Goal 2: Risk Reduction and Treatment of Sleep and Circadian Disorders
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Goal 2: Improve the Treatment of Sleep and Circadian Disorders and Reduce the Risks Associated with Sleep Deficiency and Circadian Misalignment

The negative impact of sleep and circadian disorders, and sleep deficiency outside of a disorder, has widely been recognized as a growing economic and public health concern. Addressing the problem requires the coordinated and well-planned prioritization of research. This entails developing and implementing tailored approaches, designed and targeted to populations with diverse characteristics. Such efforts could complement primary and secondary prevention approaches at the individual level.

This research would:

  • Bring effective treatments and cures to patients with sleep and circadian rhythm disorders.
  • Identify strategies that lead to long term adherence to these interventions/treatments.
  • Advance understanding of sociocultural and physical/built environmental factors that may impact these interventions.

High-Priority Research Areas

Role of Sleep and Circadian Disorders in Disease

  • Examine the effects of sleep-disordered breathing treatment on cardiometabolic outcomes and the mediator/moderator role of the gut microbiome in effecting such cardiometabolic outcomes.
  • Elucidate the relationship between circadian biology, sleep health, and the timing of food intake on cardiometabolic health and obesity.
  • Improve understanding of the influence of sleep and circadian rhythms on pain, addiction, and recovery from addiction across the lifespan.
  • Understand the effect of sleep and circadian disruption on critically ill patients.
  • Understand the impact of sleep and circadian rhythms and their disorders on traumatic brain injury through observational and intervention-based research studies.

Undecided young Caucasian woman checking fridge for some food at night

Effectiveness Research for Treatment of Sleep Disorders

  • Identify optimal and personalized interventions for individuals with obstructive sleep apnea through comparative effectiveness trials of available therapies (e.g., positive airway therapy versus dental devices or implantable hypoglossal stimulators).
  • Determine whether interventions for SDB can decrease morbidity and mortality.
  • Determine what level of intervention for SDB yields optimal outcomes and promotes adherence.
  • Develop and test interventions to improve sleep and circadian rhythms in critically ill patients and assess short- and long-term outcomes to distinguish causal influence from associations and epiphenomena.
  • Identify the effect of simultaneously or sequentially treating sleep and circadian rhythm disorders in patients with comorbid medical, behavioral, and psychiatric conditions, and explore the effect of such treatment approaches on patient- and system-level outcomes.
  • Conduct long-term comparative effectiveness research on medications versus cognitive behavioral therapy to treat insomnia.
  • Conduct comparative effectiveness research on complementary and alternative approaches for insomnia versus cognitive behavioral therapy, including various modalities of delivery, such as telemedicine, digital and mobile health. 

Modifiers of Treatment Effectiveness

  • Understand mechanisms that underlie resilience and/or susceptibility to risks associated with circadian sleep disorders and sleep deficiency.
  • Understand the impact of medications that treat mental illnesses on sleep regulation and the impact of insomnia treatments on mental illness symptoms, including suicidal ideation and behavior.

asian elderly man in the dark, in bed, with signs of insomnia

Improvements in Assessment

  • Understand the cardiorespiratory interactions of therapeutic approaches for sleep-disordered breathing in patients with underlying cardiac, respiratory, or blood disorders.
  • Develop screening and treatment approaches for sleep-disordered breathing (SDB) in the perioperative setting to improve patient outcomes and reduce healthcare costs.
  • Identify the pathobiology of SDB during pregnancy and the effect of treating SDB during pregnancy on maternal and infant morbidity and mortality.
  • Examine the effect of sex/gender on treatment and diagnostic pathways for sleep disorders and related outcomes.

 

Tired schoolboy sleeping on book in classroom

Novel Therapeutic Approaches

  • Develop and test multimodal medication and behavioral approaches targeting patients and providers to improve sleep and circadian rhythms.
  • Develop and test innovative approaches to improve healthcare coordination in patients with SDB.
  • Investigate the mechanisms by which complementary and integrative health approaches (such as botanicals, probiotics/microbials, acupuncture and other manual therapies, yoga, meditation) impact sleep and/or circadian biology and outcomes.
  • Improve adoption by providers of nonmedication approaches (e.g., light therapy) to improve circadian rhythms in patients with comorbidities and study the effects on measurable clinical outcomes.
  • Develop novel approaches (e.g., behavioral interventions) that are not limited by poor adherence to improve treatment for individuals with sleep and circadian disorders.
  • Study sleep interventions and treatment of sleep disorders as an approach to improve pain control and reduce reliance on pain medications.
  • Develop and test novel therapies for sleep and circadian rhythm disorders that meet the definition for orphan medical conditions (e.g., narcolepsy, non-24-hour sleep-wake disorder [non-sighted and sighted], fatal familial insomnia).

NIH Sleep Research Plan Strategic Goals