Sleep Experts Ring Alarm On Sleep-Related Problems

Sleep and biological rhythms affect every aspect of human health represented at the NIH and are a core focus of interdisciplinary research, said Lederhendler, chief of the NIMH Basic Behavior and Systems Neuroscience Program.

“There is a new era of cooperation among government agencies,” he said. Different divisions now combine resources to tackle complementary and overlapping areas of interest.

Research on sleep, stress, and emotional regulation is one example. Neural and chemical systems involved in the regulation of sleep and in the regulation of the body’s response to acute stress show many similarities, Lederhendler said. “The sleep and stress communities normally don’t interact at a professional level,” he noted, “yet collaboration may result in critical progress in understanding mood disorders. We’re aiming to create a synergism that hasn’t been seen before.”

This research holds implications for public health, as well as for education. Socially imposed school schedules, Lederhendler said, ensure that many students walk through their high school years in a chronic state of severe sleep deprivation. Studies at Western Psychiatric Institute and Clinic in Pittsburgh show sleep deprivation impairs adolescents’ ability to regulate emotion and to manage aggression. Other recent studies show sleep improves recall of events from the previous day.

“These findings,” Lederhendler said, “should be ringing bells in the education community.”

The recent discovery of the brain chemicals involved in narcolepsy, he said, may lead quickly to better treatment for this often-disabling sleep disorder. Additionally, because sleep attacks in narcolepsy may be triggered by emotions, these findings may help clarify ties between sleep and stress.

“Adults in our society often view sleep as a time-management strategy,” Lederhendler said, sacrificing sleep for work and family activities. One-third of the population report chronic insomnia, a form of sleep deprivation about which little is known. There’s a great need to understand better the mechanisms that enable people to fall asleep and stay asleep, he said, and to evaluate objectively medications used to treat chronic insomnia.

Overall, Lederhendler said, “we need to elevate sleep in the public consciousness to an equal footing with nutrition and exercise.”

The National Center on Sleep Disorders Research (NCSDR), housed in the National Heart, Lung, and Blood Institute, serves a central coordinating role for sleep programs at the NIH, NCSDR Director Carl Hunt, M.D., told forum attendees.

These programs include research on the neurobiology of sleep and sleep apnea; the sleep heart health study, a multicenter epidemiological study that has identified risks of sleep apnea for cardiovascular and cerebrovascular disease; studies of sleep apnea in children; and a study examining changes in O₂-sensing in intermittent hypoxia at the cellular level.

Other areas of interest, Hunt said, include sleep disruptions in pregnancy, restless legs syndrome and periodic limb movements, parasomnias—such as confusional arousals, sleep walking, and sleep terrors—and chronic fatigue syndrome.

NCSDR sponsors a program to raise awareness of the dangers of drowsy driving in teenagers, considered the largest at-risk group for fall-asleep car crashes. It also has developed a week-long biology curriculum for high school sophomores, now in field testing, with a planned introduction in 2002. NCSDR’s newest youth program uses the cartoon character Garfield as its “spokescat” to encourage children aged 7 to 11 to develop healthy sleep habits.

NCSDR will hold workshops for medical professionals on bioinformatics in neuroscience and sleep disorders research (to be videocast on July 16 and 17), neurocognitive function after cardiac surgery (September 13 and 14), and the neurobiology of insomnia (September 10 and 11). An interdisciplinary conference on sleep health for health professionals is planned for spring 2002. Details will be posted at NCSDR’s Web site at www.nhlbi.nih.gov/sleep.

Medical schools, Hunt said, typically offer fewer than four hours of formal undergraduate training in sleep medicine and virtually no programs designed for postgraduate development of skills in the area. NCSDR now sponsors 20 sleep academic awards annually to improve the quality of medical education and to stimulate the development of patient and community education, high-quality clinical research programs, and better diagnosis and treatment of sleep disorders.

Since an estimated 12 million to 20 million Americans work on evening or night-shift schedules, work-related sleep loss is a major focus of research at the National Institute for Occupational Safety and Health (NIOSH), said Roger Rosa, Ph.D., a senior scientist there. Sleepiness or fatigue increases the risk of injuries and catastrophic incidents, such as the grounding of the Exxon Valdez in 1989.

Work-imposed alterations in sleep schedules and biological rhythms also contribute to sleep disruption, gastrointestinal disorders, cardiovascular disease, reproductive difficulties in women, and other health problems. Studies in progress, Rosa said, focus on reproductive outcomes among flight attendants, many aspects of health in participants in the Harvard Nurses Health Study, and cardiovascular disease in miners.

NIOSH scientists are evaluating the effects of eight-hour and 12-hour shifts and overtime on workers’ sleep quantity and quality, as well as their work-related errors, accidents, and auto crashes.

Cumulative sleep loss, leading to slowed reaction time and decreased vigilance, is a significant problem in the transportation industry, said Jay Sora, coordinator of the Federal Railroad Administration’s fatigue countermeasures team. Physiology contributes to far more errors, he said, than laziness, lack of motivation, or not being tough.

A novel consortium of labor, management, and governmental agencies in the U.S. and Canada—the North American Rail Alertness Partnership (NARAP)—aims to remedy fatigue-related problems through voluntary measures. On-site rest facilities, as one example, now generally provide better control of noise and outside light than in the past.

Such efforts have measurable benefits, Sora said. NARAP surveys show improved safety in almost every category, fewer lost workdays, improved workers’ self-ratings of morale, and even decreased fuel consumption.

Last year’s NSF public-policy campaign sought support to create fatigue-related injury prevention and education programs. The advocacy efforts prompted the CDC to add drowsy driving to its research priorities, according to Darrel Drobnich, the NSF’s director of government and transportation affairs. The CDC also made new funding available for a study of community-based interventions for drowsy driving through the National Center for Injury Prevention and Control. Work on the 2002 appropriations bill should be complete by early fall. ▪