While the ancients lacked the vocabulary and technology to define sleep apnea as we do today, some evidence suggests Greek physicians recognized certain symptoms consistent with the disorder.
One of the earliest and most evocative accounts comes from the Greek author Athenaeus of Naucratis, who, in his 2nd to 3rd century AD work Deipnosophistae, describes the curious case of a man named Dionysius.
The concept of sleep apnea—interrupted breathing during sleep due to airway obstruction or neurological dysfunction—may seem like a modern diagnosis. However, its symptoms have likely plagued individuals for millennia.
The tyrant Dionysius of Heraclea (4th century BC) suffered from an extraordinary condition that left his physicians and attendants bewildered. The story is recorded by Athenaeus and, more graphically, by the Roman historian Claudius Aelianus. Dionysius would fall into an unnaturally deep and silent sleep so profound that observers feared he had died.
His body remained motionless, his breath undetectable, and his skin unresponsive. Concerned that he might perish in his sleep, his physicians devised an aggressive method to monitor his state. They prescribed thin, sharp needles, driven through the layers of fat in his ribs and abdomen. Each time he drifted off, they would wake him up.
If the needle reached the underlying muscle or vital tissue—beyond the excessive adiposity that surrounded him—Dionysius would feel pain and awaken. Otherwise, he remained inert like a stone. To conceal the debilitation from visitors, Dionysius installed a cabinet or chest in front of his reclining body. That way, he allowed only his face to remain visible.
This bizarre contraption, described by Aelianus as more suited to an animal than a man, enabled him to receive emissaries while hiding his vulnerability. The contrivance, paired with fabricated oracular pronouncements, further shrouded the reality of his condition.
Though ancient physicians never had a specific term for his ailment, modern interpretations have drawn comparisons to severe obstructive sleep apnea. This disorder can render breathing undetectable during sleep and result in dangerous levels of physiological suppression.
Greek physicians, particularly Hippocrates and post-Hippocratic writers, frequently associated respiration with general health. The Hippocratic Corpus contains detailed examinations of breathing in various illnesses.
Physicians observed that problems in the throat and chest could lead to suffocation, fainting spells, or sudden death. While they did not identify sleep apnea per se, their descriptions of “strangling” sensations at night, noisy or difficult breathing, and unexplained nighttime deaths may overlap with the modern understanding of the condition.
Significantly, Greek—and later Roman—physicians developed and performed surgical procedures. These we now associate with the treatment of airway obstruction. The tonsillectomy, for instance, was practiced by at least the 1st century AD. Aulus Cornelius Celsus describes a surgical method for removing enlarged tonsils in his medical encyclopedia De Medicina.
These structures are now known to contribute to obstructive sleep apnea in children and adults alike. Galen, the prominent Greek physician in Roman service, also detailed techniques for dealing with throat obstructions. Nonetheless, his descriptions focused more on swelling due to inflammation or infection than chronic airway collapse.
Another critical procedure was the tracheotomy, which—though considered a last resort—was known to some ancient surgeons. As early as the 5th century BC, Hippocratic texts allude to incisions in the neck for relieving suffocation. Later, Alexandrian physicians, such as Asclepiades and Antyllus, reportedly performed forms of the operation.
They would typically perform tracheotomies in extreme respiratory emergencies, such as trauma or sudden obstruction, and physicians did not associate it with sleep disorders. However, its existence demonstrates that ancient practitioners understood the necessity of securing the airway so as to preserve life.
Ancient Greek physicians did not explicitly identify sleep apnea as a discrete condition. However, their observations and interventions suggest a partial understanding of its physiological mechanisms. They recognized the consequences of airway obstruction, noted irregularities in nocturnal breathing, and developed techniques to address life-threatening respiratory failure.
The story of Dionysius, as recounted by Athenaeus, offers a human face for this early awareness. While we cannot definitively say that Dionysius suffered from sleep apnea, the description of his deep, silent, and unnaturally still sleep resonates with symptoms known to modern sleep medicine.
Moreover, the surgical responses developed by ancient physicians—tonsillectomy, tracheotomy, and other airway-related interventions—demonstrate that they were not only observant of respiratory dysfunctions but also technically capable of addressing them.
In the absence of polysomnography or a formal theory of sleep stages, the ancients worked with what they had: keen observation, empirical treatment, and a holistic understanding of the body. Though they lacked the language and precision of modern sleep medicine, their insight laid the groundwork that continues to echo in today’s operating rooms and sleep clinics.
