Rethinking Rest on World Sleep Day: Neurologist’s Take on Sleep Priorities

Anne Marie Morse, DO

World Sleep Day, celebrated this March 14^th, is an annual event organized by the World Sleep Day Committee of the World Sleep Society. Observed typically on the Friday before the Spring Equinox, the day is used as a way to raise awareness about the importance of sleep and to address sleep-related issues that impact global health. Throughout the day, the global community comes together to highlight the critical role sleep plays in overall health and well-being, drawing attention to sleep disorders, their consequences, and the need for better sleep hygiene.

To raise awareness efforts for World Sleep Day, NeurologyLive® sat down with sleep expert and neurologist Anne Marie Morse, DO, to discuss various sleep-related topics of importance for patients and clinicians alike. Morse, director of Child Neurology and Pediatric Sleep Medicine at Geisinger Janet Weis Children’s Hospital, highlighted common misconceptions, such as sleep being optional or a sacrifice for productivity, and stressed the need for a cultural shift in how we view sleep. She also discussed the role of new treatments like GLP-1 receptor agonists for obstructive sleep apnea and the emerging research on orexin’s impact on cognition, metabolism, and sleep. Furthermore, Morse provided commentary on the connection between the gut microbiome and sleep, explaining how disruptions in the microbiome can exacerbate sleep disorders, creating a harmful feedback loop.

NeurologyLive: What sort of misconceptions does the public still have about sleep regarding World Sleep Day?

Anne Morse, DO: The World Sleep Day slogan is "Make Sleep Health Our Priority," which really reflects the effort to shift the current global mindset. Many people still view sleep as optional, something that can be compromised without consequence. I frequently hear people say, "I'll sleep when I'm dead," or "I can get away with less sleep." Both of these attitudes are wrong. If you believe that you can get away with less sleep, you're settling for a diminished version of yourself. With less sleep, you're more likely to make errors, take longer to complete tasks, overeat, feel less satisfied, and make choices that harm your body. If that’s okay with you, then continue treating sleep as optional. But we’re seeing that people are finally waking up to the fact that prioritizing sleep leads to a better version of themselves.

The major misconception is that we live in a world dominated by FOMO (Fear Of Missing Out) and competition, where people feel the need to do more than others. Sadly, many are not following the example set by professional athletes, who have sleep doctors as part of their team to help give them a competitive edge. Sleep doctors aren’t advising less sleep—they’re asking how we can improve the regularity and duration of your sleep to maximize performance. Maximizing sleep doesn’t mean spending more time in bed than necessary, though. There’s actually a TikTok trend called "sleep maxing," where people share tips on improving sleep quality and consistency. This is important because we are seeing an increasing number of individuals with sleep problems like insufficient sleep and sleep-disordered breathing. People are realizing that better sleep is key to being their best selves.

What are some lesser-known aspects of sleep that you reiterate to patients and families?

Before we even get into talking to patients and families, I think it’s important to address how we talk about sleep in the medical field. Sleep doctors talk about sleep at night, but the rest of medicine focuses on the day. This inconsistent conversation between specialists can confuse patients, who then have to decide who to listen to—whether it's their cardiologist, endocrinologist, or sleep doctor. Unfortunately, primary care providers may not have all the tools to navigate this.

Before we even start talking to patients, we need to align as a medical field on the fact that sleep matters. Then, as sleep physicians, we need to communicate what truly matters for the patient. A patient may come in because their spouse is complaining about their snoring, but what they might not be saying is that they’re now sleeping in separate beds, haven’t had sex in a year, or their relationship is suffering. Instead of simply diagnosing them with obstructive sleep apnea (OSA) and recommending a CPAP, we should be asking, “How is this affecting your relationship? Are you fighting more? How is this impacting your intimacy?” Sometimes, the real measure of improvement isn’t a clinical metric like AHI (apnea-hypopnea index), but rather intimacy and relationship quality. There is no class in medical school, residency, or CME on prioritizing what’s important to the patient. We often talk about what's important to us, but the patient is there because something in their life is disrupted—something they view as important. We need to respect that.

When patients ask how to make sleep health a priority, it's about aligning their goals for living well with what they can control for successful sleeping.

On the research front, what emerging concepts or ideas are being introduced to improve sleep?

When it comes to sleep disorders, this isn't just relevant to Sleep Medicine—it’s also a huge part of neurology. We’re seeing exciting advances in medications that not only treat sleep disorders but also have a profound impact on neurological health. Conversely, neurology-related drugs are also influencing sleep outcomes.

For example, Tirzepatide, a GLP-1 receptor agonist, is now FDA-approved for the treatment of moderate to severe obstructive sleep apnea (OSA). While this drug is often used for weight loss and diabetes, it has neuroactive properties, both peripherally and centrally. It interacts with orexin, a neurotransmitter involved in wakefulness. In addition, there is a growing interest in developing orexin 2 receptor agonists. While we’ve historically used orexin receptor antagonists to treat insomnia, we’re now realizing the crucial role of orexin in many other functions, including metabolism, cardiovascular health, pain regulation (e.g., headaches), mood, and reward-seeking behavior. Orexin also plays a significant role in cognition.

Research has been exploring whether orexin receptor antagonists could influence Alzheimer’s disease progression, and there’s an increasing understanding of how orexin impacts brain health. With drugs like GLP-1 receptor agonists, which interact with orexin, and emerging orexin 2 agonists, we’re entering an exciting phase in sleep and brain health. It’s time to stop thinking about sleep and circadian rhythms in isolation and start considering them as tools to optimize overall brain health. These developments will help us as neurologists diagnose, prognose, and treat patients across the full 24-hour cycle, rather than focusing only on their waking hours.

What influence does the gut have on sleep? Why is this such an important area to keep healthy?

I always laugh when I get questions about the microbiome because I remember being a young, skeptical resident. I once argued that there’s no way the germs in my gut could tell my brain what to do. But now, after years of research, I can confidently say that the microbiome plays a crucial role in brain function.

There’s a close relationship between the gut and the brain through what’s called the gut-brain axis. The microbiome is incredibly complex and diverse, with different species and varying abundances. Importantly, it operates on a circadian rhythm—there’s a timed expression of our microbiome, which underscores the influence of circadian rhythm on all cellular functions in the body.

For example, we know that conditions like obstructive sleep apnea (OSA) can alter the microbiome. The intermittent lack of oxygen causes shifts in microbiome diversity, which in turn increases the severity of OSA, creating a vicious cycle. As the microbiome changes, it exacerbates desaturation and sleep fragmentation, leading to a worsening condition.

But the gut’s influence on sleep isn’t just limited to sleep apnea. We also see circadian rhythm disorders negatively affecting the microbiome. In adolescents with circadian rhythm disorders, changes in the microbiome have been linked to obesity and increased calorie intake, often from unhealthy foods. This highlights the connection between the gut and brain, and its impact on sleep and overall health.

This is a growing area of research, and researchers like Kenneth Wright, MD, at the University of Colorado are doing incredible work exploring the connection between circadian rhythms and the microbiome. His research demonstrates how manipulating the microbiome could potentially phase-shift circadian rhythms, which could have broad implications for sleep and metabolic health.

It’s still unclear whether probiotics or specific dietary interventions will be the key to improving gut health, but food is medicine. We may need to consider a more purposeful approach to nutrition to optimize our gut, microbiome, and neurological function.