Rhythms of Life: Daniel Buysse

Dan: In a way I guess my professional interests in sleep and circadian rhythms are kind of played out in the rhythms of my own life as well…

Mike: From CTSI, this is the Products of Pittsburgh. A show about the people in Pittsburgh – innovators, scientists, community leaders – and the remarkable stories behind how they came to be and the work they’ve produced. I’m Mike Flock. On the show today, we catch up with Dr. Dan Buysse, Professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh.

Mike: Life. Is it linear or is it cyclical, circadian, and rhythmic? It may depend on who is answering and in what context. Circadian rhythms can be found in animals, plants, and even microbes. They are physical, mental, and behavioral changes that follow a cycle. Many people might associate these rhythms just with sleep, but they actually influence a whole range of bodily functions throughout each day and night. Dan Buysse has spent nearly forty years studying these rhythms and has become one of the most impactful thought leaders in sleep medicine. He has made significant contributions in advancing circadian science, translating research into practice, and training the next generation. Yet, before becoming a doctor and building a career at the University of Pittsburgh, Dan was a kid like any other. He grew in a blue collar family, one of four kids, in Detroit, Michigan. Going to college, let alone being a doctor, was aspirational. Dan had an opportunity, captured the moment, and didn’t let it slip away.

 
Mike: Where did you grow up? Where are you originally from?

Dan:  I grew up right outside of Detroit, Michigan. I'm at Detroit-er. Eminem had his famous movie 8 Mile. I grew up near 7 Mile road so I'm kind of more Detroit than Eminem, but yeah I grew up in Detroit at a time of decline in the city, actually, and I was there as a child during the during the race riots of 1967 and then the Tigers world championship of 1968, so lots of ups and downs.

Mike: Your parents were they working, what types of jobs or roles did they have?

Dan: I'm actually from a very blue-collar background. My father was blue collar worker in what was called lithography it was printing before the age of computers, so they would print advertisements for newspapers and magazines and things like that, and that business slowly went away and so he got a job, as many people in Detroit do, with one of the big three automakers. He was actually a security guard at Chrysler and then, eventually, from there got to be a corporate driver at Chrysler, so, essentially, driving around the big wig executives in Detroit and my mom was a stay-at-home mom with four kids. I guess, growing up in a blue-collar background, being a doctor was something aspirational for people so that was somehow something that always seemed like a long shot but a dream to have.

Mike: So when you were in high school, did you have any particular jobs or things that you were working on at that time before going on in and going to college?

Dan: Oh yea, so I worked one way or another pretty much all through high school. One of my first jobs was working in a library, actually shelving books and cleaning up in the library, and later went on to some odd jobs, actually toward the end of high school years, a friend of mine and I did some house painting and actually somebody that we were working with got us a job doing industrial painting. So, yeah interesting summer job was painting acid storage tanks in an industrial yard in Detroit. These huge tanks on stilts that were filled with muriatic acid and things so they needed to be painted with Rust-Oleum every once in a while so we were doing that and going in in the morning in a light fog of acid made me realize that that was not something that I would like to do for the rest of my life. 

Mike: How did you decide what you wanted to do when you ended going to college and deciding on a particular major? What was that, how do you decide on that?

Dan: Well, for me, surprisingly, there was very little decision making or agonizing going on. At the time that I went to college people did not apply to 20, 30, or 50 places, and basically I only applied to one place which was the University of Michigan, which was, I knew it was a good school and I didn't see going out of state anywhere as a likely option, financially, so I applied to the University of Michigan and on the application form, at that time applications were actually written out by hand, and there was an application form, and there was a box on the application for something called the Inteflex program which stood for integrated flexible pre-medical program. Basically what this program was is at the time six-year medical education programs were gaining popularity and they would integrate your undergraduate and medical school education. So, I checked off the box went, through the application process, got an interview and was admitted to that program.  So, at the time, essentially that I was accepted to college, I was also accepted to medical school so all of my decisions were taken care of for me. At the end of my first year of college, I had essentially my first field placement externship so the way that they did it at Michigan was that for six weeks at the end of your freshman year you would go somewhere in more rural Michigan and so I went to a doctor, to live with a doctor and his family in Otsego, Michigan, which you probably never heard of, Otsego is an exurb of Kalamazoo, which you may also have never heard of but it’s in Western Michigan, very small community, and I just shadowed the doctor.

Mike: So you were shadowing a doctor but you said you also lived with them?

Dan: So yeah, that was pretty common. So, the Inteflex program that I was talking about had only 50 students per year so they were able to arrange placements for all 50 students with primary care physicians in the state of Michigan, and the most common thing was that because these were pretty rural locations, we would just live there and the most convenient thing was it what wasn’t unusual for me but in many cases people just live with the doctor and his family.

Mike: Are there any memories or unique experiences from your training that you still remember to this day or still sticks with you?

Dan - I think back on my college medical school career, I think one of the most important courses that I ever had was an English class that was called “The Fantastic in Literature” and it was kind of about speculative fiction and science fiction, but the important thing about it was that it was a huge class at the University of Michigan, hundreds and hundreds of people in it, and the grading in the class was based solely on one thing, and the one thing was that every week you had to read the assigned book, you had to write a one-page essay. If you wrote more than one page, they wouldn't read it. And every essay was just graded as plus, minus, or check, and what it taught me, through repeated practices, writing week after week, a one-page essay it taught me that you have to be able to communicate your ideas efficiently and effectively in a short space of time. I think it's kind of ironic in some sense in a standard grant application, the most important part of the entire application is called the specific aims page and in NIH you have exactly one page for the specific aims, it can't be longer than that. So, what I was practicing doing in my English class in college turned out to be the single most important skill that I have today, which is learning how to communicate the goals and methods and importance of a scientific research study in a single page.

Mike: In 1983, Dan came to the University of Pittsburgh for his residency. He considered different disciplines, although was attracted to psychiatry as it fused his interests in the humanities and sciences. At the end of his residency, Dan applied for various postdoctoral fellowships around the country and had a few different opportunities to consider but ultimately decided to stay at the University of Pittsburgh, where he has remained ever since and has become a leader in the science and practice of sleep.

Mike: You’ve sort of become this world-renowned expert in sleep and chronobiology, why that particular specificity in terms of psychiatry? Why sleep?

Dan: Yea, so I think my interest in sleep and circadian rhythms was kind of a serendipitous thing. I was in my final year of residency training. I was kind of interested in mood disorders and was doing kind of a junior attending rotation on one of the mood disorders units and a program that we had at the time was to have visiting faculty come in, people from more the research side, people who would come in and talk to the clinical trainees and clinical faculty about their research and one of the faculty who came in was a guy named David Jarrett and he was a psychiatrist who was doing research on biological rhythms in patients with mood disorders. He was interested in particular at looking at circadian rhythms of different hormones, cortisol and growth hormone, and when he talked to us, the thing that that really struck me was that he was talking about how people exist not only in the physical world and in our mental world, but also in time, and what was just fascinating to me is the thought that everything about our physiology and our psychology changes with time, with time of day, but I never learned anything about that in medical school.

Dan: So it really just opened this door that, again, people live in a physical world, that we also live in a temporal world and that temporal world has very important ramifications on how we think, feel, behave, and function. So, it really just kind of was an “aha” moment to me that I thought was really super interesting and so I wanted to learn more, started talking with Dr. Jarrett and learned about a research fellowship that would be available in the Department of Psychiatry and so I thought that that I would do a fellowship focusing on circadian rhythms and then Dr. Jarrett introduced me to other people in the department who were involved in sleep, and those people included Dr. Reynolds and Dr. Kupfer, the chair of the department at the time, and there again it was just like this this new world was open to me that we spend a third of our lives sleeping and yet I learned virtually nothing about it in medical school, and I had never really considered the implications that it would have for psychiatric disorders and for health more generally. So, it was really just because the topic seemed new and different and exciting and full of possibilities, that's really what attracted me to it. I think the other thing that should be said along the way is that the people that I had available to me as mentors were just outstanding in their jobs, and as mentors, as well. I was super fortunate to be able to work with not only Dr. Jarrett, but Dr. Kupfer, Dr. Reynolds, and another good colleague of mine over the years, Timothy Monk. So, together they were kind of my circadian and sleep mentors and I continued working with them for many years after.

Mike: So from when you first got exposed and realized this is something that you really wanted to pursue to where you're at now, how has the field of sleep and circadian rhythms changed in terms of how much more knowledge about what is happening today relative to when you first kind of dove into it?

Dan:  Wow, well there's been a huge, vast amount of change in the field, so when I first went into it really sleep medicine as a clinical discipline was just in its very early stages. It was the first generation of people who studied sleep as a clinical discipline and the first generation of people who studied sleep and circadian rhythms as a scientific discipline as well. So, during the course of my career and, kind of, more of the clinical side, what I came to see and came to be part of even, was sleep medicine developing as a clinical discipline, so we developed sleep medicine fellowship programs that are recognized by the ACGME. We developed a sleep sub-specialty exam recognized by the American Board of Medical Specialties. We saw the development and formalization of sleep medicine programs and sleep laboratories for diagnosing and treating people with sleep disorders. I saw kind of the development of a whole range of treatments for whole range of sleep disorders. All that on the clinical side.

Dan: At the same time, again the fields of sleep and circadian biology were just starting to take off, so in the course of my career, people mapped out the neural pathways that regulate sleep and wakefulness. People identified a set of genes that controls circadian rhythms, not just in our systemic physiology but literally in every single cell of our bodies. We came to identify mutations in those genes that affect how people sleep and how their circadian rhythms were and there's just been an explosion of knowledge regarding the neurobiology of sleep and circadian rhythm. So, again we understand those rhythms from every level of the entire person down to molecules within cells. So, it's just been a time of tremendous explosion of knowledge. It's just so exciting because every week there's something new and that was, you know, it was really attractive to me because there was this pioneer spirit. Other medical disciplines, even including psychiatry, had been around for decades or centuries and sleep medicine was just beginning. I mean, it was being invented as I watched so that was super exciting.

Mike: You obviously were part of that process because something called the Pittsburgh Sleep Quality Index for example, is being used across the world. Can you elaborate a bit on what that is?

Dan: Yeah, so my colleagues and I, so the people that I had previously mentioned, Drs, Reynolds and Monk, had realized that we needed tools to measure people’s sleep and so they had come up with a list of questions to ask people about their sleep and they had given it to a few hundred people but really didn't kind of have a plan on how we were going to use that. So, one of my first jobs as a postdoctoral fellow was to take the information they had collected in this kind of unstructured questionnaire and try to figure out some way of quantifying the information in it. At the time we knew that you could ask people a lot of things about their sleep. You could ask how long people sleep or what time they go to bed but there was no single metric that we had for measuring whether someone’s sleep was good or poor in a global sense. So the questions that my colleagues had administered to people had kind of the raw materials and so what I was able to do is to take those responses and kind of mold them into a format that could be reliably scored and essentially assign each person a score that would tell you something about how good or poor their sleep was on a more or less continuous scale. It was one of the first instruments devised to measure self recorded sleep in people, called the Pittsburgh Sleep Quality Index. I think because we were able to sort of take a phenomenon as complex as sleep and in some ways reduce it to a single score for each person, it turned out that was a very useful thing in both research and clinical practice. So, the Pittsburgh Sleep Quality Index came to be used by many different research and clinical groups across the world and has been used in hundreds or thousands of research studies, as well, and, ultimately, depending on how you count, it's the first or second most widely used self-reported scale for measuring and quantifying sleep quality worldwide. It's been translated into over 50 languages and used in people from adolescence to the oldest adults.

Mike: In 1989, Dan along with his colleagues published “The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research” which has become one of the most widely used study instruments. But that was just the beginning.  Since then he’s also helped developed a Daytime Insomnia Scale, the Insomnia Symptom Questionnaire, Pittsburgh Insomnia Rating Scale, and the Consensus Sleep Diary. All of these tools are publicly available for use with the appropriate permissions and has been key tools for researchers across the world. In 2017, the University of Pittsburgh Center for Sleep and Circadian Science was formally established with Dan serving as the chair of the steering committee overseeing their activities that include research, education, and clinical care. Their website, sleep.pitt.edu, showcases the range of projects and people all making an impact on health through sleep and circadian science.  

Mike: How do you think the pandemic and individuals who are working remotely is impacting sleep our cycles? I imagine a lot of people are asking those questions about trying to do some sort of research.

Dan: Yeah, there are starting to be some studies that have shown how sleep is affected by the by the pandemic and I think there's a lot of variability, early on there were some people whose sleep was actually improved because they didn't have to be up for work or school at a particular time and so they could sleep longer and some people have reported feeling better as result of that. People have commented to me and then question like what why is it that you like I feel like I'm dreaming more and what's interesting is that when you sleep longer one of the things that happens is that you tend to have more rapid eye movement sleep (REM) or dream sleep, it's just a consequence of sleeping longer because REM sleep tends to occur near the morning hours when we naturally wake up more, we tend to remember more of our dreams. So in that sense you know the pandemic has had some blessings. For high school students as well who always get shortchanged on sleep in the morning having to wake up far too early to catch buses, once the buses stop, kids can sleep in more and that was probably a good thing. Now the other side of pandemic though is that there is a lot of anxiety, a tremendous amount of anxiety and worries of an economic nature and worries of political nature and interpersonal stress, all of those things have really caused an increase in anxiety and that for other people has taken a negative toll on their sleep, as well. I think when people get out of their regular routines as well the possibility of getting more sleep can actually go too far that is if we spent too long in bed what happens is that our sleep tends to get more fragmented and more interrupted. So in a  sense the lack of schedules can be, for some people, a bad thing. I usually I recommend to people that they try to stay on a schedule and most importantly at they have a pretty regular wake up time and not spend too much time in bed, not spend too little, but try to get it just right.

Mike: The pandemic has altered the routines of many people. The timing of waking up, going to work, eating, and participating in social and leisure activities have all been disrupted. Although everyone may not be effected the same way, everyone needs quality sleep for optimal mental and physical health. Stressful life events can impair sleep and circadian rhythms, during a time when sleep is particularly important. Establishing a consistent sleep schedule and bed time routine can help facilitate a sense of normalcy during abnormal times. Research shows that a person’s quality of sleep can also be improved with exercise and spending some time outside in the natural light….  

Mike: What are any hobbies or interests you have outside of sleep research and chronobiology?

Dan:  I have been a long time runner. I like to hasten to add that I am far more persistent than good as a runner. I've never been particularly good but I have been persistent, and my goal has been to run for 50 years, rather than a specific distance, it’s time, so given that I started when I was 20, I have a ways yet to go but I'm past the 80% mark so I'm trying to beat that long-term goal of 50 years of running and, actually, for me, running is a good thing for health but it's also a great thing, I think, for your mind and creativity so I tell my trainees that a lot of times the best thing that I can do for a presentation or paper or a grant that I'm working on, the best thing I can do is go for a walk or run because that's when the ideas come to me, not when I'm usually sitting in front of the computer trying to bang it out. You need some time and space for your brain to breathe and running is one way to to do that. That's been a long time interest. I’m also interested in reading different things. I tend to like fiction more than non-fiction but I read some of both. I like listening to music. I'm not, I don't consider myself a musician but I like listening to all different sorts of music and sometimes pull together playlists for my friends and colleagues of different strange music selections that I found in different places.

Mike: If you could select one word to describe yourself what would that one word be?

Dan: Oh man, that's really hard. I think maybe persistent. I know that I'm not the most brilliant person that I know and I don't have as many skills and talents as lot of other people but I persist and that I think has stood me well. I’m actually toying with kind of a second thing so I honestly I think something that happens as you get more advanced in your career is that you gain an ability to see bigger pictures, right? So, when I'm working with my trainees they give me something to read. A common comment that I have for them is “more forest, fewer trees.” So I think seeing the big picture and seeing the connections between things is something that as I've advanced in my career I have been able to do and I think that that has helped not only me but it's helped some of my colleagues as well to kind of see how things are connected in ways that might not be immediately apparent initially.

Mike: Now the family that you’ve created, I think someone might have mentioned that you are, correct me if I’m wrong, but you’re a grandfather?

Dan: Ha, I am!

Mike: So what’s it like being now a grandfather?  

Dan: Um, well everything that you've ever heard about being a grandparent is probably true: it's like having the good parts of parenthood without the direct responsibility. It's just amazing to see, I guess it sounds kind of trite, seeing the circle of life. For me actually kind of feeds back into again into my career interest too. I'm interested in how things cycle and repeat and also change over time. So this may seem a bit of a stretch but in thinking about sleep there are two kinds of processes that regulate sleep: one is kind of a linear process that is the longer you’re awake the sleepier you feel, right, so there's just a linear measure of time that affects our sleep and the other thing is more of a rhythmic process. So the circadian process that every 24 hours we kind of come back to sleep into wakefulness and so in a sense you know when you look at your life there's kind of a similar motif that goes through that, there's kind of a linear process that, you know, things change over time and kind of don't go back the way they were, that’s kind of like the linear process of aging but there are also cycles that repeat. So you know you're a child, you grow up, you have children, they grow up, they have children, and so in a way I guess my professional interests in sleep and circadian rhythms are kind of played out in the rhythms of my own life as well and so being able to see life from the perspective of a child and as an adult, as a parent, now a grandparent, in some ways kind of brings it all together for me in my personal life and my professional life.

Mike: Dan Buysse, MD, Professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh, and UPMC Endowed Chair in Sleep Medicine. And by the way, Dan has published well over 300 peer-reviewed articles, over 100 book chapters and reviews, and has mentored countless numbers of students and postdocs, paving the way for the next generation and continuing the cycle.  

That’s our show. Thank you for listening to the Products of Pittsburgh. Be sure to check out our website at http://www.ctsi.pitt.edu/podcast to hear more episodes as well as learn more about CTSI programs and services. I’m Mike Flock along with Zach Ferguson, until next time on the Products of Pittsburgh.