Restless Legs Syndrome Foundation Blog

Board Spotlight: Dr. Christopher Earley

By Adrianna Colucci, RLS Foundation Administrative Assistant

Christopher J. Earley, MB, BCh, PhD, FRCPI, is both a professor of neurology at the renowned Johns Hopkins School of Medicine and the director of the Johns Hopkins Center for Restless Legs Syndrome, a certified RLS Quality Care Center in Baltimore. Among various other achievements, he is also chair of the RLS Foundation’s Scientific and Medical Advisory Board (SMAB). Dr. Earley’s devotion to neurology and sleep medicine for over 30 years has made him widely acclaimed, particularly for his research and expertise in managing RLS. His commitment was recognized in 2017 when he received the RLS Foundation’s prestigious Ekbom Award.

Q. When did you initially discover the RLS Foundation, and how did you become involved?

A. I believe the year was 1992. Dr. Art Walters, my colleague Dr. Richard Allen and I met with Pickett Guthrie in Washington, DC. This was right around the time Mrs. Guthrie formed the idea of establishing an RLS Foundation. By the time it was fully formed, I was an active member of the Scientific and Medical Advisory Board. I eventually became chair of the Scientific and Medical Advisory Board, and am currently in my fourth year and second term as chair.

Q. As chair of the Scientific and Medical Advisory Board, can you describe some of your responsibilities?

A. As chair, I primarily maintain an advisory role, assisting those who maintain the daily functions of the Foundation. I am responsible for the final review of any newly revised medical publications, alongside other members of the SMAB, as well as for suggesting new topics of clinical importance. More generally, I have oversight of ongoing initiatives within the SMAB, including communication with the RLS Foundation Brain Bank, reviewing grants and advising the Board on public health issues. I am actively involved in contributing to the educational components of the Foundation such as the monthly webinar series, the Virtual Summit, the National Patient Symposium and the Public Policy Initiative.

Q. Throughout your educational and professional achievements, what inspired your special interest in RLS research?

A. “Serendipitous” comes to mind. When I began working at Johns Hopkins, I was initially set to design and run the acute stroke program, which I did for numerous years. Part of my responsibilities included working in the sleep clinic where sleep research was in its earlier stages. About three years prior, carbidopa/levodopa had begun to be prescribed for RLS, so we were seeing many RLS patients with signs of augmentation. Some of the very first RLS patients I treated were augmented, so I became heavily involved with research relating to dopamine agonists and this side effect. We started to develop a reputation for treating RLS, and after about 10 years I became involved full-time with the sleep clinic. I am now the director of the certified RLS Quality Care Center at Johns Hopkins.

Q. What accomplishments or successes are you most proud of from your involvement with the SMAB?

A. One of the important accomplishments I’ve witnessed throughout my involvement is helping to establish an identity and a direction for the RLS Foundation. When Karla Dzienkowski became the executive director, she asked me to become chair of the SMAB. This was an opportunity to work with someone who was passionate about developing clear objectives and upholding the values of the Foundation. I am proud to have played a small role in successfully building and strengthening the organization, which is truly the only hope for some RLS patients.

Q. What are some of the established goals the SMAB has in the foreseeable future?

A. We would like to increase the availability of grants for those who are doing research in areas pertinent to what we believe contributes to the pathophysiology of RLS. I consider this one of my primary roles moving forward. The second goal we have set is to advance our educational outreach to a larger audience. It is imperative to reach not just the neurologists and sleep specialists, but also the primary care physicians to educate them on the clinical and scientific aspects of RLS. While we have made great strides, there is still more work to be done.

Q. Beyond RLS, you are also published in endocrinology and internal medicine. Do you find that your research intersects and if so, in what way?

A. My PhD was involved with the endocrine system, looking at behaviors and brain chemistry. My first eight to 10 years at Johns Hopkins included stroke research; however, my broadest interest was focused on sleep medicine – trying to get a more in-depth understanding of sleep-wake biology and clinical indications. There is great depth to sleep research and understanding the true biological nature of sleep, such as why we sleep and the value of sleep. The framework of RLS research exists within the framework of sleep biology. I am extremely proud of the progress made by many of our researchers on the RLS Foundation SMAB to unlock the mysteries of RLS and find better treatments.

Good Sleep Hygiene: More Than Just a Bedtime Routine

Sleep hygiene is always a sensitive subject when you have an underlying sleep condition that stops your sleep in its tracks. Sleep hygiene is not simply about crafting and sticking to a bedtime routine; sleep hygiene encompasses your daytime habits, in addition to your evening and nighttime habits. In this article, you will learn the science of how sleep works, the effects of poor sleep on overall health, how your internal circadian clock works and some helpful tips on how to achieve better sleep. This will give you some insight into the importance of maintaining and implementing a healthy sleep-wake schedule.

Studies have shown the tremendous complexity that is “sleep” and how it affects virtually all body systems. Lack of sleep in adults has been correlated to a broad range of negative health consequences that include cardiovascular problems, compromised immune function, insulin resistance, higher risk of obesity, cognitive dysfunction and mental health problems. Sleep is an essential biological function, and it is a time for your brain to restore and heal after a long day.

SLEEP ARCHITECTURE

When you first drift off to sleep, there are almost immediate changes in both the brain and the body. Your body temperature drops, brain activity goes down, your heart starts beating slower and your respiration slows.

There are four different sleep stages that you experience each night. The first three are categorized as non-rapid eye movement (non-REM) sleep, and the final stage is REM sleep. Stage one occurs just as we fall asleep. It is very light sleep and when woken up during this stage, most people will not be sure that they were actually asleep. Stage one sleep is what allows people with sleep apnea to take a breath again. When someone stays in stage one sleep, which is non-restorative sleep, they are often very sleepy in the daytime. This does not happen to people who have lots of stage two sleep.

When you transition into stage three, you experience some of your deepest sleep as your muscles relax and your brain activity slows. Researchers believe the recuperation of the body and brain happens at this time. Stage three sleep varies dramatically with age. Children may spend 30% of their sleep in stage three, while seniors may have little or no stage three sleep.

REM sleep is the fourth stage of sleep, lasting about 10–60 minutes in short episodes that increase in duration towards wake time. In REM sleep, activity in the brain and most of the body pick up significantly. The skeletal muscles experience temporary paralysis. The REM sleep stage is often believed to be critical for the brain, enabling important functions like learning and memory.

Sleep architecture is the structure of a person’s stages of sleep and cycles throughout a night. Each stage is essential to a person’s overall sleep architecture, which affects sleep quality.

THE MASTER CLOCK IN THE BRAIN: BREAKING DOWN CIRCADIAN RHYTHMS

Circadian rhythms are 24-hour cycles that coincide with the body’s internal clock, which executes essential functions and processes throughout the body. The most commonly known and important circadian rhythm is the sleep-wake cycle. The body’s master clock is directly impacted by the surrounding environment. This is why circadian rhythms are tied to the cycle of day and night.

The hypothalamus, a part of the brain, is home to the suprachiasmatic nucleus (SCN), which is highly sensitive to light and acts as a cue for brain signals to coordinate the internal clocks in the body. There are other cues that can affect the master clock, but light is the most powerful stimulus. During the daytime, exposure to light causes the master clock to send signals that generate alertness. As the day winds down, the master clock initiates the natural production in the brain of the hormone melatonin, which promotes sleep.

START SMALL AND WORK YOUR WAY UP

There are many ways to improve your sleep hygiene and cultivate healthier sleep. There is no one-size-fits-all approach. It is important to determine what works for you and implement tactics that fit your lifestyle. The Sleep Foundation has broken down sleep hygiene tips into four categories to make them more approachable.

1. Transform your bedroom environment:
• Choose a mattress and pillow that ensure your comfort and promote relaxation. Find a favorite pillow and comfortable mattress that will ensure a good night’s sleep.
• Get good quality bedding that is comfortable to the touch and will help you maintain a temperature comfortable to you throughout the night. Bedding such as a new mattress or pillow is key to promoting sleep. There are sheets and mattresses that have a cooling or warming effect.
• Reduce light disruption. A cool, dark, quiet environment is conducive to sleep. Blackout curtains can help achieve a darker environment. Earplugs and a sleep mask are other items that can help to limit light and sound in the bedroom.
• Keep noise to a minimum to elevate your sleeping. Try noise-canceling headphones, ear plugs, or machines or phone apps that create ambient noise (white, purple, rain, etc.).
• Decide an ideal room temperature, since being too hot or cold can distract you from a good night’s rest although it is known that people tend to sleep better in cooler environments.
2. Improve your sleep schedule:
• Try to go to sleep and wake up at the same time every day, even on weekends. It is nearly impossible to get accustomed to a sleep routine when you are waking up at different times. Consistency is vital to maintain healthy sleep and the wake time consistency is much more important than bedtime.
• Be wary of naps. If you nap for too long or too late in the day, there is a risk of disruption to your sleep schedule. If you enjoy a nap during the day, no worries! Try to nap after lunch in the early afternoon; it’s proven that a 20-minute nap is ideal. However, for patients with significant bedtime insomnia, napping should be discouraged.
3. Cultivate a bedtime routine:
• Don’t just jump into bed. Winding down for approximately 30 minutes can help you drift off to sleep with ease. Reading, stretching, listening to soothing music or doing relaxation exercises can help put your mind and body in the mood for a great night’s rest.
• Follow a set bedtime routine. Habitual actions are correlated to specific cues that tell your brain that you are almost ready for sleep.
• Turn down the lights. Bright lights can affect the production of melatonin in the body.
• Adjust devices, tablets, cell phones and laptops. These light- emitting devices can keep your brain awake. The more interactive the device, the bigger the impact on falling asleep. Keep the blue light down and change to orange/red light for 3 or more hours before bedtime. Most LCD screens (cell phones, computers) have a setting option to turn the light red and lower in the evening. It is recommended to disconnect at least 30 minutes prior to climbing in bed.
4. Create healthy habits during the day:
• Get daylight exposure. Natural light in the morning and early afternoon supports consistent and high-quality sleep by driving your circadian rhythm and aligning your sleep-wake pattern. For those unable to get outdoors, there is a bright light therapy box to simulate natural light.
• Try to incorporate movement into your daily routine. Activity promotes health across the board and can help make it easier to sleep at night. A short 20-minute walk can transform your day and help you get to sleep at night but don’t exercise too close to bedtime as that can hype your brain up.
• Reduce the amount of caffeine you consume after lunchtime. Caffeine can take up to seven hours to be fully out of your system.
• Plan mealtimes. It is best to avoid heavy meals two to three hours before bedtime to avoid still digesting when getting ready for bed.
• Reduce alcohol consumption in the evening. Alcohol can make it easier to fall asleep but has been shown to disrupt sleep later in the night when you are in the important stages of REM sleep. Also, avoid caffeinated beverages too close to bedtime.
• To cultivate a healthy relationship with sleep, try to limit the activities in bed to sleeping and sex only.

TIPS FOR WHEN YOU CAN’T FALL ASLEEP

Whether you have just crawled into bed or woken up in the middle of the night, here are some tips to help you fall asleep: 1. Don’t toss and turn in bed in the hopes of getting to sleep. This can create a connection in your brain between frustration and your bed. Try walking around for a couple of minutes, reading in low light, or doing something relaxing or very boring before returning to bed when you feel sleepy. 2. Avoid checking the time. Constantly checking the time can increase anxiety about sleeping and in turn make it harder to fall back asleep. 3. Record your sleep. A sleep log or journal can help identify patterns that may be hindering your sleep. If you are implementing new sleep hygiene tactics, track the changes and see how well they are working for you. A sleep diary may help your doctor get a better idea of your day-to-day habits and a clearer picture of your sleep.

To benefit from these sleep tips, it is essential to incorporate them into your daily life. It can be overwhelming to completely restructure your relationship with sleep. Start small and work your way up. Stick with your changes. You may not see the benefits right away, and that’s okay. Maintaining your plan may very well pay off over time.

Life happens, so you may not be able to follow your curated routine every single day. Give yourself some grace and set realistic expectations that are attainable for you!

Sweet dreams.