Samantha Bramich - Paediatric Sleep Technician

Sleep is a fundamental part of looking after ourselves. When we sleep well, we can improve our overall wellbeing, mood, and cognitive function. 

In this episode, Dorian Broomhall gets to know Samantha Bramich, a Paediatric Sleep Technician at the Launceston General Hospital.  

Sam shares fascinating insights into how little is known about sleep, despite it being such a significant part of our lives. She walks us through the structure of our sleep cycles, the benefits each stage provides, and how these cycles are influenced by our biological clock. 

Sam also explains the role of a Paediatric Sleep Technician and the types of conditions that can be identified through a sleep study. She also discusses the limitations of smart watches and sleep trackers. 

Sam shares some practical steps we can take throughout the day to set ourselves up for a good night’s rest, including for those who struggle to fall asleep. 

Transcript

Dorian Broomhall          

Welcome to the One Health Podcast. This episode was recorded on the land of the palawa people. I acknowledge and pay respect to all Tasmanian Aboriginal people and to their deep history of storytelling. My name is Dorian Broomhall from People and Culture at the Department of Health here in lutruwita, Tasmania. For this episode, I had the pleasure of speaking with Samantha Bramich, a paediatric sleep technician at the Launceston General Hospital and a PhD candidate at the University of Tasmania.

Sam shares fascinating insights into how little is still known about sleep despite it being such a significant part of our lives. She highlights its profound impact on individual well-being and the broader benefits that greater awareness and understanding of sleep can bring to our communities. She walks us through the structure of our sleep cycles, explaining the typical patterns, the unique benefits each stage provides for our overall health and well-being and how these cycles are influenced by our biological clock or circadian rhythm.

Sam highlights that whilst sleep might not always be top of our minds during the day, there are practical steps we can take throughout the day to set ourselves up for a good night's rest. She also shares helpful tips for those who struggle to fall asleep, offering simple strategies to calm the mind and improve our sleep. I hope you enjoy this conversation as much as I did.

One of those things that when you're in kindergarten, you're probably not going, that's the direction that I want to go down and that's what I want to be when I grow up.

Samantha Bramich

I think if you ask anyone who's involved in sleep in general or in sleep research, they always say they kind of fell into it through some random route. I studied a Bachelor of Arts originally majoring in psychology and sociology, and I found the psych aspect really interesting, so I went and did honours in psychology as well. But after that, I fell into a job as a sleep technician up on the northwest coast. So I was working in Latrobe, sometimes Devonport and Burnie doing sleep studies in an adult lab. So it was all on the job training.

But I found it super interesting because it kind of combined psychology in the brain and how it all works, and I found it fascinating that sleep disorders had such a big impact on health. So after I worked there for a little while, I found that there was an opportunity at the Launceston General Hospital for paediatric sleep technicians. So I was lucky enough to get a role there and that just fueled my interest more and I wanted to learn more about sleep.

It does change a lot over the lifespan, so I studied a master of science in sleep medicine, which gave me a really great understanding of the anatomy and the biology of sleep and all the types of sleep disorders that can happen in life. And so after that, I was still really keen to learn more, so I went and started my PhD at UTAS. I'm nearly finished that and I'm researching the links between certain sleep disorders and neurodegenerative disease in later life. It was kind of just a thing that I'd never thought I would end up here, but it's just a really fascinating area.

Sleep impacts so many different processes. It's like our body relies on sleep for pretty much everything. So I've just always wanted to learn more and try and I guess improve other people's understanding of sleep because often, we don't know what it's all about. We all do it, but what does it mean? Why do we need it? Why is it so important? I'm very keen to convey more information about sleep in the community as well.

I don't think when you're at school or uni you think, oh yeah, sleep research is what I really want to do with my life because it's not a very well-known area. I think we've only been doing sleep research since the '80s. And it's come a long way since then, but there's still so much more that we need to do as in like brain research. We don't know everything about the brain, we don't know everything about sleep. There's so much more that needs to be done, but it's getting there.

Dorian Broomhall

Really interesting. I'll come to research in a second. Let's go back a step though because as you're describing this role of a sleep technician, can you run us through what that role actually is?

Samantha Bramich:         Yeah. So in Australia, we are called either sleep technicians, sleep scientists, or sleep physiologists. Basically a person who performs a sleep study, so a polysomnography, and that's where a person will come into either a sleep lab or an area of the hospital to have their sleep study. They do them a lot at home now for adults but not children, and we wire people up with a whole bunch of electrodes and sensors to monitor everything that they do overnight.

We've got electrodes on the head to monitor all the brain waves, and that tells us all about sleep stages so we can see whether they're in light sleep, deep sleep, dreaming sleep. We monitor all the body movements, the breathings. People generally come in for a sleep study if there's concerns that there might be a sleep disorder. So most often, they come in for investigations into sleep apnea. That's probably the most common sleep disorder that we investigate.

In children, we do have a bit of sleep apnea, but we also have a lot of other things that we assess in terms of breathing because for children who have say genetic disorders or muscular dystrophy type things, they come in for sleep studies so we can monitor how well they are breathing overnight because one of the things that happens when we're asleep is that our muscles relax a lot more than they do during the day. So if you have any kind of condition that impacts on breathing, it generally becomes a lot worse at night.

So we do sleep studies to monitor that and sometimes, we have to implement things like CPAP, which is the mask that people wear to push air into the airway to keep it open at night. So we do titrations alongside sleep studies so that way we can find the perfect pressure for that person to keep their airway overnight. It's just a test to measure sleep.

Dorian Broomhall

Really interesting. It seems a fair bit more in depth and probably accurate than what your watch, your smart watch might tell you after your night's sleep.

Samantha Bramich

Yeah.

Dorian Broomhall

These trackers can have upsides and downsides, I think.

Samantha Bramich

Activity monitors like watches, they're quite good at giving you an overview of your sleep. It'll tell you sort of around about how many hours you've slept. But when it comes to telling you how much of each sleep stage you've had, they just can't be that accurate because the only way to tell is to measure the brainwaves. And the watches generally use a heart rate, light movement to estimate those sleep stages because depending on sleep stage, we'll move more or we'll move less or a heart rate will change.

So it uses an algorithm to estimate, but it does sometimes overestimate sleep. Particularly if you're just laying quietly, it's going to probably say you're asleep even though you're awake. So it is a little bit hit-and-miss, but it does give you a good overview. But we try to say don't stress too much about it. If it's telling you something like, "Oh, you haven't got enough REM sleep," that's probably not right. So the only way to know is to have a sleep study.

Dorian Broomhall

The next bit that I suppose would be useful then as we start to talk about this idea of cycles, talk me through your one-on-one of sleep if you're telling someone for the first time how it works.

Samantha Bramich

Yeah, okay. So sleep, it's a natural process. So the longer we're awake, the more our sleep pressure builds up, so the more we feel sleepy and need to sleep. So it's our homeostasis, our biological homeostasis, so we will feel sleepy the longer we're awake and that's why we do fall asleep. But it's also dictated by our biological clock or our circadian rhythm.

So that has a lot to do with the cycle of the sun because as the sun comes up in the morning, it impacts on the production of different hormones in our bodies. So as it comes up, it suppresses the secretion of melatonin so that we feel awake. And then as it gets darker in the evening, our body produces more melatonin to help us feel sleepy and eventually fall asleep. So we work on pretty much a 24-hour cycle along with the sun. That does vary slightly, but that's pretty much like how we sleep.

And then once we do get to sleep, we have general cycles throughout the night. So it can vary if you've had broken sleep and whatnot. But in general, we always fall asleep and go into stage one. So that is our lighter stage of sleep. So often, it's very easy to wake from if you've just fallen asleep and there's a noise outside. You're likely to wake up because we're not really in it to a deep sleep yet. And that generally lasts a few minutes to up to 15, 20 minutes when we first fall asleep.

And then after that, we move into stage two, which is a light stage of sleep but not as light as stage one. And we spend a lot of the night in that stage. So that lasts from about probably another 20 to 30 minutes at the start of the night, and then we move into stage three and that's our deepest stage. So that's a stage of sleep that's really hard to wake from. If you've ever been woken in it, then you often feel really, really groggy and hard to wake up because it is really deep. And often, it's a good time to move children. If you wait about 30, 45 minutes, they should be in that really deep stage and you're usually able to pick them up and move them to bed and they don't wake because they're in that really deep sleep.

So they're what we call our non-REM sleep, so non-rapid eye movement. And then we move into REM sleep, which is rapid eye movement. So that is the stage of sleep that we do a lot of our dreaming, probably our most vivid dreaming in REM sleep, but we do know that we can dream in other stages as well. But most of the time, it happens in REM sleep and that'll last for another period of time.

All up, a cycle will last about 90 minutes. We go from stage one to three REM in about 90-minute cycles about four or five times throughout the night depending on how long we're sleeping for. But the length of each stage also does change throughout the night. So at the start of the night, we'll have a lot of deep sleep, stage three sleep. But then as the night goes on, that gets smaller and we end up having a lot more REM sleep. So that's often why when you wake up in the morning, you will remember dreams because you may have woken up in REM sleep or close to REM sleep, so you remember those things a bit more.

Dorian Broomhall

How do you think that we could think differently about improving sleep over a 24-hour period rather than just before we go to bed?

Samantha Bramich

It is a 24-hour thing. If you don't think about sleep at all during the time you're awake and then bam, you've got to go to sleep, it doesn't really set your mind or your body up ready to fall asleep at that time. Even though we have the sleep pressure, we have the hormones that are increased, there are things that you can do throughout the day to also inform your brain and your body that it's time to go to sleep.

So routine is incredibly important. So trying to go to sleep and wake up at the same time each day will really set your body clock up in a pattern when it knows that that is the time when I need to go to sleep when I feel awake. But there's also things you can do during the day that really help with sleep as well. So things obviously like caffeine, we know that that can have an impact on the ability to fall asleep. But in saying that, it is quite individual, so some people are not as sensitive to caffeine as others.

So that can be a bit of a trial and error figuring out how sensitive you are because I know for myself, if I have any coffee, tea after sort of midday, that impacts on my ability to go to sleep. But other members in my family will have a coffee at like 5:00, 8:00 PM and be able to fall asleep with no issues. But then again, they may think they fall asleep with no issues, but it could be that that caffeine is still in the body and it can cause more disruptive sleep overnight because it hasn't metabolised the caffeine. So it's a good idea to try and avoid that in the late afternoon.

Things like exercise are really important for sleep as well. We know that when you don't exercise, it can be incredibly hard to fall asleep because your body hasn't expended the energy and built up sleep pressure which exercise can help with. But then again, we also don't want to do that too close to bedtime. So you're kind of thinking about what time of day you do it because if you're doing some really high intensity exercise right before bed, that's going to excite your body and your brain and make it hard to fall asleep. But if you do it earlier in the day, then you're going to build up your sleep pressure as normal and there's not that excitement right before bed.

So I guess the main things, there's also alcohol consumption. So we know that having a glass of alcohol or two before bed can help you fall asleep, but overall having that alcohol in your system is going to fragment your sleep overnight. So you're not going to go into deep sleep as much, it's going to cause you to wake up a lot more overnight.

I think they're probably the main things to think of in terms of how to set yourself up for sleep. There's this notion that we need seven or eight hours sleep, unbroken sleep, everyone needs that. But sleep is really individual, so some people will need seven or eight hours, some people might need eight or nine, sometimes 10. Other people might only need maybe six or seven, so it is very variable.

And the thought that you're supposed to fall asleep and not wake up until the next morning is completely false as well because it's perfectly normal between those 90-minute sleep cycles when we come into that light stage, it's very normal to wake up briefly overnight. Especially as we get older, we often have to wake up to use the bathroom, things like that.

So once or twice a night for that is completely normal. Little awakenings throughout the night, completely normal. I guess that only becomes an issue if you wake up and then are having difficulty falling asleep because of other things. But it is a very normal thing. It's quite rare that people would sleep through without any awakening at all.

Dorian Broomhall

I'd love to know when we started talking about eight hours of sleep compared to the fact that you said something like we only started really properly researching sleep in the '80s, our sleep cycles are 90 minutes. Like many of our cycles throughout the day, our attention cycles usually can't exceed 90 minutes. It's a really great amount of time to never exceed for anything if you can avoid it because our performance drops off during the day. But of course for sleep, the cycle restarts. So it's interesting that eight hours is the myth that's perpetuated, though 90 minutes doesn't fit into eight hours.

Samantha Bramich

No, and I think it is an average. That's what they're going by. And I suppose this is a lot based on self-report as well because I think they've done studies where you've done a sleep study, you've measured how long they've slept and then you've followed up with a questionnaire the next day to find out how people are feeling. So I think on average, eight hours is the amount of time but it's variable.

Dorian Broomhall

We've sort of gone... All right, it's important if you want to think about how you sleep, the quality of your sleep, and how you fall asleep to consider all the activities that you might have throughout the day. Nuts and bolts though, as you are getting ready for, if you're someone who struggles to fall asleep, what should we be doing differently?

Samantha Bramich

As I said, routine is the number one. So if you're following a same routine for, I think they say it's 21 days to build a habit. So if you can follow a routine for about three weeks, then you're setting your body up to really instil a good pattern to be able to fall asleep. And that's not only like the waking up time and the falling asleep time, that's important for the routine but also what you're doing before bed. But if you have a set routine and you do the same thing each night before your bed, that signals to your brain and your body that, okay, yep, I'm going through these steps, that means I'm coming up to bedtime. So you're more likely to be able to fall asleep easier.

That can be anything. We recommend calming activities, so I guess you don't want to be doing gaming and things like that right before bed because that will excite the brain. There's been a lot of talk I think about blue light and how that can impact on our ability to fall asleep and that may suppress our secretion of melatonin and ability to fall asleep. And there is some evidence that that's the case, but they're thinking more these days that it's actually more the activity that you're doing on that blue light device that is causing your brain to stay awake.

Things like reading on a Kindle they think doesn't really impact your sleep even though there's some light there. But if you were playing a really exciting game or something with your phone or your tablet or your computer, then that excitement is more likely to impact your ability to fall asleep rather than the light coming out of a device.

Dorian Broomhall

Which sort of rings true for what I think is again, lots of anecdotal experiences that you hear that for the last 10 years or so where blue light has been demonised. But I fall asleep great in front of the TV and it would make sense because the light is actually not the issue, and watching television is actually very passive activity.

Samantha Bramich

Yeah, exactly. Exactly. You're not having to put a lot of thought into watching TV, you're just sitting there taking it in. So it's not exciting our brain in a way that doing a really interactive activity.

Dorian Broomhall

That routine before bed, if you know that it's not working very well for you, you're not falling asleep well, we actually need to practise how we do it. That idea of doing what for the next three weeks, I'm going to do the same routine in whatever that might be for me, but I'm actually going to practise doing it like that. We think that we should just be able to sleep, but sometimes we actually need to practise getting better at something.

Samantha Bramich

Yeah, that's it. There's so many things in our daily life and I think over the last decade, 20 years, sleep has got worse because there's so much that's going on during the day. We've got so many activities that can keep us awake, whereas 50 years ago, we didn't have things like once it got dark, it got dark and that was it. It's time to go to sleep. But now we've got all these different things that will keep us awake.

So I think it's about trying to stick to a set routine and if you've done that for three weeks and then found that you're still not able to sleep or you're still waking up during the night, you're still feeling really tired during the day, then that could indicate that there is something physiological going on. You may have a sleep disorder. You may have insomnia that needs addressing. I think it's giving it a really good go of getting your routine down pat and following that for a good period of time to see if it helps. If it doesn't, then it's worth investigating a bit further with the GP or psychologist or sleep medicine expert.

Dorian Broomhall

Yeah, I think that's a really great frame if I think about times in my life where I know that I haven't felt great, even though I've had plenty of sleep. If I'm really honest with myself, I'd probably need to look at my consumption, things like alcohol and go, well actually if I took three weeks off alcohol and didn't have any at all, I'd probably practise that first and assess that before making any other consideration that it's the quality that's going on that might not be the same.

Samantha Bramich

Yeah. You do sometimes have these micro-awakenings as well, which causes the fragmentation from alcohol, caffeine, other things. And so you won't often remember if you've been awake even though it may have been quite a few times. And that's similar to people who have sleep apnea where they stop breathing overnight because of blockage in the airway. They snore really loudly and then there's a pause because it gets blocked, and what happens is the brain has to wake up to get that muscle tone going again to get them starting breathing again.

So they can often be these really micro-awakenings and these people with sleep apnea don't remember that they've woken up, but their brain has had to wake up often hundreds of times a night to get them to start breathing again. But they don't remember those, but then they feel super tired and lethargic the next day and don't know why even though their brain and body has had to wake up a lot to keep them breathing.

Dorian Broomhall

When you describe it like that, it really sounds like a form of torture in the most brutal sense. And that idea that your conscious brain might not remember it, but the experience has absolutely happened. And that's shaping your unconscious brain and your ability to do so many other things. That's imprinted even if you don't remember it.

Samantha Bramich

Yep, that's exactly... And for some people, they don't know that this is happening overnight and they're feeling awfully tired, lethargic every single day and that becomes their norm. They often don't get investigations for it because they just think, "Oh yeah, that's just me. I just feel tired," until one day someone maybe says, "Oh, you snored really, really loud last night." And then they talk to their doctor, they have a sleep study, they start CPAP or some other treatment and they feel like a new person because they didn't realise that their sleep was so bad that it was causing to feel like this when they could actually feel so much better with a treatment.

Dorian Broomhall

You used the word homeostasis before over time when you practise being a certain way, you find a way to adjust to being like that. And you know if you've got kids, everybody goes through that pretty much experience. If you've got kids of not sleeping very much and it's incredible how well your body adapts once you've had some practise. The other bit then to that, people who waken in the middle of the night and then they struggle to fall back to sleep, any thoughts around that?

Samantha Bramich

Yeah. So that can be very normal. So often, we go through periods of life where we might have stresses, we might have things going on that make it hard for us to fall asleep because we might have something important the next day. We feel a bit stressed about that. So short term sort of inability to sleep is quite normal because usually you might have a day or two of that, but then your body will really push for you to get the sleep. So after a few days you will get that.

But if it's more long term, so I think we say more than three times for more than three, four weeks, then it would be classified as insomnia. So that's either difficulty falling asleep or difficulty maintaining sleep. So that's waking up during the night and not being able to go back to sleep. If it's very short term, there are some just behavioural things that you can do to try and help get to sleep. One of them is breath work, so that can be a really great thing when you're stressing and you can't get to sleep. If you take a big breath in and count to five and then out and you do that for about two minutes, it really calms, I think it's your parasympathetic nervous system and can help calm your brain and your body to be able to fall asleep a little bit better.

Clock watching is something that you should try to avoid. Often, people will be like, "Oh, it took me 30, 40 minutes to go to sleep." It's like, "Well, how did you know that?" "Because I was watching the clock." So, watching the clock can make it so much worse as well, so you try and avoid that. Meditation can be really handy. I know there's some apps that you can listen to that is any sort of thing that's going to calm your brain.

I heard a recent one actually from Matt Walker who is a pretty famous sleep scientist, and he was talking about some research into thinking about a walk or a journey. So if you think about your daily dog walk or something and you go detail by detail, so think about picking up the leash, hooking it on, walking out the door, a really simple mundane thought process can also help you to relax a lot more and stop thinking about all those other sort of things that might be stressing you out.

There's a few things like that that you can do, the same would apply for if you woke up during the night. One of the key things is if you haven't been able to fall asleep within about 20 to 30 minutes, get out of bed. There's no point staying in bed and trying because often that makes it worse. So, it's a little bit like sleep restriction. So if you can't sleep, don't just lay there because it's not going to give your body or your brain any signal that it needs to fall asleep. We recommend that you get out of bed and do some calm activity like reading, or you can just sit quietly and dim light until you start to feel sleepy, but nothing too exciting that's going to get you all worked up but something to help you build up that sleep pressure again to be able to fall asleep.

I think they're the things that you can do yourself. But as I said, if it does persist for a really long time, the best treatment that we have for insomnia is cognitive behavioural therapy, which involves a whole range of strategies that a psychologist or a sleep specialist can help you engage in to change your thought processes and behaviours and give you, I guess, better strategies to fight off that insomnia over time.

Dorian Broomhall

Funny is you talk about the Matt Walker example of a mundane activity. Turns out counting sheet is actually a useful strategy.

Samantha Bramich

Yeah, yeah, it can be. Although I did hear him say that it's actually not as effective as the mundane, because I think you are using more thought having to count kind of thing. Whereas if you're just doing something so ingrained, like every day, you take this path so you're just sort of thinking about that rather than actually engaging, thinking to come up with each number.

Dorian Broomhall

The other part on all of you're sort of talking about there too, that rings true for me, is again that idea of practise. We can practise falling asleep. Practise napping for 20 minutes during the day, just a short one, sub 30 minutes. And it doesn't matter if you don't fall asleep, but you're practising  the motion of trying to do it.

Samantha Bramich

Yeah, yeah, that's a great idea. Napping is often frowned upon. People think, oh, if you've had a nap, you're lazy kind of thing. But as you said, using it as a practise sort of strategy to ingrain, I guess what you know is going to work for you can be really handy. But also, if you have had a bad night's sleep due to whatever reason, there's no harm in having yet that short 20-minute nap sort of middle early afternoon because it does give you a boost of energy to go on for the rest of the day.

The Sleep Health Foundation of Australia was approached to contribute to the Tassie thing, and so I've been involved in then. So they're like, "Oh, Sam, do you want to go along?" And I was like, "Yeah, I'll go along," just to see if there's anything I can contribute. And I was thinking specifically about sleep pods. I think it's so important because we all have bad night's sleep. And if you want to increase people's health and productivity, then allowing a space where people can have a quick nap in the workplace would be a great-

Dorian Broomhall

Totally, and it's something I think one of the learnings that hopefully was captured through COVID, when you've got an emergency management situation and you've got people in the workplace for a stupid number of hours because they're the expert and they kind of have to be...

Samantha Bramich

That's right.

Dorian Broomhall

That's sort of the mitigation strategy for it in the short term to have those quiet rooms, sleep pods, even bean bags, whatever it can be to just help people get that short shut and to normalise that.

Samantha Bramich

Yeah.

Dorian Broomhall

I'm with you. So your research then, my oversimplified understanding of it would be something like if you have prolonged periods of sleep that is really no good, that can possibly lead to some pretty significant outcomes cognitively for us, some significant deteriorations. But it sounds to me like what you are researching is very much the pointy end of people who have got significant cognitive decline possibly leading to dementia and it could have a link to sleep.

Samantha Bramich

So I can talk about that in general and then more specifically about my research if you like, because my research is a little bit more niche. We know from years of research that poor sleep over the lifespan does increase mortality. Fragmented broken sleep over many, many years will increase your risk of dying earlier. Why that is, there's so many different variables that can impact it, but one of them we think is probably likely to sleep apnea. That's the sleep disorder where you have a lot of snoring, pauses in your breathing because of blockage in the airway, and having to wake up multiple times a night.

And what that does is it actually decreases the oxygen to your brain. We think cognitively that has a really big impact because you're not getting the oxygen that you need for your brain for many hours overnight. And so that contributes to this decline in cognition over time and we think does increase people's risk of dementia. But along with that sleep disorder, it also increases your risk of a lot of other diseases such as diabetes and heart disease.

If you think sleep is a period where we do a lot of rest, our brain is very active in some parts. And if you're not getting that because this sleep disorder is keeping you awake all night, then that's going to have ramifications for so many other biological systems that are trying to do their processes overnight. But they just can't because they can't follow the usual routine, because there's this physiological thing happening that's disrupting all of the processes. So we think that is a really big factor in the development of other diseases in later life.

Insomnia, I'm not so sure whether that has an impact, but I would assume if it's long-term sleep deprivation for many, many years, that's also going to have an impact on our disease in later life because of, again, the disruption in the normal processes we're supposed to be doing while we're asleep.

So what I'm researching is actually a sleep disorder called REM sleep behaviour disorder. In REM sleep, as we talked about a bit earlier, that's our main dreaming sleep stage. And what happens is we actually lose muscle tone. Our brain sends a signal to our limbs down to stay relaxed because if it didn't, we would actually act out what we're dreaming. And that's what happens in REM sleep behaviour disorder.

So there's something happening in the brain that stops that signal getting to the limbs and people do act out whatever they're dreaming. It can result in some quite violent actions because we find a lot of people dream about being attacked or defending themselves, and so there can be a lot of arm movements. But the problem is people who have this disorder very rarely know that they have it unless they have injured themselves or fallen out of bed and thought, "Oh, that's not normal." So it's not unless they have a bed partner that notices something going on that it's generally brought to the attention of a GP and referred for investigations.

But it's actually a really significant sleep disorder because there's been some longitudinal studies in America and in Europe that have followed people with this sleep disorder over many years and found that within about 10 to 20 years, most people, they usually develop this disorder in their fifties. Most will go on to develop a brain disease in later life, usually Parkinson's disease or dementia with Lewy bodies.

So the sleep disorder is now considered sort of a prodromal stage of these other disorders, even though they might not be showing any other symptoms. So they might not have any memory trouble yet. They might not have any movement symptoms like shaking or rigidity of Parkinson's. They have something going on in their brain really early on that is developing, turning into degeneration, which results in these other diseases.

So what we're looking at in Tasmania is how many people have the sleep disorder because we don't actually know. There's never been any studies done in Australia. In other countries, they've estimated at about one to 2% of people over the age of 50. But we're also looking at whether people with REM sleep behaviour disorder have any other characteristics that can help us understand or determine which disease pathway they're going to take.

So at the moment, we don't really know why some people will develop Parkinson's and some people develop dementia with Lewy bodies. They have similar disease characteristics in terms of the changes in the brain, but the symptomology is quite different for each of them. So we are trying to do a bit of research to figure out what's going on, and then if we can understand more about this process, we'll have an opportunity to implement clinical trials and possible medications to either alleviate symptoms or we are hoping there's a possibility that we can change that trajectory so people don't go on to develop these diseases. But there's just not enough known about it yet for us to do anything.

Dorian Broomhall

The research that you're doing is sort of an early signal detection of what could come later, and of course the hope being the earlier steps that we get, the easier that might be to have an intervention even if we don't know what those interventions might be yet. Once we get a better picture of that to then go, okay, but what's happening to those steps before that? What's people sleep like normally? Is there a link there? I'm so interested in that because I think that the physiological nature of sleep and what that means for us, that you can't not have an impact if it's not working well, right?

Samantha Bramich

That's it. It's so vital to overall health. And the thing about Parkinson's and dementia, there's no cures for those diseases. If we can find people in the earlier stages, and if we can test disease modifying drugs, then we have an opportunity to develop cures and treatments for these. But the only way to do that is to find people who may be in this early stage and get them involved in research so that we can have an impact on decreasing the prevalence.

Parkinson's, it's the fastest growing neurological condition in the world and there's nothing that will stop it. And we don't know why it's increasing, it could be a lot of environmental factors, but we know that REM sleep behaviour disorder is one of the earlier symptoms. So what can we do to help these people and delay or even prevent them from progressing over time, we just don't know.

Dorian Broomhall

Fascinating. It's such an important space to be playing in. It's like dedicating so much time to working in something like that that is so big but also the time delay, or the time... How do I put this? What you're working on is going to take a whole generation for us to understand what's going on and what the changes are going to be. That's so different to how so many of us live in this short term, what's on today, what's the next thing this week, how do I get that new hit, that next thing? What's it like working in a space that is that longitudinal?

Samantha Bramich

Yeah, and it's hard because I guess a lot of research is like that. So you'll have your lab-based research that'll find something at a dish, but it may be decades before that's translated into person-centred treatments. So I think that's the nature of research. It could be hastened with money because all research relies on funding. So if there was an endless amount of funding, you could dedicate so many people and so much time to solving these problems.

And we saw that during COVID, so there was so much invested into the vaccine that that came out so quickly. But for every other disease, the resources just aren't there to contribute that amount, which is really sad because we know that these diseases have such an impact on not only the individual but community as a whole and the resources and the expenditure and the healthcare system and things like that. So if we could invest more into the research to try and solve some of these health issues, it would be ideal.

But I guess in terms of my research, a PhD is a tiny speck in the realm of research. So I know that it's only a little bit, but I hope it'll contribute to the broader picture and that we will be able to follow a path to treatment and cure. But on a more local level, I think that this research project, the ISLAND Sleep Study that we've started at UTAS has really had some benefits for our community because people with the sleep disorder, first of all, not many people know about the sleep disorder. Even some medical professionals don't know about the sleep disorder because it is quite rare, and they don't see it a lot in general practice. And there's not a lot of education about sleep disorders through medical education and things as well.

So I think we've really tried to, I guess, bring that out in the open so that people who do have symptoms are more aware that, oh, yeah, my husband kicks me every night. I just thought that was him just being restless. But it really is opening those conversations and getting people to seek more treatment and more advice around it and potentially being diagnosed down the road, which they wouldn't have had any knowledge to do so unless they had seen what we were doing at UTAS.

But then for people also enrolled in our study, we try and give back to them because we know if you receive a diagnosis of REM sleep behaviour disorder and you go and Google it, you're going to see all this research that shows, oh, yes, you're probably going to develop on these diseases. So it can be really not a nice thing.

So what we do for them is we will tell them what we've found because they're having sleep studies and we tell them if we find that they have that, then we give them an opportunity to see our neurologist to discuss the diagnosis and to talk openly about what it means for them and also give them treatment advice and things. It can be a lot of, there's not really so many treatments but there's a lot of strategies people can do to keep themselves safe within the bedroom due to the movement. So we try and improve their wellbeing by telling them what we think is going on, but also providing them with a lot of support long term.

And I think that isn't something that's readily available to people within the health system because I don't know if you know, we only have one sleep laboratory in Tasmania, which is in Hobart. We do home sleep studies around the rest of the state, but home sleep studies can't actually diagnose REM sleep behaviour disorder because they don't have the additional electrodes that we need to measure that. So people will go undiagnosed for years, if not forever, because one lack of awareness and two, lack of services or access to services that can provide diagnostic opportunities for them.

So I hope that through our research we're able to just have a slight little good impact on the people of Tasmania as well.

Dorian Broomhall

I love how you were managed in your response there to touch on so many different perspectives at so many different logical levels. I don't think that anybody who's ever undertaken a PhD would find it a tiny speck for them. However, when you put that in the context of all the research, it's sort of massive and can be overwhelming.

But then to come back in and go, well, what other good can we do with that and how can we have an impact right now despite the challenges or the wicked bind that we've got of needing to fund the conditions that we're treating in the health system right now and to try and fund stopping those existing in 20, 30 years is a really, you've articulated a lot in all of that. But to have that frame of, yeah, and we can do something and everybody that we can help, that's actually, that's rewarding in itself, right?

Samantha Bramich

Yeah. That's what I think I get the most out of it. Through my research, I do telephone calls with all of our participants to ask them more about their sleep, and then myself or a research assistant does the sleep studies. So we get to know our participants really well, and I find that that's the most valuable thing that I've gotten out of my PhD is to meet all these people and to hear their stories.

And I think by hearing their stories, it really makes me want to pursue the area even after my PhD because I can see that it has such a big impact on people's lives. You hear about couples that they can't share a bed any more because of the movements happening with one partner overnight. And that fragments relationships as well if they want to do that. So it's been really, really interesting and heartwarming, but also very sad experience as well hearing about all these symptoms.

So yeah, I'm hoping that through the research path, we will be able to have a small-scale impact in Tassie. But also overall, we will contribute to the bigger picture and hopefully be able to help a lot more people.

Dorian Broomhall

I love that. It's a really nice example of a story means a lot more than a set of statistics. You get to know the stories within the statistics and find meaning in that for what you do. And I think that that's a brilliant reframe for any of us who ever have that moment of going. But the problem is just too big and what can I possibly do? But to be able to find something in that for yourself and to find the small wins that also have big wins for other people is a great, great reframe.

Sam, last thing I want to ask you just a little bit more of a general thing. If you think people are more interested to learn more about sleep or they do want to go down any sort of rabbit holes after the conversation today, any resources in particular that you might recommend?

Samantha Bramich

Yeah. The Sleep Health Foundation website is amazing. They've got so many fact sheets and it's all developed by researchers and scientists and medical professionals in the area of sleep. So I think that's the best place to go if you want to get an overview or a rundown on a specific sleep topic.

I would say in terms of people's individual sleep, the best way to know if you are getting good sleep is how you feel the next day. So if you've done all of your sleep hygiene and all of your routine and got that down pat for at least three weeks and you're still feeling really tired, lethargic, foggy during the day, then it's worth chatting to your GP about getting a sleep study because I think everyone should get a sleep study because you don't know what you're doing when you're asleep. So I think it can be really beneficial, even if it's a home sleep study, it's going to give you a wealth of information.

And then we do have sleep specialists in Hobart that they have a department at the Royal now. So there are people who can help if you do have a sleep disorder or serious concerns with your sleep as well as psychologists for that CBTI aspect as well if needed.

Dorian Broomhall

Great. It's good to know that there is support out there and that we're only so early into this journey of learning. And I think if you're going to be interested in anything about yourself, getting curious about your sleep and objective as well, not panicking, I think if you're going to start to think about how am I today, how was my sleep, take notes over a period of time perhaps because your perception on one day you might get into a spin about it. But actually if you look back over three weeks, oh, actually it's perhaps not as bad as I thought. Or actually, there's a bit more of a pattern here of something being maybe a little bit worse than I realised, but it's only when I look at all of that minor evidence.

Samantha Bramich

Yeah, that's it objectively. So you can keep a sleep diary, like a 24-hour sleep diary if you really want to keep track and try and figure out if there's any pattern as to why some nights you aren't sleeping well compared to others. You can find them online and you pop into that when your meal times are, when your exercise times are, what time are you going to sleep and going awake. And you do that for two or three weeks to get an idea of whether there is something in particular that you didn't notice before.

But then when you look at it on paper, you think, oh, that is a pattern and every night, I'm having a bad sleep and I've done that during the day. So then you can try and change certain things that may be having a big impact that you didn't realise before.

Dorian Broomhall

Yeah, that's a really great suggestion. Sam, thanks so much. It's been such a great conversation. Really appreciate you taking the time.

Samantha Bramich

No, thank you for having me. It's been fun.

Dorian Broomhall

Thanks to Sam Bramich for taking the time to speak with us and to you for listening. I hope you found something in our conversation that you can take away and use in your own life.