By Renee Diiulio
According to the Centers for Disease Control and Prevention, 70 million Americans suffer from chronic sleep problems. Yet, even more people experience intermittent episodes of lost sleep. The National Sleep Foundation (NSF), headquartered in Arlington, Va, reports that 48% of Americans experience occasional insomnia. With symptoms ranging from the mental to the physical, the mild to the severe, some of these weary souls will turn to a sleep aid in their search for slumber.
The NSF cites that 25% of Americans will use medication for help sleeping every year. Unknown is how many will utilize alternative “medications,” such as alcohol and illegally obtained drugs. Roughly 30% of patients with insomnia report using alcohol as a sleep aid, and 18% to 20% use hypnotics chronically, according to Timothy A. Roehrs, PhD, director of research at the Sleep Disorders and Research Center of the Henry Ford Health System in Detroit, and professor in the Department of Psychiatry and Behavioral Neurosciences at the School of Medicine, Wayne State University, also in Detroit. He has often asked what this means for the patient.
Is the use of a sleep aid a good thing or a bad thing? Does the type of aid matter? Does the answer differ over the long term? At what point does a substance’s use develop into abuse? Is there a difference between dependence and abuse? Can at-risk patients be identified? Can better drugs be developed?
These are not new questions, but without the work of Roehrs, medicine would have fewer, newer answers. His work in the field of sleep has primarily focused on issues involving sleep and drugs, advancing the science with every publication (and he has more than 200). He has studied the effects of alcohol, hypnotics, stimulants, and analgesics, among others. He has looked at the relationship between sleep and drug use and abuse, pain assessment and sensitivity, elective surgery, and daytime sleepiness.
All of his work, however, has not been behind a “laboratory bench.” A meaningful portion has been behind the lectern’s podium or seated at a figurative round table. A fervent supporter of education, Roehrs has contributed to the field of sleep medicine through related associations in a variety of roles often served on a volunteer basis. He has sat on institutional committees, national advisory boards, and association committees and held executive and leadership roles with the Sleep Research Society and the Association of Professional Sleep Societies.
He has participated in efforts to educate groups from young sleep professionals to the mass public to high school students. “Getting sleep education into college and high school curricula is a complex but important goal. Education regarding sleep needs to stand with education on nutrition. Recognition of the importance of sleep in the general population is highly critical and, ultimately, probably has a greater impact, I think, than nutrition,” Roehrs says.
Recognizing these vast contributions to the field of sleep—and that he has earned the respect of his colleagues—the National Sleep Foundation honored Roehrs with its Lifetime Achievement Award this year. The designation recognizes individuals who have “made outstanding contributions in original research; developed and/or led an enduring or effective program, organization, or department; volunteered to lead and develop public and professional organizations; mentored; taught; contributed to policy initiatives and advocacy; completed additional activities that have clearly advanced sleep science, sleep medicine, or the public health related to sleep; and/or made other contributions that the National Sleep Foundation Board of Directors may deem to be appropriate.”
It is an apt description for Roehrs. “In addition to being an excellent researcher, [Roehrs] has modestly, and rather stealthily, been an individual who has served the field in a very unselfish way,” says research colleague James K. Walsh, PhD, senior scientist with the Sleep Medicine and Research Center at St Luke’s Hospital in St Louis.
A CV Story
Roehrs’ list of accomplishments is indeed long. He has been working in the field since 1970 when he received a research assistantship studying the effect of sonic booms on sleep in the sleep laboratory of the Cincinnati VA Medical Center in Ohio. “At the time, I didn’t know anything about sleep,” Roehrs recalls.
But, like many sleep professionals, as Roehrs learned more about sleep, he became more entranced. The following spring, Roehrs was given the opportunity to attend the annual meeting of an associated professional organization. “I was able to meet the premiere figures of the field, such as William Dement [MD, PhD] and Allan Rechtschaffen [PhD], which was overwhelming,” Roehrs says.
His time in Cincinnati endeared him to research. After completing his master’s degree in clinical psychology, he spent 2 years doing basic research that looked at the effect of morphine and methadone on the sleep-wake cycle in rats. “This was frontier research, and French and American broadcasters videotaped our work. The excitement of being part of cutting-edge science convinced me that I wanted to be a researcher,” Roehrs says.
So he pursued a PhD at the University of Georgia (which he obtained in 1978), where he further delved into research. A postdoctoral fellowship at the Alcoholism and Drug Abuse Institute at the University of Washington, Seattle, allowed him to explore the resulting effects on sleep and daytime sleepiness.
“A major contribution of his has been identifying the various determinants of daytime sleepiness in both healthy people and individuals with sleep disorders,” Walsh says.
A Secondary Focus
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| Dr Timothy Roehrs works collaboratively with colleagues at Henry Ford’s Sleep Disorders Center, one of the first sleep disorders centers founded in the United States. |
This early work was performed under Thomas Roth, PhD, director of the Henry Ford Health System’s Sleep Disorders and Research Center, who shares that Roehrs was his first graduate student. The two have continued to collaborate frequently and are currently working together on studies examining pain and sleep, a topic they returned to in the early 2000s. Roehrs says that three projects are focused on chronic pain, involving patients with conditions such as fibromyalgia and rheumatoid arthritis.
Roehrs considers his work on pain and sleep to be a secondary focus compared to his work studying pharmacologics, but one that is fitting as it circles back to his original research on rats and methadone and is an area in which much more remains to be discovered. In addition to the studies involving chronic pain, Roehrs also would like to look at sleep and surgery, from prophylactic improvement of sleep in preparation for a procedure to the impact of postsurgical sleep on the transition from acute pain to chronic pain, work that could potentially have beneficial clinical applications.
“Roehrs and his colleagues very elegantly demonstrated in a series of studies that there is a reciprocal relationship between pain and sleep,” Walsh says, explaining that a lack of sleep coincides with an increased sensitivity to pain; then, of course, is the impact of pain on one’s ability to sleep.
Walsh notes that follow-up research, including a study completed at the St Luke’s Hospital sleep center, is finding that improving the sleep of individuals with chronic pain conditions not only provides the benefits of better sleep but also decreased pain. “I believe it’s an area that, with a few more studies, will be integrated into clinical medicine,” Walsh says.
Sleep Aids: The Good, the Bad, and the Neglected
Ultimately, Roehrs would like to see all of his work benefit patients. He particularly wishes to examine the factors that may indicate or lead to substance abuse, asking, “What is the likelihood of developing addiction when you use a hypnotic as a patient with insomnia? Or when you use alcohol as a sleep aid? What predicts your transition to alcoholism? What are the risks—related to both side effects and abuse—associated with the therapeutic use of marijuana? How does therapeutic use transition into abuse, and what are the red flags that you need to look for?”
He has already done preliminary work in these areas, noting that use-abuse progression has been a recurring research theme. In general, his work has been groundbreaking. “The area of drugs of abuse and sleep had been neglected until Tim [Roehrs],” Roth says.
His exploration of the abuse of sleeping pills revealed that the risk of abusing these medications has been overstated by the medical community and the media. “[Roehrs] has clearly shown that the sleeping pills most commonly used these days are quite safe for those without a history of drug abuse,” Walsh says.
More recently, Roehrs was the first to show evidence that hypnotics remain effective for at least 8 months using objective measures. “So the risk associated with nontreatment of a sleep disorder because a drug might carry risk is unconscionable, but risk of abuse may be mitigated by recognizing what the risk is for a given patient and the potential signs of abuse,” Roehrs says.
The clinical benefits are obvious, but irrelevant if never applied. Roth notes that sleep medicine today suffers from the same challenges presented to other branches of medicine: reduced and overmanaged reimbursements, a need for better drugs with fewer side effects, and the resource-restricted development of clinically useful and cost-effective procedures and protocols.
Pioneer of Sleep
The field of sleep is further challenged by its relatively young age and continues to change dramatically, although never quickly enough. “We are still using classic methodologies, such as the EEG, and new methodologies for assessment and diagnosis, as well as new drugs for treatment, need to be discovered. There is a lot of room for new understanding and new methods,” Roehrs says.
One question easily leads to 10 more, and Roehrs has a lot of questions. “[Roehrs] generally doesn’t tip his hand on where his next great idea will take him,” Walsh says, but it is usually a road less taken and, in fact, may be first blazed by Roehrs. Roth notes he has planted the flag of sleep research in areas where it was unrecognized and focuses on issues relevant to everyday life in the general population.
With a prolific resume and the respect of his colleagues, Roehrs has helped to advance the field in multiple ways, both scientifically and clinically, doing so quietly, modestly, and productively. “Tim is probably one of the most underappreciated major contributors to clinical sleep research,” Walsh says. But thanks to the Lifetime Achievement Award by the National Sleep Foundation, he has received recognition for his years of service. SR
Renee Diiulio is a freelance writer based in Manhattan Beach, Calif. She can be reached at [email protected].
