Welcome to BIDMC Neurology

BIDMC – Neurology Fellowship: Sleep Disorders

Sleep Disorders Center at BIDMC

Clinical

The Sleep Disorders Clinic is accredited by the American Academy of Sleep Medicine and is staffed by faculty from Neurology (Drs. Tom Scammell, co-director, Jean Matheson, Ina Djonlagic, Monica Makhija, and Paul Rosenberg) and ten specialists in Pulmonary Medicine. The BIDMC Sleep Clinic is the largest and busiest of its kind in New England, and it provides evaluation and care to patients with a variety of sleep disorders. The clinics based in Neurology predominantly focus on problems such as narcolepsy and other central nervous system hypersomnias; parasomnias such as REM sleep behavior disorder and sleep walking; movement disorders such as periodic limb movements during sleep; seizures during sleep; and sleep disorders secondary to neurological disorders such as Parkinson’s disease and traumatic brain injury.

Education

Residents may choose to take an elective in Sleep Medicine with exposure to the spectrum of sleep disorders and opportunities to work with adult and pediatric sleep medicine specialists.

The program also offers an ACGME-accredited Sleep Disorders fellowship in which fellows have opportunities to learn from adult and pediatric sleep medicine experts from across the Harvard hospitals. 
The training program typically support 3 fellows each year, with an individualized curriculum in adult and pediatric sleep medicine. Fellows wishing to pursue research are eligible for 2 years of research support through a NIH-funded training grant.  More information about the fellowship can be found here. https://sleep.med.harvard.edu/training/clinical-sleep/BIDMC

Research

The BIDMC Neurology Department contains one of the largest basic science sleep research groups in the world. Drs. Saper, Scammell, Fuller, Arrigoni, Lu, and many others study how the brain normally regulates wakefulness and sleep, and how dysfunction in these circuits contributes to sleep disorders such as narcolepsy, coma, and obstructive sleep apnea. Research techniques include optogenetics, chemogenetics, conditional pathway tracing, and rodent sleep recordings.

Several faculty in the department pursue clinical sleep research. Dr. Mullington and Dr. Haack study the how sleep and circadian rhythms affect hypertension, autonomic tone, and immune function. Dr. Djonlagic examines how sleep promotes learning and how poor sleep may contribute to Alzheimer’s disease, and Dr Makhija studies the interactions of sleep and epilepsy.

Hypnograms (sleep recordings) of a healthy individual and a typical person with narcolepsy. The healthy individual has relatively consolidated sleep between midnight and 8 AM, but the person with narcolepsy has fragmented sleep, a rapid entry into REM sleep (magenta bars), and numerous naps during the day that include REM sleep.
Noradrenergic neurons of the human locus coeruleus (brown staining for tyrosine hydroxylase) are densely innervated by axons and synaptic terminals (black) from hypothalamic neurons producing the orexin neuropeptides.
Several systems in the brainstem and diencephalon promote wakefulness. These include cholinergic neurons in the basal forebrain (BF) and laterodorsal and pedunculopontine nuclei (LDT/PPT). Other key aspects of arousal are driven by monoaminergic neurons in the locus coeruleus (LC; norepinephrine), raphe nuclei (5-HT, serotonin), ventral periaqueductal grey/ventral tegmental area (vPAG/VTA; dopamine), and tubermomammillary nucleus (TMN; histamine).
Sleep consolidates and strengthens memories, but this process can be impaired in sleep disorders such as obstructive sleep apnea. On a motor skill learning task, patients with fragmented sleep from sleep apnea show less improvement with a night of sleep compared to controls. Djonlagic I, Saboisky J, Carusona A, Stickgold R, Malhotra A. Increased sleep fragmentation leads to impaired off-line consolidation of motor memories in humans. PLoS One. 2012;7(3):e34106.
Distribution of the orexin-producing neurons in the lateral hypothalamus and perifornical region in a normal human brain. These neurons are lost in patients with the classic form of narcolepsy.