The 37th annual SLEEP meeting was held in Indianapolis this June. The SLEEP conference is a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society (SRS), and is arguably the premier global gathering of sleep medicine professionals. About 4,000 clinicians and sleep researchers from around the globe attend the SLEEP conference every year to discuss best practices for sleep measurement and advancements to the field. I have been attending the SLEEP conference since 2017. This year, I was on the career fair committee and served as a key opinion leader. I presented two posters and hosted a discussion section, jogged in the conference-hosted fun run, promoted the conference on social media, and taught a seminar. Despite the massive amount of engagement that I did at this year’s conference, I still feel like an outsider whenever I attend SLEEP. The conference is traditionally focused on sleep as a neurophysiological phenomenon or suite of medical disorders rather than a day-to-day behavior that can be influenced by work and social schedules. The sessions are peppered with acronyms like OSA (obstructive sleep apnea), SCN (suprachiasmatic nucleus, brain’s master clock), and CBTi (cognitive behavioral therapy for insomnia), but nobody mentions my favorite acronym: FRMS!
(Dr. Jaime K. Devine, Dr. Siobhan Banks and Dr. Nita Shattuck, at the 37th Sleep meeting)
Every fatigue risk management system (FRMS) conference or document talks about the importance of sleep science. Sleep and circadian rhythmicity are integral to understanding fatigue. Laboratory-developed tests of cognitive function during sleep deprivation, like the Psychomotor Vigilance Task (PVT), the Go/No-go test, cognitive throughput, or performance in a simulator form the foundation of our understanding of the impact of fatigue on human performance. Mitigating risk related to fatigue requires at least a basic understanding of how humans fatigue as a function of time spent awake and time of day. Regulators depend on the science to provide an objective understanding about the limitations of the human body that can be used to guide rules about the working environment.
There is a rich history of fatigue-relevant scientific research[3-10] and an established global community of fatigue risk researchers[11,12], but the operational fatigue research community is perhaps 10 times smaller than the North American sleep medicine community alone (~400 vs. 4,000 members). The European Sleep Research Society (ESRS), by comparison, has approximately 2,000 members. Fatigue is a niche research topic within these larger scientific and medical communities. Here’s an anecdote. A few years ago, the IBR science team launched a survey targeted to “sleep scientists or industry professionals who conduct research related to human sleep physiology or behavior in real-world environments”[14,15]. Based on our recruitment analytics, over 14,000 individuals were exposed to the study recruitment materials through sleep science networks, presentations, and direct outreach, but only 46 researchers filled out the survey. What likely happened is that the vast majority of real-world sleep experts just blew off the survey, but we cannot rule out the slim possibility that only 46 people globally feel confident in their ability to conduct sleep research outside the lab.
The sleep medicine community does seem to be warming up to the concept of collecting sleep data in the real-world environment. At this years’ SLEEP conference, there were multiple sessions on operational research or field collection of data, including a session entitled “Are Lab-Based Human Research Studies Going Extinct?”. Society is entering an era where the technology to track sleep behavior and even neurophysiology outside the lab is approaching scientific rigor[17-19], meaning that researchers may be able to conduct sleep studies in a messy environment without sacrificing their high standards for validity. Sleep is gaining prominence in the medical community as well. Twenty years ago, the majority of primary care physicians admitted having only a poor knowledge about sleep, but today’s physicians likely take sleep education more seriously since the American Heart Association added sleep to Life's Essential 8 measures of cardiovascular heath last year.
The medical community is beginning to embrace the role of sleep in overall health and technology is adapting to accurately capture sleep metrics outside the laboratory. At the same time, remote patient monitoring and telemedicine have gained significant footholds in the healthcare space since the pandemic. These new technologies mean that clinicians and academics can begin testing preventative or real-time intervention paradigms to improve sleep outcomes simultaneously as they collect the data. There is also a greater push from the science field in general to communicate results effectively with the public and engage with politicians to enact laws that are scientifically informed. Engagement with regulators and laypeople are intrinsic to FRMS. Medical and academic scientists could learn a lot about effective rule-making by studying the history of FRMS in aviation and rail[5,22,23]. In short, as sleep medicine’s focus shifts from observational to translational, the broader academic community may benefit from the lessons learned by operational fatigue experts. Now may be the time for the term “fatigue risk management” to work its way into the academic vernacular.