James Rowley, MD is the president and a board member of the American Academy of Sleep Medicine (AASM), the largest professional organization in the U.S. dedicated to the advancement of sleep medicine. He is also a critical care pulmonologist, a professor of medicine, and the program director of the Sleep Medicine Fellowship at Rush University Medical Center. He has published many position statements in the field and has contributed to several sleep medicine guidelines for clinical care. Doximity recently asked Dr. Rowley about the AASM’s current initiative to increase awareness of sleep disorders, the future of sleep medicine, and advice for physicians interested in pursuing a career in the field.
Dox: In June 2022, the AASM launched the “Sleep is Good Medicine" campaign to increase public awareness about the importance of sleep. Adding to this, the AASM released an initiative in October 2023 for primary care physicians, “Ask One Question.” What does the AASM hope to gain with these initiatives?
JR: “Sleep is Good Medicine” is a national campaign developed for the public and health care professionals to elevate sleep as the third pillar of health, equivalent to nutrition and exercise. Sleep has a profound impact on both physical and mental health and is closely associated with conditions that patients and health care professionals manage every day, such as heart disease and diabetes.
With the “Ask One Question” campaign, we are asking health care professionals to talk to their patients about sleep. Asking one initial question–How is your sleep?-can begin the conversation and lead to improvements in sleep health, including improving sleep hygiene for better quality sleep or addressing undiagnosed sleep disorders. Our goal is to empower health care professionals to incorporate sleep health discussions into their everyday practice, thereby improving their patients’ lives through better sleep.
Dox: How has sleep medicine (and the AASM) evolved since you began in the field?
JR: The biggest evolution has been in testing for sleep apnea. When I started in sleep, we were still doing paper polysomnography! Now, we recognize that many patients can be diagnosed in their own home. Other major changes: recognition that sleep medicine is its own distinct field of medicine (and with it, board certification recognized by the American Board of Medical Specialties); increased sleep research and research funding (particularly from the AASM Foundation); increased guideline development so that physicians have evidence-based guidance on diagnosing and treating sleep disorders; new medications for narcolepsy; expansion of sleep providers to include APPs.
Dox: What new discoveries or advancements are you most excited about in sleep medicine?
JR: I am excited, though cautious, about how artificial intelligence will affect our field. It will clearly have an impact on the sleep lab with enhanced automated scoring. But I am equally excited that it might change the office practice as well with tools that give us more patient-oriented/precision management. I think we are also moving toward looking at more data from sleep studies to better diagnose and treat patients. In other words, we will go beyond just using the Apnea-Hypopnea Index as a metric. Hypoxic ventilatory burden is one example that could be incorporated into practice. Also, using sleep studies to determine endophenotypes of obstructive sleep apnea, which will allow more patient-centric management options.
Dox: Why did you choose sleep medicine originally? Why would you choose it now?
JR: I chose sleep medicine during my pulmonary/critical care medicine fellowship for a couple of reasons. First, I saw that you could really help patients get a better night of sleep and then feel better during the day with better overall function. Second, the sleep faculty at Johns Hopkins were phenomenal teachers and mentors, who stimulated my interest in sleep, got me interested in the pathophysiology of the upper airway, and introduced me to the wider sleep community.
Dox: What advice would you give to a medical student who is considering sleep medicine as a specialty?
JR: Consider an elective at your school in sleep medicine or, if there is not one offered but there is a sleep lab, ask if you could spend some time with the clinic staff or physician staff. To do sleep medicine as a specialty, one must first do a residency, generally in internal medicine, pediatrics, family medicine, or neurology, so you have to decide which of those fields interests you for the long-term, as many sleep physicians also continue to practice in their original specialty as well.
Dox: On a lighter note, if you had an extra hour in the day, how would you spend it?
JR: I would spend it exploring the Chicago/Lake Michigan lakefront, reading a good history book, or spending more time with family.
Dr. Rowley has no conflicts of interest to report.
Interview conducted by Suzanne Baga, MA, RRT
Image: PCH-Vector / gettyimages