From Bicycles to Sleep Cycles: How Professor Danny Eckert’s Pursuit of Peak Performance Led to Major Advances in our Understanding of Sleep

Professor Danny Eckert of the Adelaide Sleep Institute at Flinders University didn’t set out to be one of the world’s foremost sleep experts. He started as an elite cyclist, representing Australia at the World Championships. Wanting to use his head as well as his body, he studied exercise physiology and sports science in the afternoons, trained on his mountain bike in the mornings, raced competitively, and presumably left some time for sleep. After receiving his degree, he was offered a prestigious appointment with the South Australia Sports Institute.

But on the Friday before he was due to start his internship, he was also offered a 3-year position with a respiratory and sleep unit in a hospital. When he reported for his new job at the Sports Institute on Monday, he immediately asked his new boss if he could take a walk to consider his options, came back, and left for a field he knew nothing about. “It turned out that everything I’d learned about the body being at its most vulnerable and physiologically interesting when you push it as hard as you can during exercise is also true when you are sleeping and the body is at its quietest.”

Professor Eckert was on fertile ground for his newly chosen field. Australia has long been a leader and innovator in sleep science, especially in respiratory medicine. When he started studying sleep apnea, the research centered on anatomy: the collapse of the upper airway, especially due to obesity. As such, treatments such as Continuous Positive Airway Pressure, (CPAP, invented in Australia), mouthguards, and surgery were designed to open the airway.

Professor Eckert’s groundbreaking work changed nearly everything we thought we knew about sleep apnea. Importantly, he identified three nonanatomical endotypes that can cause sleep apnea. Between them, they account for 70% of sleep apnea cases.

1) Low Arousal Threshold: Light sleepers who wake up when their muscles relax.

2) Instability in Breathing Control: Sleepers who are too sensitive to minor changes in carbon dioxide. Their overactive respiratory system turns off their drive to breathe.

3) Poor Muscle Responsiveness to the Narrowing Airway

Simplified, scalable diagnostic tools and machine learning can identify the endotype(s) that causes a particular patient’s sleep apnea. Endotypes can inform targeted therapies and lead to an 80% success rate for treating sleep apnea. This individualized, precision medicine approach includes emerging pharmaco-therapies, such as drugs that can activate the muscles, or strategies, such as cognitive behavioral therapy, that can help light sleepers.

What’s next? With 70 researchers working on 40-50 studies at any one time at the Adelaide Sleep Institute, there are many exciting developments to come. One area of interest is sleep irregularity. Researchers have found varying bedtime by even 30 minutes throughout the week is associated with a 30% higher chance of hypertension; vary by 90 minutes and increase the odds by 90%, regardless of the total amount of sleep.

New technologies that allow longitudinal data are especially useful for studying sleep variability. Combining sleep data with measures like body fat, step counts, and blood pressure will allow for quicker treatment changes, better monitoring of treatment effectiveness, and reach many more people who suffer from sleep disorders.

The three pillars of health are exercise, diet, and sleep, but sleep directly affects the other two. Not getting sufficient or quality sleep makes us crave bad food and makes it hard to exercise. That’s why Dr. Eckert believes sleep is the foundation for optimal health. Through research and scientific and technological breakthroughs, Professor Eckert thinks we are at the precipice of transforming the entire sleep field. That’s a comforting thought for the billions of people around the globe desperate for a good night’s sleep.

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