Couldn’t make it to Sleep Down Under 2015? Here are some of the things that caught my eye.

sleep down under 2015Sleep Down Under is the annual scientific meeting of the Australasian Sleep Association, the peak professional body for sleep in Australia and New Zealand. It runs over 3 days each year, usually in October, and this year was held in Melbourne from Oct 22-24. Research being done in sleep in Australasia is presented, and symposia allow discussion of clinical practice. There is also a trade display where industry can show off their latest products. I’ve selected things that caught my eye from each of these 3 areas and written short summaries below.

We also recorded some interviews and video product reviews that will appear on SleepHub’s website, YouTube channel, podcasts and Soundcloud over the next few months.

Research highlights

Circadian rhythms and…..everything: The circadian rhythm, our internal once a day rhythm, impacts on all aspects of health including sleep and energy levels during the day as well as mood. Australian researchers are really leading the way in circadian rhythm research, particularly the Monash sleep research group. Selected highlights were:

  • Depression – there is data showing that in depression there can be both a delayed (late) circadian rhythm and a reduced amplitude rhythm. This raises the possibility that addressing circadian phase and amplitude could have an impact on depression symptoms and the risk of relapse. Already, the interaction of light and mood is seen in disorders such as seasonal affective disorder, but increasingly it is thought that circadian rhythm management using light treatment and melatonin may have an important role to play in the treatment of depression.
  • Energy levels – Waking up in the morning can be hard for a lot of people. How we feel when we wake up and then through the day is related to our underlying circadian phase. Although sleep deprivation also causes tiredness, it has more impact when our circadian phase is not in sync.

One of my favourite quotes from the conference was from Dr Sean Cain of Monash University and summed up the relationship between circadian rhythms, mood and performance well:

“Wake in your (circadian) trough….and you’ll feel off”

Mindfulness for….everything: Mindfulness is the practice of present focussed awareness. There is good research showing mindfulness is an effective treatment for depression, anxiety, pain and stress management. At the conference the use of mindfulness for other sleep disorders was discussed.

  • Insomnia – Ms Allie Peters presented her work using mindfulness-based therapy (a combination of mindfulness meditation and behavioural therapy) as a treatment for insomnia done as part of her PhD studies at RMIT University and Melbourne Sleep Disorders Centre. In 30 people with insomnia, Allie showed significant reductions in insomnia symptoms.
  • Restless legs syndrome – A pilot study led by Vicky Bablas as part of her Masters thesis at RMIT University and performed at Melbourne Sleep Disorders Centre, looked at using mindfulness-based stress reduction (MBSR) as a treatment for restless legs symptoms. Vicky showed that MBSR was effective at reducing restless legs symptoms and improving quality of life and sleep with longer sleep and less awakenings from sleep.
  • Narcolepsy – In a symposium discussing narcolepsy and the psychosocial effects, Dr Moira Junge (Health psychologist), discussed strategies for helping manage narcolepsy symptoms. In her review of the literature in this area, and based on her clinical experience, Moira discussed the role of mindfulness-based strategies in helping to deal with narcolepsy symptoms. This raises the possibility of incorporating mindfulness in to the management of narcolepsy.

insomniaOnline information on insomnia: People with sleep problems, commonly seek out information about sleep on the web. Janet Cheung from University of Sydney and Woolcock Institute of Medical Research reported her study on 1013 people with self-reported insomnia. Use of online insomnia information was associated with unhelpful behaviours in bed and before getting in to bed, as well as unhelpful ruminations about sleep. There were no differences in behaviour or thinking around sleep between those who had seen a health care professional about their sleep. Having closely followed online postings on sleep for around 18 months, I’m not surprised by these results, as a lot of the information highlights the health risks of poor sleep without providing evidence-based advice or tips. If there are tips, they are often lists of rules that can actually increase sleep-related anxiety.

Clinical practice updates

Narcolepsy: There were 2 sessions on narcolepsy at the conference, both very relevant for clinicians working with people with narcolepsy. One focussed on a new medication whilst the other was on a team approach to narcolepsy including addressing psycho-social factors.

  • Xyrem (Sodium oxybate): In November 2014, Xyrem’s legal status changed, such that it is no longer illegal to import or possess in Australia. This created an opportunity for people with narcolepsy in Australia to gain access to Xyrem. However, there are still lots of regulatory hurdles to accessing Xyrem that I discuss in this post. Xyrem is now being used in select people with narcolepsy who are having difficulty with side effects or finding that current drugs aren’t working well for them, particularly at controlling symptoms of cataplexy. A specific breakfast session at the conference aimed to update physicians working with people with narcolepsy on the use of Xyrem.
  • Team approach to narcolepsy: Health professionals working with people with narcolepsy had the privilege of hearing from someone with narcolepsy about the impact it has had on their life. They heard a very open and real description of living with narcolepsy which really helped get a better understanding of issues facing people with narcolepsy. Dr Moira Junge also discussed her approach to working with people with narcolepsy as a health psychologist. Some of the points Moira discussed she had previously raised in this interview I recorded with her earlier this year. I’ve also had the opportunity to interview Julie Flygare about her personal experience with narcolepsy and some of the things she wishes friends and family understood to help support her managing her narcolepsy. You can find that interview here.
sleep apneaModels of care in OSA: There is currently a lot of debate amongst health professionals and government about different ways of diagnosing sleep apnea. For many years, the only pathway was seeing a sleep physician, having a hospital-based sleep study, then being seen by a sleep physician to discuss the results. Whilst this model provides a lot of contact with specialists and opportunity to discuss and personalise treatment, in many areas of Australia, the waiting list is years long, or sleep physicians are not accessible at all. This, together with research showing that simpler models, with GP referred home-based sleep apnea testing, could more efficiently diagnose and manage sleep apnea has led to the development of other models of care. Commercial interests wishing to sell CPAP machines have also entered the field. Together with increased awareness, this has led to a sharp rise in the number of home-based sleep tests being performed, something being reviewed as part of the current Medicare review process. At a breakfast meeting these issues were discussed with general agreement that a range of models of care need to be used to provide a timely and accessible service to people with sleep apnea. There will be further discussion of this as the Medicare review process progresses.
Surgery in the management of obstructive sleep apnea: A 2 day course was run for ENT surgeons on surgery for snoring and sleep apnea. The main message for me from this course, was that a contemporary approach to surgery in sleep apnea is to see it as part of an overall management plan, rather than a single curative procedure. Research supports this approach, with surgery being able to reduce the severity of sleep apnea, but getting better results when combined with other strategies such as weight loss, avoiding sleeping supine, use of a mandibular advancement splint or nasal EPAP for example. I discussed the role of surgery in sleep apnea with Assoc Prof Stuart MacKay, the convenor of the course, in this interview.

Interesting or new products

At the trade display there were the usual array of CPAP machines and masks for treating sleep apnea. However a couple of things stood out for me, that I think will be useful devices in investigating or treating sleep disorders.
Apnea-sealApnea-Seal: This NSW-based group have developed a process for making inserts for CPAP masks that are specifically moulded to an individual’s facial profile. A 3D image is taken, then they print an insert using 3D printing technology, that is designed to fit inside an existing CPAP mask. This allows a perfect fit and reduces leak. Whilst these inserts are around $500-600, many people I see have purchased multiple masks at $250-300 each in an attempt to fix leak. So for the cost of a couple of masks this could be a good solution.
sleep profilerSleep Profiler: This device measures EEG (brain wave activity) for up to 3 nights in the home wearing just a headband with the recording device and electrodes on the forehead. This is particularly useful in managing people with insomnia, who can have difficulty accurately estimating how much sleep they are actually getting. Danielle Kelly, from Melbourne Sleep Disorders Centre, presented a study of 11 people with insomnia who had sleep recorded using the Sleep Profiler and a sleep diary. On average people under-estimated their sleep by around 2 hours per night. In addition the Sleep Profiler is able to stage sleep and give insights in to sleep macro and micro-architecture.

snoring treatmentsMute snoring: Rhinomed have been promoting their Mute snoring device (shown right) as an over the counter snoring aid over the last year or so. That’s not so interesting as there is currently no published data, just a lot of marketing claims. What is more interesting is Rhinomed’s nasal EPAP device that is currently in clinical trials as a treatment for sleep apnea. It follows the same principles as other forms of nasal EPAP like Provent, with a set of valves that fit snugly in to each nostril. Rhinomed hopes to have results by early 2016.

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