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Focus on Stephen Duntley, MD

Stephen Duntley, MD is an associate professor of neurology and director of the Sleep Medicine Center. He specializes in sleep disorders that include sleep apnea, narcolepsy, cataplexy, insomnia and restless leg syndrome.

He sees patients at the Sleep Medicine Center, Chase Park Plaza Building, 212 North Kingshighway, Suite 237, St. Louis, MO, 63108.

FOR AN APPOINTMENT, PLEASE CALL 314 362-4342.

What happened in the course of your schooling to make you choose neurology, and more specifically, sleep disorders as your specialty?

My interest in sleep disorders actually goes all the way back to my undergraduate biology classes at Yale University. I had a professor who was studying the evolution of sleep and I had to come up with a term paper on something -- so I chose sleep as my topic. I was astonished to discover how little we knew about the nature of sleep and the function that it serves. I found it fascinating that something so basic could be understood so poorly. That’s what really initiated my interest in sleep medicine.

When I decided to go on to medical school, I found neurology to be the most interesting field. There was a nice opportunity to pursue the study of sleep from inside the specialty of neurology. It is possible to pursue sleep from multiple different disciplines, but neurology seemed very natural to me because I liked the electrophysiology aspects of it. When I did my neurology residency, I focused on epilepsy and sleep. There is a fair amount of overlap between the two, because there are a lot of nocturnal spells that need to be evaluated during sleep – and sleep can affect epilepsy. But really, sleep remained my main interest, and has been ever since.

The Duntley family at the Magic House


Is the study of sleep a fairly new field?

Yes it is. In my medical school experience, we had almost no training on sleep disorders. We were vaguely aware of sleep apnea and insomnia. But really, most of the developments have occurred since I’ve been out of school. It’s a very dynamic field – the understanding of sleep and our ability to treat disorders of sleep is evolving very rapidly.

What brought you to Washington University?

I was looking for a very strong basic science program and one that had a lot of research opportunities. I was also looking for one that had a strong clinical population which would allow me to become very proficient in taking care of patients. That actually is not as common as you would think. A lot of programs offered very good research opportunities, but the patient population was fairly light – so you might not see some of the important disorders in neurology. Other programs focused very heavily on the clinical training – and you might not get the research opportunities. Washington University was really the best mix of any of the programs I considered.

Which aspect of your practice is most interesting?

That’s a difficult question to answer because there are so many aspects that are interesting – but there are two that are special.

One is that our practice is very multidisciplinary. On any given day, we’ll have physicians that span the entire spectrum of sleep medicine seeing patients in our clinic -- ENT, psychology, psychiatry, pulmonary, neurology and pediatrics. That’s unique – because sleep affects all parts of a person’s medical well-being and we treat all parts of a person’s well-being.

The other is research. We collaborate with different departments within the university on a variety of research projects. We’re looking at preoperative assessment of patients for apnea risk and the interaction between depression and sleep. We’re also studying the genetics of sleep in the drosophila (fruit fly) -- taking those findings and applying them to humans and then back to the fly. There is just a tremendous variety of research interactions that span the entire campus.

It’s a fantastic environment for learning, for teaching and for research.

What are some of the new developments in your field?

Because all animals sleep, it’s believed that sleep provides a basic function – although we really don’t understand what that function is. We didn’t understand it when I entered the field and we still don’t understand it now – which is disappointing.

What is exciting is that we’re beginning to understand the mechanisms of sleep. When I first entered the field, the brainstem was pictured in our textbooks with caption saying “ascending reticular activating system”. That’s what kept us awake. Now we can point to nuclei, and define the roles for those nuclei in keeping us awake. We can define neurotransmitters, in fact we now have a link between a neurotransmitter and a disease entity – that disease is narcolepsy.

We now know that the majority of patients with narcolepsy and cataplexy have lost hypocretin neurotransmission. Hypocretin is an important neurotransmitter that wasn’t even known about until 1998, is now known to be absent or very markedly decreased in narcolepsy. In the near future, this will translate into radically new treatments for narcolepsy.

We’re beginning to understand the basic physiology of sleep disorders -- that’s probably the single most important change in the field right now.

What is narcolepsy?

Narcolepsy is a distinct disorder that’s characterized by excessive daytime sleepiness. It is often severe and characterized by what people would call sleep attacks. However, it’s also accompanied by other signs of dysregulation of sleep. If we weren’t paralyzed while sleeping, we’d act out our dreams. But in narcolepsy, this paralysis occurs when we are awake. It’s usually triggered by emotions. Somebody might make a person with narcolepsy laugh and suddenly they will become weak and may even fall to the ground from the weakness. Somebody with narcolepsy becomes sleepy when they shouldn’t, they wake up at night when they shouldn’t, and paralysis kicks in when it shouldn’t.

How many years have you been in the sleep disorder field?

My first experience with the sleep field was as an undergraduate with a professor, Truett Allison, PhD, at Yale. He was studying sleep in monotremes -- I believe it was the spiny echidna (anteater) in Australia. I worked my way through graduate school as a sleep technologist for both clinical and research projects. After my neurology residency in 1992, I entered a fellowship for sleep medicine and epilepsy. It’s been full time sleep ever since then.

Where are you from?

I was born in St. Mary’s, Idaho -- it’s a beautiful and rather isolated part of the state. We moved to Seattle when I was a child and that’s where I lived until I left after high school to attend Yale. Because I grew up in Seattle, I grew up on Starbuck’s. My patients note that I don’t follow my own advice when it comes to not drinking coffee -- I’m a Starbuck’s addict.

Is there a particular award or achievement that is most gratifying?

My most gratifying achievement has been developing the sleep center here at Washington University. When I ended my fellowship in 1995, there were few people, if any, who were interested in sleep medicine itself. Over the years, we’ve developed a center with all the key elements that provides a comprehensive approach towards the sleep medicine field – both in clinical care and in research. That’s what I’m most pleased about -- I’ve been able to accomplish what I set out to do.

What do you enjoy doing in your free time?

I was a “late starter”, so I have two young children – a boy and a girl. They consume a tremendous amount of our leftover time and energy. Of course, there is nothing else I’d rather spend time and energy doing. For instance, we had three separate parties for my boy’s birthday – we had a party for his daycare, we had a party for the relatives and we had a party for him. Thank goodness, the party’s over for now.

Besides my family, my church is a large part of the focus of my social life. I also love outdoor activities --hiking and camping. My children are now old enough to get outdoors. We’ve purchased a new tent, and we are going to be hitting the woods a lot this summer.

What is the best advice you’ve ever received?

I’ve received tremendous amount of good advice – some of which I unfortunately ignored, and some of which I followed.

As far as general advice that impacted my career, a number of people have told me to do what I enjoy --forget about what’s popular, forget about what’s hot. If you do what enjoy, you are going to be much more productive and much happier
.
I could have gone into more lucrative careers. I could have gone into things where I developed more breakthroughs, but I don’t think I could have done anything where I had more fun and impacted more people’s lives in a favorable way. I’m glad I took that advice.

My family gave me a second piece advice -- have kids. Since I just survived three birthday parties, I would definitely say that was tremendous advice and I’m happy I followed it.

For your particular specialty, is there a lifestyle change that could benefit people?

The pillars of good health are good diet, good exercise and good sleep. It’s clear that people don’t value sleep the way that they should, because sleep is often the one “optional” element that can be cut back on. You should place an emphasis on sleep, just as you would diet and exercise -- and you will feel better.

What would you be doing if you weren’t a doctor?

For me, one of the reasons I went into sleep was because of the broader philosophical questions –“Why do we sleep? Why do we dream?” Dreaming is often seen as a sign of being an intelligent creature. In the movie I Robot, one of the evidences they used for the robot being a sentient creature was that he dreamed.

If I had taken a different career direction, I probably would have gone towards exploring the cosmos, trying to answering some basic questions -- “Who’s out there? What’s out there?” I would have been an astronomer at the Jet Propulsion Lab or perhaps NASA.

But if I had not pursued neuroscience, then I would not have been able to treat patients. I love the patient contact and love the fact that we are able to transform lives. I’m very glad I made the choices I did.

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Copyright 2013 Washington University School of Medicine