By Dr. Emmanuel Mignot, Director, Center of Sleep Sciences and Medicine
Everyone loves talking about sleep. It is full of interesting factoids. Trained as a psychiatrist, I often joke and say that when I used to present myself as a psychiatrist at cocktail parties, people either fled me like the plague or loved me too much. As a sleep doctor, I have an entirely different experience -- opening up wonderful conversations and having everyone enjoy himself or herself as a result.
Such conversations can cover a lot of ground. Sleep is a window to our general health and a very mysterious process that still mystifies scientists today. Almost a quarter of the population has sleep issues, and these can affect many organs in our body: the brain, of course, but also the heart and many others. It is truly a trans-disciplinary field. Sleep issues can be trivial (why do we jerk when we fall asleep?), cause enormous suffering (insomnia), or have lethal consequences (falling asleep at the wheel). Finally, too much of what is written on sleep and sleep problems in the press is either not accurate or sensationalized. Sleep problems affect real people, and the information available often washes out the complexities of sleep problems at the individual level.
In the weeks and months to come, various sleep experts from Stanford University will attempt to bridge these gaps here, alternating between the presentations of real sleep medicine cases, with favorable or unfavorable resolution, and scientific discussions on sleep and sleep disorders that will cover general background or news. Our goal will not be simply to inform but also to teach not only what we know but also what we don't know. We come to this subject with an educated and critical eye.
Stanford's long-standing commitment to this field is clear. The first clinic ever to specialize in evaluating and treating patients with sleep disorders was established at Stanford University in the 1970s, and our program still leads the field today. Our past director, William C. Dement, is a legend, and many called him the father of sleep medicine. Yet considering it is only a few decades old, sleep medicine is still in its infancy. Consider that rapid eye movement (REM) sleep, the stage of sleep where we dream, was only discovered in the late 1950s. It was only in the 1980s that sleep apnea, a disorder that affects about 10 percent of the population, was recognized as a frequent sleep problem. Dr. Christian Guilleminault, who coined the term "obstructive sleep apnea" and established the importance of this condition, remembers the time when patients with sleep apnea were treated using tracheostomy (creating an opening in the neck to help people breathe at night) rather than CPAP, dental appliances, or upper airway surgery.
Fuelled by patient need (largely related to sleep apnea), the field of sleep medicine grew exponentially and haphazardly in the last 30 years to now include over 5,000 sleep clinics in the U.S. alone. Unfortunately, however, financial incentives for sleep physicians and hospitals were all designed to reward testing and diagnosis, not treatment, the responsibility of which was shifted to less qualified personnel. Like many areas of medicine, the ground is now shifting rapidly. Reimbursement for sleep physicians has dropped significantly in the last three years. A shift to ambulatory (and away from in-laboratory) sleep studies is occurring without much quality control, something that is problematic for patients who have more complicated concerns. This is creating pressure for hospitals. Yet the field is young and inventive, and we believe patients will be better served at the end. New software programs are being created that will automatically analyze sleep patterns, and these results will one day be directly sent from your home to a sleep doctor. The study of your sleep at home will be routine, and will allow physicians to probe the functioning of your brain from time to time in a non-invasive and inexpensive way. Genetic predisposition to sleep disorders and the ability to predict who will benefit from what type of treatment will become a reality. Some scientists are studying how humans would adapt their sleep to a Martian day while others are discovering the cause of narcolepsy or restless legs syndrome. Scientific and medical breakthroughs are coming one after another, with transformative possibilities.
The Stanford Center for Sleep Sciences was established three years ago to face these challenges and turn them into opportunities. The Center has been established to work across multiple disciplines within the medical school so that scientists and physicians can work together toward the same goal. At the clinical level, our sleep physicians include dentists, neurologists, pulmonary physicians, psychiatrists, obesity specialists, psychologists, and surgeons. Some are pediatricians while others focus on adults. These clinical specialists work in partnership with PhD researchers in engineering (for devices), computer specialists, genetics, immunology, physiology, and neurosciences. Only with such an integrated and comprehensive team can we hope to treat our patients properly and heuristically, especially in complex cases.
In the coming weeks, our sleep clinicians and scientists will share their passion for this field, so that at the end the vast terrain of sleep and its disorders will be covered for all to read, learn, and enjoy.
Dr. Mignot is the director of the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: http://sleep.stanford.edu/.