NeurologyLive® Clinician of the Month Spotlight: Nancy Foldvary-Schaefer, DO, MS

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As part of our monthly clinician spotlight, NeurologyLive® highlighted sleep medicine and epilepsy expert Nancy Foldvary-Schaefer, DO, MS, director of the Sleep Disorders Center and staff in the Epilepsy Center at Cleveland Clinic.

Nancy Foldvary-Schaefer, DO, MS, director of the Sleep Disorders Center and staff in the Epilepsy Center at Cleveland Clinic

Nancy Foldvary-Schaefer, DO, MS

Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.

In medicine, clinicians have recognized that sleep and epilepsy are closely related as certain stages of sleep provide a hypersynchronous state, allowing more frequent epileptiform abnormalities and more frequent seizures. According to a published review, there are certain epilepsies associated with sleep, especially in pediatric patients, with epilepsies in adults activated by both sleep and sleep deprivation.1 Additionally, comorbid sleep disorders are common occurrences in patients with epilepsy and can impact the management of seizures.2 Overall, research shows that these conditions are intertwined with one another, suggesting that clinicians should consider both in the clinical practice in terms of the care process for the patient.

In a recent conversation with NeurologyLive, Nancy Foldvary-Schaefer, DO, MS, director of the Sleep Disorders Center and staff in the Epilepsy Center at Cleveland Clinic, discussed how personal experiences, such as her mother's stroke, influenced her decision to pursue medicine in neurology. She talked about what inspired the development of a sleep app, and how it benefits both neurologists and patients. In a rapidly evolving healthcare landscape, Foldvary-Schaefer also spoke about the challenges she faces in providing comprehensive care for patients with central nervous system disorders (CNS) of hypersomnolence.

Clinical Facts on Sleep Health

  • More than 50 million patients in the United States have chronic sleep disorders.1
  • An estimated 35% of patients in the United States reported their sleep quality as “poor” or “only fair.”2
  • About 1/3 of adults reported insomnia symptoms and between 6%-10% of the criteria for insomnia disorder.3
REFERENCES
1. Centers for Disease Control and Prevention. Insufficient Sleep is a Public Health Problem. Accessed February 23, 2024.
2. National Sleep Foundation. Sleep Health Index. 2014.
3. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013.

NeurologyLive: What are some of the main responsibilities you have in your role as a neurologist at your clinic? 

I am a neurologist with board certification in clinical neurophysiology, sleep, and epilepsy. My primary role is to advance the care of adult patients with sleep disorders and epilepsy. I attend the adult epilepsy monitoring unit one month per year and read sleep studies, often combined with full EEGs, one day per week. I have a clinic in both the Epilepsy and Sleep Disorders Centers. I also serve as director of the Sleep Disorders Center, one of the largest multidisciplinary programs in the country with nearly 35 providers and seven sleep labs. I also led the development of SLEEP by Cleveland Clinic, an app that neurologists can have their patients use to help screen for common sleep disorders that affect brain health.

Could you describe a typical day in your work as a neurologist at your clinic

It depends on the day! My clinic days are full of patients with seizures or sleep problems who are eager for a diagnosis or a second opinion. On these days, it is challenging to keep up with administrative tasks, though I tend to ensure sleep center functions move along even when I am busy with patient care. Despite the pace, I enjoy practicing 2 disciplines. Very few epilepsy experts also practice sleep medicine. I see many patients who have both problems at once and are grateful when I find solutions for both.

What motivated you to pursue a career in neurology, and when did you make this decision? 

I think I developed an interest in neurology at the age of 12 when my mother had a stroke. I became a candy striper and remember being in awe walking down the halls of the local hospital. The rest is history. As a neurology resident, I had an outstanding mentor in Dr. Madeleine Grigg Damberger, still a friend and collaborator, who introduced me to both EEG and sleep medicine. She taught me how to score sleep studies and read EEGs, which led me to fellowship training in clinical neurophysiology at Duke, where I honed my skills also under the terrific mentorship of Dr. Rod Radtke.

What do you find most rewarding about your work as a neurologist at your clinic

I love team care at Cleveland Clinic ‒ as a neurologist, I work routinely with behavioral health providers, pharmacists, technologists, advanced practice providers, and nurses to provide world class care. We couldn’t deliver the outcomes we do without our outstanding teams.

What are some of the biggest challenges you face in your role? 

Probably the biggest challenges relate to the evolving landscape of healthcare. Providers often do not have the time to care for increasingly complex patients. I see many patients with CNS disorders of hypersomnolence in my sleep clinic ‒ narcolepsy, idiopathic hypersomnia, and undifferentiated types. Making a correct diagnosis takes more than one clinic visit. Tailoring tests the meet an individual’s needs also takes time. Patients may be left without a diagnosis, which can lead to years, if not decades, of disability.

Is there something that you wish more patients and clinicians at your clinic understood about the field?

Most epilepsy experts have not had formal training in sleep medicine and vice versa. Sleep is critically important to all aspects of brain health. Good sleep and treatment of sleep disorders reduce seizures and EEG abnormalities in people with epilepsy. Similar gains are found in caring for patients with other neurological problems, cardiovascular disease, and metabolic disorders, to name a few. Good sleep is a therapy for virtually all medical and psychiatric disorders, which makes sleep medicine a rewarding discipline.

In addition to your work as a neurologist, what hobbies or interests do you have outside of the clinic? 

I love to read! I enjoy reading before bedtime and on weekends. I love the classics, and leadership and spirituality titles. Currently, I’m reading The Prophet and other works by Kahlil Gibran, a Lebanese American 20th century writer and poet, gifted to me by my current research fellow (and hopefully future sleep neurologist) Christian Mouchati. I also love (and hate) to exercise. I’m developing skills as an archer in the summer months and enjoy virtual reality boxing when it’s too cold to be outside. I have a 21-year-old daughter at Ohio State University who I try to keep up with too!

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Transcript edited for clarity.

REFERENCES
1. Lanigar S, Bandyopadhyay S. Sleep and Epilepsy: A Complex Interplay. Mo Med. 2017;114(6):453-457.
2. Moore JL, Carvalho DZ, St Louis EK, Bazil C. Sleep and Epilepsy: a Focused Review of Pathophysiology, Clinical Syndromes, Co-morbidities, and Therapy [published correction appears in Neurotherapeutics. 2021 Apr 13;:]. Neurotherapeutics. 2021;18(1):170-180. doi:10.1007/s13311-021-01021-w
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