Episode 55: Medication in Pregnancy

Pregnancy can be a challenging time, particularly for women with sleep disorders such as narcolepsy who rely on medications to manage symptoms. There isn’t clear information to guide either women or their healthcare providers on what to do during pregnancy. To discuss managing women with narcolepsy during pregnancy we spoke to Dr Michael Thorpy from Montefiore Medical Centre, New York.

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 / Chapters:

  • 00:00 – 02:36 Introduction
  • 02:36 – 26:29 Theme – Medication in Pregnancy
  • 26:29 – 27:46 Clinical Tip
  • 27:46 – 30:40 Pick of the Month
  • 30:40 – 32:36 What’s Coming Up?

Next episode: Sleep and Pain

Links mentioned in the podcast: 

Presenters:

Guest interview:

Dr. Michael Thorpy is Director of the Sleep-Wake Disorders Center at the Montefiore Medical Center, Bronx, New York. Both a clinician and a well-published researcher, Dr. Thorpy serves as Professor of Clinical Neurology at Albert Einstein College of Medicine. In addition, Dr. Thorpy served on the National Sleep Foundation (NSF) Board of Directors and founded and directed the NSF’s National Narcolepsy Registry, which was located at Montefiore Medical Center. He is past Chairman of the Sleep Section of the American Academy of Neurology. He is President of the New York State Society of Sleep Medicine (NYSSSM). He has published extensively on narcolepsy, insomnia, and sleep disorders. His 14 print books include “The Encyclopedia of Sleep and Sleep Disorders”. He has published more than 100 peer-reviewed articles, including publications in journals such as The New England Journal of Medicine. Dr. Thorpy’s computerized textbook on sleep medicine, SleepMultiMedia (available on DVD-ROM), is the only one of its kind.

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 is actively involved with the Australasian Sleep Association (ASA) and a board member of the Sleep Health Foundation. She has presented numerous workshops for psychologists and is involved with Monash University with teaching and supervision commitments. She is one of the founders and clinic directors at Yarraville Health Group which was established in 1998. 

Connect with Moira on Twitter – @MoiraJunge

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 an International Sleep Medicine Specialist, Diplomate Behavioral Sleep Medicine and Registered Polysomnographic Technologist. David’s clinical practice covers all areas of sleep medicine and he is actively involved in training health professionals in sleep.

Connect with David on Twitter – @DavidCunnington. David also regularly posts information on sleep to his Facebook page.

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Transcript:

Welcome to Sleep Talk the podcast about all things sleep, brought to you by sleephub.com.au. Here are your hosts, Dr. David Cunnington and Dr. Moira Junge.

Dr. David Cunnington: So welcome to episode 55 of Sleep Talk, the podcast talking all things sleep. And welcome again, Moira.

Dr. Moira Junge: Hello, Dave. Hello, everyone.

Dr. David Cunnington: So in this episode, we’re going to be talking about the use of medications in pregnancy. And we’ll as well focus on narcolepsy because that’s a really good example where there is a range of different medications that are used. What we’ll talk about really does generalize around a number of sleep medications in pregnancy. It’s an episode I’ve wanted to do for a while because there’s really not much out there to guide clinicians and women. So I wanted to develop a resource for that.

So Moira, what’s been happening for you this month?

Dr. Moira Junge: OK. So obviously not going out much, we’re still in semi lockdown. I guess in terms of sleep, I think that it’s just been very busy as I’ve said in previous episodes, like clinically, and things like webinars and other education, it’s high demand. I think that it’s a perfect storm really is that the COVID 19 pandemic is a perfect storm for sleep problems because you’ve got the circadian disruption of people staying at home or – and it blurred boundaries at work and home and not getting the last cues at least to get. And then there’s also the potential for a lot of angst, a lot of anxiety, a lot of uncertainty, which of course, increases hyperarousal, decreases sleep quality and quantity. So I feel like I’ve been phenomenally busy actually with all of those things. What about you? What’s topical for you?

Dr. David Cunnington: You know, they’re great the – and we’re moving into a different phase, at least in Australia, we’re in the very fortunate position in the phase of this pandemic of now trying to work out well, how do we come out? The other side of that then, what’s the new normal? And that’s also keeping us pretty busy in the healthcare area of what – how do we deliver healthcare in a new normal? You know, what things do we need…

Dr. Moira Junge: Yeah, that’s right. What does it look like?

Dr. David Cunnington: Yeah, exactly. What does it look like? What do we change about how we’ve previously delivered health care? Because it’s not the same, and just thinking how all would just get back to usual is just not – not where it’s at. It’s good to see you’re developing your expertise in webinars. You really have been delivering a lot of really great content, Moira.

Dr. Moira Junge: Yeah, really enjoying that. And I don’t think – and not only just the sleep, the other part of my world as well that’s outside of sleeps, other interests in psychology. So, there’s a lot of health anxiety, particularly now that the restrictions are lifting, like how do we come out of this, and we’re super scared of actually getting sick, been taking up a lot of my time.

Dr. David Cunnington: So the theme for this month’s podcast is the use of medication in pregnancy. And as I talked about, I’ve really wanted to develop a resource and help people get an idea about where they could go to get more information. And also, some ideas about how to manage this both for clinicians but also for women throughout their pregnancy. And it is a complicated area because it’s a moving feast.

There are different phases of pregnancy. And if I look at a lot of the drug regulatory recommendations, it does break it up into the conception or preconception. And then early pregnancy, which has the highest risk of a pregnancy for malformations or fetal defects. And then there’s the second and third trimester, which are somewhat more stable phases of pregnancy where there’s lower risk of drug-related side effects, but more of a risk of other medical complications and often change. And then the breastfeeding phase when people have delivered but then thinking about how drugs might be transmitted via breast milk or what might be the impact on the newborn.

Moira, with your pregnancies, did this ever come up as an issue, use of medication?

Dr. Moira Junge: Now for me personally, I’ve been fortunate not needing to be on any medication. But certainly clinically, it’s a really big issue. It’s a very big issue that has been part of my practice for a long time now. Not only the sleep medication, but in general, just general mental health conditions like when people are taking antidepressants and the like. I don’t think there’s a lot of information of – I mean I’m lucky I’ve worked alongside the likes of you and other sleep physicians, where I can feel really confident that that’s safe in pregnancy. But would you say there’s a big discrepancy, even within sleep physicians of what you deem safe or not? Oh, that’s my personal experience. I don’t know whether that’s correct.

Dr. David Cunnington: Oh, absolutely, and that’s what the research bares out. In doing some background reading for this episode and trying to think about, you know, why produce this content, some really nice work and actually, I guess, Michael Thorpy, he published some of this work. And there were some surveys done both by prescribing clinicians, for women with narcolepsy and then women with narcolepsy and what happened with medication. The majority, in fact, over 80% in some of the studies of the prescribing physicians just said blanket no, no medications under any circumstances for women with narcolepsy through pregnancy, based on really very little data, just based on opinion and almost between…

Dr. Moira Junge: Well… well being cautious still I guess. It’s just being an abundance of caution.

Dr. David Cunnington: Exactly, an abundance of caution, so wishing to do no harm, in essence. And so, the majority of women do not have any medication throughout pregnancy, and absolutely, that’s the most cautious approach in terms of if your thinking just about medication risk. But it also exposes women then to significant hardship through pregnancy. Because one of the surveys of the women with narcolepsy showed that their under the minority worked at all throughout pregnancy, so about two-thirds stopped work for the entirety of the conception and pregnancy period. So think if that as at least 12 months before then the baby and then another six or 12 months off work with breastfeeding and looking after the baby. So that’s a major impact on quality of life. And I think we sometimes undervalue that by going for the abundance of caution. So it’s a really tricky thing to balance.

Dr. Moira Junge: And I know there’s a lot of fear around that, a lot of – in fact, a lot of times I see people with narcolepsy, they might be women in their early 20s, in their 20s, pre-children. And one of their biggest fears, of course, or something they do, like we talk through is what if I can’t have children? Or what am I going to do? How can I have children? How can I have nine months or more without this medication, et cetera, et cetera? It’s a huge, huge topic. And pregnancy itself is pretty hard. I mean, I think some women sail through it. But in gen– you know, I’ve never sailed through it, it’s a pretty difficult time, in terms of you’re pretty tired, really, really, really tired and people who don’t previously have insomnia. So, yeah, it’s a tricky thing. And I’m so glad we’re talking about it today.

Dr. David Cunnington: So there are a number of general principles that I’ll just talk through first. And then that’ll help in understanding some of what we talked about with Michael Thorpy a bit later. So, as we talked about with pregnancy, there’s not great information. So there’s not these black white information about medications. So the regulatory bodies in different countries have different approaches for advising both women and clinicians about the risk of medications.

So in Australia, we have a category system that rates medications as A, B, C, D, X, and increasing risk, as you go down the alphabet. And there’s a really nice website run by a drug regulatory body, the TGA, where you can essentially log on, put in the name of the drug, and it’ll tell you what category it is.

Interestingly, the US shifted away from that categorization about five years ago in 2015, and the FDA has shifted to more of a system that doesn’t provide that think of it as a yes, no type of information, but provides more a collation of all the background information about particular medications, to then inform physicians and women, to then make an informed individual decision balancing perceived risks or potential risks against potential benefits or risks of not being on treatment, to really guide that more individualized approach.

With the argument being that categorization of A, B, C, D or X really just say right, it’s Category B3, you’re off. Even though for that particular woman being on medication may be really important and the very small risk of a B3 medication may be something that they’re willing to tolerate. Each of those countries does have databases you can search. And I quite like I actually find myself searching each of them to try and get that categorical thing for medication as well as some of the background information to then have a discussion with women about that.

And as I talked about earlier, it’s also important to think about the phases of pregnancy. The highest risk with medication is actually in the conception phase and the early pregnancy phase. And that’s actually really tough because conception doesn’t always occur when you want it to occur, and that…

Dr. Moira Junge: No, that’s right.

Dr. David Cunnington: …maybe prolonged process as well, that’s even more challenging for women. Because once you’re obviously pregnant, people cut you a bit of slack once you’re into the late second trimester, early third trimester, they can see you’re pregnant, they may place lower expectations on you, even if you’re feeling tired. But when you’re getting around your daily life just wishing to become pregnant, that’s tough if you’re not able to access your usual medication.

A common thing we see is managing women with insomnia and maybe they’ve got co-morbid depression or anxiety, some may need to be on antidepressant medications or sedative medications. That becomes an individualized decision in pregnancy. The majority of the antidepressants are not considered in the Australian system Category A which is completely safe. They – most of them are in Category B, which is a suggestion of either there may be some animal data, saying there may be some issues, or that they’ve just never been tested to be proven to be safe.

And so it does come down to an individualized discussion. But it’s important because the use of antidepressants is very common in the community. And the risk of relapse of either depression symptoms or anxiety symptoms during pregnancy and then particularly in the postnatal period is real and can be very derailing and very impactful for women.

Dr. Moira Junge: Absolutely. Well, I mean, we all – we know that increased risk of personal depression if your pregnancy has been really tough and if the birth has been really tough. And people in this category, they’re not having their normal medication and normal supports would certainly be in that category, I would think.

Dr. David Cunnington: So to use narcolepsy as an example around the use of medications in pregnancy and some of the thinking in this area. I spoke to Dr. Michael Thorpy, who’s the Director of the Sleep-Wake Disorders Center at the Montefiore Medical Center in New York. So thanks very much for helping us out on the podcast, Michael.

Dr. Michael Thorpy: You’re welcome. Happy to be here.

Dr. David Cunnington: So what are some of the issues for women with narcolepsy around pregnancy?

Dr. Michael Thorpy: The most important issue, of course, is medication, and what to do about their medication during pregnancy. That’s the thing that worries most women. Many women feel that they really just can’t get by without taking medication. They usually come for advice on whether to stop the medication, whether to reduce it or just how to handle the medication during the course of the pregnancy. Some of them are a little concerned about the possibility that there may be changes in the narcolepsy during pregnancy too, either a worse thing or… but really main concerns are about medication.

Dr. David Cunnington: And what about for women with narcolepsy, are there greater risks outside of medication with pregnancy?

Dr. Michael Thorpy: Well, no greater risks other than those due to the narcolepsy itself, of course. If a woman does come off medication during the course of the pregnancy, and she has cataplexy, she’s at risk of injury, not only from the cataplexy but also because of sleepiness. So, usually, they have to modify their lifestyle in some way. For example, if they’re not going to be taking medication during pregnancy, they are not going to be able to drive and they have to be careful about any situation that they may be in when – if they were to get a cataplectic episode, they may put themselves in danger. But there’s – the pregnancy itself doesn’t have any direct negative effects at all in narcolepsy.

Dr. David Cunnington: I bet you and I have managed many women with narcolepsy through pregnancy. And sometimes one of the concerns women asked me about is, you know, will I be able to manage a newborn or manage our pregnancy? And I’ve certainly not said that has been an issue for women with narcolepsy.

Dr. Michael Thorpy: Yeah, I mean, after delivery, there’s usually not too much of an issue. People can get back onto medication and get – so long as their narcolepsy was relatively well controlled before, they can get back to control of it. But if for some reason why they can’t take medication after pregnancy, then that can be an issue particularly again if they have cataplexy, they’re maybe concerned about something emotional comes up that may affect their ability to hold the baby.

Dr. David Cunnington: And your point about needing to stop driving if people stopped medication is important. So there was that survey published last year in the Journal of Clinical Sleep Medicine that showed that 78% of women stopped pharmacotherapy during pregnancy, and then a third of them had to stop working through pregnancy. So it has significant lifestyle impacts if you do elect not to use medication in pregnancy.

Dr. Michael Thorpy: Yeah, it does. And, that article was interesting in that it sort of implied that most women really didn’t get much in the way of ideal counseling about how to handle pregnancy. And so there’s a need for a lot more information for women during pregnancy. For example, there’s a lot of misinformation regarding medications, and one really has to balance the risks versus the benefits. And in fact, we looked at all the medications in a paper that we did a few years ago and looked at the potential risk. And really in therapeutic doses, there’s really virtually no risk for any of the narcolepsy medications, so long as they’re taken in the appropriate doses.

But, the general recommendation is you know David is that most physicians would advise a woman not to take any medication during pregnancy. And I think that’s still the best recommendation. If a woman doesn’t need to take any medication during pregnancy, then certainly, don’t take it. But if they are significantly impaired, and I’ve had patients in my office, and I’ve told them the best thing is not to take any of their narcolepsy medication, they’ve just broken down in tears and said, “Look, I just can’t function. I mean, it’s impossible and…”

And so, generally what we do tend to do is to discuss the benefits versus the risks with patients and then come to a mutual decision. And I think that’s very important. You got to come to a mutual decision with the patient as to what’s best for them. And most cases, what we tend to do is to sort of reducing some medications somewhat so that the more functional and able to continue activities of their daily life to a large extent, but at a lower dose than what they might normally be taking. And then subsequently, they can go back to their higher dose.

But then again, there are some women who prefer to stop medication altogether. I mean, there is a risk of about proximately 2% of a woman, even if she’s not taking medication or having a child with a fetal malformation. And if a woman takes medication, I always ask them, you know, “If you took your medication during pregnancy, and you did happen to have a child that had a fetal malformation, how would you feel? Would you be able to handle that?” Some women tell me, “Yes, that’s no problem. I understand that is a potential risk, even if I wasn’t taking medication.” Whereas other women say, “Look, I would never be able to handle that. And so therefore, I just have to stop medication totally.” So it’s a decision that has to be made between the clinician and the patient themselves.

Dr. David Cunnington: Yeah, I agree. It really does come down to clinical medicine and that sort of work we have between the clinician and the patient or the person with narcolepsy. In the absence of really any evidence of harm for medications and maybe that’s different with the registry data that was published last year on modafinil and armodafinil, do you sort of stratify medications? Are there some you consider as sort of lower risk versus higher risk?

Dr. Michael Thorpy: Well, there are a number of issues. I mean, as you mentioned that there was some evidence that came out from Canada, regarding modafinil. And in that, there was data that came from the United States narcolepsy pregnancy registry that suggests that there was a higher rate of fetal malformations in women taking modafinil during pregnancy. It’s interesting because that was something that was felt by the Canadian medical agencies that required a sort of a black box warning for women during pregnancy but didn’t happen in the United States. And there hasn’t been, to my knowledge, any direct source of that information that’s become available, so not quite sure, just how accurate that information is. It certainly wasn’t any information that was released through the United States registry itself that I’m aware of.

But anyway, I think just the fact that it’s mentioned would suggest that it’s wise for a woman not to take modafinil during pregnancy in view of that until it becomes clear as to what that data really means. In most cases, you see the concern – if a woman has concerns about fetal malformations, it’s really around the time of conception that is the main concern, and for the first 60 days also of the pregnancy. So some women choose not to take medication at that time, around the time of conception and for the first couple of months after conception and then take it later in the pregnancy when there’s less risk of any drug causing a fetal malformation in the second half of the pregnancy. So that’s one tactic that some women can do.

The other concern is really around the time of delivery and breastfeeding and what medication can somebody take. For example, if there’s sodium oxybate as the main medication, a lot of people, in my experience, have tended to reduce the amount of those during the course of pregnancy. And then when it comes to the main concern is really that it’s a sedative and depressant medication, and that does get excreted into the – or secreted into the breast milk. And so the baby can be exposed to it in breast milk.

And so, what we generally recommend for someone who wishes to continue with their sodium oxybate after delivery is that we recommend that they express milk before they take their nighttime dose of sodium oxybate and then use that expressed milk for feeding the baby during the night, and then eliminating the express milk first thing in the morning when they awakened. And the evidence was all that because sodium oxybate has such a short half-life that really recent studies have shown that it’s virtually all eliminated from the breast milk and is no longer secreted into breast milk after about five or six hours. So the next morning a woman can express milk, eliminate that milk, not give it to the baby and then continue to breastfeed during the day. And many women have done this means of dealing by taking sodium oxybate during the – after the delivery.

Dr. David Cunnington: So we talked a bit about medications. What are the general advice do you give women with narcolepsy about pregnancy?

Dr. Michael Thorpy: Well, I mean, the general advice, as I say is to reduce the dose. It depends on what type of medication that the patient is on. A lot of my patients are on sodium oxybate, so we would reduce it to the lowest effective dose in terms of sodium oxybate. And if they’re on other medications, I mean, up until the time that this information became available from Canada, we would tell them to take the lowest effective dose of modafinil, and sodium oxybate and modafinil were probably the two commonest drugs that most patients were on.

But, it’s interesting that many people can actually get away with a greatly reduced doses of medication during pregnancy. Some patients will say that they notice their symptoms actually get better, even when they’re not on medication during pregnancy. So it’s not all doom and gloom if they were to stop their medication. So there are individual differences there.

Dr. David Cunnington: Yeah, great. And often the second trimester, for some women with narcolepsy seems to be a period where they can get by with quite a lot less medication and feel pretty well. And then by the third trimester, everyone expects pregnant women to be tired. So they’re not – they don’t stand out as much from the background population. Everyone is giving them a break if you like. And then what about management around delivery, do you have any recommendations about the obstetric team or instructions for the pediatric team?

Dr. Michael Thorpy: You know, I think there is a lack of information out there for healthcare providers about patients with narcolepsy and around the time of delivery. There have actually been cases in the past where people have had caesareans recommended to them because they had severe cataplexy, under the understanding that they would have greater difficulty during delivery. And there is some evidence that rarely somebody does have some difficulty during delivery because of severe cataplexy.

But by far the majority of women are able to have normal vaginal deliveries without any difficulty at all. There isn’t too much concern around the time of delivery for most of these patients. And I think the average patient certainly can think that there – and be quite right in thinking that there’s not going to be any problem with delivery of their baby because they have narcolepsy.

Dr. David Cunnington: Yeah, thanks very much, Michael.

Dr. Michael Thorpy: Pleasure.

Dr. David Cunnington: Hey, so what did you get out of Michael’s interview?

Dr. Moira Junge: Well, first of all, I thought, “Hah!” I was expecting a New York accent. And I thought, “Hah! He’s Australian.” And then I really quickly realized he’s definitely kiwi, ex-kiwi. And if he lived…

Dr. David Cunnington: Yeah, you’ve got it.

Dr. Moira Junge: Yeah, lived a long time, I think. Then I looked him up. I think the 1970s, ‘80s lived in New York for a long time. But yeah, really, thank you. I really enjoyed that interview. But it really seems like a lovely guide. I would personally be really happy to see him as my clinician. And also, clearly, across, you know, done a lot of really key research. Speaking of which, I mean, tell me, I need to know a bit more, I guess, just even if it’s anecdotal, what you know, what he knows about the rate of birth defects, et cetera like what are the actual risks of these medications in pregnancy?

Dr. David Cunnington: We don’t really have good data to be able to answer that birth defects happen in women, not even on medication, and just they’re part of normal pregnancy, unfortunately, and are more common than what we may perceive. So then, if you’re looking at something that occurs quite infrequently, with medications, and at a time when lots of other things are changing, it can be really hard to pick up that signal to really get an idea. But that modafinil registry study does give some insights into that, where around 300 women were followed, and the background rate of malformations was around 3%.

Dr. Moira Junge: Not insignificant.

Dr. David Cunnington: Oh no, absolutely. So as I discussed with Michael, the modafinil and armodafinil data is very compelling and compelling enough that now the recommendation is not to be on those medications during conception, early pregnancy and even late pregnancy. Whereas prior to understanding that data from the registry study, we would have taken the approach of trying to minimize the medication to reduce the exposure to medication, which is a strategy that can be helpful for some medications because, for some medications, the risks are dose-related. Whereas, now, we definitely just have people off modafinil.

Dr. Moira Junge: So Dave, if you had to summarize your approach, particularly after speaking to Michael Thorpy, what is it now? What’s the summary statement or two from you?

Dr. David Cunnington: And so really my summary would be decisions about the use of medications in pregnancy have to be individualized for any given patient, bearing in mind, what are the consequences of not being on medication, versus what are the potential risks of medication? And now in 2020, we’ve got good access to online databases that can inform us and provide us with that background information so that both women and their trading practitioners can have an informed discussion about the risks, to make the decision about what’s going to be done for that individual patient.

Dr. Moira Junge: Well, thanks so much to both of you for that really, really good conversation.

Dr. David Cunnington: So if we were looking for more information on this topic, there’s quite a nice review that was written in the journal Chest earlier this year on using sleep medications in a range of sleep disorders in pregnancy and during breastfeeding. And then the general databases that I’ve talked about, so the TGA’s database for classification of drugs in pregnancy, as well as information from the FDA in the US. And there’s a really nice, US-based database called LactMed, which gives information about the use of medications during breastfeeding.

So, Moira, I’ve done lots of talking, what’s your clinical tip for the month?

Dr. Moira Junge: Well, I think it’s just a reminder to us all and particularly, I suppose the medical people listening who might be the ones who are not prescribing now, and what are they going to do instead, to remember the benefits of the non-drug strategies. And if you don’t have a team around you of psychologists et cetera to know where to send people or to arm them with strategies and websites and mindfulness and exercise and…

But also to remember that this pregnancy period, it’s a whole new era for them, this woman and their partner and family, but like us, in the pandemic era that we realized, we pull back a little bit from all the normal life. And in pregnancy, they pull back a bit from perhaps on all the stuff they were trying to do and work included, and that they can surprise themselves, all parties can be surprised at how you can actually perhaps just rest a bit more, more scheduled naps, less stress, more meditation, more gentle walks, more laughter, and things probably will be OK, and a lot of reassurance, and just a time of reassurance, perhaps more time in these consult, just more education.

So Dave, what’s your pick of the month?

Dr. David Cunnington: Oh, well, I’ve got another Christopher Barnes’ paper. I really love his research, which is very much about leaders, and managers, and how their behaviour impacts on the sleep not just of them, but of people who work under them and work around them, and with them. So this paper was published last month in The Sleep Health Journal and looked at whether leaders devalued sleep. So whether they really had that bravado about come on…

Dr. Moira Junge: Sleep when you’re dead.

Dr. David Cunnington: Sleep when you’re dead, rise and grind, work while others are sleeping, crush the opposition, that type of ethos. And leaders who devalued sleep. Essentially, it had a negative impact on employees’ sleep. They didn’t sleep as well. And the employees actually engaged in unethical behaviour in the workplace. So they really, not only did they devalue sleep, they devalued ethical behaviour in how they went about their work. So…

Dr. Moira Junge: Wow.

Dr. David Cunnington: Yeah, really powerful impact. And so it just highlights the importance of how important it is for leaders to be positive role models for sleep. And the disappointing thing is you then look at our politicians and some of our other leaders, and they’re not necessarily good positive role models for sleep.

So I really liked that research. What about you, Moira, what’s your pick 

Dr. Moira Junge: Well, I’m excited about – we’ve just both been told recently, just tonight, in fact, about a project that’s up and running at Monash University in Melbourne here. And it’s called the NITE Project, which stands – it’s an acronym for Novel Insomnia Treatment Experiment. And we’ll put some – we’ll put a link to it and it’s… we’ll talk a bit more about it in the coming months. But it’s just really nice, it’s a research project that’s going to be what is looking at insomnia and looking at wearables and devices from their tracking sleep. And we all know my – I’m a bit of a Luddite with that. And David is much more all for, all for it.

Dr. David Cunnington: Absolutely.

Dr. Moira Junge: I’ve always got this, always got this caution around it thinking it increases anxiety and all that sort of stuff, which is valid. But it’s nice to say that they’re integrating it, looking in – looking at people with insomnia, and looking at using wearable devices, and having some education and support around what the feedback, what the data that’s there. Because I’m always worried about the data that’s there is sometimes is misinterpreted, or sometimes it’s just plain wrong, inaccurate. And so yeah, I’m really excited about that. That’s a great opportunity for all of us to learn more about how they can help with our sleep and our community in general.

Dr. David Cunnington: Yeah, I’m excited about that project. It looks really interesting.

So thanks very much for listening to the podcast. We’ve got episodes coming up on sleep and pain. And I said a number of people asked me about doing an episode on parasomnias, so strange things that happen during sleep.

Dr. Moira Junge: Yes.

Dr. David Cunnington: And I also – we had a nice request via email, I didn’t send you that Moira, of someone asking about hypersomnia as post-COVID infection.

Dr. Moira Junge: Hmm. That’s interesting.

Dr. David Cunnington: And I reckon that’s going to be a thing that we might – we’ll see a number of people with that. But it’s early for that. So we barely understand what COVID infection does as yet, let alone the sequel, the long-term effects.

Dr. Moira Junge: Yeah, but the fatigue. Yeah, certainly the fatigue/hypersomnia…

Dr. David Cunnington: Exactly.

Dr. Moira Junge: …seems to be really prolonged in quite a few people. So that would be interesting.

Dr. David Cunnington: Yeah, so we’ll come to that. But I think we need a bit more data – data first.

Dr. Moira Junge: Hmm. And don’t forget there’s the ASA, Australasian Sleep Association. I’ve got a webinar series, which is great, up and running. They’ve had the first couple, there are two more coming up in June, one with Nat Marshall and one with myself. So, I get onboard – look at the ASA websites for more details on that.

Dr. David Cunnington: So send us any suggestions for further episodes at podcast@sleephub.com.au and recommend the podcast to your friends and colleagues.

Dr. Moira Junge: You can also write a review, of course, on Apple podcasts and subscribe by any podcast streaming service or app.

Dr. David Cunnington: Thanks a lot.

Dr. Moira Junge: Thanks for listening. See you next month.

This podcast is not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider within your country or place of residency with any questions you may have regarding your medical condition.

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