An interview with Rosalind Cartwright, PhD, provides a veteran’s insight into sleep medicine.

Rosalind Cartwright, PhD, chairman of psychology at Rush University Medical Center, the “grandmother” of sleep medicine, has devoted her half-century-long career to researching sleep disorders. Cartwright’s interest in sleep research began while working at the University of Chicago in the 1950s. She eventually moved to the University of Illinois Medical College, and as director of psychology, opened her first sleep laboratory there in 1963. Later, she opened a second sleep laboratory at the University of Illinois Chicago’s Department of Psychology. Cartwright has been at Rush since 1977, where she has continued researching the psychology of sleep; she opened a laboratory there in 1978. Among her areas of interest are incidents of sleep-related violence and sexual behavior, and depression and dreaming. In addition to her study of depression and sleep financed by the National Institute of Mental Health (NIMH), she is working on a new oral appliance for the control of snoring and mild sleep apnea using home monitoring studies. In addition to her position at Rush, Cartwright is an affiliated scientist at Presbyterian-St Luke’s Hospital, Chicago. She has written a number of books, including Crisis Dreaming (1992). Sleep Review recently spoke with Cartwright about her work in sleep and depression, her other research interests, and where sleep medicine needs to improve.

Sleep Review: You are doing research into depression and how dreams can be used to help patients recover from a depressive period, such as a divorce. How did you become interested in this problem?

Cartwright: My interest in working with the problem of sleep in those with major depression was sparked by being on a grant review committee for NIMH, site-visiting Dave Kupfer at the University of Pittsburgh, going to the Associated Professional Sleep Societies meetings in those early days, and learning what was going on in this and other countries in the area of sleep and dreams. I thought it offered a way to get at another level of understanding the human psyche than was easily assessable in waking.

Sleep Review: One of the treatments you are experimenting with is dream “repair.” Can you describe this research, its origins, what is involved, and the implications it has for both sleep specialists and psychologists?

Cartwright: Dream repair is described in Crisis Dreaming. It is modeled on cognitive behavioral therapy in that it identifies the negative aspects of dream thinking and trains subjects to reverse these to the opposite or positive side of the same dimension. It is another tool psychologists can use to change the attitudes and expectations of patients that are dysfunctional and self-defeating. It gets at the underlying emotional bad habits and helps to restructure these.

Sleep Review: You are also doing research into sleep-related episodes of violence, eating, and sexual activity. How big a problem are these sleep-related episodes, what are their causes, and what are some of the treatments you are researching?

Cartwright: The NREM parasomnias in adults are estimated to be a problem in 2.1% of people [according to the research findings of Maurice M. Ohayon, MD, DSc, PhD]. These parasomnias have a genetic basis although the gene has not yet been identified. They are best treated currently by eliminating the precipitating factors: stress leading to poor sleep, alcohol, caffeine, and irregular sleep/wake hours. Treatments combine good sleep hygiene, relaxation training, and a good muscle relaxant such as clonazepam.

Sleep Review: Insomnia continues to be an area of interest. How is the understanding and treatment of insomnia changing?

Cartwright: Insomnia is a huge but poorly understood problem. It needs definitional work to separate out what is primary from the many secondary forms.

The treatments will have to be tailored to the cause. It’s a big problem, which is only getting bigger the more people work too many jobs to keep up [financially] and use stimulants to keep going.

Sleep Review: Are there any areas in which sleep medicine needs to improve?

Cartwright: It is very important to keep good quality control in this field. It is such an attractive source for new patients that poorly trained people are seeking to capitalize on this market. Not all sleepy people are sleep apneics and not all need CPAP. That has gotten so much press that it is scary. We must continue to fund young investigators and encourage research into new treatments. Educating the public, the primary care physicians, and medical students should be encouraged, and insurance companies must learn that preventive care saves bigger costs later.