Episode 34: Measuring Sleepiness

How is sleepiness measured? Can sleepiness from different causes be differentiated? What new tools are being developed? These are questions that come up in clinical practice every day and are important when putting together treatment plans for people with symptoms of hypersomnolence (sleepiness) or hypersomnia disorders. We address these questions and more with the help of Assistant Prof David Plante from University of Wisconsin.

Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk, talking all things sleep.

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Audio Timeline:

  • 00:00 – 02:11 Introduction
  • 02:11 – 19:11 Theme – Measuring Sleepiness
    • 02:11 – 04:13 Introduction
    • 04:13 – 16:51 Interview – A Prof David Plante – measuring sleepiness
    • 16:51 – 19:11 Discussion
  • 19:11 – 21:44 Clinical tip: Acknowledge uncertainty
  • 21:44 – 25:05 Pick of the month:
    • 2144 – 23:54 Moira – Social jetlag in Australian adults
    • 23:54 – 25:05  David – Dopesick – Book
  • 25:05 – 26:27 What’s coming up in sleep?

Next episode: Sleeping pills

Links mentioned in the podcast: 


Guest interviews:

Assistant Prof David Plante is the Medical Director of Wisconsin Sleep  and Professor of Psychiatry at University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin, USA. Dr. Plante is a clinician-scientist with a broad background in sleep and psychiatric research that has shaped his translational perspectives on biomedical investigation.  Dr. Plante completed his clinical sleep medicine fellowship at Brigham and Women’s Hospital, followed by a dedicated research year sponsored by a physician-scientist training award from the American Sleep Medicine Foundation (ASMF), under the mentorship of Dr. John Winkelman.  Since commencing at the University of Wisconsin-Madison in 2010, Dr. Plante has continued to conduct translational research at the sleep-psychiatry interface.

Regular hosts:

Dr Moira JungeDr Moira Junge is a health psychologist working in the sleep field, who has considerable experience working with people with sleeping difficulties in a multidisciplinary practice using a team-based approach. Moira has consulted at Melbourne Sleep Disorders Centre since 2008, and is actively involved with the Australasian Sleep Association (ASA). She has presented numerous workshops for psychologists wanting to learn more about sleep disorders, and is involved with Monash University with teaching and supervision commitments, as well as clinical involvement with the Monash University Healthy Sleep Clinic. She is one of the clinic directors at Yarraville Health Group which was established in 1998. In addition to her expertise in sleep disorders, her other areas of interest and expertise include smoking cessation, psychological adjustment to chronic illness, and grief and loss issues.

Dr David CunningtonDr David Cunnington is a sleep physician and director of Melbourne Sleep Disorders Centre, and co-founder and contributor to SleepHub. David trained in sleep medicine both in Australia and in the United States, at Harvard Medical School, and is certified as both an International Sleep Medicine Specialist and International Behavioural Sleep Medicine Specialist. David’s clinical practice covers all areas of sleep medicine and he is actively involved in training health professionals in sleep. David is a regular media commentator on sleep, both in traditional media and social media, and blogs for the Huffington Post on sleep. David’s recent research has been in the area of non-drug, psychologically-based treatments such as cognitive behavioral therapy and mindfulness in managing insomnia, restless legs syndrome and other sleep disorders.

Connect with David on Twitter or Facebook.

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Dr. David Cunnington:Welcome to episode 34 of Sleep Talk, the podcast talking all things sleep and welcome again Dr. Moira Junge.

Dr. Moira Junge:Hello everyone. Hi Dave.

Dr. David Cunnington:So this month, we’re going to talk about measuring sleepiness and it is a bit self-indulgent for me because this is something I really struggle with in clinical practice and we’re going to take the opportunity to get the insights from Assistant Professor David Plante who’s really leading world research in this area, looking at can you differentiate different types of sleepiness by doing different measurements. How do you actually measure sleepiness? How do you sort of utilise that information in clinical practice? So I will try and tease David out about that and answer my own questions too.

Dr. Moira Junge:Great. So what’s topical this month regarding sleep?

Dr. David Cunnington:In our practice and in a couple of centres around Australia, we’re beginning to gear up for a clinical trial of a once nightly formulation of sodium oxybate as a treatment for narcolepsy. So for me that’s really exciting. So yes, I have treatments available for narcolepsy. But unfortunately, a lot of them are only partially effective for people – people still left with significant symptoms or they don’t tolerate them because of side effects.

We have some experience with the sodium oxybate formulation. That has actually been a great rescue medication for a number of people, but it’s expensive and it’s not registered in Australia. So to have a clinical trial of potentially a once nightly formulation is something I’m really excited about and Narcolepsy Support Australia is hosting an event in Sydney on October 13thwith Julie Flygare from Los Angeles and Project Sleep. She’s going to come to Australia and share her experience with narcolepsy and Julie is awesome. She’s just a great person to follow. If you want to understand narcolepsy, she’s very active on social media and a great positive advocate not just for narcolepsy actually but for sleep problems in general.

Dr. Moira Junge:Yeah. She isn’t, isn’t she? Great. Excellent.

Dr. David Cunnington:Then also in Australia, there’s Idiopathic Hypersomnia Awareness Week. So that’s from the third to the ninth of September. Then look out for that and there’s lots of information on the website for hypersomnia Australia or about idiopathic hypersomnia

Dr. David Cunnington:So this month’s topic is measuring sleepiness. So why is that important? Well, part of the reason it’s important is sleepiness is incredible common. So if you survey the general population and you ask people, “Are you sleep?” at least a third of people will report being sleepy and do your own survey amongst your family or your workplace. You start saying, “I’m sleepy,” and everyone goes, “Yeah, I’m sleepy too,” and then it becomes a “Who’s sleepier?” rather than the busy off. You know, I’m busier than you. It’s a bit of sleepiness off. I’m more tired than you are or more sleepy than you are.

Dr. Moira Junge:I think mostly we’re focusing often too on people not sleeping enough rather than this group of people that perhaps are sleeping too much or needing a lot of sleep and having non-restorative sleep.

Dr. David Cunnington:Yeah, absolutely. These have been a tricky area because in clinical practice, one of the questions that comes up for me is how sleepy is too sleepy. What’s outside the normal range?

So at least a third of the population is reporting feeling sleepy. When is it abnormal? When do we think of it as a medical disorder and therefore think about treating it versus when do we think of it as just a social disorder or lifestyle –?

Dr. Moira Junge:Yeah, particularly if I was sleep deprived and particularly if it’s coming in the afternoon and it might – all of us have a dipand do need to have sleep. Most people – the general population wouldn’t know that that’s considered normal. People would think that they’re sleeping, they’re abnormally sleeping.

Dr. David Cunnington:Yeah. One of the things I struggle with, is all sleepiness the same? So if someone who’s voluntarily sleep-deprived choosing not to sleep and feeling sleepy, is that the same as someone who has got a neurological condition like an orexin deficiency and narcolepsy type one of feeling sleepy versus someone who has got depression and is feeling sleepy?

Dr. Moira Junge:Are you going to tell me by the end of this podcast we will know? Is anyone looking at that? Is it something that we …?

Dr. David Cunnington:Funnily enough, that’s one of David Plante’s particular research interest, which is why …

Dr. Moira Junge:Yeah, great.

Dr. David Cunnington:… for this episode.

And that’s one of the questions I will put to him is, yeah, “Can we differentiate these different types of sleepiness?” So let’s get into it and see what David has got to say. David is a clinician scientist from the University of Wisconsin in Madison and has a particular interest in disorders and excessive daytime sleepiness and measuring these and seeing if we can differentiate these different types of sleepiness. So what are some of the current clinical tools available for measuring hypersomnolence?

Dr. David Plante:In clinical practice, we basically have three major tools – well, three or four major tools that we can use to try to assess someone’s complaints of hypersomnolence. So one of them that I think is often overlooked is actigraphy and I think actigraphy is absolutely important because it’s really the only means that we have right now of quantifying longitudinal sleep-wake patterns in people.

So when we bring people into the lab for our other sort of objective measurements, it’s just a snapshot. So we have to be aware of what’s actually happening to people outside of the lab because that can have pretty profound impacts on the readings that we get of tests when we do bring them in the lab and also it may give us a little bit more hint about what may be going on with the person.

So a great example is people who have a circadian rhythm disorder. Because of that, they’re sort of functionally sleep deprived during the week. But then on the weekends, they may sleep long amounts of time or when they come into the sleep lab, they may sleep long amounts of time if you let them. But they may not have a true disorder of central hypersomnolence.

So actigraphy is a great way to at least estimate longitudinal duration of sleep over sort of a period of time.

And then in the lab, we’ve got different tests. We’ve got the classic polysomnogram, which tells you a lot about sort of sleep fragmenting disorders, et cetera. But to try to understand if someone has got excessive sleep duration, it does have to be modified to let people sleep.

So one of the things that our lab frequently and typically does in patients who we suspect may have for example idiopathic hypersomnia or they have a complaint of hypersomnia, so we don’t suspect they have a sleep disorder breathing or something like that is we let people sleep and what I mean by that is our lab does not necessarily set a prescribed wake time.

So you can objectively record sleep duration and see how long someone will sleep and it does take some flexibility among daytime technicians and patience among staff. But it can actually give you a lot of really – a useful information that I think we often miss when we kind of routinely wake people up in the morning.

Then other tests that we have are the MSLT, which is our gold standard measure of objectively measured sleep propensity and we use that very frequently. It’s probably the most common sort of standard assessment that we’re doing for people that we suspect have a central nervous system hypersomnia or at least if we’re trying to rule in or out narcolepsy for example. But it’s an imperfect test to say the least but it does have a very important sort of area in clinical practice.

Then I think the other test that we can use clinically is the Maintenance of Wakefulness Test or MWT and my gut tells me that we’re probably using the MWT less than we probably could. Part of that at least in the United States is driven by one, reimbursement. But two, it’s not a diagnostic test per se.

So in the MSLT, we rely on it heavily to make a diagnosis of narcolepsy or even idiopathic hypersomnia whereas the MWT gives us a sense of how sleepy someone may be. But it’s not a diagnostic tool in the same kind of sense. It’s not written in any of the diagnostic criteria. So I think we tend to use it very, very infrequently.

Dr. David Cunnington:So these are some of the objective measures if we’re trying to measure hypersomnolence. What about some simple subjective tools that people can use in the clinic?

Dr. David Plante:Sure. Well, there’s a number of relatively straightforward objective tools that can be used. They vary a little bit in terms of what they’re quantifying and also the duration over which they’re asking people about. So probably the most common and most familiar tool is actually – was developed in Melbourne by Murray Johns and that’s the Epworth Sleepiness Scale. It’s a very straightforward scale that asks people to rate how likely they are to doze off in various real or imagined situations. There’s eight of them and people score each item from zero to three and then basically it’s a very simple scale to some.

Once you start getting to scores of more than 10, that’s starting to suggest clinically significant daytime sleepiness. So that’s an excellent scale to use all the time clinically in the United States and I imagine elsewhere. The Epworth is not a perfect scale and it doesn’t – like for example it measures over a window of time. There are a couple of subjective scales that are usually used more in research to try to quantify how sleepy someone is at that moment in time.

So there’s the Karolinska Sleepiness Scale and the Stanford Sleepiness Scale, which are very similar in that respect. They’re asking the person to rate how sleepy they are at that moment. Then there are other scales that are either targeted towards a specific symptom or area of sleepiness or results of sleepiness or you may take a broader stance of hypersomnolence. What I mean by that is they’re scales – the Functional Outcomes of Sleep Questionnaire or FOSQ is a very widely utilised scale that measures sort of the impact of daytime sleepiness on people’s lives and there’s sort of an extended version and then a shorter version as well that’s available.

There are also questionnaires that are more symptom-specific. So a great example is there’s a sleep inertia questionnaire that has been developed by Allison Harvey and her group at Berkeley that ask questions more specifically about sleep inertia specifically.

So that’s referring to the phenomenon that people with hypersomnolence often have extreme difficulty getting out of bed in the morning and feeling very groggy or even hung over or drunk when they wake up. It’s very hard to sort of become fully awake. So there are questionnaires for that.

I have a colleague Kate Kaplan who’s working on validating something called the “Hypersomnia Severity Index,” which is a little bit akin to the Insomnia Severity Index. This is a measure that asks about different aspects of hypersomnolence, so daytime sleepiness, excessive sleep duration, sleep inertia, et cetera, and then also its functional impact. So that’s something that we’re working on as a field and trying to develop.

So there’s a whole host of different sort of options out there. But I would agree with you that the Epworth is definitely the most commonly used scale right now.

Dr. David Cunnington:Yeah. I like the sound of the Hypersomnolence Severity Index. So that would be a really useful clinical tool I think because –

Dr. David Plante:Yeah, more on that to come.

Dr. David Cunnington:Great. Well, I look forward to that. So then we’ve got these tools, the objective tools and the subjective tools. One of the things I really struggle within clinical practice is in differentiating different causes of sleepiness. So in the work you’ve done, we’re using these tools such as MSLT. Have you been able to show any differences in the characteristics of these test results with different causes of sleepiness?

Dr. David Plante:Well, so I think that one of the things that we’ve noticed as we’ve sort of done more and more research in clinical population specifically using the MSLT and then what I would call ancillary measures of sleepiness is that we’re replicating very similar things that we’ve actually seen a lot of times in the literature, which is the following.

So one, the multiple sleep latency test results weekly correlate if at all with sort of other objective measures of sleepiness. They tend to have some kind of a significant relationship but it’s usually very, very modest, if at all, in terms of how the variance of one explains the other. The MSLT doesn’t capture a lot of people who may have other specific impairments.

The other thing that we’ve seen which I – again, I think has been described in a literature previously and it still hasn’t really changed clinical practices within individuals. People can often be discordant for these values.

So in other words, someone may have a completely normal MSLT, completely normal, but have – be very, very impaired if you were to even measure them with the MWT. That was described a long time ago in a paper I think in 1992. But even if we use things like a Psychomotor Vigilance Task, which is a neuro-behavioral measure of alertness or infrared pupillometry that measures kind of pupillary undulation in darkness, which are both other measures or ancillary measures of different aspects or facets of daytime sleepiness, we find that some individuals may be quite abnormal on one metric, one or even two metrics. But then completely normal on the others.

So these things are relatively independent from one another and I would argue that ideally in the future, we do a better job of what I would call phenotyping people. So understanding sort of the nature of their sleepiness beyond just relying on the MSLT as a standard measure for assessing sleepiness.

Dr. David Cunnington:Yeah, that’s a really helpful tip because the MSLT is pretty non-specific and it does make it hard to then give us that information. Like what’s underpinning the sleepiness? There’s an area of research for you. Give us a look at what’s coming ahead? What sort of things are you looking at and how might you start to tease this apart?

Dr. David Plante:One of the things we’re trying to do is to apply these different measures of sleepiness to specific populations that have proven to be somewhat challenging to identify excessive sleepiness in objectively. So a great example of that is in depression. We’ve known for a long time that sleepiness is really common in depression and depression is one of the most common reasons for people to complain about sleepiness. But when we bring people into the sleep lab and we do multiple sleep latency tests on these individuals, they tend to have relatively “normal values”.

Now that isn’t to say that someone with depression isn’t going to have an abnormal MSLT. The chances are about one in four that they are going to have an abnormal MSLT. But the problem is that’s about the same as the general population. So the MSLT has very poor normative data in terms of the mean and standard deviation. So a lot of people in the population, if you just pull people off the street, will have an abnormal MSLT.

So one of the things that I would like to do is start to use some of these ancillary measures of sleepiness in people with depression to see if we can do a better job of objectively identifying their sleepiness. Then from there, beyond just being able to identify people objectively as being sleepy who have depression is then trying to map specifically which objective measure of sleepiness – how that maps on the different sort of neurophysiologic changes in the brain.

So there are probably lots of reasons for people to be sleepy, right? Our ability to stay awake is a pretty complex phenomenon. Generally, we boil it down into it’s a balance of sort of the arousal mechanisms in the brain and sort of – and dampening down or sleep-promoting mechanisms and there’s something sort of – some imbalance there between them. But it could happen in theory and lots of different parts in the brain.

Alluding to one of the questions you had asked before is, “Have we kind of mapped some of these specific measures of daytime sleepiness to a specific brain function?” Unfortunately, the answer is for the large part no. We have some ideas about what changes in the PVT or Psychomotor Vigilance Test can represent and the systems that may be involved there. They can involve motor systems, attentional systems and even in some components of the PVT, the default mode network. Infrared pupillometry we think tends to be a reflection of noradrenergic activity in the locus coeruleus because that’s integrally involved in sort of the circuit that’s involved in pupillary constriction and dilation.

So we at least have some sense of some of the nuclei involved or related to that particular measure. But it’s relatively non-specific and so besides just being able to identify that fact that someone does have pathology objectively or is sleepy objectively, the next step that we also want to do is try to then map those objective findings onto specific neurophysiologic changes because that will tell us a lot about what’s happening in the brain and then allows maybe tailored treatments a little bit more specifically moving forward and that would apply for depression. It would also apply for other disorders of hypersomnolence that I study and care about. So things like idiopathic hypersomnia for which again like depression is probably a heterogeneous disorder and like depression, not everyone with idiopathic hypersomnia – we even have an abnormal MSLT.

So clearly some of those folks are going to be a little bit different than other folks in trying to figure out what’s going on. I think it will be very, very important to develop effective strategies for their management over time.

Dr. David Cunnington:Yeah, good luck with your research. I’m really looking forward to getting more tools that we can use in the clinic.

Dr. David Plante:Well, thank you.

Dr. Moira Junge:Great work, David. Another good interview. What are your take-home messages or the standouts from that interview?

Dr. David Cunnington:So again, nice to hear that David struggles with this in the same way that I do is differentiating these different types of sleepiness and some of his work gives us some insights of things we can try and think about that may help us to differentiate sort of who’s sleepy versus not sleepy and what may be a particular cause of sleepiness. But still we don’t have the perfect answer unfortunately. So it doesn’t solve my clinical problem.

Dr. Moira Junge:Not yet.

Dr. David Cunnington:Not yet. And it is something that’s really a problem in clinical practice. So some of the people we get sent to see, it’s – are they safe to drive for example? And one of the tools we’ve got that we talked about was a questionnaire like the Epworth Sleepiness Score, so a self-reported scale of do people feel sleepy in particular situations.

And transport drivers or if your license is depending on it, you’re going to say, “No, I don’t feel sleepy in any of those situations.”

So that’s tough if I’m trying to measure sleepiness and the main sort of questions I’m trying to ask people about symptoms, it comes back as – I don’t have any symptoms. I don’t then have a great – sort of other tests to go to beyond that. At the other end of the scale with the Epworth Sleepiness Score, you and I had seen that clinical picture where someone scores 24 out of 24. I’m maximally sleepy in every single situation.

Dr. Moira Junge:All the time, yeah.

Dr. David Cunnington:All the time.

And really that’s a reflection of the underlying sleepiness. Much more it’s a reflection of distress, response to symptoms and how impactful they are on some …

Dr. Moira Junge:Yes, I agree with that.

Dr. David Cunnington:So it does make it a challenging area to work in. How do we then assess someone’s safety for driving, for operating heavy equipment? And it’s challenging. But the good news is – so there’s great research happening in Australia. So Monash University together with Woolcock Institute and Flinders are involved in research looking at some of these safety measures particularly around sleepiness via the Alertness CIC and hopefully the types of things we will have in the future are some sort of biomarker like a roadside test. At the minute, we got roadside test for alcohol but a roadside test potentially for sleepiness. Are you too sleepy to be driving? Whereas at the minute, we don’t really have great tests for that.

Dr. Moira Junge:Oh, that will definitely come in our lifetime as clinicians.

Dr. David Cunnington:Yeah. So if you’re looking for more information on the measurement of sleepiness, I will put some of the links to David Plante’s research in the show notes.


Dr. Moira Junge:So what’s your clinical tip of the month, Dave?

Dr. David Cunnington:So a tip that’s really relevant to my clinical practice in measuring sleepiness and managing people with sleepiness is for clinicians to just acknowledge uncertainty if we’re not certain about something. We don’t admit that. We’re not open with the people that we’re treating and say, “You know what? There are some things we’re good at and we can measure really carefully and there are other things we’re not so good at,” and this is definitely an area where the measurement isn’t perfect. I think we just got to be honest about that and say, “Look, happy to support you. It’s clear there’s a problem here.

We’ve done some measurement. It shows a trend in this direction and I think that’s what’s going on,” but that’s – having that sort of way of thinking about it is having a working framework or a working diagnosis rather than telling someone with absolute certainty, “Right. You definitely have this. My testing shows this is what you absolutely have.”

It’s also an area where I don’t want to give people a label or an incorrect label that sticks. So if you label someone with a disorder of sleepiness that sticks and you’re sort of implying you’ve got a lifelong condition that’s not going to get better, that’s going to have significant impact on you going forward, I want to be pretty cautious about that, particularly if my testing is not perfect.

Dr. Moira Junge:It’s hard though, isn’t it? Because people have gone to a lot of different people to get to you and there’s a lot of expectation or a – you know, credentialed, experienced sleep physician. So that would be expecting that – expectancy effect. They don’t want to hear that, “Oh, we’re not sure. We don’t have really good measures yet.” People would be really surprised by that.

Dr. David Cunnington:That’s a good point and it is a tricky balance I reckon between not trying to fool people, that there’s greater certainty than what there is.

And being open and honest with people, but also reassuring them that, you know what, there’s a little bit of uncertainty on the diagnostic side. But these are the symptoms you’ve got and we’re going to work together to manage them.

Dr. Moira Junge:Yeah, and I think it’s not only honest but just the reality of it. Sometimes things do change over time. The symptoms can manifest as different things at different times over the course of – say with an idiopathic hypersomnia or narcolepsy disorder. It might not have been that when they got tested 20 years ago. The markers weren’t there. It doesn’t mean that physician was wrong.

Dr. David Cunnington:Absolutely, because a couple of nice papers went out of France and went out of the US showing if you repeat multiple sleep latency tests five years down the track and people look like narcolepsy type two or idiopathic hypersomnia upfront, about two-thirds of them actually change diagnostic category five years down the track.

Dr. Moira Junge:Yeah. You’ve got to be actually cautious. That’s the research.

Dr. David Cunnington:So Moira, what’s your pick of the month?

Dr. Moira Junge:Well, what I want to talk about was this – a paper that was in Sleep Medicine in June 2018 and was an Australian group of researchers led by Robert Adams. It was taking from data from our 2016 National Sleep Health Foundation Study and there has been a number of papers.

This one is called “Socio-Demographic and Behavioural Correlates of Social Jet Lag in Australian Adults”. What I wanted to mention about that and we’ve got the link to it in the show notes is not – oh, it’s great, beautiful, beautiful research.

What was interesting was the media interest in it. Like unbelievable. Unexpected and unprecedented media interest, particularly because of the words “social jet lag” I think because people think, “Wow, what’s that? That’s new,” and my little anecdote is always on TV news. I don’t like TV at all. I don’t really. So she was wanting to do an interview around social jet lag and I’m thinking, “Well, it’s not really a thing.”

I’ve been in the field for 20 years and it’s not in my textbooks social jet lag. But it’s just a good headline grabbing thing. It’s really around looking at sleep deprivation, all the people who aren’t sleeping enough and got a mismatch to their sleep and their wake schedule and the daytime correlates of that mimic jet lag. It’s just a nice way – it’s an eloquent way of getting the general public to understand how – what it feels like because everyone knows and understands what jet lag feels like. So this is jet lag all the time, nothing to do with jets.

Dr. David Cunnington:If you think about the physiology, it grates because it’s not quite right.

But if you think about the functional outcome or how it feels, yeah, it makes sense.

Dr. Moira Junge:So I felt like a real fool with this journalist. I was saying oh – just saying, “What is it?” and I was like, oh – I was just referring to my phone from a text from him because I said I’m being interviewed tomorrow. What is it exactly? So for me, it’s not really a thing. I’m just checking it, sort of thing. I’m writing out all his words. I thought gee, this is not – I asked for an expert. They sent me this.

Dr. David Cunnington:I’m sure you did a good job there.

Dr. Moira Junge:So that’s a little funny anecdote for my pick of the month. What’s your pick of the month?

Dr. David Cunnington:So it’s a book, another book and this one is not so much about sleep but it’s something that’s relevant to healthcare. So the book is called Dopesickby Beth Macy and it’s a story about prescription opiate medications in the United States and the whole story of how it began and how the United States got to where they are at the moment in just a terrible situation with overuse and misuse of prescription opiate medications and a large proportion of the population misusing opiate medication.

Yeah, very interesting insights into how that evolved and scary insights into how commercial interests and drug company interests in selling products then got health professionals involved and health professionals help sort of fuel the use of the medication. So yeah, I think a lot for us to learn about that and to learn about how things can go poorly if we’re not so careful about what we do.

Dr. Moira Junge:All right. So a cautionary tale.

Dr. David Cunnington:A cautionary tale and yeah, I really enjoyed it. I thought it was really well-written and yeah, it’s a major health issue in the United States and in Australia. There’s – in Australia thankfully, but nice insights into how we’ve gotten there and potentially ways to avoid getting there with other topics in the future.

Dr. Moira Junge:Oh, good, excellent. Good pick. So here we can talk about the coming up – all the stuff coming up and particularly the next episode.

Dr. David Cunnington:Yeah. So for the next episode, which will be episode 35, we’re getting up to three years of …

Dr. Moira Junge:I know. It’s three years in November that we’ve been doing this.

Dr. David Cunnington:Yeah. So it would be episode 35 and so we’re going to talk about sleeping tablets or sleeping pills as we will call it and we’re going to interview Wallace Mendelson. Wallace was a professor of psychiatry and clinical pharmacology at the University of Chicago. He has just actually updated his book on sleeping pills, so a perfect time to talk to him about that and his book is really nice, sort of good messaging and good communication about the role of sleeping tablets and the pros and cons of different medications.

Dr. Moira Junge:Excellent. I look forward to it.

Dr. David Cunnington:So thanks for listening to this episode and thanks again for your help Moira

Dr. Moira Junge:Thank you. It was my pleasure.

Dr. David Cunnington:And if you’ve got any suggestions for topics or want to send us any comments, email us at podcast@sleephub.com.au. Send us a review on iTunes and subscribe to the podcast via any of the podcast apps or our Sleep Talk app in the iTunes store.





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