AASM Statement: Sleep’s Role in Health and the Gaps in Knowledge

Raman Malhotra, MD

The American Academy of Sleep Medicine (AASM) recently released a position statement in hopes of drawing attention to sleep’s role as a vital factor in the overall health of the population. The statement was endorsed by more than 25 medical, scientific, patient, and safety organizations, all of which noted the need for improved awareness and additional circadian research into how sleep relates to quality of life.

Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and president, AASM, discussed the current state of sleep care in the context of AASM’s initiative to increase awareness of healthy sleep and highlighted its impact on well-being in a recent conversation with NeurologyLive. Malhotra further detailed information about the statement and clarified the consequences of insufficient sleep and untreated sleep disorders can have for personal health and be a threat to both individual health and the overall health of the population.

NeurologyLive: Could you offer some background on what motivated the AASM to release this statement and the main takeaways for the clinical community?

Raman Malhorta, MD: Awareness of the value of sleep has definitely been increasing amongst clinicians and patients, and around the world. But we still feel that there needs to be a greater emphasis on sleep health in our clinical encounters, as well as in public safety. We felt that it was important, as the American Academy of Sleep Medicine, to bring this message to our colleagues about the importance of sleep and what we've learned throughout the years of research showing how it really is vital and essential for health. We feel it's as important as nutrition and regular exercise for our health and well-being. We feel it's a biological necessity, and we feel that insufficient sleep and untreated sleep disorders—if one has those—are detrimental to your health and public safety as well.

Did the pandemic have any impact on the timing of this statement and does it serve as a reminder about how important sleep is for health?

We've always felt that sleep is essential for health as our mission and vision, even prior to the pandemic, but the pandemic changed a lot of our thoughts and really highlighted the importance of health in many respects, and sleep as part of that. A couple of the obvious issues with the pandemic were how stress and fears caused poor sleep in a lot of our patients in our society, and we all saw how that could impact us in our health. And honestly, with the flexibility of some of the things that the pandemic brought—for example, like virtual school and virtual remote working, where you would be able to cut out your commute time and have a little bit more flexibility—some of our patients that we see in clinic actually felt like that showed the importance of being able to get more sleep, and that they've actually felt better because of having that flexibility of being able to work from home. Then, as we move on toward the normalcy of going back to work or back to school, they still want to value that time that they got as far as getting adequate sleep.

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How would you describe the general state of provider knowledge on sleep treatment?

Study after study, every time we look at that, even amongst neurologists, but definitely other specialties or primary care providers, we continue to see a lack of awareness or lack of inquiring about sleep disorders in their patients. But we're definitely making some improvements, and I understand the challenges when you're evaluating a patient for a neurological condition and having time to ask about everything. But we do feel that it is essential, especially for patients with neurological conditions, to ask about their sleep. Does start, with the education of our medical students, our residents, and our fellows? There's very little time dedicated in most programs to sleep medicine, and we're continuing to try to make that better and try to improve on that by incorporating this into different aspects of the curriculum.

Are there any knowledge gaps that stand out or that definitely need to be addressed in the short term?

One of the glaring concerns we have is insufficient sleep and not getting enough sleep in both adults, and, unfortunately, in our children. Teens seem to be the highest—we have studies showing that almost three-quarters of teens aren't getting enough sleep. We can only imagine what that can do to the developing brain and if they do suffer from neurological disorders, like headaches or other developmental disorders, how that could impact them. To be honest, sometimes it's impossible for them to get enough sleep because of how their schedules are set, and what the expectations are as far as getting to school at a certain time.

That is one group, but even adults—and even as medical providers serving as an example, sometimes our schedules are not conducive to allowing us to get at least 7 hours of sleep. I still think that that is a great thing to start with. Just like you would ask your patients to try to get more exercise or eat healthy, asking them to get enough sleep can go a long way in keeping them healthy.

Where does the effort start in terms of addressing some of those patient education challenges?

The key is that we need to start off young. It's hard to change behaviors or impressions about your health when you’ve already reached mid- to late adulthood, although we still try. But really starting off with school-aged children and incorporating the importance of sleep to help in the curriculum that we have. On our website, sleepeducation.org, there are some excellent learnings and examples of how to incorporate that into the curriculum for elementary school students, middle school students, high school students, and even college students.

We feel that just like we promote other healthy aspects of nutrition and exercise, sleep should be part of that. I think that will go a long way as kids understand how important that is for their health, to include those. I think kids want to be healthy, and their parents want them to be healthy, so I do think that actually having that in the curriculum would be important to get that out. And we’re not doing a very good job of that.

Transcript edited for clarity.

REFERENCE
Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. Published online June 21, 2021. doi: 10.5664/jcsm.9476