University of Rochester Sleep & Neurophysiology Research Laboratory

Research Mission

The general focus of our research at the URSNRL is on the reciprocal relationships between sleep quality and quantity and physical and mental health. Within this broad arena, we have targeted interests in sleep in psychiatric disorders, neurocognitive phenomena in insomnia, and the efficacy and mechanisms of action of behavioral therapy and of sedative hypnotics. Some of our more recent research interests within these domains pertain to:

• an assessment of illness severity and variability over time with the end goal of demonstrating that there is a predictable rhythm to when patients experience insomnia and that this is fundamentally related to how sleep is homeostatically regulated.

• the placebo effect as it occurs in insomnia clinical trials and how the episodic nature of insomnia may interact with pill use to 1) reinforce and sustain placebo-related clinical gains and 2) result in increased clinical gains via conditioning.

• the use of partial reinforcement schedules during long term therapy with hypnotics to sustain clinical gains while reducing the amount of medication used to achieve clinical gains.

• an assessment of the effectiveness of CBT-I for insomnia secondary to chronic pain and insomnia secondary to cancer.

• the development of a risk factor model for insomnia so that the natural course of the disorder can be empirically assessed.

Long Term Goals

Our intent is, simply put, to create a premiere program in Insomnia Research. The program has three components which are typical foci for academic medicine (Research, Education, and Clinical service) but, unlike what typically occurs with academic medicine, our intent is for the three components to be highly integrated. One way we will seek to accomplish this is by strongly encouraging the members of our group to participate in two or more aspects of the program.

Apart from creating a “triple threat” program, it is my intent that our research will span across the entirety of the research spectrum and ultimately include:

• basic research with animals. It is expected that this approach will allow us to study, in a more controlled fashion, the “causes and consequences” of insomnia.

• basic human research using a broad spectrum of techniques (neuropsychological testing, QEEG and ERPs, pharmacologic probes, imaging, etc). It is expected that this approach will allow for empirical evaluations of the factors that are thought to precipitate and perpetuate insomnia.

• clinical research across most, if not all, the medical and psychiatric populations that exhibit insomnia. It is expected that this approach will allow us to appreciate the differences in how insomnia occurs across diagnoses and the extent to which it interacts with the primary disorders.

Collaborative Ventures

Our group has begun several collaborations which, while outside the scope of insomnia research, allow us to share our sleep medicine expertise with other groups and provides us the opportunity to gain exposure to ideas, techniques and methods from allied disciplines. Our most recent collaborations include:

1) The assessment of PSG sleep correlates of treatment related fatigue in cancer patients
(PI: Joe Roscoe, PhD – UR Cancer Center)

2) The assessment of sleepiness and orexinergic tone in myotonic dystrophy patients
(PI: Emma Ciafaloni, MD – UR Department of Neurology)

3) The use of Dynamic Negative Airway Pressure to predict upper airway collapse during sedation and the incidence and severity of apnea as it occurs during sleep
(PI: Suzanne Karan, MD & Denham Ward, MD - UR Department of Anesthesiology)

4) Examination of partial reinforcement as a means toward the long term management of insomnia
(Co-PI: Robert Ader, Ph.D. UR Behavioral Health)

5) The investigation of attention bias as a "marker" for primary or secondary insomnia.
(PI: Collin Espie, Ph.D. University of Glasgow Scotland)

6) The comparative efficacy and safety of CBT-I, trazodone and zolpidem.
(Co-PI: Collin Espie, Ph.D. University of Glasgow)

7) fMRI and cognitive performance in patients with Primary Insomnia as compared to Good Sleeper Controls.
(Co-PI: Gayle Page, PhD & Michael Smith, PhD. Johns Hopkins University)

8) A rodent model of chronic insomnia
(Co-PI: Gayle Page, PhD & Michael Smith, PhD. Johns Hopkins University)

9) CBT-I in patients with PTSD
(PI: Tom Neylan, MD UCSF)

10) Hangover, Congeners, Sleep and Occupational Performance (PI: Jonathan Howland, Ph.D., M.P.H. Boston University;
(Co-I: J. Todd Arnedt, Ph.D University of Michigan)

Our hope is that we will continue to engage in such collaborations, both here at URMC and with faculty from other Universities and Research Centers.