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Healthy Patterns Sleep Study

National Institutes of Health, P30 NR0141319/26/2013 - 6/30/2016

Meet the Investigator

Nancy A. Hodgson, PhD, RN, FAAN
Assistant Professor, Johns Hopkins School of Nursing
Primary Faculty, Center for Innovative Care in Aging
Research Associate, Hopkins Population Center


Over 5 million Americans have Alzheimer’s disease (AD) or a related dementia, a progressive and irreversible neurodegenerative condition, affecting also close to 15 million family caregivers (CG). Sleep efficiency (percent of time in bed asleep) in AD patients is severely impaired and complicated by frequent night awakenings and nocturnal restlessness. Untreated sleep disruption in AD patients is associated with increased rates of neuropsychiatri symptoms, daytime napping, ‘sundowning’ behaviors, cognitive and functional decline, and morbidity and mortality.

The circadian abnormalities in the sleep-wake cycle commonly observed in AD patients occur more often in individuals with hypothalamicpituitaryadrenal (HPA) axis hyperactivity. Cortisol (a measure of HPA activity) has been shown to amplify AD neuropathology. As a result, HPA axis hyperactivity may influence daily sleep-wake activity by decreasing an AD patient’s ability to respond to external cues which, in turn, can further propagate HPA axis dysfunction. Thus, interventions to normalize daily HPA axis patterns may be beneficial in treating sleep-wake disturbances.

Current clinical sleep hygiene practices in institutional settings (such as nursing homes) hold promise for reducing disruptive sleep by reestablishing circadian patterns. These interventions include the use of timed and planned activities (TPA) during daylight hours and creating a relaxing environment in the evening. Unfortunately, little work has been done to determine the efficacy of these interventions in the home setting where most ind ividuals with AD reside.

Among a sample of community residing older adults with AD, participants and their CG will be randomized to receive an intervention of TPA or an attention control condition. This project will:

  1. characterize objective measures of sleep, behavioral symptoms, and HPA axis activity associated with sleep disturbance
  2. examine the effects of TPA on objective measures of sleep (wrist actigraphy) and HPA axis status (saliva sample)
  3. examine the effects of TPA on subjective measures of sleep and behavioral symptoms (CG questionnaires and journal)
  4. evaluate measurement approaches in home-dwelling AD patients.

Lastly, we will explore the feasibility of assessing sleep architecture in home-dwelling AD patients using ambulatory polysomnography which will inform the pursuit of future intervention research in this area. The goal of the Healthy Patterns Sleep Study is to educate both individuals with dementia and their caregivers about healthy sleeping patterns and ways to improve overall well-being. This 10-day project focuses on home-based daily routine activities and education so caregivers are better able to care for their loved one with dementia in the home setting.

Additional Resources


For more information on the project, contact:

Mary Kathryn Franchetti, MHS
Research Project Coordinator
Center for Innovative Care in Aging,
Johns Hopkins School of Nursing
525 North Wolfe St.,
Baltimore, MD 21205
410-614-5406 |