Science in the Field: Exploring the Personalisation of Sleep Health with Dr. Mitchell Turner

Sarah Hull: I always love to find out how people ended up in sleep. Can you share a little bit about your background and what drew you to specialise in sleep research?

Mitchell Turner: I didn’t start out in sleep. I had a sports science background and wanted to work in elite sport. I started my PhD, looking at different factors that were influencing performance, and specifically in tennis players. Throughout that, sleep obviously came up a fair bit and my supervisor suggested I go and do the adult sleep science course at UWA with Jen and Kath – who you spoke with in a previous podcast episode.

That sparked my interest in sleep. I ended up switching my entire PhD to focus solely on sleep and chronobiology or, you know, the effects of Diurnal variation in tennis players, and then started working with people with neurological conditions in sleep. Now all my PhD research is solely focused on sleep and chronobiology, so I’ve completely switched gear and I’m quite happy doing it.

Sarah Hull: It’s funny how it sucks you in, isn’t it? Nobody starts in sleep, but we all end up there.

Mitchell Turner: Yeah, it’s one of those things we know influences so many different parts of our life and so many different people, whether it’s working with athletes to shift workers, to people with neurological conditions. It’s the impact of sleep across the board, and it’s nice working in a field you can apply to so many different populations.

Sarah Hull: Yeah, absolutely. Can you share with us about the projects and research you’re working on right now?

Mitchell Turner: At my role at Edith Cowan University I’m working with people with neurological conditions, and we have two main projects that we’re focused on at the moment. One is called Improved Sleep Health, and that’s looking at sleep in a triage approach, where we look at the sleep health of individuals, including their sleep hygiene, which is like their sleep behaviours and environment, and then providing them feedback and information about their sleep using different devices.

The other project is a longitudinal evaluation of sleep health, which is conducted from the time of diagnosis. We’re in the hospital system, where people are diagnosed, and I’m particularly interested in the acquired brain injuries and looking at their recovery and seeing if sleep can be a factor for predicting recovery in these individuals.

They are the two main projects, and we have a lot of smaller projects we’re working on as well.

Sarah Hull: We’re starting to see people pay more attention to sleep across the board, which is really exciting for us in the field, but you’re also seeing people in ICU and NDD talk about it too. It’s an exciting time to be in sleep, isn’t it?

Mitchell Turner: It is. And that’s the exciting thing about both of these projects I mentioned. One is what we call an outpatient setting, where we’re working with allied health practitioners such as physiotherapists, occupational therapists, exercise physiologists etc. We’re able to educate them so if they have clients reporting fatigue, which is a feedback or symptom that people are reporting, it allows them to offer resources and information to be able to send them onto this study.

We can do the reports and give some recommendations and summary, and educate them on what that means, so as a physio, they can say ‘well maybe you can look at doing X, Y and Z’. Obviously staying within their scope of practice, of course. But I think sleep is something we need to educate the wider health community about, and the impact, and not rely solely on having a sleep scientist because most people won’t come and speak to a sleep scientist.

Sarah Hull: Yeah, definitely. Obviously you’re working with some very different groups, because in Melius, you’re also working with Occupational Health and Safety. Can you talk about some of the projects you’re working on there?

Mitchell Turner: Like I mentioned earlier, sleep can apply to so many different populations in that space, and we’re working predominantly with people in the mining industry and providing sleep education. One of my main roles is doing more personalised sleep consultations with people. We have monitoring devices where we track people’s sleep for a period of about six weeks, depending on their roster cycles, and then we complete screening questionnaires. From that, we can talk to people about screening for potential sleep disorders, which we know is a big issue in shift workers. So that’s a really exciting and interesting area.

There’s lots of different areas that Melius is working in and Ian Dunican, who’s the director of Melius Consulting, is exploring a lot of different aspects of sleep and fatigue monitoring, and that’s one area I’m particularly interested in as well.

Sarah Hull: For people who don’t know, can you explain what bio-mathematical roster monitoring or modelling is?

Mitchell Turner: Modelling is basically looking at different shifts and rosters. A roster might be they fly up to site and work eight days, and these days might be 12 hours in duration. Then they fly back and have six days off, and they do that on repeat.

What we’re trying to do is predict the levels of fatigue based on that shift pattern, the shift lengths, commute duration, flight times and all these things, to factor them into a model. And there’s a number of different models available that give you a summary of overall fatigue levels, but also fatigue levels at different times throughout the shift and roster.

You can see the fatigue levels change from day one, to days two, three, and four. It’s quite interesting looking at the different types of rosters and how small changes, even in commute times and shift lengths, can actually make a big difference.

Sarah Hull: I think anybody who’s done shift work can attest to that firsthand.

Mitchell Turner: Exactly.

Sarah Hull: From your opinion, obviously working in all those different groups, what do you think are some of the most pressing sleep related health concerns today and how can they be addressed? And how do we take those learnings from research and then apply them into the mainstream like you guys are doing in the OH&S space right now?

Mitchell Turner: It’s an interesting question. I think it depends specifically on the type of research we’re talking about and what we’re trying to do. The big thing at the moment is around education, and the areas of organisational responsibility such as shift lengths, rosters, as well as the individual’s responsibility, looking at their sleep behaviours, environment etc.

I think if we can better educate individuals that there are known issues and consequences of working shift work, long shifts, and fly-in fly-out, but there are ways of managing it they have the proper education. I think we need to do a better job of individualising our advice, or being more precise with our advice to individuals. Rather than having sweeping advice that you shouldn’t have screen time before going to bed,  looking at that individual and trying to find advice that’s not perfect, but what’s best for that individual based on their circumstances.

I think we can probably do a better job of translating from research into practice, and not being so broad strokes across everyone, but actually being a bit more personalised with our feedback.

Sarah Hull: Is that the kind of stuff you guys are doing in the SPIN team as well?

Mitchell Turner: Yeah, exactly. In all our monitoring we provide individual sleep reports, advice, and consultations with all our participants. One of the things we take pride in is actually working with the community to try and make a difference. We’re trying to produce research and further our knowledge in this field, but we also want to try and make a difference right now for these individuals. I think we can do both.

I think we are doing both at the moment. There are certainly times where a broad education to the masses is warranted, but I think we can go down a bit deeper with individuals on occasion.

Sarah Hull: Staying in that research space, what is some research or some papers that are getting you excited at the moment?

Mitchell Turner: Sleep health is an area that I’m quite passionate about. This is something that Daniel Buysse first brought to the frame and I follow a lot of his work, as well as Meredith Wallace who has done a fair bit of work in this space. They are looking at multidimensional sleep health frameworks, encompassing different aspects of sleep, like the duration, the quality, the regularity, all these factors, rather than just looking at sleep purely as ‘did you sleep eight hours’? Yes or no. That research is looking at multiple factors and it’s something we’re trying to incorporate into a lot of our research as well. I try and follow what they’re doing.

From the chronobiology space I read a lot of Till Roenneberg and Myriam Juda. They have a lot of interesting work. Here in Australia, and we both probably saw his presentation at the ASA conference last year, is Andrew Phillips. I think he’s doing some really interesting work and I always try and keep up with his papers. They’re very math heavy and I have to read them about four or five times to understand exactly what he’s doing, but I find them very interesting.

Sarah Hull: Switching gears a little bit… As the cool tech guy from Melius, which is what you and I first bonded over, what are some of your go-to gadgets for the work you do? And is there anything you think is missing from the field in Australia that you’re seeing in other countries?

Mitchell Turner: We first met to talk about different gadgets you have had at BMedical. We use a wide variety of different devices and technologies both here at Edith Cowan University and at Melius Consulting. It ranges from actigraphy-based devices, which are lower cost and we can get more data from them, so we can have an individual wear them for a longer period of time and get sleep wake behaviour measurements.

We’re quite excited now we have access to a lot of portable PSG devices; which is a little bit of a new frontier for us to expand some of our research into this space. Even at Melius Consulting, we are using these devices to screen for sleep disorders, which is exciting.

The biggest thing in the field of sleep I have noticed more recently, is the prevalence of lower cost options for the portable PSG devices. Which I think is exciting for shift workers who are on a remote mine site and you’re asking them to come down, potentially in their time off to go to a sleep clinic, where we can go there and run the assessments.

Other devices that we’ve talked about in the past are light therapy glasses, which is something we’ve used here at ECU in our research to combat fatigue. We’ve got a few trials coming up in people with traumatic brain injury, looking at the use of light therapy glasses to combat fatigue and assess circadian issues.

The last one I’ll probably mention is just around sleep environment. We use different devices to look at light and temperature of people’s sleep environment. It’s probably an area that’s not focused on a lot and I have a PhD student at the moment Philipp Beranek, who’s looking particularly at sleep environment in shift workers as well, and he’s using a lot of these objective measurements and devices to look at the temperature and light of people’s sleep environment when on site versus at home.

Sarah Hull: That’s a big one, because you go to some of the mine sites and in a donga it’s 40 degrees in the middle of the night. So that can make a big difference.

Mitchell Turner: Yeah, especially for people working night shift and having to sleep during the day, where you’re trying to block out light as much as possible and trying to get it cool, but it’s pretty hard to get some of dongas cool in the middle of summer.

Sarah Hull: Yeah.

Mitchell Turner: As far as gaps in the area, there probably are some gaps but I think we’ve got a really good amount of technology. It’s something that drew me to the sleep field as well, is that I like playing around with different gadgets and devices, and there’s lots of gadgets and devices and stuff in the sleep space.

I think it’s just about utilising and interpreting them correctly, and I think that’s probably the biggest thing rather than if we need more devices at the moment. I think we just need to better understand and how to interpret the data that is coming from those devices.

Sarah Hull: Looking ahead, what do you envision for the future of sleep research, particularly regarding the impact on overall well-being and health?

Mitchell Turner: I think it comes back to a little bit of what we’ve touched on already. It’s interpreting big data. We’ve got a lot of data coming in at the moment from a number of these devices, and I think it’s about interpreting it, finding trends and potentially identifying phenotypes. It might be certain people, or people with certain behaviours, or the prevalence of sleep disorders, or even sleep health; different makeups of those sort of multi-dimensional sleep health frameworks that I was talking about.

If we can identify some of those phenotypes, then we can provide a little bit more of that personalised advice I was mentioning earlier. I think that’s probably the area where we need to move to; where we have broader level education but can go down further and use some of this technology which is becoming a lot more affordable and available. So we can start to provide more personalised advice and information to students, to individuals, based on that data.

Then there is obviously the sleep disorder side of things, which we know is quite a large issue. If we can identify people who have those sleep disorders that’s great. But I think the other area that’s sometimes forgotten is people who have poor sleep or who are struggling with fatigue who get assessed for a sleep disorder. They go, ‘no, you don’t have a sleep disorder so you’re fine’. And those people say, ‘well I’m still not sleeping well, so what’s going on? I still feel really tired and fatigued’. I think that’s the other area we try and play in a bit more from a research side of things – where we try and come in and offer more sleep hygiene advice, so looking at sleep behaviours and environment and trying to improve people’s sleep, because if they don’t have a sleep disorder, that’s probably the other area that I’d like to see expand a bit more as well.

Sarah Hull: Obviously, the more bespoke we get, the more challenging it can be to apply it to a systems level. And you’re working in the OH&S space, but also with neurological conditions. So how do you think all that will tie together from a systems perspective?

Mitchell Turner: That’s a good question. That’s probably the million-dollar question – if we can solve that?

Sarah Hull: But what’s your take on it?

Mitchell Turner: I think it comes back to identifying what is the responsibility of the individual versus what’s the responsibility of the company, or the responsibility of, the healthcare system if it’s individuals with any sort of condition, whether it’s neurological or not.

What we’re trying to do, from the health care side of things, is to offer an alternative stage approach, which is like a triage approach to potentially take some of the pressure off the health care system. We have a lot of this technology now in the research space, and there’s sleep labs and places around that have a lot of really useful technology that we can be used as a screening mechanism for people so we don’t have to go straight to a sleep lab, which we know has a long waiting list. So there’s potentially avenues where we can screen people and then go through a triage approach – that’s the approach we’re trying to do Melius.

We’re using things like questionnaires, which we can give to the masses, we can then go down a bit further into actigraphy-based measurements, which we can still do with a lot of people. The ones that get identified with some red flags, that’s when you go further with a PSG. It’s going through more of a staged approach, or a funnel system, and I think in the industry, in OH&S, and in healthcare can use the same approach to try and tackle the issue. That’s probably not going to be solved anytime soon, as I think it’s quite a large issue.

Sarah Hull: Definitely. It’s a hard one, let’s be honest.

Mitchell Turner: I’m trying to solve big problems here.

Sarah Hull: You know, in our spare time.

Mitchell Turner: Yeah.

Sarah Hull: What are some books or resources you’d recommend to some of our listeners?

It doesn’t have to be sleep-based, just stuff that’s getting you excited at the moment.

Mitchell Turner: I must admit I’m not a big reader of books. I read all day for my job so the last thing I feel like doing is going home and reading more. I’m actually big into micro-credentials, short courses through platforms like Udemy and Coursera.

At the moment I’m doing a lot of stuff around data. I do a lot of programming, Python coding, and statistical analysis courses, and then there are a couple of sleep courses. There is a couple in there that I just couldn’t resist joining and going through.

Podcast wise I guess a plug for Ian Dunican’s Sleep for Performance Podcast – check it out. It’s always a good one. Sleep Talk is another good one with David Cunnington and Moira Junge. There is one I have listened to a few times with Matt Walker.

I probably listen to a lot more podcasts and do a lot of those short courses rather than read.

Sarah Hull: It takes all kinds, right? You gotta have all kinds of different ways to get your info.

Mitchell Turner: Yeah. It’s one of those ones, you’re reading papers and reading things all day… I find it hard to get motivated to go home and open another book and start reading again.

Sarah Hull: Excellent. Well, thank you so much for taking the time to chat to us today.

Mitchell Turner: Thank you very much.