Evaluation Of A Rapid Behavioural Treatment For Sleep Onset Insomnia
Funder
National Health and Medical Research Council
Funding Amount
$268,500.00
Summary
Chronic insomnia is a prevalent health problem that affects 5-10% of the population. It is associated with significant physical and mental health problems as well as lowered quality of life. By far the most common treatment for insomnia continues to be sleeping tablets despite the problems of drug dependence, daytime impairment and long term loss of effect. It is also despite the evidence that behavioural therapies are more effective in the long term. In clinical experiments stimulus control the ....Chronic insomnia is a prevalent health problem that affects 5-10% of the population. It is associated with significant physical and mental health problems as well as lowered quality of life. By far the most common treatment for insomnia continues to be sleeping tablets despite the problems of drug dependence, daytime impairment and long term loss of effect. It is also despite the evidence that behavioural therapies are more effective in the long term. In clinical experiments stimulus control therapy (SCT) is consistently the most effective of the behavioural therapies. However, SCT is difficult to carry out over the 4-6 week period necessary for effective treatment. If the treatment process could be shortened, it may increase the number of successful treatments. We have developed a laboratory procedure which includes the effective elements of SCT. These elements include sleep restriction and the experience of one rapid sleep onset each night. Our procedure involves some sleep deprivation and the experience of many (over 40) rapid sleep onsets over just one day. Therefore, it condenses 40 nights of the re-training benefits of SCT into just one day. A preliminary study has shown this procedure to be as effective as normal SCT. However, with no follow-up therapy to the procedure the initial gains tended to diminish with time. Our proposal is to test and extend the possible benefits of this new treatment procedure. We will compare it with the standard SCT as well as combine it with SCT. We feel that the greatest benefit may be to use the laboratory procedure as a kick start to SCT, which will by-pass the most difficult first 2--3 weeks of SCT. This will greatly reduce the time as well as absolutely improve the outcome. In further studies the laboratory procedure may be transferred to the patient s home, thereby further increasing its effectiveness. We feel the proposal will lead to a significant improvement in the non-drug treatment of insomnia.Read moreRead less
Comparing Light And Cognitive-behavior Therapies For The Treatment Of Sleep Maintenance Insomnia In Older Adults
Funder
National Health and Medical Research Council
Funding Amount
$383,961.00
Summary
Chronic insomnia affects more than 1 million Australians over 55 years of age. The most common treatment is sleeping pills despite their negative side effects. Our proposal is to compare non-drug cognitive-behaviour treatment with a new therapy of evening bright light, the combination of the two expected to be superior to either therapy alone. The project aims to improve the treatment of chronic insomnia in older adults leading to improved quality of life and reduced health care costs.
DEEP LEARNING AND PHYSIOLOGY BASED APPROACH TO DERIVE AND LINK OBSTRUCTIVE SLEEP APNOEA PHENOTYPES AND SYMPTOMATOLOGY
Funder
National Health and Medical Research Council
Funding Amount
$402,978.00
Summary
Obstructive sleep apnoea (OSA) is a highly prevalent nocturnal breathing disorder strongly related to daytime sleepiness, accident risk and reduced quality of life. However, the current severity index, the apnoea-hypopnoea index, poorly predicts daytime sleepiness and vigilance. In this project we elegantly combine physiological insight and artificial intelligence to develop and evaluate novel clinically applicable computational tools for detailed quantification of OSA severity and its symptoms.
Experimental Investigation Of Driving Impairment In Obstructive Sleep Apnea
Funder
National Health and Medical Research Council
Funding Amount
$466,764.00
Summary
Obstructive Sleep Apnea (OSA) affects 2-4% of the adult population. Repetitive throat obstructions at night lead to sleep disturbance and oxygen deprivation which in turn lead to excessive daytime sleepiness and poor concentration. Studies in severely affected OSA patients have demonstrated driving simulator performance impairment and a 2-7 fold increased rate of motor vehicle accidents. Current data suggest that up to 50,000 MVAs may be caused each year in Australia by OSA. While driving impair ....Obstructive Sleep Apnea (OSA) affects 2-4% of the adult population. Repetitive throat obstructions at night lead to sleep disturbance and oxygen deprivation which in turn lead to excessive daytime sleepiness and poor concentration. Studies in severely affected OSA patients have demonstrated driving simulator performance impairment and a 2-7 fold increased rate of motor vehicle accidents. Current data suggest that up to 50,000 MVAs may be caused each year in Australia by OSA. While driving impairment and increased crash risk in severe OSA seems clear it is not known whether patients with mild-moderate disease are also affected. This is an important question since patients with mild-moderate disease make up the great majority of OSA sufferers and therefore potentially pose the greatest concern for overall public safety. This study will determine whether mild-moderate, as well as severe, OSA is associated with driving impairment. The study will also determine how partial sleep deprivation and low dose alcohol impact on driving performance in OSA. These two behaviours are considered part of the norm for modern societies, yet we recently showed that they act synergistically to markedly impair driving in healthy subjects. We suspect that years of prior sleep disturbance and oxygen deprivation will render OSA sufferers more vulnerable to the effects of these additional central nervous system insults. Finally, we will determine how well driving impairment in severe OSA responds to nose mask CPAP treatment. We will find out what minimum level of treatment adherence is needed to produce significant improvement and whether driving impairment is ever truly reversed. The information obtained in this study will inform and significantly improve patient care,fitness to drive guidelines and driver safety campaigns.Read moreRead less
Collapsibility Of The Human Upper Airway: Relationships Between Sleep, Sedation, Anaesthesia And Head Posture.
Funder
National Health and Medical Research Council
Funding Amount
$469,359.00
Summary
The proposed studies will examine the sites and mechanisms of narrowing and collapse of the upper airway (throat) in individuals with obstructive sleep apnoea (OSA) during different levels of general anaesthesia, stages of sleep and head postures. The studies will help us understand the reasons for upper airway collapse in individuals with OSA and may result in the development of methods of identifying the most appropriate patients for specific surgical treatments of OSA.
Factors Determining Collapsibility Of The Human Upper Airway During Sleep And General Anaesthesia
Funder
National Health and Medical Research Council
Funding Amount
$259,625.00
Summary
Obstructive sleep apnoea (OSA) is common, affecting between 2-4% of middle-aged adults. It is characterised by repetitive partial or complete collapse of the upper airway during sleep. Each episode is accompanied by transient hypoxemia, hypertension and arousal. The repetitive arousals disrupt sleep resulting in excessive daytime tiredness and lethargy, which have major consequences for social well-being and productivity in our community. OSA is an independent risk factor for vascular disease. C ....Obstructive sleep apnoea (OSA) is common, affecting between 2-4% of middle-aged adults. It is characterised by repetitive partial or complete collapse of the upper airway during sleep. Each episode is accompanied by transient hypoxemia, hypertension and arousal. The repetitive arousals disrupt sleep resulting in excessive daytime tiredness and lethargy, which have major consequences for social well-being and productivity in our community. OSA is an independent risk factor for vascular disease. Central to understanding OSA is knowledge of the mechanisms responsible for vulnerability to upper airway collapse. It remains unclear to what extent this vulnerability relates to abnormalities in the underlying structure and passive physical characteristics of the upper airway, versus abnormalities in activity of upper airway muscles. Making this distinction has been problematic because current methods of testing upper airway collapsibility in sleeping humans tend to result in changes in muscle activity and-or sleep state, affecting the measurements. It is, however, possible to suppress upper airway muscle activity and eliminate measurement-related changes in muscle activity and state with general anaesthesia, while maintaining normal spontaneous breathing. We have developed and refined this method and propose to use it in novel investigations to (a) relate the behaviour of the flaccid airway (no muscle activity) under anaesthesia to its behaviour during sleep (when muscle activity is variable but quantifiable), and (b) determine the effect of changes in body habitus (posture and lung volume) on airway collapsibility. These studies will allow examination of the exciting possibility that measurements made under brief general anaesthesia could be used to define propensity to obstruction during sleep. They will also allow examination of the contribution of common changes in body habitus toward vulnerability to upper airway collapse.Read moreRead less
Mechanisms And Treatment Of Upper Airway Collapse In Obstructive Sleep Apnoea
Funder
National Health and Medical Research Council
Funding Amount
$328,668.00
Summary
Obstructive sleep apnoea (OSA) is characterized by intermittent closure of the upper airway (throat) resulting in episodes of decreased blood oxygen levels, increased blood pressure and disturbed sleep. Repetitive overnight arousals from sleep cause excessive daytime tiredness and lethargy, which have major consequences for social well-being and productivity in our community. OSA is a common condition, affecting as many as 2 to 4% of middle aged adults, and is associated with an increased cardio ....Obstructive sleep apnoea (OSA) is characterized by intermittent closure of the upper airway (throat) resulting in episodes of decreased blood oxygen levels, increased blood pressure and disturbed sleep. Repetitive overnight arousals from sleep cause excessive daytime tiredness and lethargy, which have major consequences for social well-being and productivity in our community. OSA is a common condition, affecting as many as 2 to 4% of middle aged adults, and is associated with an increased cardiovascular risk, however the mechanisms underlying the increased upper airway collapsibility in individuals with OSA are not well understood. The proposed studies represent a series of investigations into fundamental mechanisms of neural and mechanical control of upper airway patency, how these mechanisms act to stabilize the upper airway, and whether these reflex control mechanisms can be manipulated to provide a novel treatment for OSA.Read moreRead less
Mechanisms Of Pharyngeal Collapse In Obstructive Sleep Apnoea Defined By Optical Coherence Tomography
Funder
National Health and Medical Research Council
Funding Amount
$476,764.00
Summary
Obstructive sleep apnoea is characterised by intermittent collapse of the upper airway (throat) resulting in episodes of decreased blood oxygen levels, increased blood pressure and sleep disruption. Obstructive sleep apnoea is common, affecting 5% of middle-aged adults, and is associated with worsening health, increased motor vehicle accidents and increased risk of heart disease. However the mechanisms responsible for obstructive sleep apnoea are not well understood. One reason for this lack of ....Obstructive sleep apnoea is characterised by intermittent collapse of the upper airway (throat) resulting in episodes of decreased blood oxygen levels, increased blood pressure and sleep disruption. Obstructive sleep apnoea is common, affecting 5% of middle-aged adults, and is associated with worsening health, increased motor vehicle accidents and increased risk of heart disease. However the mechanisms responsible for obstructive sleep apnoea are not well understood. One reason for this lack of understanding is that current diagnostic techniques can not accurately measure changes in the size and shape of the upper airway during sleep. Such information is vital for the accurate diagnosis and treatment of obstructive sleep apnoea. This project proposes to use a technique called endoscopic optical coherence tomography (eOCT), recently developed by ourselves, to measure the changes in upper airway size and shape in patients with obstructive sleep apnoea during wakefulness and, importantly, during sleep. A prototype of the system has been developed. Preliminary in vivo studies have been performed in the human upper airway and the results from these preliminary trials have been published. To our knowledge, world-wide, this is the only such system capable of making these measurements. The studies proposed in this application will provide a better understanding of the mechanisms underlying obstructive sleep apnoea and may lead to the development of greatly improved and more specific treatments that are tailored to the exact needs of the individual patient.Read moreRead less