Caroline Lustenberger
Influential Woman Winter 2022
“Brain activity during Sleep”
Caroline Lustenberger, Sleep Researcher, Neural Control of Movement Lab ETH Zurich.
Scientist Leader Caroline Lustenberger.
Born in Switzerland, Caroline Lustenberger did her Master’s Thesis in sports physiology. She studied Human Movement Sciences at ETH Zurich, has a PhD in Neuroscience from ETH Zurich and was always interested in looking at muscle and brain activity during sleep.
Brain activity during sleep can be measured with a so-called Electroencephalogram or short EEG, it captures the electrical activity of many neurones in our brain and illustrates their synchronised behaviour as brain waves. She was fascinated the day she opened one of these recorded EEG files and inspected the brain activity during sleep and got immediately hooked.
I currently work on two initiatives:
The SLEEPFLUENCER is a collaborative project that establishes a self-sustaining sleep education program to be used in classes of adolescents to raise awareness about the importance of sleep on adolescents’ social, societal, mental, and physical well-being at a crucial moment of their development to reduce insufficient sleep and to furthermore prevent mental and physical illnesses later in life. The EARDREAM project also placed at the ETH Zurich is lead by Prof.Rafael Polania and myself. The project aims at establishing an early detection of Alzheimer Disease before symptoms arise.
Caroline Lustenberger

” Together with a task force I am leading the Gender Equality Forum at the European Sleep Research Society (ESRS) that aims at creating a culture of inclusivity and gender equality within the ESRS, provide training opportunities and develop strategies to stop the ‘leaky pipeline’ of women and minoritized gender identities leaving research “.
EARDREAM principal investigators Dr. Rafael Polania & Dr. Caroline Lustenberger

Meet Caroline Lustenberger
1. Hello Caroline, what motivated you to become a sleep researcher?
My interest in sleep research started when I was doing my master’s thesis in sports physiology. At this time, I was studying Human Movement Sciences at ETH Zurich and was interested in looking at muscle and brain activity during sleep. Brain activity during sleep can be measured with a so-called Electroencephalogram or short EEG, it captures the electrical activity of many neurons in our brain and illustrates their synchronised behaviour as brain waves. It all started when one day I opened one of these recorded EEG files and inspected the brain activity during sleep and I was hooked. During wake, the EEG looks noisy and apparently there is not much we can see, but when someone falls asleep and enters deep sleep the brain activity drastically changes and we suddenly see that interesting patterns emerge which are visible to our naked eye. I realised there must be something happening in our brain when we are asleep, and I thought: “that is very special”. In contrast to the common idea that sleep is a time when not much happens… quite the opposite! Sleep is not a waste of time but one of the most important behaviours we all do and should do for several hours daily. And from this moment on, I really wanted to understand what is happening in the brain during sleep and how this is linked to why sleep is so important for our health.
2. Your excitement for sleep is inspiring, how did you continue your journey in sleep research and what is your current position?
At the end of my master thesis, there was this lucky coincidence that a PhD position was advertised in sleep research. I got this position, and I started my journey to do a PhD thesis in neuroscience with the focus on sleep at the University Children’s Hospital Zurich and ETH Zurich. During my PhD, I was looking at these brain activity patterns during sleep, I was talking about before, and we found very interesting insights showing that these patterns are related to for instance memory, intelligence, and also maturation of the brain. After my PhD I received a postdoctoral fellowship prize from the Swiss National Science Foundation (SNSF) to join a lab at UNC Chapel Hill in North Carolina (USA) where I was able to develop novel technologies to modulate and enhance sleep. After three years in the US, I decided to move back to ETH Zurich and received yet another investigator prize from the SNSF to be part of the development of a portable device that can modulate sleep brain activity using sounds based on in-home wearable technologies. This postdoc was important because it taught me a lot about the development of such mobile and wearable technologies, which enable us to bring our laboratory research into the real world and into people’s and patients’ homes. After this postdoc, I decided I want to try my step into independence and received an SNSF Ambizione career prize that allowed me to create and establish my own small group at ETH Zurich. So currently, I am a junior group leader at ETH Zurich and lead a small team of brilliant PhD and master students with the goal to independently find my research direction and to establish myself as a principal investigator.
3. Apart from your role as a group leader in sleep research, you are the Chairwoman of the Gender Equality Forum of the European Sleep Research Society (ESRS), can you tell us more about this position ?
Research, including sleep research, still shows a pronounced leadership gender imbalance. Even though women and men are about equally distributed in PhD and postdoc positions on a global level, leadership/highly visible/permanent positions remain overwhelmingly stocked with men. There are manifold reasons for this leaky pipeline including different internal and external barriers that women face such as the maternal wall or successful scientist stereotypes that are male by default. We miss out on diversity and we miss out on a lot of talented people and we can just not afford that. Because diversity of different perspectives and experiences will maximize innovation and creativity in science and beyond. Instead of complaining about this inequality I decided that I rather want to change something about it. Together with a taskforce I am leading the Gender Equality Forum at the ESRS that aims at creating a culture of inclusivity and gender equality within the ESRS, provide training opportunities and develop strategies to stop the ‘leaky pipeline’ of women and minoritized gender identities leaving research. We hope that more and more people in decision-making and leading position support this movement because change will inevitably only happen, if we have allies on the top that help to lead this transformation.
4. What is your current research focus in your own lab?
My current research centers around the characterization and modulation of brain activity during sleep to promote recovery processes of brain and body across the age and health span. My team and I combine laboratory and real-life experiments where we develop and apply novel technologies based on wearable devices. For some time now I started to be more and more interested in the translational component of my research by bridging our laboratory research with applications that target societal needs, with particular emphasis on neurological disorders related to abnormal sleep.
5. The translational aspect of the research sounds very interesting: do you have concrete examples?
I currently work on two initiatives: the SLEEPFLUENCER and EARDREAM project. The SLEEPFLUENCER is a collaborative project with my colleagues Prof. Salome Kurth and Dr. Paul Andrä. The project establishes a self-sustaining sleep education program to be used in classes of adolescents to raise awareness about the importance of sleep on adolescents’ social, societal, mental, and physical well-being at a crucial moment of their development to reduce insufficient sleep and to furthermore prevent mental and physical illnesses later in life. This project is still in its infancies and we are currently trying to acquire funding through specific funding schemes.
The second initiative is the EARDREAM project that I lead together with my colleague Prof. Rafael Polania, also placed at ETH Zurich. The project aims at establishing an early detection of Alzheimer’s disease before symptoms arise using wearable and integral approaches that can be deployed at low-cost, everywhere in the world. We recently acquired seed funding for this project from the Alzheimer Drug Discovery Foundation (ADDF) and are very excited to get it started. This project, if successful, is of potentially high social impact.
Alzheimers by Havens Michael 34.CCBY2.0

AD
The Alzheimer’s Disease is the most common cause of dementia. Symptoms include severe memory loss that rapidly progresses after disease onset, leading to death few years after onset. It has no cure! It is difficult to diagnose, and in fact, often undiagnosed. Studies indicate that early diagnosis could enable early interventions potentially delaying or preventing the progression of the disease.
78 million dementia cases projected in 2030 and 139 million in 2050. Classified as an epidemic by the WHO. Countries will spend US$ 1.3 Trillion treating dementia related disorders.
EaRDream
Towards early detection of Alzheimer’s Disease in privileged and underprivileged individuals worldwide.
Early detection of Alzheimer’s Disease also means early interventions to improve forthcoming symptoms, which translates to less costs in the healthcare system, and the well-being of individuals, families and social groups.
Development of novel neurobehavioual markers for early detection of dementia and Alzheimer’s Disease, with unique access to the largest population in the world with the highest prevalence of a genetic disease that triggers Alzheimer’s Disease with almost 100% certainty in a rural region located in Colombia.
‘Research, including sleep research, still shows a pronounced leadership gender imbalance and I have decided I want to change something about it ‘ Caroline Lustenberger.
Alzheimer's Disease by Pixabay 63615

6. Tell me more about this EARDREAM initiative. How did it all get started?
I often like to say: “Good ideas start with the fruitful exchange among like-minded colleagues and a good glass of wine” and this is also how the EARDREAM project was born. Rafael invited me for dinner to discuss future collaborations, we both share the same lab space and enjoy putting our brains together and discuss about future research projects. Rafael is born and raised in Colombia and his expertise is in the neuroscience of decision making. At this dinner, I told him about a special rural village in Colombia where an astonishingly high number of people inevitably develops Alzheimer’s due to a genetic mutation. Alzheimer’s is a devastating disorder and is the most common cause for dementia. When we started to dig deeper into the topic, we realized that globally Alzheimer’s cases increase drastically in the next decades because our society gets older, and age is still the biggest risk factor for developing Alzheimer. We also realized that globally most Alzheimer’s cases remain undiagnosed, specifically prominent in rural and under-developed regions. This is not surprising because people in these regions have not the same access to health care systems and technology as we do. Thus, we put our heads together and discussed how we could merge our expertise as neuroscientists and our technological know-how to detect Alzheimer as early as possible, before symptoms arise, but with approaches that are low-cost and can get deployed everywhere in the world benefiting under-developed and developed regions equally.
7. Why is so important to enable the diagnosis of Alzheimer’s even before symptoms arise?
To date, Alzheimer’s is a disorder that has no cure after onset. Many pharmacological trials failed to slow or cure Alzheimer’s disease. One likely reason for the failure is that at the time when the drugs are administered, patients already show clear symptoms such as dementia which is at the stage when a lot has already been destroyed in the brain and then it is likely too late to prevent progression of or cure the disease. There is evidence that neuropathological processes in the brain start up to 20 years before cognitive symptoms appear. Furthermore, there is research showing that this asymptomatic stage offers a critical window of opportunity to capture these pathophysiological processes as early as possible potentially preventing neuronal degeneration and progression to a clinical stage. Thus, asymptomatic detection will enable us to identify a window when interventions might help delaying or preventing the onset of Alzheimer’s disease.
8. What is puzzling to me is to understand how can you detect a disorder before symptoms arise, can you explain?
Early detection requires us to know who will develop Alzheimer’s disease before the classical symptoms, such as a cognitive decline, are detectable. And this is where the special village in Colombia comes into play. The population living there is unique in the world because it has the world’s highest prevalence of a genetic mutation (30%, compared to less than 1% in the rest of the world) that inevitably leads to Alzheimer’s disease at around 35-50 years of age. Thus, these people with the genetic mutation offer us the advantage of a predictable time window before their Alzheimer’s disease exhibits symptoms and thus provides a unique opportunity to develop novel biomarkers to detect the risk to develop Alzheimer’s disease before symptoms arise. Access to study this population is possible thanks to a close collaboration with Drs. Francisco Lopera and Carlos Tobón from Universidad de Antioquia in Medellin, Colombia.
9. There are likely other researchers that investigate how we can achieve an early diagnosis of Alzheimer’s.What is so special about the EARDREAM project?
For an asymptomatic detection, we do not only need a specific genetic population, but another important factor is to measure irregularities in the brain that appear to occur in asymptomatic stages of Alzheimer’s, such as specific changes of brain activity during sleep and wakefulness. Brain activity can be captured using EEG and this is typically done with costly equipment in the lab. However, to enable brain activity assessment at the people’s home, both during wake and sleep, we developed a wearable device that can record high-quality brain activity from the ear-canal. Our device can record these signals over long time periods in a non-obtrusive way, is low-cost and easily appliable by the user. Or in other words, it is like putting earphones into your ear and pressing a few buttons on a small box to start the recording. The development of this technology was successful because of the collaboration and the involvement of a cross-functional team of engineers, material designers, and neuroscientists, including close collaborators from the Feasibility Lab from ETH Zurich.
10. In the centre of the project is the self-developed EARDREAM-device, tell me more about it..
For an asymptomatic detection, we do not only need a specific genetic population, but another important factor is to measure irregularities in the brain that appear to occur in asymptomatic stages of Alzheimer’s, such as specific changes of brain activity during sleep and wakefulness. Brain activity can be captured using EEG and this is typically done with costly equipment in the lab. However, to enable brain activity assessment at the people’s home, both during wake and sleep, we developed a wearable device that can record high-quality brain activity from the ear-canal. Our device can record these signals over long time periods in a non-obtrusive way, is low-cost and easily appliable by the user. Or in other words, it is like putting earphones into your ear and pressing a few buttons on a small box to start the recording. The development of this technology was successful because of the collaboration and the involvement of a cross-functional team of engineers, material designers, and neuroscientists, including close collaborators from the Feasibility Lab from ETH Zurich.
Vintage Postcard-Little Girl Sleeping by Chicks 57 CCBY-NC 2.0

11. What are the next steps for you and your team in this project?
We just acquired seed funding from ADDF to use our EARDREAM device along with specific in-lab assessments to collect data in Colombia from individuals with the genetic mutations, their family members that do not have the mutations and from participants from Switzerland at different age-ranges to have several control conditions. We are excited because data collection will start in a few weeks. This is hopefully just the start of a big initiative that could revolutionize how we diagnose Alzheimer’s disease. Rafael and I currently try to get more funding to expand the project. However, we are both early career scientists that are still looking for permanent positions to continue with our research visions for the next thirty years. It is therefore difficult to plan ahead when our academic career path is still uncertain.
12. How can we help?
First, thank you Maria for doing this interview and for broadcasting our project. Social impact projects such as ours rely on supporters and allies like you that help us to make change happen. Thus, we are looking for people that help us to spread the word, provide intellectual support, contribute network resources, or provide financial backing. If you are interested to support us in any way, please contact us. This will be crucial to secure the future of this initiative and our positions in academia. There are indeed mechanisms in place at ETH such as the ETH Foundation who are a great resource to manage incoming funds from donors in a transparent manner that have recognized experience in supporting large-scale funding projects.
We hope that people understand the importance of our initiative. Life expectancy drastically increased in the last decades and with that the need to maintain a healthy and independent life until very old ages. Dementia-related disorders such as Alzheimer’s will affect many of us as we grow older. The time is now to enable early interventions thereof and with that hopefully to delay and prevent the onset of Alzheimer’s across the globe.
Neural Control of Movement Lab © ETH Zurich / Gian Marco Castelberg

Neural Control of Movement Lab, ETH Zurich
Winterthurerstrasse 190
8057 Zurich
Schweiz
LinkedIn: https://www.linkedin.com/in/caroline-lustenberger-phd-891493219/
Photos copyright by: Caroline Lustenberger ,© ETH Zurich / Gian Marco Castelberg, Havens Michael 34, Pixabay and Chicks57.