group, 1981. From left: Charles Pollak (partly out of photo), John Adler, Elliot Weitzman, Arthur Spielman, Mark Pressman, Charles Czeisler, Janet Zimmerman, and Richard Coleman.

in Dr Pittendrigh’s circadian research laboratory. Weitzman, who both worked with and mentored Czeisler, influenced Czeisler to study circadian rhythms and sleep. The relationship between Czeisler and Weitzman became even closer when, in 1976, Weitzman chose to take a sabbatical at Stanford; he wanted to use his sabbatical time to pursue his goals of creating “Circadian Medicine” and would visit both Dement’s sleep laboratory and Pittendrigh’s circadian laboratory. Weitzman was not only interested in circadian rhythm research, but also in sleep apnea; he also collaborated with Merrill Mitler, PhD, because of his interest in narcolepsy. Weitzman underwent treatment for a lymphoma at Stanford that had been diagnosed a year earlier, the disease that would take him away in a fairly short time. “Elliot was so impressed with the Stanford sleep clinic that, he returned to the Bronx and started the second comprehensive sleep disorder center in the world in 1977,” said Dement. Daniel Wagner and Pollak, both neurologists, worked with Weitzman at the Montefiore Sleep-Wake Disorders Center (Fig. 2). After Weitzman opened the Montefiore Sleep-Wake Disorders Center, Roffwarg had the opportunity to visit and learn about sleep disorders. Roffwarg stayed at Montefiore, doing basic sleep physiology research until 1977 when he moved to the University of Texas Medical Center in Dallas and started his own sleep disorders center. “Although it was evident that difficulty falling asleep was initially due to psychological events, Weitzman offered the view that it could be due to circadian sleep phase delay,” said Roffwarg. In 1976, at the International APSS meeting held in Edinburgh, Scotland, with Ian Oswald as the local host, a decision was made by a small group including Weitzman, and a vote taken to create a “sleep” journal. Weitzman was one of the individuals who supported Guilleminault’s selection as “Editor in Chief” of the new journal, and he was one of the original members of the small editorial board. Weitzman, along with many individuals in the APSS, was initially not convinced of the need for a new journal dedicated to a new “unrecognized field or medical specialty,” but he later agreed and was the most assiduous reviewer of all the initial articles submitted to the journal Sleep. Around that time, Weitzman played a significant role in the early career of Wallace Mendelson, MD, who was a staff psychiatrist at the NIMH conducting studies on the effects of medication on the secretion of growth hormone. Elliot invited him to present the data in 1977 at an endocrine meeting in Dublin. It was Mendelson’s first international meeting, and they spent time walking around Dublin. “What I remember best was his interest in talking and sharing with

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a young junior investigator, and his willingness to share about himself,” said Mendelson. “That has stuck with me all these years, and I’ve tried to do the same, using him as a model.” Weitzman was the Executive Secretary of the Sleep Research Society from 1975 to 1978. The Sleep Research Society Foundation, since 2006, offers the Elliot D. Weitzman, MD, Research Grant. The grant is intended to support established researchers in developing novel and innovative lines of research that differ from their previous areas of research, by assisting them in developing pilot data that will support applications for NIH or other federal grants. In 1978, Mitler left Stanford and went to State University of New York (SUNY) at Stony Brook and founded its sleep disorders center. Weitzman invited him to visit the sleep center at Montefiore and join the regular clinical meetings. He was very supportive of Mitler’s efforts to establish a sleep center, providing him with advice and introductions to the sleep community in New York. “One thing that Elliot never let us forget is that sleep apnea has important neurological components,” said Mitler. “He was a proponent of visualizing the entire anatomy and the dynamic patterns of upper airway closure in patients with sleep apnea,” he added. Also at Stony Brook was Robert Y. Moore, MD, PhD, who was appointed the first Chairman of Neurology in 1980. In 1972, Moore and Eichler while at the University of Chicago had shown that the anatomic destruction of the suprachiasmatic nucleus (SCN) located in the anterior hypothalamus eliminated circadian rhythms in adrenal corticosterone, drinking, and locomotor activity in rats [23,24]. In 1978, Weitzman established the Laboratory for Human Chronophysiology (LHC), the nation’s first time-isolation laboratory at Montefiore Medical Center, where he conducted pioneering investigations of chronophysiology. “Sleep is a very powerful biological rhythm process, and the physiological clock can’t just be turned around at will,” said Weitzman. “Furthermore, the kind of sleep people get when they shift to daytime sleep is demonstrably abnormal and fragmented in its quality.” Czeisler would spend months with Elliot developing research protocols for the laboratory. Weitzman, along with Czeisler, developed “chronotherapy” to treat delayed sleep phase syndrome [25]. Broughton visited the chronobiology laboratories and was very impressed with the facilities and the work being done there. “Elliot’s integrated focus across the spectrum of sleep, circadian processes and neuroendocrinology was unique at the time and was at least a full decade ahead of its time. This showed Elliot’s remarkable foresight as to future evolution of the field,” said Broughton. In 1979, Weitzman and Roth, along with Elliot Phillipson of Toronto, undertook a lecture tour in Australia, following which Weitzman and Roth became close friends. “Given the time of the Australia trip, medical knowledge about sleep and its disorders was virtually nonexistent,” said Roth. “Elliot’s excitement about introducing to an enthusiastic audience a new branch of medicine was palpable. He felt like it was discovering sleep disorders all over again.” Michael Thorpy, MD, a neuroendocrinology fellow at Montefiore from 1980 to 1982, assisted Weitzman and Czeisler with the chronophysiology studies at the LHC, and also was a clinician at the Sleep-Wake Disorders Center. Arthur Spielman, PhD, joined the sleep center in 1980 as a clinical psychologist. At that time, because sleep disorders were poorly understood, each patient spent 1 h with a physician and 1.5 h with a psychologist. Sleep studies often involved two nights of polysomnography and a multiple sleep latency test (MSLT). Wagner and Pollak, along with psychologist Spielman, were the faculty clinicians at the sleep center with Weitzman. Weitzman trained many future sleep specialists at Montefiore; however, he was known to be a tough and unforgiving mentor who demanded excellence from his trainees and “did not suffer fools gladly.” At meetings, Weitzman had the ability to see the important component of any research study when others would miss the most basic

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Fig. 3. Elliot Weitzman and Peter MacGregor in the sleep laboratory, 1981.

and important element (Fig. 3). He would say, “It is not important to just ask questions but to ask the right question.” In 1982, Weitzman left Montefiore and Einstein College and founded and directed the Institute of Chronobiology at Cornell University in White Plains, New York. Wagner and Pollak joined him. He was an attending neurologist in psychiatry at New York Hospital and professor of neurology at the Cornell Medical Center. When Weitzman left, Thorpy was appointed director of the Sleep-Wake Disorders Center at Montefiore Medical Center. Spielman stayed on as clinical psychologist, and subsequently they developed sleep restriction therapy for insomnia [26]. After Stanford, Czeisler went to Harvard and is the current Baldino Professor of Sleep Medicine, Director of the Division of Sleep Medicine, and Division Chief of Sleep Medicine at Brigham and Women’s Hospital in Boston. Weitzman was awarded the Distinguished Scientific Service Award by the University of Chicago Medical Alumni Association. He was president of the New York Neurological Society in 1972, vice president of the ASDC in 1975, and chairman of the North American section on Neurology of the Pan American Medical Association in 1976. In 1983, he was awarded the field’s highest honor, the Nathaniel Kleitman Distinguished Service Award, by the ASDC. The Dr. Elliot D. Weitzman Service Award was established in 1984 by the American Association of Sleep Technologists (AAST). It recognizes individuals who have made significant contributions to the growth and development of the sleep technology profession. Weitzman provided a tremendous amount of support and encouragement to the development of the AAST. Weitzman had a lymphoma that had been diagnosed 8 years earlier and had been in remission for 7.5 years. He died at the early age of 54 years at the Memorial Sloan Kettering Cancer Center in 1983 when the lymphoma became malignant. Elliot was survived by his wife, Muriel, daughter, Ellen, and son, Matthew. Guilleminault stated: “His premature death deprived the field of the blossoming of The Institute of Chronobiology at Cornell.” However, Weitzman’s vision of chronobiology sleep research was pursued at Harvard in Boston under his mentee, Charles Czeisler. Conflict of interest The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2015.05.017.

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