Melissa Papesh, Au.D., Ph.D.
Meet the Researcher
Papesh received her clinical doctorate in audiology and dual doctorates in neuroscience and hearing science from Indiana University. She completed an audiology externship at the VA's National Center for Rehabilitative Auditory Research (NCRAR) and was awarded an advanced fellowship in Polytrauma/TBI from the VA’s Office of Academic Affiliations. Papesh is now a research investigator within the Veterans Health Administration. Her 2026 Emerging Research Grant is generously funded by Royal Arch Research Assistance.
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.
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 toward a method of actually improving auditory functioning in patients via improved sleep.
We recently conducted a review of 100 veterans who had been evaluated for auditory processing disorders (APD) across the VA system and were surprised to find that 62 percent had diagnoses of sleep disorders, including insomnia. This made sleep disorders the third most common comorbid condition in patients seeking help for APD (after traumatic brain injuries and mental health conditions).
Diving into the literature revealed that while very few studies had previously addressed the effects of sleep disorders on hearing, those that did tended to indicate a link with poorer performance on common APD tests such as dichotic listening. Further, additional studies indicated that insomnia may be linked to hyperarousal within the brain, a condition that impacts sleep initiation and maintenance as well as auditory conditions such as tinnitus and sound sensitivity. Thus, we conceived of this pilot study to more fully address the potential relationship between insomnia and auditory function.
A close relative of mine suffered from mental health issues when I was growing up. This led me to wonder about psychology and how the brain works differently in different people, leading to different perceptions and sometimes different realties. I started taking psychology courses as a college freshman and quickly realized I was most interested in the neurophysiological aspects of psychology rather than the counseling aspects. Hence, I started studying neuroscience which was a perfect fit for me and my interests.
I have a lot of difficulty hearing in noisy situations compared with other folks and often have a hard time understanding accented speech despite having typical hearing sensitivity. I’d just thought this was one of the “quirks” of my brain until I started to learn more about how traumatic brain injury can affect auditory processing. I suffered a concussion in my teens due to a vehicle accident and another shortly after during a horseback riding incident. I wish I had baseline data on myself, as it’s entirely possible that these accidents contributed to my hearing issues.
One of the most memorable things in my career so far has been my Ph.D. mentor in neuroscience, Dr. Laura Hurley. Dr. Hurley is one of the most compassionate and even-tempered people I’ve ever had the joy to know. She taught me a lot about not only how to be a good researcher, but how to be a good human even when life gets really tough. She’s incredibly intelligent and motivated but was never condescending and never failed to see her students for the full human beings that they are. If I can live up to her standards as a scientist and a mentor, I'll consider myself a success!
When I was a child, I wanted to be a veterinarian. Then I realized that all the animals hate going to the veterinarian! And I developed a deep interest in the brain and the role that it plays in shaping a person and their perceptions, so I went the neuroscience route instead. However, I’ve always said that if my research career goes kaput, I’ll become an alpaca farmer.
So. Many. Hobbies! I like woodworking, crocheting, watercolor painting, gardening, houseplants, sewing, ponds, aquariums, and animals (furry, feathered, scaly, slimy), and I also play the piano and trombone (okay, it’s been several years for the trombone) and dance. I think scientists are often very creative people, and my creativity and love of music and the natural world have had huge impacts on my interest and drive to learn more about hearing and the brain. I like to know how things work and how all the pieces fit together!
I’m a huge fan of retired racing greyhounds as pets. They’re much more calm and relaxed than folks think when they see them race. They've earned the nickname 40-mile-per-hour couch potatoes for a reason! I currently have two, and they are the sixth and seventh greyhounds that I’ve owned, in addition to fostering several as well.
I am currently a research investigator within the Veterans Health Administration, and I love working with veterans and helping to address their needs. Within the next five to 10 years, I hope to have secured a large-scale VA Merit Award and/or NIH R01 funding to continue studying the relationship between sleep disorders, in addition to continuing to study the impacts of traumatic brain injury and other disorders on auditory processing disorders.
The Research
Melissa Papesh, Au.D., Ph.D. | 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
