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 Center for Sleep-Related Symptom Science

the Center


About the Center

The center is a unique opportunity to expand the Hopkins Sleep Research infrastructure to permit investigators unfamiliar with sleep research the opportunity to include this critical aspect of health into their work."

More than one-quarter of the adult population of the U.S. suffers from sleep disturbances known to contribute to life-threatening illnesses such as cardiovascular disease, diabetes, and dementia as well as depression, chronic pain, and fatigue. Often such sleeplessness is a consequence of obesity, lifestyle, and work. The Johns Hopkins Center for Sleep-Related Symptom Science works to define and break these cycles of sleeplessness and suffering.


Serve as a catalyst for investigators to develop the necessary expertise to undertake the measurement of sleep outcomes as well as promote interdisciplinary collaboration and partnerships to enable sustainable growth in the conduct of sleep research.


Research Projects


Sleep enhancement to mitigate paclitaxel-induced mechanical hypersensitivity

Investigator:  Sharon Kozachik, PhD, RN

More than 1.6 million persons in the US will be diagnosed with cancer in 2012; many will undergo chemotherapy. Cancer treatments have helped transform cancer from certain death into a chronic illness, yet this transformation comes at a great personal cost to cancer patients. Symptoms from cancer treatment are distressing, difficult to manage, and adversely affect quality of life. Sleep disturbance and pain are among the most frequently reported and severely rated treatment-related symptoms, and they can endure long after treatment has ended. Paclitaxel, a commonly prescribed chemotherapy for a variety of cancers, causes a painful, debilitating and dose-limiting neuropathy of the hands and feet. Sleep disturbance is a less recognized paclitaxel side effect. Sleep disturbance and pain have a positive and bi-directional association. It is well known that disrupted sleep increases pain, but it is not clear whether enhanced sleep can reduce pain. The overall goal of this pilot project, using a reverse translational, bedside-to-bench approach, is to identify a potential intervention strategy that may ameliorate co-occurring sleep disturbance and pain during chemotherapy. I propose a pilot experiment using male and female Sprague Dawley rats, undergoing a standardized paclitaxel protocol, developed by the PI to model the human experience of chemotherapy, while concurrently pharmacologically enhancing sleep via the widely used hypnotic, zolpidem. The specific aims are to determine: (1) the effects of zolpidem on sleep architecture perturbations relative to paclitaxel receipt; (2) the effects of zolpidem on the onset, severity and trajectory of mechanical hypersensitivity relative to paclitaxel receipt; and (3) whether hypothalamic-pituitary-adrenal axis responsivity to stress moderates sleep perturbations or mechanical hypersensitivity relative to paclitaxel receipt. Successful completion of this project will help guide the development and testing of a novel intervention strategy to reduce the burden of co-occurring cancer treatment-related sleep disturbance and pain. Improved health and quality of life are goals of the National Institute of Nursing Research.

Disrupted sleep, neuroendocrine status and the behavioral symptoms of dementia

Investigator:  Nancy Hodgson, PhD, RN

Sleep disturbance is common in adults with Alzheimer’s disease (AD), a  progressive, irreversible  neurodegenerative condition associated with functional performance deficits,  neuropsychiatric symptom burden, and high levels of morbidity and mortality. To date there has been little study of strategies to improve sleep disruption in this large population. The purpose of this developmental research project is to examine the effects of a CAM intervention (reflexology) on subjective and objective characteristics of sleep and behavioral symptoms,  and to characterize disruptive sleep and behavioral manifestation of sleep disturbance in a dyads of older adult with moderate stage AD. Fifty four AD patients will be randomized to receive the reflexology intervention or a sham control intervention. Subjective (CG questionnaires) and objective (wrist actigraphy) characteristics of sleep and behavioral symptoms will be measured a baseline, during, and after the intervention. We will also obtain diurnal measures neuroendocrine activity including salivary cortisol, DHEA(s) and alpha amylase (HPA/SNS activity). We will: evaluate the size of the effects of a reflexology protocol, compared with a sham control condition, on objective (actigraph) and subjective sleep characteristics, behavioral symptoms of disrupted sleep, and biological indicators of diurnal HPA/SNS-axis activity in community residing older adults with AD; examine the relationships between objective sleep parameters and behavioral symptoms of disrupted sleep, neuropsychiatric symptoms of AD, and biological indicators of diurnal HPA/SNS-axis activity; and explore the feasibility and utility of a in-home, ambulatory polysomnography monitoring in a subgroup (N=10) of community residing older adults with AD at baseline and post intervention.  The results will be used to support design decisions for a future efficacy study and may ultimately lead to translation of CAM interventions into the care of sleep disturbance in patients with AD.

Positive affect as a mechanism for the association of sleep and pain

Investigator:  Patrick Finan

Over 30% of adults report inadequate sleep. Insomnia is one of the most common disorders contributing to sleep disturbance (SD), significantly increasing the risk for serious comorbidities. Chronic pain is one of the most physically debilitating and affectively challenging comorbidities. Over 80% of patients with chronic pain have symptoms of SD, a combination that severely compromises affective functioning and well-being. Despite the high co-occurrence of sleep disorders and chronic pain, mechanisms for these associations are virtually unknown. Evidence shows that SD causes heightened pain sensitivity in healthy adults; however, the mechanism is unclear. As depression is a core feature of insomnia and chronic pain, affective dysfunction is a promising candidate mechanism of SD-induced pain sensitivity. Research and treatments typically focus on negative affect as a vulnerability factor promoting SD and pain sensitivity. An emergent, innovative line of research suggests that positive affect may be a critical target of novel interventions that help patients capitalize on naturally rewarding opportunities and accrue resources that promote recovery, resilience, and even flourishing in the face of adversity. Preliminary data suggest that positive affect protects against clinical pain exacerbations and promotes analgesia to experimental pain stimuli. On the balance, the potential benefits of positive affect have been understudied in the sleep and pain fields, and we do not understand the effects of SD on positive affect, relative to negative affect. Further, it is unclear if SD attenuates the analgesic benefit of positive affect. We propose a within-person experimental study to systematically investigate positive affect as a mechanism of the SD-pain symptom cluster. Rigorously screened, healthy men and women will undergo one night of experimental SD via multiple forced awakenings and one night of uninterrupted sleep, the order of which will be determined randomly. After each night, participants will complete 1) validated self-report assessments of positive and negative affect; 2) standardized quantitative sensory testing to measure pain sensitivity; and 3) standardized tests to measure the analgesic efficacy of evoked positive affect.


Research Pilots

A Microfinance Intervention to Improve Health of Rape Survivors in DRC

Investigator:  Nancy Glass, PhD, MPH, RN, FAAN

Uses the SMC to characterize sleep disturbance in female survivors of gender-based violence (GBV) living in the Democratic Republic of Congo (DRC) and to identify potential contributing factors such as insomnia, nightmares, and pain. This is an ancillary project to the funded RCT, “A Microfinance Intervention to Improve Health of Rape Survivors in DRC” (R01MD006075, 2010-2015, PI: Glass). Although work to date has not focused on assessing somatic symptoms in female survivors of GBV; many women report difficulty sleeping [18;19]. Study seeks consultation and SMC resources to identify appropriate self-report and objective measures to assess sleep continuity in female GBV survivors participating in both the intervention (n=50) and control groups (n=50). Investigators use SMC ActiSleep Plus monitors and technical support to score actigraphy records.

Community Aging in Place - Advancing Better Living for Elders (CAPABLE)

Investigator:  Sarah Szanton, PhD, CRNP

Poor sleep quality is both a predictor and a result of functional disability in older adults. This ancillary pilot study to characterize sleep quality and quantity in a population of low income functionally disabled older adults receiving an in-home functional intervention, Community Aging in Place - Advancing Better Living for Elders (CAPABLE)[23] versus attention control (R01 AG040100, 2012-2017). The study also collects salivary cortisol, Interleukin-6 and functional status measures in a sub-sample of 60 participants (30 CAPABLE and 30 attention control) from n = 300 participants total. Investigators work with the sleep SMC investigators to develop the best sleep measurement approaches.




2/26/2013 -- "Sleep 101- Whirlwind Tour"

View Dr. Charlene Gamaldo's Presentation

11/5/2013 -- “Within and Beyond the Bedroom Walls to Talk: The Importance of Learning About One's Sleep Environment”

View Dr. Rachel Salas' Presentation


5/15/2014 -- “Sleep and Pain: Interactions and Interventions”

View Dr. Michael Vitiello's Presentation





Contact the Center: 410-955-7484 |