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By: Makena Binker Cosen (CC ‘21)
Let’s start with your background as a researcher. How far back would you like to go? As far as we need to go to understand what fields influences the way you view research today! My background begins with nutrition. I have a PhD in Nutrition from McGill University and my research focuses on sleep as a causal risk factor for obesity and cardiovascular disease. I started my research career mostly interested in diet and life-style behaviors, and how those could influence cardiometabolic risk factors. Then I got pulled into the sleep field when there was an increased awareness of a relationship between sleep duration and obesity. The field was trying to figure out why that would be the case. How could sleep influence energy balance? At that time, where I was, sleep researchers wanted to get someone who had expertise on the measurement of energy balance to be able to help them respond to a call for grant applications by the NIH. I knew nothing about sleep. However, I was very interested in how lifestyle could impact energy balance regulation and was very open to the idea of bringing my expertise to this group and helping them assess energy balance in relation to sleep duration. Then, the grant didn’t get funded. I moved away from that institution, back to Columbia, where I had done my post-doctoral fellowship. I reapplied and kept applying for this grant to really assess whether sleep was a causal factor in the regulation of energy balance and a causal factor in the development of obesity… and the grant got funded! From there on, I became a sleep researcher. It was very fascinating. Also, a lot of the researchers in the field of sleep are psychologists or medical doctors—people without a nutrition background trying to get at how sleep influences aspects of life that are also influenced by food intake and physical activity level. So, I’m very aware of how intertwined those two fields are. A lot of the hormones that regulate sleep also regulate appetite and food intake. Therefore, if you’re trying to isolate the influence of sleep on metabolic risk factors or obesity, for example, we also have to take into account what is going on with the food intake and physical activity level. That’s where my research is different from what others do. Now, I’ve really begun to think about sleep and diet as having a bi-directional relationship and really wanting to figure out what we can do in the diet space and nutritional space to influence sleep and help people sleep better. Maybe doing that will help them achieve better diets and better life-style practices. That’s absolutely fascinating. You have a lot of experience integrating your previous research into new fields and venturing forward with interdisciplinary projects, which is very impressive. I always tell my trainees that you have to keep an open mind; not to go into their careers with a very narrow focus. You never know where research will take you. When these sleep researchers came to my department and asked for someone to help them measure energy balance, we were two investigators in that space and I was very junior. The other investigator was much more senior. At the end of the meeting they told me, “I’m not interested in sleep. If you want it, go for it. It’s all yours.” I didn’t know anything about sleep at that time, but I thought, “it’s just a different way of applying my knowledge” and I think that can be very interesting. That opened up a lot of doors for me and really helped me find my niche, so to speak. It sounds like your flexibility opened a lot of doors, but it also brought your expertise to where it was truly needed: sleep research needed a nutrition perspective and you really brought that through. In relation to your current research, how can we expect the COVID-19 pandemic to influence the way people sleep? There could be many different ways that the pandemic could influence sleep. Sleep timing and meal timing is very dependent on your personality and personal preferences — your chronotype, as we call it. In general, anxiety and depression brought on by this pandemic could really adversely influence sleep. On the one hand, if individuals are worried, it keeps them up at night; they are not able to fall asleep readily. On the other, it might make them more depressed, and depression is associated with longer sleep. What I always say helps with sleep is waking up at a regular time, going to bed at a regular time, and getting sunlight during the day. I can imagine in the city that it might be difficult for some people to really get that dose of sunshine when they wake up in the morning, if they’re living in tight quarters and are not able to get outside. So that’s also something that can impact their circadian rhythms and have a negative influence on their sleep. Working remotely could also have various benefits considering that people aren’t commuting. If they are not spending an hour or two commuting, they can sleep in a little longer and maybe get adequate sleep during the week, just as they may get adequate sleep on the weekends. Now more than ever, the general public is aware of the relationship between sleep and mental health. How do your earlier recommendations, i.e. waking up and going to bed at a regular time and getting sunlight, contribute not only to our mental health but to staying healthy during the pandemic? That is to say, how does sleep influence our risk of having COVID-19? There have been studies that look at your susceptibility to viral infections based on sleep duration. If you’re not sleeping enough, you are sleep restricted and at a higher risk of catching a viral infection or experiencing related symptoms. The issue is that your immune system is suppressed when you don’t get adequate sleep. That’s actually something that we’re trying to look at right now with our research. Over the years, we’ve screened almost 250 people with wrist actigraphy, so we have objective sleep data from all of these people prior to the pandemic. We want to contact these people again and see what proportion were infected by the virus. How many had symptoms? How many were treated? What were their outcomes? Ultimately, the goal is to see if there is a relationship between the sleep we measured prior to the pandemic and the symptoms during the pandemic. How has your progress been in this project so far? Have there been any setbacks? We’ve been applying to the Institutional Review Board (IRB). We’re creating a list of all participants to be able to call them up. I imagine the IRB is very busy right now. Everyone must be trying to push their projects through. The IRB is very responsive, actually. We’ve been able to start a new project, which has been great. We’re conducting a well-being study that we decided to take completely online when the pandemic started. We were right about to get it started bringing participants in for counseling with a PhD student of mine when the pandemic hit. So we were no longer allowed to have in-person visits at the Medical Center and we thought this might be a good opportunity for us to test our ability to do counseling online, to conduct research with telemedicine and to see how that goes. We have to try to make the best out of these situations that are thrown at us. It’s interesting that you bring up telemedicine. It seems like this is going to be a trial period to see how far we can take it, how we can improve it and how we can integrate it to previous research and healthcare models. What’s your perspective on the future, regarding both your own future and the broader impacts of COVID-19 upon the scientific community? I think it’s definitely going to be more challenging for researchers like me who do clinical research. We’re used to very stringent protocols where we’re bringing people into the clinical center to make sure that we’re verifying everything objectively; that all of our measures are taken on site. Now we have to explore different ways of conducting research that are not necessarily bringing people into the Medical Center. We’ve had studies where people come in every single week for us to verify their sleep. Maybe they don’t need to come in every single week. The battery life on the monitors we use to measure sleep lasts up to 3 weeks. Perhaps we can space out our visits to reduce on-site testing. We can combine this with virtual visits to verify questionnaires. Those are things we’re thinking of doing now. I imagine it might be complicated to conduct research without bringing people into the Medical Center. How do you set up and monitor controls to give your results validity? That will be an interesting challenge. So, yes and no. In one way, for us, it removes a little bit of control from the study. At the same time, it may be very helpful for recruitment. How many people can make the trip up to the Medical Center if they’re working, for example, in Brooklyn or Queens? How many people can come to the Medical Center on a weekly basis? Maybe that would allow more people to participate in our research because they don’t have to have these commitments. That’s an excellent point. With what we know right now, what do you expect the timeline of your COVID-related research to be like now that you’re in the application process? I assume we will be able to get it started really soon. We haven’t really had much waiting time between reviews with IRB. Data collection will probably take a couple of months since everything will be virtual visits on the phone or online by questionnaire. From the description on Columbia’s Research website, I understand that it’s going to focus mostly on sleep. Is there anything you’re going to bring in from the nutrition side? We have a questionnaire that asks if you’ve had a change in weight or diet over the pandemic, but nothing in terms of actual food questionnaires. We want to keep it simple. The questionnaires are quite extensive. It’s hard. You have to be selective I imagine with the questions you ask so there aren’t too many. You need to achieve a right balance between critical information and participant burden. Wrapping up, is there anything you think people should know right now, any final thoughts on sleep, nutrition, or both? I think people should try to keep rhythms as stable as possible — a stable bedtime and a stable wake time, achieving adequate sleep duration of at least seven hours per night. If possible, it’s great to get a little bit of sunshine outside. When you’re indoors all the time close to your kitchen, close to your fridge, it’s very easy to just go and grab something to eat in between meals. If you were in an office, you really wouldn’t have access to food as readily; you wouldn’t have the leisure to eat at any time. So, trying to keep those stable patterns of food intake, so as not to be over indulging. Also to keep in mind that we are not really commuting anywhere. I just walk from my bedroom to my home office. I used to ride my bicycle to the office, thirty minutes each way. You have to find new ways of being physically active to compensate for that.
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