Dr. Aatif Mairaj Husain is director of the Neurology Fellowship Program for the Department of Neurology at Duke’s School of Medicine. Dr. Rodney Allen Radtke is a professor of neurology and division chief also at Duke’s School of Medicine. Both Dr. Husain and Dr. Radtke are on-staff at the Duke University Hospital Sleep Disorders Center, conducting sleep studies and treating patients with common and more complex sleep disorders.
How did you first get involved in this area of study?
Dr. Husain: I’m a neurologist by training. So, initially, I was attracted to the study of the brain. When I came to Duke to do my fellowship, I was learning about epilepsy. Along with epilepsy, we got training in sleep, and, ultimately, I got interested in how the brain works in terms of sleeping and wakefulness and the different types of brain waves involved. Then, one thing led to another, and I found myself in sleep medicine.
Dr. Radtke: I got involved because it was a new technology—a new investigation. The first recordings of sleep were done in the 1950s, and the initial observations of REM sleep and that sort of thing were being made. Then, in the 1960s, there was the identification of breathing problems and sleep, and then the first sleep labs opened in the mid-‘70s. And so then I got involved in the early ‘80s and opened Duke Sleep Lab in 1985.
How does sleep relate to students, in particular?
Dr. Husain: I think stressing the importance of sleep, especially in your formative years, especially as you’re growing as a teenager, is critically important. I know people talk a lot about this, and there may be circumstances when you can’t get the right amount of sleep, but you should strive towards it.
I often get asked, What is the right amount of sleep? The right amount of sleep is when you wake up without an alarm clock at the time that you want to wake up. If you’re using an alarm clock, you’re not getting enough sleep.
Narcolepsy is a neurologic condition, which usually affects younger individuals, so it can be anywhere from early teens to mid to late 20s, typically. It typically shows up as someone who is very sleepy, tired, fatigued, doesn’t want to do a whole lot, and is socially becoming isolated. They may have other symptoms, like very vivid dreams. They may have episodes of not being able to move when they wake up. They fall asleep very quickly. They may have episodes where when they’re laughing or otherwise emotional, their muscles may feel weak.
This condition can greatly impair someone because it will often affect their ability to concentrate and do well in school, so they start doing poorly in school. This is a real medical condition, and it can greatly impair their ability to function.
What drew me to this condition is that when this is appropriately recognized and treated, patients’ lives can be turned around remarkably, and they can once again become highly productive and have wonderful, very successful careers. The challenge here is in the correct diagnosis, because it mimics a lot of other conditions, such as depression or laziness. To try to find it and diagnose it is important, and then to treat it appropriately is also important.
Dr. Radtke: Young adults tend to burn the candle at both ends. They usually need eight hours of sleep, or more. They rarely get it.
Teenagers tend to sleep-deprive themselves. If they sleep in on the weekends, that’s basically a sign that you’re playing catch-up, that you’re not getting enough sleep. That’s a big impact on teenagers, and there have been studies done that actually show that they’re higher functioning on Monday and they get lower functioning as the week goes on because they chronically sleep-deprive themselves. Then, they catch up on the weekend. So I think it’s important to realize that sleep is important to your daytime functioning and protecting time for sleep allows you to function better during the day.
Why is it important to study sleep?
Dr. Husain: Well, I mean, if you think about it, you spend a third of your life in this state, and a lot of things can happen in this state. Many different diseases can start while you’re asleep. Many different diseases can be worsened while you’re asleep.
Let me give you a few examples. If you are someone who has sleep apnea—this is a condition in which you stop breathing during sleep—then not only are you tired and sleepy and fatigued during the day, which is a direct consequence of the sleep apnea, but also often times your blood pressure goes up. Your diabetes is under worse control. You have a higher risk of stroke, and heart attacks, and things of that sort. It’s one condition that affects numerous other conditions. Some researchers feel that it can even affect your memory and lead to dementia. One sleep condition has such wide-ranging effects.
Dr. Radtke: In other words, everybody sleeps. Everybody needs to sleep effectively in order to function well during the day. When you have something disturbing your sleep, it has a marked impact on your quality of life. It may impact on your ability to function well, and certain sleep disorders can be associated with long-term health risks, primarily associated with sleep apnea.
One logical question to ask is: Why do we sleep? The answer is we don’t know. We assume it to be a restorative function, and you can’t do without sleep. But at the same time, it’s not really understood as to, one, why we sleep, and two, why we have different stages of sleep and particularly REM sleep, which is predominantly dream sleep. There are some speculations that we have REM sleep in order to consolidate memory, but, at the same time, we don’t completely understand its purpose.
What do you like most about the work that you do at your practice?
Dr. Husain: The best part of the job is when a patient comes back to see me and tells me that the diagnosis and the treatment I instituted has remarkably affected their life for the better. I think that’s what any doctor finds most rewarding in their job. In sleep medicine, and often times in conditions such as narcolepsy, sleep apnea, and others, we get to hear this a lot. That is very rewarding and very satisfying.
Dr. Radtke: It’s the ability to help people have quality sleep so that they approach life feeling much better, functioning much better. When people have bad sleep they are very unhappy, and if you can restore the quality of their sleep, whether it’s treating sleep apnea or resolving chronic insomnia, people enjoy a better quality of life.