Micromanaging Human Sleep Physiology to Treat Sleep Apnea and Other Disorders - PROJECT SUMMARY Poor sleep impacts health in many ways, so improved sleep could yield wide-ranging public-health benefits. Sleep-disordered breathing constitutes a huge public-health problem and current treatments fail for many patients. Lapses in breathing can fragment sleep, disrupt oxygen levels, and cause other problems. Contemporary treatments for sleep disorders and recommendations for sleep hygiene are valuable, but more can be done to engender health-promoting sleep - this project will introduce new strategies for real-time modulation of sleep physiology that have not been applied or tested in this context. Basic memory research has shown that memory networks in the brain are active during sleep and that we can alter this activity. Variants of this method here won't aim to improve memory, as in our past studies, but rather to impact physiology to yield specific health benefits. Using soft sounds that avoid sleep disruption, with state-of-the-art monitoring devices applied in the home (nasal respiration, in-ear EEG, and chest EKG), we aim to change what people do during sleep - their mental and physical sleep habits. The moment one falls asleep, one's sleep physiology seems automatic and largely beyond control. Yet, our twofold premise is that (1) memories and habits naturally reactivate during sleep, and (2) we can intervene to strategically modify this reactivation to achieve specific health-focused goals, transcending basic memory research, as follows. We start with obstructive sleep apnea patients without structural upper-airway abnormalities. Poor neural control of breathing during sleep likely contributes to many such cases. Patients will first undergo extensive daytime training to elicit inhalation when a cue sound is played, such that responses become automatized. After training, patients continue emitting the conditioned response at night as they fall asleep and, remarkably, they continue to do so during sleep, thus reducing apnea symptoms. Lab studies testing the methodology will pave the way for at-home studies; this therapy is designed to be easy-to-use in the home via wearable tech and sound delivery configured to avoid arousal and target periods when respiration is insufficient (i.e., closedloop stimulation adjusted based on real-time respiration, movement, and EEG recorded wirelessly). Expansion to additional applications will be guided by evidence-based methodological insights and will fuel the development of a new understanding of high-quality sleep. For example, people with or without apnea may have affect-laden sleep that is maladaptive, as when unconscious rumination pervades sleep. We thus seek to bias overnight thinking in positive directions to enhance sleep quality; sound cues during sleep will displace anxious- or depressive-memory retrieval by promoting positive-memory retrieval. Given that suboptimal sleep is associated with poorer outcomes for mental and physical health, we envision a means to optimize sleep by correcting maladaptive muscular or affective activity, The high-risk challenge is to develop noninvasive, lowcost, precision-sleep-control interventions with adaptive protocols to produce better sleep at home.
