Here’s a reason it’s so tough to diagnose and treat sleep disorders: nobody knows for sure what sleeping is for. There is no scientific consensus, or anything approaching a consensus, as to why humans and animals need to sleep. There are sketches of theories, and we understand some of the physiology – the mechanisms of sleep. But there are still mysteries, and the big picture is far from complete.
The answer: Research! Scientific research is intrinsically valuable and helps us develop new medical technology and ways to improve sleep quality. The word somnology covers study of human sleep and its irregularities.
Most of what we know about the biology of sleep has been discovered only in the last 50 years. Sleep remains largely a mystery despite the enormous amount that researchers have learned in recent decades. There is still no accepted reason for why humans developed the need to sleep.
In 1993 Congress created the National Center on Sleep Disorder Research (NCSDR) within the National Heart, Lung, and Blood Institute (NHLBI). There are many different National Institutes of Health in the US government, and you might wonder why sleep research isn’t part of the institutes of mental health or neurological disorders and stroke, or even the National Institute of General Medical Sciences. For whatever reason, sleep was given to NHLBI.
Congress also mandated development of a National Sleep Disorders Research Plan. The U.S. federal government spends over $100 million per year on sleep and sleep-disorder research. The first plan came out in 1996 with a revision in 2003 and a further revision in 2011.
A big challenge will be to translate the findings of basic research to clinical treatments. “Translational research” refers to attempts to find ways to turn the understanding of basic biology to patient therapies.
From the National Sleep Disorders Research Plan
We are now beginning to understand the impact of chronic sleep loss or sleeping at adverse circadian times on our ability to function optimally and on our physical and mental health. How sleep loss, sleep displacement (e.g., shift work, jet lag), and a wide range of sleep disorders affect one’s ability to maintain health and healthy functioning in this 24/7 world, however, remains relatively poorly understood. Thus, despite the scientific progress made since 1996 in both clinical and basic science related to sleep and its disorders, there remains the challenge and the need to discover the functions of sleep, to understand and develop better treatments for the many disorders affecting sleep, and to explain the nature of human physiology during wakefulness and the individual stages of sleep. Without progress in these areas, countless millions will continue to suffer the consequences of dysfunction and abuse of this most basic regulatory process.
Questions We Need to Answer
The 2011 NIH Sleep Disorders Research Plan listed 5 primary goals for research.
They are quite broad
- Figure out sleep and circadian functions and mechanisms across the lifespan
- Figure out the factors that lead to sleep and circadian disorders and how those factors affect other diseases of the body and mind.
- Improve clinical practice when it comes to sleep disorders.
- Get results from basic research into real-life applications and therapies and to influence public policy
- Get enough scientists trained in sleep research so that they can bring an awareness and knowledge of sleep issues to other fields of academic endeavor.
Those are all general and the kind of goals you expect from high-level policy documents.
The government’s HealthyPeople 2020 initiative lists four sleep-related goals
- Increase the proportion of persons with symptoms of obstructive sleep apnea who seek medical evaluation
- Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving
- Increase the proportion of students in grades 9 through 12 who get sufficient sleep
- Increase the proportion of adults who get sufficient sleep
Sleep medicine in the real world
Doctors have turned their attentions in clinical practice related to sleep disorders, but scientific research is not keeping pace. There are over 2,000 specialized sleep centers existed in the United States now.
Indeed, the on-the-street practice has run ahead of the formal medical establishment. Medical student training does not explicitly treat sleep as a separate discipline. There is a dearth of formal systematic study. There are over 4,000 clinical professionals in the American Academy of Sleep Medicine, yet fewer than 100 basic research faculty members spend the majority of their time in sleep research. A 2006 report from the National Academy of Medicine recommended programs to enhance career opportunities for physicians in sleep medicine.
Other Areas of Research Needed
Tuck feels these areas need further research:
- The two-process model – is it accurate? Or can we develop a more detailed model?
- Insomnia and restless legs syndrome are common disorders for which we know very little about neurobiologically.
- Why are there differences between sleep durations of animals in the wild and members of the same species in captivity, and what light can this shed on the question of sleep duration and sleep debt?
- What is involved in “consolidation” of memory and how does sleep facilitate the transfer of memories from one area of the brain to another.
- When people talk of “refreshing” sleep versus unsatisfying sleep, there is no obvious difference in the brain chemistry or physiology after the two types of sleep. What does this mean? Even medical literature uses the term “restorative sleep” even though every scientist knows the brain uses the same amount of energy at night as during the day.
- More on the interaction between sleep and the environment
- How do three levels of the nervous system – behavior (higher), circuit, and neurons (lowest) – play a part in sleep and work with each other?
- Need to quantify individual differences in circadian patterns and flush out the idea of chronotypes
- Sleep disorders and their interaction with mental health – cause or effect
- Animal models for human physiology are limited and there are no models for some disorders. Can we use transgenic animals for better insight into human problems in the future?
- How can we bring personalized medicine to sleep? How can we get better diagnosis about causes of individual cases of insomnia? Can we find biomarkers for sleep disorders?
Reliability of Research
Evidence from Science. It is well known that the research can be biased and there is pressure on scientists to publish results with impact. One observer has gone so far as to say “most published research findings are false.“