Joseph Ojile, MD, D.ABSM, is a practicing clinician and chief medical officer at Clayton Sleep Institute in St. Louis, Mo, as well as president of the Clayton Sleep Research Foundation. On July 1, he began a 12-month term as chairperson of the National Sleep Foundation. Sleep Review spoke to Ojile about his plans for the organization and how he hopes to build on the successes of his predecessors.
Sleep Review (SR): Why did you want to be the chair of the National Sleep Foundation (NSF) as opposed to one of many on the board?
Joseph Ojile, MD: I started by working on the Education Committee and was working away, trying to contribute wherever I could. During that time we had to start to look at what the educational needs were, both among our doctor community and for the public in general. Clearly, as an advocacy organization, I think the National Sleep Foundation has a unique role, as sleep is making the turn from being purely disease-oriented to being much more a part of the conversation that we’re having about overall health.
The analogy I use when I speak to folks is that if you go back historically and look at where we were in the conversation 40 years ago about water: where water was viewed as sort of a burden, that if you needed water, you were weak. Soldiers were given a single canteen of water and boy, you better save that. Now, hydration is part of health. Water now is part of the conversation about performance, health, and wellness, not so much focused on the disease state of dehydration.
Cholesterol also started with the disease state, more or less, of coronary disease, but now we’ve seen a real focus on reduction of lipids and cholesterol that is part of working on a healthy dietary regime, health promotion, and health prevention; really a big change in how we position cholesterol and fat into our dialogue with both our fellow citizens and our patients.
I think sleep is on the verge of making that turn. The last 10 to 20 years or more, we’ve been talking about obstructive sleep apnea and insomnia and abnormal behaviors. All those -are still in play, and they’re very important. But even in a bigger way, now you’re hearing sleep is part of how “I have to feel good during the day, how I have to keep weight off, how I have to perform athletically.”
We’re starting to get this whole advancement where sleep is becoming part of the dialogue and conversation about overall health. I think that’s really an exciting thing to be part of. Advocacy and education to the public has a large role there, so the National Sleep Foundation has been working towards those goals for quite some time. It’s been fun to be a part of that. I’m excited about the year ahead and being able to talk about these topics.
SR: You started on the Education Committee. It sounds like that’s perhaps what you’re most passionate about. Is that going to be a focus of your time as chairperson?
Ojile: Well, there are a couple things. One goal is there’s been some great leadership that’s preceded me…Max Hirshkowitz, Chuck Czeisler, Chris Drake, they did really great things with the [Sleep Time Duration Consensus Panel] and the [Sleep Monitoring Standards Work Group] that they worked on with the Consumer Electronics Association. So one effort will be to try to bring a focus and say, “hey, these things have been accomplished.”
The other is to try to help our primary care doctor colleagues as well as the public in general with our educational efforts. Our primary care colleagues are under so much pressure to do so many things each day, but I think they’re really coming to the point of saying, “Sleep’s part of our overall evaluation, and sleep’s becoming a vital sign.” Helping with that effort, I think, should be a key thing that we want to continue to work on, and we are working on it.
I think the sleep.org website [powered by the National Sleep Foundation] has been helpful. There’s good data on there. Providing some focused continuing medical education for primary care doctors has been quite successful. To continue to work on that, we have a great committee. Dr Stephen Sheldon from Northwestern has been a very large influence in our field over the last several decades on the pediatric side, but he’s also an expert in medical education. He’s been working diligently in those areas for the last couple years, so it’s been great to work with Dr Sheldon and work on that committee. I can go on and on.
SR: If you could pick one thing to call your top priority, what would that be?
Ojile: If I had to pick one thing, first and foremost is to continue to drive forward the idea that sleep health touches almost every one of our fellow citizens in some way, shape, or form. If we do that, people who have actual disorders will come along and, of course, will be part of the discussion as well, but how we live a better lifestyle by incorporating good sleep habits into our day-to-day life and making it part of what we call the trifecta: diet, exercise, and sleep. If we can get people to think about those big 3 items as part of their everyday process, the way they view each day and living healthy in those ways, we can make some real improvement.
I think that would be the biggest thing, if we can help continue to expand that dialogue among both our colleagues and among the public. Doctors have so much information coming at them every day, if we can just help focus that dialogue a little bit. Even in sleep, we have the National Sleep Foundation, the Sleep Research Society, which does basic research, and the American Academy of Sleep Medicine, which focuses on the practice of treating sleep disorders. Having all 3 of them moving in the same direction and helping focus those efforts, I think, would be helpful.
SR: On the NSF website, there’s a lot of material for patients and consumers. Can you tell me a little bit more about how you plan to engage with physicians directly? And are they mostly primary care physicians or other kinds as well?
Ojile: The focus of the National Sleep Foundation for several years has been to focus more on the primary care educational efforts. The specialty sleep education efforts have been really well attended to by the American Academy of Sleep Medicine, which has a large meeting here in the United States. The World Association of Sleep Medicine has a large international meeting, and those organizations and meetings are where sleep docs get together, as well as the Sleep Research Society (focusing on research).
There are several regional meetings that the National Sleep Foundation has been hosting for primary care physicians, working with the American Academy of Family Physicians and the American Osteopathic Association. Recently, the National Sleep Foundation achieved an Accreditation with Commendation recognition from the Accreditation Council for Continuing Medical Education, which was really a neat accomplishment. It’s focused on how that education is being delivered. The staff at NSF and Dr Sheldon and others really helped with that process.
The National Sleep Foundation has an online learning platform with on-demand video courses for primary care physicians. I think continuing to move that forward and expanding these offerings will be a significant part of what we’re trying to accomplish in the next 12 months.
SR: One hot topic right now in sleep is consumer sleep trackers. The NSF created the Sleep-Tech Council in part to come up with guidelines about these devices, so I’m curious what the Technology Council is working on now and where we are in terms of coming up with some standards for these devices?
Ojile: There was a committee that Dr Hirshkowitz worked on very diligently and has come out with the standards recommendations. That was called the Standards Working Group, and that was done in conjunction with the Consumer Technology Association. They’ve been working on that. They’ve been meeting, and they did release a report on that in the last year. The next phase is going to be how do those standards get adopted or adapted by these companies working in that area. They want to do that. I think they’re all trying to figure out how that’s going to work.
Part of it is we need to be there to support the technology side as it interfaces with the health side. It’s really interesting, but it’s not as fast moving in a sense as you’d think. The good news, the way I view it, is how it’s helping to raise awareness among patients. Let’s not call them patients, just among the public. Because most of these people literally aren’t patients, they’re just people trying to live better.
What I think is encouraging is people are starting to bring that into the conversation. “I’m measuring how many steps I walk per day, but also I’ve noticed I have these sleep findings on my wearable device, and I want to have a conversation with you about that.” That’s a chance for us to start to impact things. I think we’re early in the going.
Where all this is going to settle and how we practice either medicine or health promotion, I would not feel comfortable saying that we’ve reached an end point or a decision point yet. I don’t think industry has decided where they sit, and I don’t think as professional physicians and people working with the public, we know yet where all this is going to settle. But it’s great that the medical community is being engaged by the developers to work together.
Working together and collaborating, to me, is quite a positive development. It’s exciting. There’s a sleep technology conference, which will be in Silicon Valley, with the National Sleep Foundation and the SleepTech Summit that’s going to be out October. There’s going to be the NSF Sleep-Tech Award for new sleep tech innovation.
SR: The Sleep Health journal has been around a few years. How is it distinguishing itself from other journals that publish articles about sleep?
Ojile: I think that’s turned out to be a really cool outcome The journal received the award as the best new medical or healthcare journal, I think it was, last year or the year before*, which was really exciting….It’s the only journal that’s talking about sleep health versus, again, other disease states, disorders or basic research.
*Editor’s note: Sleep Health won the Association of American Publishers’ PROSE award for Best New Journal in Science, Technology and Medicine in 2016.
It focuses on sleep in the context of public health, the environmental consequences, so it’s at the intersection of public health and sleep research. It’s got a little bit different focus. We certainly have plenty of journals in medicine generally, but this is filling a little bit of niche…that has been very well accepted.
Lauren Hale, who’s really done a great job as the editor-in-chief, she’s been working really nonstop for the last 2 or 3 years on this. The board and the committees know that this is a really good endeavor and a focus and, again, a way to touch the core stakeholders, to touch health advocates who also are interested in sleep and to raise the issue of sleep to other advocates and bring home the science part of sleep as it relates to all these different aspects of sleep, not just sleep disorders. It’s fulfilled that goal.
SR: What can we expect to see NSF bring to Capitol Hill in your tenure?
Ojile: We’ve got organizations that are actively representing or trying to represent physicians, sleep disorders, sleep testing, and we certainly want to support those efforts while at the same time making an effort to promote things like public health, sleep health, and sleep safety. I really think a year is a very brief period of time, so I think for me personally would be the idea of finding a couple things where we can raise awareness of the congressmen and their staffs of why sleep should be considered as part of health promotion and how they can better start to place that. They probably themselves are not following the best sleep health hygiene, if truth be told, so I think that should be our focus.
I don’t see right now, and this is a sort of uneducated statement, but I don’t see that there’s necessarily a clear opportunity for us to impact legislation directly as much as start to advocate and affect the perception of sleep as part of a healthy lifestyle and get it into the conversation. If we can succeed in that, then we can lay the groundwork, I hope, for other topics. Part of this, when you’re a 1-year chairman, I think we always have to remember our main job is frequently to plant seeds to create the shade that others will sit under.
You have to look at what Dr Hirshkowitz, Dr Czeisler, Dr Drake, and others before them, how they’ve done that for us. We owe them the respect and the effort to continue some of those efforts for the next set of people that come forward in sleep. Medicine is particularly sensitive to that. We each are standing on the shoulders of the guys and gals who came before us. If we can plant a few seeds that are going to sprout in the years to come, I’d be really happy with that, frankly.
As a clinician, since I see patients all day, those sorts of the things, the steady progress of how we care for people is really compelling for me. Because we see the fruits of that down the road, and if we don’t work towards those ends, we see the other side of that. In sleep, what we’ve wanted to do, and I think what’s happening thanks to the efforts of so many of our colleagues, is to continue to advance sleep as a disciplined science and also as something that’s applicable to people’s normal lives even when they’re not sick. Those two things are really important and actually rather different from many other specialties.
You’re seeing other specialties start to do it. You used to only think about going to the heart doctor when you were having a heart attack. Now people go to the heart doctor because they want to do all these heart health things like lower their cholesterol in a healthy way because they’re starting to think about what their life looks like down the road. In the prior generations, they weren’t thinking about down the road.
Now we live in the sandwich generation. Many of us are blessed, our parents are alive at age 90, and we still have children at home. By and large, on such a large scale, that’s a unique thing to our generation. If you think about it, look back on the arc of history, that hasn’t happened before.
Plus, we have the 40- and 50-year-olds, of which I fall in that group, who are like, “Hey look, I want to do things now so when I get to be 80 or 90, if I’m so fortunate, I’m still able to do all this stuff.” Well, how cool is that?
SR: Earlier in this conversation, you talked about some progress in sleep medicine, sleep being viewed as not just a symptom of a disorder necessarily but as a wellness measure.
In that sense, there’s a lot of progress going on. I wonder what you think are some major challenges facing sleep medicine in this country, things that maybe aren’t going so well and perhaps how NSF can help to address those issues?
Ojile: There are several issues. On the one side, I could not be more optimistic about everything having to do with sleep medicine, so I want to start by saying that. The sleep doctors that I’m honored to work with around the country and other advocates, like if you look at the NSF Board, we have non-physicians on there as well, there’s just so much awareness and things are so much further along than they were 10 or 15 or 20 years ago. At every level, I see that that’s exciting and moving in the right direction.
On the other hand, because sleep’s growing and doing so well, we, at some level, have a person-power shortage, whether it’s at the specialty level, the technician level, the support level, we still have a shortage of trained people. While that’s not an area that falls to me or the organization I’m currently involved with, it is one, as someone who cares about sleep medicine, that’s concerning. I know folks around the country are having that conversation and of course we want to be helpful and encourage that.
The other thing that’s concerning is that we are supportive in a way that brings the best of both sleep science and common sense to the conversation. Because what would be concerning or disappointing is if all the efforts at sleep health don’t happen in an organized way so that you end up with having things like fad diets. We want to help the public distill this information in a way that’s orderly and that applies to their life in a scientifically rigorous way that they can use every day without having to learn the science.
SR: It sounds like you’re thinking that since there’s more awareness being paid to sleep and sleep issues, there’s also more opportunity for those lessons to be distorted a little bit or even maybe taken advantage of.
Ojile: Yeah. I think you’ve said that better than me; that’s exactly it. You can kind of see it where we have to provide the information so folks don’t come to conclusions that can be harmful or disruptive to their lives by interpreting data the wrong way or getting the wrong ideas or again, fads.
The great thing for us is that people are coming out and speaking about this, like Olympic athletes. I mean, you heard Michael Phelps talk a few years ago about how he eats, swims, and sleeps, that’s the big part of his training. You recently had LeBron James talk about how much he sleeps per day. Same with Tom Brady, the New England Patriots quarterback, how now as his career’s gone on, he’s really incorporated sleep health into making his career more sustainable. I don’t think any of us have any delusion that we’re going to become them, but if it’s a big enough issue to be part of their conversation, for those of us that are just trying to lead healthy lives, maybe there’s something there for us to look at and say, “I think I could do this better.”
The same with learning, you’re starting to see it in the children’s realm now. I’m hearing teachers talk about young people—grade schoolers, high schoolers—getting enough sleep to learn or figuring out that such and such a child is struggling, and they may not have a disorder; they’re just not getting enough structure or enough input to know that it’s important to them. That’s really cool stuff. It’s bringing the right conversation.
SR: Is there anything else that you wanted to add about your leadership with the NSF before we get off the phone?
Ojile: I would just close by saying, I have enjoyed working with our colleagues from around the country, and I’m looking forward to this year of focusing our efforts together to make things better for our fellow citizens. That’s the public advocacy side, and if we can do some little things to make some progress over time, I’ll be really happy with that.
Rose Rimler is associate editor of Sleep Review.