Q: What interests you about sleep medicine?
Dr. David White: I entered the sleep medicine field through pulmonary disease research. I was fascinated by the mechanisms that control breathing and their ability to keep oxygen and carbon dioxide levels stable with the least amount of respiratory work. In sleep diseases, these mechanisms don’t work as well during sleep as they do during wakefulness. This is what first sparked my interest in sleep research and I’ve now dedicated more than 35 years to this field of study.
Q: What new areas of sleep medicine are being explored?
Dr. David White: For Philips, research on understanding and harnessing circadian biology and studies focusing on improving the quality of deep sleep are exciting new areas of focus this year. Circadian rhythms and sleep are tightly linked. Circadian biology involves many “body clocks”, with one of the main outputs of the circadian system being the sleep-wake cycle. Although the primary oscillator (clock) is located in the brain (hypothalamus) many organ systems have their own clocks which influence circadian events in that system; examples include the liver and the heart. Currently, we (Philips) are working in a variety of areas related to circadian biology. An example would include investigators in England that administer chemotherapy for cancer based on cell cycle circadian biology. And they are seeing remarkable results. Despite the fact that circadian rhythms have the potential to impact virtually all biologic processes and thereby all medical fields, Philips is one of few companies interested in circadian biology. Circadian rhythms certainly play a large role in a number of sleep disorders which will be an initial focus at Philips.
Additionally, scientists at Philips are investigating how to improve certain stages of sleep, particularly what we call slow wave sleep, as slow waves are indicative of an important neurological process involving brain cell connections (synapses). We believe that by increasing the quantity of slow wave sleep, people can improve the quality of their sleep and cognitive function while awake.
Q: Why has it taken so long for sleep medicine to become top of mind?
Dr. David White: Sleep medicine is a multi-disciplinary specialty. The field grew rapidly as sleep apnea emerged as an important health concern in the late 70s. Sleep studies (polysomnography) to diagnose sleep apnea became the driving force in the field and, in my opinion, too much attention was devoted to in-lab polysomnography, limiting the growth of sleep medicine in other important areas. Now, that is beginning to change and we are starting to understand and address other complex sleep disorders.
Q: Until now, wearable health trackers have been popular for tracking fitness and sometimes sleep patterns. How will new sleep research affect the consumer wearable market?
Dr. David White: Most devices now come with functions that monitor sleep, but their accuracy is questionable and most physicians will caution their patients on that notion. Nevertheless that function is popular. Generally, when consumers purchase wearables, they are interested in 1) monitoring exercise, and 2) monitoring sleep. However, these devices generally do not often therapeutic solutions to address sleep problems.
Beyond wearables, consumers have started to install non-contact devices in their homes that can track sleep. For example, the Withings system links multiple devices together, including a wearable fitness tracker and sleep sensor placed under the mattress. Bedside and in-bed devices can also measure/record heart rate, humidity, noise, etc. thereby providing even more information about a user’s daily health habits.1 Monitors, combined with an in-depth questionnaire, can provide extensive information about a patient’s sleep health. With all of these options available, people have started paying more attention to their sleep health. However, with few devices offering holistic feedback or viable solutions for sleep problems, wearables or non-contact monitors aren’t providing as much value as they might. Philips hopes to change this with sophisticated use of the information derived from these devices to address sleep problems and disorders.
Q: Do you see this being an entry point for new sleep specialists?
Dr. David White: Possibly, as the devices may help identify a lot of people with sleep problems who aren’t typically identified. This may spark the need for more sleep doctors, therapies and sleep devices. Medical students are starting to gain interest, but it will take time as the complexity of sleep medicine increases. Additionally, as patients become identified, more patients will follow.
Q: What are the challenges for the next big industry leap?
Dr. David White: Collaboration between industry and academia is not a difficult concept and can produce creative ideas. Physicians and industry professionals seem to understand the challenge between academia and industry is primarily due to potential conflict of interest. However, if both sides recognize this and work to minimize it, progress can be made in basic science and its clinical applications in the sleep field. As we move forward in the study of sleep medicine, we must remain open to collaboration for mutual gain with the patient always front and center.