Nicole Lovato

Nicole Lovato
Flinders University · Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University

PhD
Senior Research Fellow and Sleep Health Research Development Coordinator, FHMRI Sleep Health, Flinders University

About

115
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Publications

Publications (115)
Article
Study objectives: In a population-based survey, we determined sex-differences in health profiles and quality of life between individuals who have a confirmed diagnosis of obstructive sleep apnea (OSA) and those who are at high risk of OSA yet remain undiagnosed. Methods: An online survey of Australian adults ≥18 years (n= 3818) identified partic...
Article
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Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insom...
Article
Study Objectives Wind turbine noise exposure could potentially interfere with the initiation of sleep. However, effects on objectively assessed sleep latency are largely unknown. This study sought to assess the impact of wind turbine noise on polysomnographically-measured and sleep diary-determined sleep latency compared to control background noise...
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Introduction Insomnia is the most common sleep disorder, 10–30% of adults have regular difficulties falling and/or staying asleep that cause significant daytime impairments. General Practitioner (GP) clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment rather than medications. However, most GPs...
Article
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Introduction Good sleep is not merely the absence of sleep disorder symptoms, yet this criterion is commonly applied in research studies. We developed the Good Sleeper Scale-13 (GSS-13) to standardise identification of good sleepers. Methods We conducted a secondary analysis of the 2019 Sleep Health Foundation online survey of adult Australians (N...
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Introduction Past research and our own has not shown a differential response to Cognitive Behaviour Therapy for insomnia (CBTi) based on objective sleep duration. It is valuable to investigate CBTi responsiveness is a function of objective sleep efficiency (SE) instead of objective sleep duration. This study is a secondary exploratory analysis of o...
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Objectives Insomnia is diagnosed using clinical interview but actigraphy is often used as a consecutive multi-day measurement of activity-rest cycles to quantify sleep-wake periods. However, discrepancies between subjective complaints of insomnia and objective actigraphy measurement exist. The aims of the current study were to (i) predict subjectiv...
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Introduction Chronic insomnia is a common sleep disorder, with an estimated 15% of Australian adults reporting symptoms of insomnia. Australian general practitioner (GP) guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first-line treatment for insomnia however research suggests that GPs instead rely heavily on sleep hygiene...
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Introduction The prevalence of sleep difficulties from wind farm noise (WFN) compared to road traffic noise (RTN) or other sources is unknown. This study investigated the prevalence, severity and source of sleep difficulties in WFN, RTN and quiet rural exposure areas. Methods Geographic sampling and computer assisted telephone interviews were used...
Article
Obstructive sleep apnoea (OSA) is a prevalent disorder managed in Australian general practice. This article aims to provide an overview of the presenting symptoms, assessment, management and referral options of OSA. Key Points Obstructive sleep apnoea (OSA) is a prevalent, debilitating, and costly disorder managed in Australian general practice....
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Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line t...
Article
Background: Insomnia is a prevalent and debilitating disorder commonly managed by family physicians. Insomnia guidelines recommend cognitive behavioral therapy for insomnia (CBTi) as the ‘first-line’ treatment. However, family physicians report limited time, knowledge, access, support, and referral options to manage patients with CBTi. Consequently...
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Methods for predicting circadian phase have been developed for healthy individuals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep–wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO)...
Article
• Depression and insomnia commonly co-occur, resulting in greater morbidity for patients, and difficult diagnostic and treatment decisions for clinicians. • When patients report symptoms of both depression and insomnia, it is common for medical practitioners to conceptualise the insomnia as a ‘secondary symptom’ of depression. This implies that th...
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Daytime impairments feature in the diagnostic criteria for insomnia disorder yet are rarely assessed comprehensively in clinical practice and tend to focus on mood and subjective assessment of cognitive competence. In order to gain more information about the engagement in daily activities we developed the Sleep Impact on Activity Diary (SIAD). This...
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Study Objectives: THIM is a wearable device designed to accurately estimate sleep onset. This article presents two studies that tested the original (Study 1) and a refined (Study 2) THIM sleep onset algorithms compared to polysomnography (PSG). Methods: Twelve (Study 1) and twenty (Study 2) individuals slept in the laboratory on two nights where p...
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Introduction: THIM is a new wearable device worn on the finger that can passively monitor sleep and wakefulness overnight using actigraphy. This article showcases the development of the THIM sleep tracking algorithm (Study 1), and the testing of its accuracy against polysomnography (PSG) with an independent sample of good and poor sleepers (Study 2...
Preprint
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Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as first line t...
Article
Little is known about the potential impacts of wind turbine noise (WTN) on sleep. Previous research is limited to cross‐sectional studies reporting anecdotal impacts on sleep using inconsistent sleep metrics. This meta‐analysis sought to comprehensively review studies evaluating the impact of WTN using widely accepted and validated objective and su...
Article
Study objectives Compare the degree of sleep misestimation in older adults with insomnia presenting with objectively short relative to normal sleep duration, and investigate the differential therapeutic response on sleep misestimation between the proposed sleep duration phenotypes to Cognitive Behaviour Therapy for insomnia (CBTi) Method Ninety-on...
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Behavioural responses to auditory stimuli cease in late N1 or early N2 sleep. Yet, responsiveness to minimal intensity tactile stimuli and the correspondence with sleep microstructure during the sleep onset period is unknown. The aim of the present study was to investigate sleep microstructure using quantitative electroencephalography analysis when...
Article
Insomnia is a common disorder managed in Australian general practice. The RACGP recommends cognitive and behavioural therapy for insomnia (CBTi) strategies as the first-line treatment. There are multiple simple and effective CBTi options accessible to Australian general practitioners and patients, but these are often underused.
Article
Study objectives: Myopia, or near-sightedness, is the most common refractive vision disorder and predisposes the eye to many blinding conditions in adulthood. Recent research has suggested that myopia is associated with increased endogenous melatonin production. Here we investigated the differences in melatonin circadian timing and output in young...
Article
Although cognitive behavioural therapy for insomnia (CBTi) is the recommended ‘first-line’ treatment for insomnia, most patients are initially treated with sedative-hypnotic medications. Given the risk of impaired cognitive and psychomotor performance, serious adverse events, and long-term dependence associated with sedative-hypnotics, guidelines r...
Article
SHORT OVERVIEW Insomnia is a common disorder managed in Australian general practice. The RACGP recommend cognitive and behavioural therapy for insomnia (CBTi) strategies as the ‘first line’ treatment. There are multiple simple and effective CBTi options currently accessible to Australian general practitioners and patients, but these are often under...
Article
Background: Co-occurring insomnia and symptoms of depression, anxiety and stress pose difficult diagnostic and treatment decisions for clinicians. Cognitive Behavioral Therapy for Insomnia (CBTi) is the recommended first-line insomnia treatment, however symptoms of depression, anxiety and stress may reduce the effectiveness of CBTi. We examined the...
Article
Background: Chronic insomnia is a prevalent and debilitating disorder managed in Australian general practice. The most effective and recommended first-line treatment for insomnia is cognitive behavioural therapy. This treatment has also been translated to a condensed brief behavioural therapy for insomnia (BBTi) which is suitable for delivery in th...
Article
We examined whether a polymorphism of the PERIOD3 gene (PER3; rs57875989) modulated the sleep promoting effects of melatonin in Delayed Sleep‐Wake Phase Disorder (DSWPD). One hundred and four individuals (53 males; 29.4±10.0 years) with DSWPD and a delayed dim light melatonin onset (DLMO) collected buccal swabs for genotyping (PER34/4 n=43; PER3 5...
Article
Study Objectives We investigated biological and behavioural rhythm period lengths (i.e., taus) of Delayed Sleep-Wake Phase Disorder (DSWPD) and Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD). Based on circadian phase timing (temperature and dim light melatonin onset), DSWPD participants were dichotomised into a circadian-delayed and a circadian no...
Article
Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention with established efficacy, yet evidence of its cost-effectiveness remains unclear. Systematic searches were conducted in Medline, Psychinfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare. Titles and abstracts were screened against eligibility criteria, an...
Presentation
Introduction THIM is a new ring-like sleep device that, if found to accurately measure sleep onset, could be used for a variety of clinical purposes. These include administering a brief but effective treatment for insomnia called Intensive Sleep Retraining, facilitating the optimal 10-minute power nap, and administering Multiple Sleep Latency Tests...
Presentation
Introduction THIM is a new consumer ring-like device that can passively monitor sleep overnight using actigraphy. This project aimed to develop the THIM sleep tracking algorithm (Study 1), and test its accuracy against polysomnography (PSG) with another independent sample of good and poor sleepers (Study 2). Methods Study 1: 25 healthy individuals...
Article
Objectives Older people who are admitted to inpatient rehabilitation settings often experience sleep disturbance or disorders. Both intrinsic and environmental factors may contribute to reduced sleep quality. Poor sleep quality has been reported to be associated with poorer rehabilitation outcomes. The aim of this review was (1) to describe the pre...
Article
Objective The present study investigated the relationship between difficulty initiating sleep and depressed mood and whether it is mediated by repetitive negative thinking. A moderating role of perfectionism was also examined. Methods We surveyed 393 adolescents aged 14 to 20 years (M = 17.32, SD = 1.90) via an online questionnaire that assessed d...
Article
The accurate estimation of sleep onset is required for many purposes, including the administration of a behavioural treatment for insomnia called Intensive Sleep Retraining, facilitating power naps, and conducting objective daytime sleepiness tests. Specialised equipment and trained individuals are presently required to administer these application...
Presentation
Full-text available
Introduction: Online treatments for insomnia offer a solution for the growing number of sleep-related concerns in the population and lack of accessible treatment services, yet concerns regarding treatment efficacy and adherence to the protocols in the un-supervised home environment remain. Sleep On Cue is a smartphone application designed to admini...
Presentation
Introduction: There are many consumer sleep trackers which claim to accurately estimate sleep, but few have empirical evidence publicly available to support their efficacy. The evidence that is publicly available suggests that these devices overestimate sleep and underestimate wakefulness. More accurate data collected from sleep trackers could be a...
Presentation
Introduction: Accurate measurement of sleep onset in the home environment is difficult. THIM is a wearable device designed to accurately estimate sleep onset for use in the home environment. THIM administers low intensity vibrations to which the user responds with a gentle finger twitch. When responses to the vibrations cease, THIM assumes the user...
Presentation
Introduction: Intensive Sleep Retraining (ISR) is a brief yet effective treatment for a pervasive sleep disorder known as chronic insomnia (Harris et al., 2012; Lack, Scott, & Lovato, 2019). This treatment provides the experience of falling asleep increasingly rapidly across one night on repeated sleep attempts. It requires accurately detecting the...
Article
Chronic insomnia is associated with subjective daytime cognitive dysfunction, but objective corroborative data are often lacking. In this study, we use Perceptual Load Theory to objectively assess distractibility in participants with insomnia (N = 23) compared with age- and sex-matched controls (N = 23). Following overnight supervised sleep observa...
Article
Effective and durable cognitive/behavioral therapies for insomnia are time consuming and not readily available to the large insomnia population. Intensive sleep retraining (ISR) provides multiple (>40) short (<5-minute) sleep latencies over a 24-hour period. Two pilot studies and a randomized controlled trial have shown that ISR is an immediately e...
Article
Background In healthy populations, irregular sleep patterns are associated with delayed sleep and poor functional/mood outcomes. It is unknown whether irregular sleep contributes to poor functional/mood outcomes in individuals with Delayed Sleep-Wake Phase Disorder (DSWPD). Methods In 170 patients with DSWPD, we collected sleep-wake patterns, dim...
Article
Background: The popularity of biofeedback as a non-pharmacological treatment option for insomnia has increased in recent times despite inconsistent empirical evidence for its therapeutic efficacy. Objective: The purpose of the current review was to systematically assess the efficacy of using biofeedback to treat insomnia. Methods and results:...
Presentation
Introduction: Measuring sleep onset accurately in the home environment is difficult. Some procedures are invasive or expensive to administer, while others are less invasive but also less accurate. THIM is a novel device designed to estimate sleep onset in the home environment. THIM administers low intensity vibrations to which the user responds wit...
Article
The purpose of this review was to evaluate the strength of evidence for a relationship between risk of mortality and frequent and ongoing insomnia using a meta-analytic strategy. Seventeen studies, including a total of 36,938,981 individuals followed up for a mean of 11.6 y, reporting the investigation of the association between mortality and frequ...
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Background Delayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled...
Article
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This study evaluated the effectiveness of a head-mounted portable light device, Re-Timer, for phase advancing the circadian rhythm of healthy sleepers in the home environment. The Re-Timer was designed to address the limitations of traditional bright light boxes, making it more practical and efficient for administering light therapy. Eighteen healt...
Article
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Adequate sleep is important for good health and well-being, and inadequate sleep leads to impaired attention and performance. Persistent poor sleep is also associated with cognitive and metabolic impairment, cardiovascular problems and diminished psychological well-being. Recent growth in wind farm developments has been associated with community co...
Article
Full-text available
The aim of the study was to investigate the accuracy of Sleep On Cue: a novel iPhone application that uses behavioural responses to auditory stimuli to estimate sleep onset. Twelve young adults underwent polysomnography recording while simultaneously using Sleep On Cue. Participants completed as many sleep-onset trials as possible within a 2-h peri...
Article
Introduction In this study we investigated biological, sleepiness and behavioural rhythm period lengths (i.e., taus) of Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD) patients and healthy control sleepers. We also ran cross-correlation analyses between different rhythm variables to examine phase angle of...
Article
Full-text available
Intensive sleep re-training is a promising new therapy for chronic insomnia. Therapy is completed over a 24-h period during a state of sleep deprivation. Improvements of sleep and daytime impairments are comparable to the use of stimulus control therapy but with the advantage of a rapid reversal of the insomnia. The initial studies have been labora...
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Objective: The prospective, bidirectional relationship between sleep disturbance and depressed mood was assessed in a school-based sample of adolescents. Method: One hundred and thirty-eight Australian adolescents (mean age time 1 =15.69, SD =0.92; 64% male) completed questionnaires to assess sleep parameters and depressed mood, on two occasions o...
Article
Study objective To examine the prevalence of circadian misalignment in clinically diagnosed DSPD, and compare mood and daytime functioning in those with and without a circadian basis for the disorder. Methods 182 DSPD patients aged 16 to 64 years, engaged in regular employment or school, underwent sleep-wake monitoring in the home, followed by a s...
Article
STUDY OBJECTIVE: To examine the prevalence of circadian misalignment in clinically diagnosed DSPD, and compare mood and daytime functioning in those with and without a circadian basis for the disorder. METHODS: 182 DSPD patients aged 16 to 64 years, engaged in regular employment or school, underwent sleep-wake monitoring in the home, followed by a...
Article
Introduction: The efficacy of bright light and/or melatonin treatment for Delayed Sleep Wake Phase Disorder (DSWPD) is contingent upon an accurate clinical assessment of the circadian phase. However, the process of determining this circadian phase can be costly and is not yet readily available in the clinical setting. The present study investigate...
Article
Full-text available
Circadian rhythms strongly influence when we are sleepy and when we are alert. If the timing of these rhythms is later than normal, it can contribute to sleep onset insomnia. If the timing is earlier than normal, it can lead to early morning awakening insomnia. Therefore, management of these types of insomnia need to include treatments, such as bri...
Article
Full-text available
Our objectives were to investigate the period lengths (i.e., taus) of the endogenous core body temperature rhythm and melatonin rhythm in delayed sleep-wake phase disorder patients (DSWPD) and non-24-h sleep-wake rhythm disorder patients (N24SWD) compared with normally entrained individuals. Circadian rhythms were measured during an 80-h ultradian...
Article
Full-text available
According to classification manuals for sleep disorders, nine disorders are directly related to biological clock timing misalignments. Of all, Delayed Sleep Phase Disorder (DSPD) is the most commonly diagnosed, predominantly affecting adolescents, young adults, and insomnia patients. It is a persistent inability to fall asleep at earlier, more desi...