Ruth Benca, MD, PhD, believes a new day has dawned for studying and teaching the importance of sleep.
“It’s not like the old days,” says Benca, chair and professor of psychiatry and behavioral medicine at Wake Forest University School of Medicine and a leading sleep medicine researcher. “When I was a medical intern, you were on call every third night. You would work 36-hour shifts every three days. We got one Sunday off a month, but not every month, and some people were on call every other night.”
“It was kind of a ridiculous badge of honor. We realize now, though, that this is not good for the health of our trainees or our patients.”
As part of the school’s Research Plan for Excellence, Benca is leading the development of a new translational research center focused on sleep and circadian rhythms. The school is recruiting a director and additional faculty for the program, which Benca says would complement the school’s strengths in other research areas such as Alzheimer’s disease, neuroscience, addiction studies and exercise.
Before joining the School of Medicine, Benca taught and studied sleep medicine for years at the University of Wisconsin and the University of California, Irvine, medical schools. She says it is important for physicians and students to learn the value of sleep, for themselves and their patients. For instance, she says studies have shown that sleep-deprived medical residents make more diagnostic and treatment errors with their patients.
“Pretty much every major medical disorder can be impacted by sleep,” she says, noting links between lack of sleep and increased risk of mood disorders and suicidal tendencies among health care providers. “Sleep is also important for learning and cognitive function. It’s a pillar of health, and it’s often under-recognized when we think about things like exercise, diet and avoiding substance use. We don’t pay enough attention to sleep.”
Benca believes the center that is under development could change that by helping to raise awareness.
“Focusing on things like sleep, nutrition, exercise and avoiding substance use are keys to improving the health of the population, rather than chasing disease as it pops up,” she says.
Teaching the Importance of Sleep
While the school does not yet offer a sleep medicine course, the importance of sleep could not be more acknowledged by the school’s educators, students and clinicians. Recognizing the importance of sleep throughout health and health care, sleep medicine training is embedded across the curriculum, according to Roy E. Strowd III, MD ’09, House Staff ’13, MS ’20, MEd, MS, associate professor and vice dean for undergraduate medical education.
Students learn the fundamentals of sleep physiology in their foundational courses and gain exposure to the importance of sleep for patients and providers later in their training.
Maria Sam, MD, professor of neurology who formerly directed the clinical neurology clerkship for 20 years, says first-year Wake Forest MD students have been exposed to sleep medicine through lectures as part of the neuroscience curriculum since the late 1990s.
In the first year, MD students take a nine-week neuroscience course that includes a lecture on sleep and sleep medicine from Jane Boggs, MD, clinical professor of neurology.
In years three and four, students are exposed to sleep medicine in the clinical neurology didactic series as well as experientially in the clinic and laboratory as part of the comprehensive teaching in the required third-year rotation. There are also fourth-year electives in sleep medicine for those who want an immersive month in clinics and laboratory exposure.
The third-year neurology rotation includes the lecture, Introduction to Sleep Medicine, delivered by Sandhya Kumar, MD, House Staff ’00, ’01, associate professor and graduate of the Sleep Medicine Fellowship Program that she now leads as director.
As students prepare for residency, Cedric Lefebvre, MD, House Staff ’06, professor of emergency medicine, leads a discussion on sleep in residency from a well-being and safety perspective during the Transition to Residency course.
A more recent addition are elective rotations available to residents in neurology, family medicine and internal medicine.
Sam describes the school’s fellowship program in sleep medicine, which also dates to the late ’90s, as highly sought after, with more than 100 applicants per interview season competing for roughly 50 interview slots.
“We have a robust sleep medicine faculty with neurology, pulmonary and psychiatry physicians who participate in the education of the fellows,” Sam says. “They are also actively engaged in the practice of clinical sleep medicine and are working hard to support Dr. Benca’s effort to create a research center.”
The faculty team includes Boggs, Kumar and Sam along with Scott Otallah, MD, director of the Child Neurology Program and the Neurology Clerkship, and Michael Cartwright, MD ’02, House Staff ’03, ’06, professor of neurology.
Says Strowd, “These individuals have clearly been committed for decades to ensuring that Wake Forest medical students are prepared to address the impact of sleep on both health care and disease care for their patients and for themselves as physicians.”