Massey Documents by Type

Permanent URI for this communityhttps://mro.massey.ac.nz/handle/10179/294

Browse

Filters

2005 - 200922010 - 20204

Settings

Subject: search.filters.subject.Sleep disorders

Search Results

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Fatigue Risk Management Systems (FRMS) for cabin crew : evaluation of the current status and future needs : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health, Massey University, Sleep/Wake Research Centre, Wellington Campus, New Zealand
    (Massey University, 2019) Van den Berg, Margaretha (Margo)
    Fatigue Risk Management Systems (FRMSs) are a more recent approach to improving safety and increasing operational flexibility and have been utilised in the operation of Ultra-long range (ULR) flights that exceed traditional flight and duty time limits. Because ULR scheduling and FRMS processes for cabin crew are predominantly based on flight crew data, little is known about how well these work for cabin crew. A mixed methods approach was used to evaluate the current status of, and future needs for, FRMS for cabin crew. The sleep of 55 cabin crew was monitored throughout a ULR trip between Johannesburg and New York. On each flight, crewmembers rated their fatigue, sleepiness, and workload, and completed a 5-minute Psychomotor Vigilance Task at key times. In addition, semi-structured focus group discussions were held and thematic analysis was undertaken with data from 25 cabin crew with ULR experience. Findings demonstrate that collecting fatigue monitoring data, as for flight crew, is also feasible for cabin crew, provided that operational differences between cabin crew and flight crew are considered. Using mitigations that mirror those used for flight crew, cabin crew fatigue can be managed effectively on a ULR flight. The findings also highlight the importance of: a) considering workload, the cumulative effects of fatigue across the entire ULR trip, and the impact of the entire schedule worked, for improving the management of cabin crew fatigue associated with ULR operations, and; b) sufficient rest for adequate recovery and work-life balance in support of employees’ overall health and well-being; c) company support, in the form of fatigue-related processes and resources, effective communication and management’s engagement with cabin crew. Priority should be given to fatigue management training for cabin crew, which may also enhance perceived company support and assist with achieving a better work-life balance. Viewing fatigue as a compound hazard, the management of fatigue-related safety risks and health risks may be optimized if FRMS and OHS can be more closely linked or integrated, in support of improving cabin crews’ safety and service, and health and well-being.
  • Thumbnail Image
    Item
    "I could cope so much better if I could just get a good night's sleep" : maternal sleep and mental health from early pregnancy to three years post birth : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2020) Ladyman, Clare Iona
    Healthy sleep is vital to health and wellbeing at all life stages. But for many women, achieving restorative and satisfying sleep consistently throughout pregnancy is challenging. Because vulnerability to experiencing depressive symptoms increases with poor sleep and poor sleep influences the development and trajectory of depressive symptoms, sleep is an important and modifiable factor in the prevention and treatment of depression. Pregnancy is also considered a key teachable life stage as mothers wish to be healthy in order to protect their unborn baby. Yet research investigating non-pharmacological sleep education interventions for preventing perinatal depression is scarce. This thesis comprises three studies that investigate the relationship between maternal sleep health and depression. It presents findings from a scoped review examining sleep health throughout pregnancy; a longitudinal analysis of depression trajectories from late pregnancy to three years post-birth and the association of different sleep dimensions to trajectory group membership; and, the development, implementation and efficacy of a sleep education pilot intervention designed to promote sleep health and reduce the likelihood of depressive symptoms throughout pregnancy. Findings from the scoped review showed that while sleep in pregnancy is highly variable from one woman to the next, significant changes to sleep throughout pregnancy were not indicated for women who were considered physically and mentally healthy. However, the results of the longitudinal analysis revealed that for a sub-group of women, poor sleep was significantly associated with clinically elevated and persistent depressive symptoms throughout the perinatal period and into their child’s preschool years, with the probability of experiencing depressive symptoms especially pronounced for Māori women. The Sleep HAPi pilot study found recruiting and retaining previously depressed women into a longitudinal perinatal sleep education study achievable and the study design highly acceptable to participants. Similar to the results of the scoped review, self-reported sleep duration, quality, timing, continuity and daytime sleepiness remained stable throughout pregnancy, and at intervention end none of the women in this study were experiencing clinically elevated depressive symptoms. Sleep HAPi women were compared to a control group from a previous study with no sleep education component; Sleep HAPi mothers had significantly better sleep initiation and experienced fewer depressive symptoms at intervention completion, though results require confirmation in a larger randomised control group study. Collectively, the findings from these studies highlight the strong relationship between sleep and maternal mental health. Sleep education interventions, such as Sleep HAPi, show promise for minimising depressive symptoms, and optimising sleep for pregnant women. These findings have important health care practice and policy implications and the potential to improve outcomes for mothers, children, families and society.
  • Thumbnail Image
    Item
    Understanding and managing dementia-related sleep problems : community-based research with older New Zealanders : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy at Massey University, Sleep/Wake Research Centre, Wellington, New Zealand
    (Massey University, 2014) Gibson, Rosemary H.
    Sleep changes with ageing and people with dementia and their carers often have disturbed sleep, but information on the sleep of older New Zealanders is lacking. Four studies were conducted in order to address these factors. The first two used pre-existing survey data to understand the sleep health of older people, and to explore the relationship between caregiving and sleep. Sleep problems were reported by 20-32% of participants, prevalence decreased with increasing age. In those aged at least 79 years, sleep problems were associated more with health status rather than demographic factors. Older carers were more likely to report feeling tired than non-carers. Dementia-related sleep problems are challenging for individuals and their carers, and poor sleep may exacerbate waking dementia symptoms. However, there is limited research with community-dwelling dyads of people with dementia (PWD) and their carers. Studies 3 and 4 were conducted to understand and treat dementia-related sleep problems. Focus groups with 12 dyads revealed the multifaceted nature of their sleep problems. Normalisation of sleep problems was common. In the final study, a five-week trial was piloted involving sleep education, light therapy and an exercise programme. Sleep of the dyads was monitored using actigraphy and standardised questionnaires. Questionnaires also measured cognitive functioning, quality of life, and dementia-related disruption, as well as carers’ mental health and coping. Fifteen pairs participated, of whom nine completed the trial. Case studies revealed that five PWD had improvements to their subjective sleep ratings. These PWD also showed some improvements in wake time at night, cognitive functioning, and carer-rated quality of life. These changes did not always translate into improved sleep or mental health for carers. Many PWD’s health deteriorated across the trial, masking the effects of the intervention. Overall, these studies illustrate the importance and diverse nature of sleep with ageing, dementia, and caregiving. Non-pharmacological interventions can be used successfully by some community-dwelling dyads. It is recommended that these low-risk interventions are considered by healthcare professionals. Increased knowledge and options could empower individuals to manage their own symptoms, providing hope for improving the sleeping and waking experience of older people affected by dementia.
  • Thumbnail Image
    Item
    Group treatment of anxiety-related insomnia using cognitive-behavioural therapy : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2013) de Lacerda Mottin, Fernanda
    Insomnia affects 25% of the New Zealand population and up to 33% of the population worldwide. Untreated it incurs high economical costs to society and takes its toll on the people’s mental health, physical health, and quality of life. Psychological treatments for insomnia have developed over the decades to reflect the scientific literature’s knowledge about the causal and maintaining factors of insomnia (i.e., maladaptive behaviours and cognitions about sleep and the consequences of insomnia and physiological and cognitive arousal). The critical review found that although physiological and cognitive arousal play a significant role in the development and maintenance of insomnia and there is some evidence that anxiety disorders predict the development of insomnia, few published treatment programmes targeted all causal and maintaining factors as described in the literature. The current main clinical study investigated the effectiveness of a group therapy programme that targeted all the main factors described in the literature. Twenty-eight participants suffering chronic insomnia and at least subclinical anxiety or stress were randomly assigned to one of two treatment interventions, administered through five treatment groups. Each group had 5-6 participants. Two groups received the insomnia first intervention (n = 11) and three groups received the anxiety first intervention (n = 17). Within- and between-subjects analyses were performed. Follow-up assessment took place about three months after the end of each treatment group. The main study found that targeting anxiety (i.e., physiological and cognitive arousal) directly improved participants’ insomnia, t(1708) = 3.574, p <.001, d = .86. At three months post-treatment, both treatment conditions had large effect sizes on measures of insomnia severity (insomnia first d = 3.35; anxiety first d = 1.17) and sleep efficiency (insomnia first d = 1.09; anxiety first d = 1.17). However, in examining the outcome trajectories, the anxiety first intervention produced more consistent improvement across the course of the therapy sessions, which might be more desirable for both clients and clinicians. This study provided evidence that a cost-effective group intervention is beneficial for symptoms of insomnia and anxiety, and it also significantly improves participants’ quality of life. While some findings need replication (e.g., order of interventions), this study showed not only that insomnia can and should be treated, but also that its assessment and treatment must address anxiety as well as sleep. Given the high occurrence and co-morbidity of insomnia, and its detrimental effects for the individual and the society, psychological interventions for insomnia should be more readily available in New Zealand.
  • Thumbnail Image
    Item
    Positive airway pressure for obstructive sleep apnoea : systematic evaluation versus clinical and technological drift : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington Campus, New Zealand
    (Massey University, 2005) Marshall, Nathaniel Stuart
    The practice of sleep medicine is expanding and evolving rapidly, often ahead of the evidence base to support clinical practice. Obstructive Sleep Disordered Breathing (SDB) is a condition characterised by repetitive airway collapse causing harmful intermittent blood oxygen desaturations and fragmented sleep. When combined with daytime sleepiness it is known as Obstructive Sleep Apnoea Syndrome (OSAS). Continuous Positive Airway Pressure (CPAP) eliminates SDB by pneumatically splinting open the airway with positive air pressure applied through the nose and/or mouth. CPAP effectively reduces daytime sleepiness in patients with severe OSAS. However, doubt remains as to the effectiveness of CPAP in the majority of patients with mild-moderate OSAS. The effects of CPAP were compared to a placebo CPAP during a three week crossover Randomised Controlled Trial (RCT) that included 31 mild-moderate OSAS patients. CPAP effectively eliminated SDB (when worn) and moderately improved subjective sleepiness. But. it did not improve objective wakefulness, mood, psychomotor function, or quality of life. Patients who were extremely sleepy at baseline tended to gain the most placebo adjusted benefit from treatment. A systematic review and meta-analysis aimed to gather and objectively combine all relevant RCT studies to find our whether CPAP reduced sleepiness in patients with mild-moderate OSAS. Seven trials were combined and showed that both subjective sleepiness and objective wakefulness were slightly improved by CPAP therapy. Objective sleepiness was not improved by CPAP. It is not clear from these two studies that treating mild-moderate OSAS with CPAP is an effective use of resources. CPAP effectiveness might be limited by sub-optimal compliance. C-Flex aims to improve compliance by modulating pressure during exhalation. C-Flex was compared to CPAP during a pilot RCT that included 19 patients with severe OSAS. C-Flex was associated with a non-significant increase in compliance of 1.7 hours/night compared to CPAP. However, this increase in compliance was not associated with better daytime patient outcomes. Further experiments are proposed as a result of our pilot RCT. This thesis helps expand evidence-based sleep medicine. Practitioners need to be vigilant, ensuring that treatments are effective in the patients groups in which they are being used (clinical drift), and that new treatments are not adopted without superiority over existing treatments (technological drift).
  • Thumbnail Image
    Item
    Obstructive sleep apnoea syndrome among taxi drivers : consequences and barriers to accessing health services : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Sleep/Wake Research Centre, Wellington Campus, New Zealand
    (Massey University, 2006) Tupai-Firestone, Ridvan
    Untreated Obstructive Sleep Apnoea Syndrome (OSAS) increases the risk of motor vehicle accidents and morbidity. Its prevalence among taxi drivers is unknown. The goals of this thesis were to: (1) estimate the prevalence of OSAS symptoms and risk factors among taxi drivers; and (2) identify the barriers to accessing health care services for the diagnosis and treatment of OSAS. Between June and July 2004 questionnaires were mailed to 651 taxi drivers from two Wellington taxi companies (response rate 41.3%, n=241). Excessive daytime sleepiness (ESS>10) was reported by 18% of drivers. The estimated proportion with a pre-test risk of OSA (RDI≥ 15/hour) was 15%, according to a questionnaire-based screening tool. Pacific drivers were more likely to report OSAS symptoms than people of "other" (non-Māori) ethnicities. Logistic regression analyses identified the following independent risk factors for OSAS symptoms: increasing neck size, age groups: 46-53 years and 61-76 years, and self-reported snoring 'always'. Three focus groups were conducted in November 2004. Thematic analyses identified the following barriers to accessing health care: (1) sleepiness was not a perceived health problem; (2) personal demands; (3) industry demands; and (4) driver avoidance and dissatisfaction with general practitioner's services. Detailed examination of these themes indicated that drivers were deterred from seeking care by limited knowledge and awareness of OSAS, confusion about responsibility for health and safety, medical costs, and the risk of finding out about other health conditions. General practitioners reportedly failed to screen for OSAS symptoms and demonstrated little knowledge about sleep health. These barriers are a major cause for concern, and they are used to support the belief that earning a living is more important than personal health and safety. The key finding is that improving drivers' knowledge is unlikely to change their behaviour, without concurrent measures to address systemic issues in the taxi industry and in the health care system.