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Brahms’ Lullaby Revisited*
Did the Composer Have Obstructive Sleep Apnea?
Mitchell L. Margolis, MD, FCCP
(CHEST 2000; 118:210 –213)
Key words: Brahms; sleep apnea
Abbreviation: OSA ⫽ obstructive sleep apnea
If there is anyone here I have not offended, I apologize.
Johannes Brahms
are divided as to whether Johannes
H istorians
Brahms (1833–1897), whose music is among the
most beloved and masterful in history, actually made
the above remark on taking his leave from a party.1,2
But there is little doubt that he could have. Brahms
was possessed of a crusty personality, and even long,
close friendships with Clara Schumann and the violin
virtuoso Josef Joachim were frequently punctuated
by bursts of rancor and thoughtlessness. Brahms’
personality was probably influenced by humiliating
childhood experiences playing the piano in Hamburg
bordellos to augment the meager family income,
although considerable debate persists as to the exact
nature of these episodes.3–5 Also, the overwhelming
expectations thrust on him by no less than Robert
Schumann and Hans von Bulow (the leading music
critic of the day) as the successor to Bach and
especially Beethoven contributed an additional huge
psychic burden. Indeed, it is a measure of his genius
that Brahms was able to meet and even exceed these
daunting predictions. The reader is referred to Jan
Swafford’s fine biography3 of the composer for a
more complete understanding of Brahms’ personality and life.
From a medical standpoint, Brahms’ life seems
rather straightforward. A lithe and handsome man in
his young years (Fig 1), Brahms seems to have
*From the Pulmonary Section, Philadelphia VA Medical Center
and Hospital of the University of Pennsylvania, University &
Woodland Ave, Philadelphia, PA.
Manuscript received November 19, 1999; accepted November
22, 1999.
Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary and Critical Care, Philadelphia VA Medical Center,
University & Woodland Ave, Philadelphia, PA 19104; e-mail:
[email protected]
210
Figure 1. Brahms in his thirties. Repeated with permission from
Swafford.3
known few illnesses throughout his life; even at age
57, on the occasion of a rare flu-like sickness, he
“seemed to have no idea what a fever was.”3 Finally,
in 1896, he developed progressive jaundice and
weight loss. This terminal illness, analyzed in depth
by Neumayr,4 was probably carcinoma of the pancreas.
However, a more careful reading of the Brahms
canon suggests that he may have suffered from
obstructive sleep apnea (OSA), a condition unknown
Special Report
to the physicians of his day. In this article, I summarize evidence in support of this hypothesis.
Symptoms
As Brahms never married, we have no spousal
description of habitual snoring. However, with the
following account by baritone George Henschel
(1850 –1934), we don’t need one. Henschel’s humorous and revealing testimony dates from joint concert
tours in the 1880s, and is quoted verbatim with
permission.2
We retired to room No. 11, and it was my instant and most
ardent endeavor to go to sleep before Brahms did, as I
knew from past experience that otherwise his impertinently healthy habit of snoring would mean death to any
hope of sleep on my part.
My delight at seeing him take up a book and read in bed
was equaled only by my horror when, after a few minutes,
I saw him blow out the light of his candle. A few seconds
later the room was fairly ringing with the most unearthly
noises issuing from his nasal and vocal organs. What
should I do? I was in despair, for I wanted sleep, and
moreover, had to leave for Berlin early next morning. A
sudden inspiration made me remember room No. 42. I got
up, and went downstairs to the lodge of the porter, whom,
not without some difficulty, I succeeded in rousing from a
sound sleep. Explaining cause and object, I made him
open room No. 42 for me. After a good night’s rest, I
returned, early in the morning, to the room in which I had
left Brahms.
He was awake and, affectionately looking at me, with the
familiar little twinkle in his eye and mock seriousness in his
voice, said to me, well knowing what had driven me away,
“Oh, Henschel, when I awoke and found your bed empty,
I said to myself, There! he’s gone and hanged himself! But
really, why didn’t you throw a boot at me?”
The idea of my throwing a boot at Brahms!
The composer also seems to have been an inveterate napper, particularly in his middle and late
years; however, his ability to drop off to sleep “in a
second” was noted in early adulthood by his friend,
the composer Albert Dietrich.3 Ironically, the most
infamous nap of Brahms’ life may have had nothing
to do with sleep apnea. In 1853, he fell asleep during
a performance of Liszt’s B minor sonata. The performer was none other than Liszt himself, who was
properly miffed; the occasion was the initial meeting
of the two men. That as keen a student of the piano
as Brahms would doze during his first hearing of this
virtuosic and dynamic work, rendered by perhaps the
most spellbinding pianist in history, seems odd to say
the least. Nevertheless, it is difficult to link this
episode with OSA, since the Brahms of 1853 was a
fragile-appearing 20 year old in whom the more
pervasive symptoms of the disorder (and the composer’s familiar obesity) had yet to emerge.
In later years, portly Brahms frequently snoozed in
the afternoon in the cafes of Vienna, and his motionless flowing beard comprised a familiar sight for
gawking tourists.3 A subsequent nap on the occasion
of Brahms’ first hearing of a promising young conductor by the name of Gustav Mahler in 1890 was interrupted by a “queer snort.”3 While one is reluctant to
ascribe too much significance to a single such description, the episode is reminiscent of the “resuscitative
snort” that frequently terminates an obstructive event
in sleep apnea. By October 1896, Brahms would sometimes fall asleep at the table or theater box.3
Physical Characteristics
Brahms was a short man, even by the standards of
the day. While slender as a youth, he became
progressively obese with age, until his final illness.
By age 35, he was already too stout for his fur coat.3
By the early 1890s, he had difficulty reaching past his
belly for his keys.3 Obesity and male gender are
among the strongest risk factors for OSA,6,7 and
untreated sleep-disordered breathing seems to
worsen with time.8
In addition, Brahms had a thick, short neck that is
clearly demonstrated in photographs and sketches
from the 1850s and 1860s; it then disappeared under
the bushy beard of the mid-1870s (Fig 2). His neck
size doubtlessly contributed to his aversion for neckties of any kind, and from age 50 onward, Brahms
wore the collarless shirt of a hunter.4 This preference
was so pronounced as to prompt the doggerel
chanted by his friends on his receipt of the Order of
Leopold in 1890. In English, the meaning without
the rhyme:
“Now he’s really got something to wear around his
neck / A shame it’s still not a collar.”4
Increased upper-body obesity, as reflected by neck
circumference, is a particularly good predictor of
OSA.9
Exacerbating Factor
Brahms was never a drunkard, but he did consume
substantial quantities of alcoholic beverages throughout his life. Alcohol intake probably began as a
teenager in Hamburg dives, as drunken sailors and
their female liaisons toyed with their mortified pianist-plaything.3 By age 21, he was drinking enough to
alarm Clara Schumann.3 Later, throughout his extended residence in Vienna, Brahms amply demonstrated his knowledge of fine wines and became a
fixture at various pubs and taverns. Alcohol is recognized as a common and important exacerbating
factor in OSA, possibly via selective depression of
genioglossal nerve activity.10
CHEST / 118 / 1 / JULY, 2000
211
vulgar remarks, and patronized similar establishments to those that provided the setting for his
aforementioned youthful humiliation.3 However, details of these visits remain unknown, and the composer repeatedly and pointedly shied away from
long-term intimacy and marriage. Thus, the role of
OSA, if any, in Brahms’ sexual functioning remains
obscure.
Finally, we return to the issue of Brahms’ prickly
personality, as evidenced by the possibly apocryphal
quote at the beginning of this article and by innumerable examples of peevish behavior throughout
his life. Patients with OSA may demonstrate chronic
abnormalities in mood and affect; in fact, irritability
and depression are typical of the personality changes
that may accompany the disorder.13 Thus, it is
tempting to hypothesize that the composer’s intermittent bouts of depression and notorious irascibility
could in part relate to chronic sleep fragmentation
and/or nocturnal hypoxemia. Unfortunately, this notion will likely remain forever in the realm of speculation.
Comment
Figure 2. The composer in his maturity. Reprinted with permission from Swafford.3
Clinical Sequelae
The appeal and clinical importance of the Brahms
OSA hypothesis are uncertain, apart from the intrinsic interest of attempting to diagnose a substantial
medical disorder in so famous a patient (and one who
has been dead for 103 years).
In the late phase of pancreatic cancer, 6 weeks
prior to death, Brahms developed distorted facial
features, an immobile eye, and dysphasia for a few
days, associated with weakness that prevented him
from taking his usual walks. Stroke is an obvious
diagnostic possibility, and OSA may be a risk factor
for stroke.11 However, since no autopsy was performed, these findings alternatively could have
arisen from other diseases, including brain metastases or Bell’s palsy.4 The latter would not explain the
possible ophthalmoplegia and difficulty with ambulation, however.
A second issue is impotence, another common
feature of OSA. It is in this context that Hugo Wolf’s
contemptuous and ludicrous dismissal of Brahms’
music as “a celebration of impotence”12 must be
mentioned. Brahms was quite capable of lusty and
212
The medical diseases of the great composers
continue to exert a powerful hold on the imagination
of physicians. Neumayr4 and O’Shea14 have written
scholarly texts on the subject, and an article in
CHEST on the pulmonary illness of Frederic
Chopin15 brought forth numerous critiques and responses. Thus, a new theory about so famous a
composer as Johannes Brahms is forwarded with a
good deal of trepidation. Furthermore, the clinical
evidence does not precisely correspond to classic
OSA in Brahms’ case; we have no record of witnessed apneas or overt nocturnal awakenings, for
example.
However, the evidence that Brahms had OSA is
intriguing. A detailed reading of the literature reveals near-classic descriptions of the most characteristic symptoms of the disorder: loud snoring and
daytime hypersomnolence. The composer’s eventual
physical attributes also correspond to those of a
typical OSA patient, particularly his obesity and thick
neck. Extensive lifelong alcohol consumption comprises a likely and familiar exacerbating factor.
I conclude that the hypothesis that Johannes
Brahms suffered from OSA is tenable, and that OSA
could help explain some important aspects of his life
and personality. One wonders if the disorder contributed to lifelong alienation from friends and marriage (“fetters” according to Brahms), thereby indirectly nurturing his determined devotion to the
creation of his immortal music.
Special Report
ACKNOWLEDGMENT: The author thanks Allan Pack, MD,
PhD; Martin Heyworth, MD; and Professor Jan Swafford for
reviewing the manuscript; Gregg Lipschik, MD, for his suggestions; and Mia Fields for secretarial assistance.
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