Melissa Papesh, Au.D., Ph.D.
The Research
Portland VA Research Foundation
Central auditory processing disorder and insomnia
At least 26 million American adults complain of hearing and communication difficulties that negatively impact their quality of life despite having no signs of hearing loss. This condition is often referred to auditory processing disorder (APD) reflecting altered processing of auditory information in the brain. While traumatic brain injuries are the most widely known cause for APD, a host of other health conditions are also likely to significantly impact how the brain interprets sound. Our goal with the current project is to examine possible associations between APD and another common condition: insomnia. The objectives of this project are a) to compare peripheral and central auditory system function in patients with normal hearing sensitivity with and without diagnoses of chronic insomnia, and b) to examine the potential for cognitive behavioral therapy (CBT) sleep therapy to improve auditory function in patients with chronic insomnia.
In addition to standard hearing tests, we will also measure responses on questionnaires to gauge self-perceived hearing difficulty, assess participants’ ability to discriminate and identify several different types of auditory stimuli, and measure brain responses to sound at multiple levels of the auditory pathway within the brain. Because chronic insomnia is associated with higher rates of cognitive impairment and mental health conditions, we will also measure cognitive function and symptoms of depression and anxiety. Auditory, cognitive, and mental health measures will be obtained in patients with diagnosed chronic insomnia both before and after completion of CBT, as well as in a group of control participants following a similar testing timeline. We hypothesize that patients with chronic insomnia will perform more poorly on clinical measures of auditory processing and will report higher rates of hearing handicap compared to controls. In addition, we suspect that that those with chronic insomnia will display abnormally high levels of activity in the brain as well as poor pre-attentive filtering of auditory information compared to good sleepers due to persistent neuronal hyperarousal. Finally, our hope is that these auditory manifestations will improve once participants complete CBT, thus providing a pathway to improved hearing in a subset of patients experiencing APD.
Long-term goal: The long-term goal of this program of research is to develop effective, patient-centered assessment and rehabilitation options for patients whose hearing difficulties are not due solely to hearing loss. Presently, when patients present to audiology clinics with these types of complaints, the most common response is to provide tell them that their hearing is “normal” and provide some counseling on how to improve their listening skills. This leaves many patients feeling unheard and dismissed. One way that we can improve this situation for patients is to learn more about how physical and mental health challenges affect auditory processing both so that we can help patients understand the causes of their difficulties and so that we can better target treatment to specific individuals. Sleep disorders are highly prevalent amongst the American populace and may be an important factor affecting hearing and processing. Even better, effective treatment options are available to treat sleep disorders, including insomnia. Thus, if this study reveals a link between insomnia and auditory processing disorders, it will help to improve our counseling of patients in audiology clinics, facilitate dialogue between audiologists and sleep medicine professionals, and point towards a method of actually improving auditory functioning in patients via improved sleep.
Generously funded by Royal Arch Research Assistance
