78.png

WAKE UP
PROBLEM

to the

writeonrita3.png

PhD Research

Why Sleep?

Epidemiological studies suggest insomnia symptoms occur in approximately 35%–50% of adults, with approximately 10% meeting diagnostic criteria for insomnia.

Insomnia is characterized by chronic difficulty with either falling asleep, staying asleep, or waking too early with associated daytime impairment(s) occurring 3 times/week for 3+ months.

"...disrupted sleep
is a public health
pandemic..."

World Health Organization, 2021

Globally Highly Prevalent

Disordered sleep and insomnia are highly prevalent, estimated to impact 30-60% of the world's population, and are on the increase.

Learn More
Disease
Risk Factor 

Sleep plays a critical role in physical and psychological well-being. Chronic sleep problems are linked to worsened health outcomes.

Learn More
Image by Toa Heftiba

A persistent difficulty falling or staying asleep that impairs daily functioning is the most common type of insomnia. 

Can't fall asleep!

Onset

Insomnia

Can't stay asleep!

Maintenance Insomnia

Chronicity of sleep problems over 3 months and level of impairment differentiates acute from chronic insomnia. 

websiteorange_edited.png

Sleep
Takes Out
the Trash

The image is credited to Laura Lewis, Boston University.

During sleep, the brain does its housekeeping.

The change in neural activity associated with sleep results in the flow of blood out of the brain, to be replaced by cerebrospinal fluid (CSF) that rhythmically removes the toxins associated with neuronal activity.

 

Disrupted sleep prevents the needed clean-up, resulting in a buildup of toxic proteins that appears to be associated with impaired brain function.​

Research by Fultz et al., (2019) shows large rhythmic waves of CSF during deep sleep (blue) occurring immediately after waves of oxygenated blood (red) leave the brain.

IMPACT
of Chronic
Disordered sleep

Premature Death

Disordered sleep is a risk factor in 8 of the 10 leading causes of premature death or preventable diseases. It is associated with greater health care utilization.

Risk Injury

Disrupted sleep increases the risk of all types of accidents and injuries. The relationship between poor sleep and motor vehicle accidents is very strong.

Preventable Co-Morbid Diseases 

Many of the physical disorders that are associated with disordered sleep are preventable and insomnia is frequently reported in psychiatric disorders.

 

Poor Health

Chronic insomnia is associated with a long period of difficulty falling or staying asleep and is associated with an increased risk of multiple health conditions including cardiovascular disease, Alzheimer’s and Parkinson's disease, cancer, diabetes, obesity, and pain.

Insomnia Risk Table.jpg

DISRUPTED SLEEP

"...the canary in the psychiatric coal mine..."

Disordered sleep is endemic in all psychiatric disorders and is believed to have a bidirectional relationship. Insomnia is a risk factor for depression, anxiety, PTSD, and suicide.

Emerging research points to sleep as the trigger of psychiatric disorders.

webpsych.jpg

Insomnia &
Psychiatric Disorders

Disrupted sleep is a presenting, predisposing, precipitating, perpetuating, and protective factor

in all types of psychiatric disorders.

 

Insomnia is the most common sleep disorder and is predictive of the new onset of depression, anxiety, alcohol

and substance use, nicotine dependence, recurrence of depression, and worst outcomes.

 

Disordered sleep during adolescence equates to an increased risk of depression in later life.

Difficulty falling asleep, early morning awakening, and hypersomnia are risk factors for suicidal behavior independent of psychiatric history, in adolescents and adults.

Insomnia & Depression

COMMON Pathophysiology

The striking association between insomnia and depression in so many studies suggests that insomnia is an early marker for the onset of depression, and the two may be linked by common pathophysiology.

Although the pathophysiological relationship is not known, the overlapping neural pathways that regulate sleep also regulate mood and anxiety.

It's unclear if the temporal association between insomnia and psychiatric disorders is an early manifestation or potential trigger.

The impact of insomnia is believed to be bi-directional, with the strongest causal pathway being disrupted sleep preceding psychiatric illness.

Disordered sleep is a more powerful predictor of suicide than a suicidal intent or plan. 

sleepcircuits.jpg

Sleep Circuits for A: Wakefulness, B: Non-Rapid Eye Movement (NREM), C: Rapid Eye Movement (REM) 

#1

Depression

Globally depression is the leading cause of disability and is strongly correlated to insomnia.

depression_global.jpg

Increases Wellbeing

2_edited_edited_edited.jpg

 Untreated insomnia negatively impacts health and well-being resulting in reduced quality of life.

Reduces
Risk

3_edited_edited_edited.jpg

Disordered sleep is a risk factor for all psychiatric disorders and death by suicide.

Improves
Mood

7_edited_edited.jpg

Chronic sleep problems make depression and anxiety more likely to start, persist, or return.

Treatment
Recommendations

Cognitive Behavioral Therapy is a type of structured evidence-based talk therapy (psychotherapy) that was developed for the treatment of depression.

 

With the support of a trained therapist, typically over 12 consecutive psychotherapy sessions, an awareness of the negative thoughts contributing to depression is made and new ways to view and challenge those thoughts are learned.

Multiple studies have shown the efficacy of CBT to treat depression and considering the prevalence of insomnia with depression, a modified version of CBT was developed to target disordered sleep.

 

CBT for insomnia (CBT-i) has become a first-line treatment for insomnia across the globe

Teal and Green Healthy Lifestyle Health Infographic Poster (5).jpg

IMPORTANCE
Insomnia Treatment

For many insomnia is a new symptom after recovery from depression and anxiety.

In 94.6% of people, insomnia persists after depression symptoms have improved.

Approximately 80% of people who wake in the middle of the night can't resume sleep.

38_edited.jpg
Image by Olga DeLawrence

Adjunctive Treatments

​Medications such antidepressants, anxiolytics, and sedatives can lead to improved sleep as a function of treating another psychiatric disorder such as depression or anxiety.

Behavioral Treatment

Cognitive impairment, lack of attention, memory, and focus associated with depression pose challenges to cognitive-based treatments.

Promising New Treatments

The distress and risks of under-treated insomnia and the limitations of cognitive-behavioral approaches warrant exploration of alternative treatments and delivery modalities.

Different approaches have been explored for the treatment of disordered sleep that focus on addressing the overthinking or inability to 'switch off' that many people with insomnia experience.


Mindfulness-based approaches have the benefit of providing a means to be aware of unwanted thoughts that may be contributing to depression and disordered sleep while supporting the urge to address the thoughts, to avoid or challenge them. 

37.jpg
Stress & Anxiety Contributes to Inability to Fall Asleep.
insomnia_graphic_edited.jpg
Worry & Demands Associated With Early Rising.

Mindfulness
Stress Reduction 

Jon Kabat-Zinn at the University of Massachusetts Medical School, Center for Mindfulness brought mindfulness meditation outside of traditional eastern practices.

Mindfulness has no religious connections it's an approach that teaches different ways to reduce stress and anxiety,

By learning to be aware and accepting of unwanted or distracting thoughts by learning to not respond to them facilitates sleep.

mbsr.jpg

Therapeutic Application of
Mindfulness for Insomnia

Mindfulness has been shown to improve reduce stress, anxiety, depression, and pain and concurrently improve disordered sleep.

It's hard to sleep when you're in pain.

Mindfulness
Facilitates

Lower Pain

Effectively lowers pain and stress.

Better Sleep

Reduced pain better sleep.

For Everyone

Suitable for all insomniacs.

Mindfulness
Training
Takes Time

Distraction is all around. Focusing is difficult.

Facilitating
Mindfulness Practice

Findings ways to offer the benefits of mindfulness while overcoming the initial challenges of developing a mindfulness practice mindfulness and developing sustained attention and focus to benefit more readily from mindfulness.

Power

Virtual
Reality

of

The

Not just for gaming.

Visual System

The visual system is the highway that delivers information to the brain and appears to modulate cortical activity.

The information captured by each eye travels through its respective optic nerve arriving at the orbito-frontal region of the brain to then be combined at the optic chiasm to enable stereoscopic perception. 

 

The information from the visual field is then relayed to the lateral geniculate nucleus (LGN) located in the  hypothalamus and processed.

visual system.jpg

Image: Miquel Perello Nieto, CC BY-SA 4.0 via Wikimedia Commons

Brain Circuits

Using optic radiation, the LGN then sends the information to the right and left primary visual cortex, and the associated visual cortex located at the back of the brain just above the cerebellum.

A few axons (nerve cells) in the visual system connect to the superior colliculus in the mid-brain that controls eye movements. 

The visual system is part of the central nervous system and outside of conscious control. VR uses the visual system to modulate brain circuits and facilitate focused attention.

Anyone Can Use VR

2.jpg
Man in VR Cafe_edited.jpg
5_edited.jpg

Therapeutic Applications of VR

PAIN

VR is extremely effective at providing pain relief during medical and is comparable to medication. 

Image by XR Expo

INJURY

Has been used to support rehabilitation following physical injury in clinic and at home.

VR controllers

FEAR

Used in the management of mood and anxiety disorders including phobias and PTSD.

Suitability of VR for Insomnia

S

SCALABLE

Different populations, and skill levels, supports rehabilitation in clinical settings and encourage at-home treatment adherence.

 

Treatment delivery has high acceptability and user engagement.

 

Enables entertaining, adaptive feedback, increasing motivation and improving outcomes.

 

Is an ecologically valid environment to explore factors that contribute to insomnia.

L

LOW-RISK

A meta-analysis on the safety of VR treatment reported significant low to large changes in outcome with low attrition rates.

 

The use of VR technology supports a safe and rapidly efficacious modality for the delivery of psychological treatment.

 

Evidence of VR's ability to address comorbid cognitive impairment and chronic pain as a secondary benefit.

E

EFFECTIVE

 

Four weeks of twice-weekly VR for insomnia resulted in significant reductions in anxiety and improvements in mood.

 

Patients in intensive care showed improvements in sleep quality using a VR meditation protocol, recommended addition to clinical care.

 

Faster sleep onset, fewer awakenings, lower heart rate during sleep, and less sleep fragmentation using VR relaxation vs control.

E

EQUIVALENT

 

Comparable efficacy for Phobia treatment has used VR exposure to gold standard in-vivo, may surpass once procedures improve.

A meta-analysis of VR for depression and PTSD reported greater symptom reductions compared to waitlist and control.

 

In a review of 285 VR studies, 54% focused on psychiatric disorders concluded the strongest evidence for the treatment of anxiety.

P

POTENTIAL
 

Has the potential to reduce insomnia associated with environmentally conditioned responses.

 

The objective impact of VR treatment in Parkinson's patients showed improvements to sleep quality and sleep-related biomarkers.

 

Merging VR and biometric devices enables improved treatment by behavioral modifications and learning to target individual symptoms.

Virtual Reality

black VR smartphone headset on yellow su

VR for insomnia has the potential to help millions of people live longer, healthier, happier lives.

The potential cascading impact of improvements to the available treatments for insomnia may lead to a reduction in its associated risks of preventable chronic illnesses and frequently co-morbid mood and anxiety disorders.

PhD Supervisors

I am fortunate and extremely grateful to have A/Prof Lisa Lampe, MBBS, PhD at the University of Newcastle an expert on anxiety and A/Prof Christopher Gordon,  RN, PhD, at the Woolcock Institute experts on sleep as my PhD supervisors.

Stay fit with VR_edited.jpg

GET IN TOUCH

I'd love to hear from you