As part of our “Meet Yale Internal Medicine” series, today’s feature is with Melissa Knauert, MD, PhD, assistant professor of medicine (pulmonary, critical care, and sleep medicine).
Being a circadian rhythm expert and mom of three, Melissa Knauert, MD, PhD, understands the value of sleep.
Her research looks at circadian rhythms, or the natural biological process that regulates the sleep/wake cycle, and sleep deprivation in the intensive care unit (ICU).
Knauert was introduced to the field by her co-mentor, Margaret Pisani, MD, MPH. During her Pulmonary and Critical Care Fellowship, Pisani introduced Knauert to her work in delirium in the ICU. Additionally, Pisani wanted to investigate sleep deprivation in the same unit, which Knauert was also recognizing as an issue in her patients.
“I am basic science trained, but this issue of sleep deprivation fascinated me. It was a phenomenon that I was actually seeing in my patients,” explained Knauert. “I knew that I needed my research to be more translational. So, I started working with Margaret on the project.”
Sleep expert and co-mentor Klar Yaggi, MD, MPH, urged Knauert to pursue a Sleep Medicine Fellowship at Yale School of Medicine (YSM) during which she learned about circadian rhythms.
“Circadian rhythms are phenomenal,” said Knauert. “More than half of our genes are controlled by them. Every single cell in our body has a circadian rhythm. Every organ system functions differently day and night. When you start thinking about how fundamental this biology is, studying it in critically ill patients makes perfect sense.”
During the day in the ICU, the lights are so dim that the body can’t recognize daytime. At night, a patient’s sleep cycle is interrupted by tests, noise, and outside light and patients weren’t getting critical, restful deep sleep.
“It is incredibly important to get exposed to bright daytime light,” Knauert explained. “My current work is looking at patients getting bright light during the day. Circadian investigators have shown that if you have enough bright light during the day, you could actually overcome some indiscretions at night.”
While Knauert is immersed in the world of sleep and circadian biology now, she didn’t grow up knowing she wanted to be a physician, but she did love science. She completed her undergraduate degree in biochemistry and moved to Philadelphia, Pa. to become an AmeriCorps VISTA volunteer serving as an HIV/AIDS educator.
She loved her years with AmeriCorps. Serendipitously during her time in Philadelphia, she spent time with friends in medical school and was fascinated by what they were learning. Knauert decided to attend YSM after her years in Pennsylvania. She loved the open curriculum and flexibility and opted to enter the Yale MD-PhD Program.
“When I speak to medical school applicants, I tell them, ‘YSM gives a huge menu, and you can do you want, but you’d better do it well,’” explained Knauert. She loves that now as YSM faculty, those freedoms continue. She can take a risk and pursue her ‘out of the box’ research interests and isn’t shut down because her project is too unique. Additionally, she likes that her research drives her to collaborate across disciplines at Yale.”
Knauert decided to go into critical care after her first time in the ICU. She acknowledges that her role can be high stress, but she feels comfortable in a room with families talking about end-of-life decision making, crying and praying with them.
“It's an incredible honor to be with families during this time,” Knauert said. “This is a part of ICU care that some love or hate. It can be very bad. It can be overwhelming. But we generally think about critical illness in a very structured way. We go through each organ system, list what's wrong, and then generate a list of possible solutions to fix each problem.”
Knauert’s long term goal is to establish a systematic change in how Yale New Haven Health hospitals operate, making sure to provide patients with a sleep opportunity and to restore normal physiology as much as possible in the ICU. She was lead author on the 2018 paper, “Creating Naptime: An Overnight, Nonpharmacologic Intensive Care Unit Sleep Promotion Protocol,” in the Journal of Patient Experience which noted that sleep interruptions can be minimized in the ICU.
She knows that changes will take time but as a Yale ‘lifer,’ she is committed for the long haul. “It is a lot of culture change, but I am going to continue with my research, make relationships, and build trust. I’ve got to keep going.”
To learn more about the Section of Pulmonary, Critical Care, and Sleep Medicine, visit Pulmonary, Critical Care, and Sleep Medicine.