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By John Schieszer
Medical Minutes 

Improving sleep; Combating Parkinson's

Medical Minutes

 

November 1, 2018



Using new technology to get a better night’s sleep

A whole new approach to getting a good night’s sleep just a click away. A new study from the University of Oxford and Northwestern Medicine has found treating insomnia with digital programs can improve insomnia symptoms. In a year-long study involving 1,711 people, researchers found online cognitive behavioral therapy (CBT) improved not only insomnia symptoms, but functional health, psychological well-being and sleep-related quality of life.

A major limitation of insomnia treatments is the lack of providers to deliver CBT, but this study used an online platform that made it easily accessible to users. It also automated and tailored the treatment based on the user’s sleep patterns. Study co-author Jason Ong said there is a four-to-six month wait for an insomnia patient to get an appointment in his sleep clinic. “We can reach many more patients with insomnia by using a digitally based program,” said Ong, associate professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Insomnia has been identified as a risk factor for the development of mental health disorders, cardiovascular disease and type 2 diabetes. “Sleep ranks with air, water and food as one of the essentials of life, yet 10 to 12 percent of the population doesn’t get enough of it due to insomnia,” said lead study author Colin Espie, Oxford University professor of sleep medicine and chief medical officer of Big Health, a provider of automated and personalized behavioral medicine programs for mental health.

He said these study findings, which were published in JAMA Psychiatry, suggest that digital medicine could be a powerful way to help millions of people not just sleep better, but achieve better mental and physical well-being as a result.

Though insomnia has traditionally been treated with pharmaceuticals, new guidelines published in 2016 by the American College of Physicians recommend that CBT be used first-line, ahead of sleeping pills. Study participants received treatment using the Sleepio program and an associated iOS app.

Delivery was structured into six sessions lasting an average of 20 minutes each, with participants having access to the intervention for up to 12 weeks. Researchers assessed the study participants online at 0 weeks (baseline), four weeks (mid-treatment), eight weeks (post-treatment), and 24 weeks (follow-up). Program content was based on CBT manuals and included behavioral, cognitive and educational components.

In the digital CBT (dCBT) group, 689 participants (80.8 percent) logged on for at least one session, 491 participants (57.6 percent) completed at least four sessions, and 413 participants (48.4 percent) completed all six sessions. At each follow-up visit, dCBT was associated with significant improvement in global health and mental wellbeing.

Combating Parkinson’s disease in a whole new way

Parkinson’s disease is really a blanket term for many different conditions. Until now, it has been hard to sort them out into different categories. Now, thanks to molecular technology it is possible to apply precision medicine to Parkinson’s disease.

Precision medicine allows physicians to provide the most tailored diagnostic tools and treatments for patients. By knowing the nature of a disease with molecular-level accuracy, doctors can treat that root cause. Researchers at Penn Medicine in Philadelphia just announced they are launching the Molecular Integration in Neurological Diagnosis (MIND) Initiative.

“We have long recognized that no two people with Parkinson’s are alike. Patients have big differences in their symptoms, responses to medications, and to the side effects of treatment,” said Alice Chen-Plotkin, MD, a neurologist who is heading up the initiative. “This new initiative aims to define groups of patients based on how one’s genes or other biomarkers contribute to these differences and to improve the diagnosis of Parkinson’s disease and develop better treatments in the future.”

Movement disorders is a large umbrella term for Parkinson’s disease, tremor, Huntington’s disease, and other neurological conditions that affect the speed, quality and ease of movement. But there is a wide range of characteristics within each of these groups. For example, within Parkinson’s disease, some patients barely progress over a two-year span, where others will have symptoms of Parkinson’s that progress more quickly. The MIND Initiative will bring precision medicine techniques to Parkinson’s research to uncover why this happens.

The goal is to enroll 2,500 patients and collect medical information such as family history and personal symptoms of Parkinson’s as well as a blood sample from participants. The purpose is to find out how each subject’s genetic make-up can be analyzed to improve a clinician’s ability to diagnose Parkinson’s and select the right type of therapy for each individual.

In the short term, this allows the center to identify large numbers of individuals with genetic mutations that may make them eligible for experimental therapies. This type of knowledge is valuable for patients and for researchers. For example, mutations in the GBA gene occur in five to 10 percent of Parkinson’s patients, and treatments targeting this genetic subgroup are already in clinical trials, yet most neurological clinics lack comprehensive ability to find mutation carriers.

“Right now, patients involved in research give their time, DNA samples, and more, but they usually get very little back beyond the hope that their contributions help find better treatments for people with their condition,” said Tom Tropea, who is an instructor of Neurology at Penn and member of the MIND Initiative team. “We’re passionate about this center and our patients, and want to offer them the opportunity to stay engaged with our findings and opportunities for clinical trials. This type of knowledge is valuable for patients and it’s another way to thank them for their time.”

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.

 
 

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