Ultradian Sleep/Wake Protocol for Sleep Patterns

(CARRS-P1 Trial)

Overseen By Ronette Blake, MS

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Pittsburgh

Must not be taking: Antidepressants, Sleep medications

Disqualifiers: Drug use, Seizures, Bipolar, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

96 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how sleep patterns affect the brain's reward and decision-making systems in teenagers, particularly concerning substance use risk. Participants will follow an ultradian sleep/wake protocol, involving alternating periods of wakefulness and sleep over 36 hours, to study its impact on cognitive and reward functions. Teens aged 13-15 who are physically and mentally healthy and attend traditional high school may be suitable for this study. As an unphased study, this trial provides a unique opportunity to contribute to scientific understanding of sleep's impact on teenage brain function.

Will I have to stop taking my current medications?

The trial may require you to stop taking certain medications, especially those that impact sleep/wake function. Some medications might be okay if you can stop them before and/or during the study procedures.

What prior data suggests that this ultradian sleep/wake protocol is safe?

Research shows limited specific safety information for the Ultradian Sleep/Wake protocol. This protocol involves a 36-hour cycle of waking and sleeping, differing from normal sleep patterns.

The trial is labeled "Not Applicable" for a phase, indicating it is primarily observational or exploratory. This means it hasn't undergone the usual stages that assess side effects or safety in new treatments.

Currently, no strong evidence of serious safety concerns exists, but the protocol's safety is still under study. Participants should ask the researchers any questions about safety and what to expect during the trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the ultradian sleep/wake protocol because it offers a fresh approach to understanding sleep patterns and their impact on cognitive functions. Unlike traditional sleep studies that focus on prolonged night sleep, this protocol alternates between short sleep and wake cycles, potentially revealing new insights into how our natural rhythms affect reward systems and cognitive control. By exploring these ultradian cycles, scientists hope to uncover innovative ways to enhance mental performance and address sleep-related issues more effectively.

What evidence suggests that the Ultradian sleep/wake protocol is effective for sleep patterns?

Research has shown that ultradian sleep/wake schedules, involving shorter cycles of sleep and wakefulness, might help regulate sleep patterns. This trial will have participants follow an ultradian sleep/wake protocol to examine its effects on circadian and homeostatic sleep systems. One study found that young adults on a structured ultradian schedule experienced rhythmic patterns in their lighter sleep stages. These rhythms, shorter than the usual 24-hour cycle, could influence attention and mood. Additionally, healthy ultradian rhythms have been linked to better sleep, potentially enhancing thinking and decision-making. This suggests that an ultradian sleep/wake schedule could align sleep patterns and address issues like impulsivity and sensitivity to rewards. ^{1 6 7 8 9}

Who Is on the Research Team?

Peter L. Franzen, PhD

Principal Investigator

University of Pittsburgh

Are You a Good Fit for This Trial?

This trial is for healthy teenagers aged 13-15 who attend a traditional high school and are not home-schooled. They must not have sleep apnea, be within a certain weight range, and cannot have serious medical conditions or a history of substance use. Those on certain medications or with MRI contraindications like metal implants can't participate.

Inclusion Criteria

I am between 13 and 15 years old.

Provision of written informed consent and assent

I am in good physical and mental health.

Exclusion Criteria

History of alcohol, cannabis, or illicit drug use in the past month, or greater than monthly use in the past year

I have a sleep disorder that is not insomnia or Delayed Sleep Phase Disorder.

I am not between the ages of 13 and 15.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2 weeks

Home monitoring with actigraphy and sleep diary

Baseline Assessment

Participants complete fMRI measures of reward and cognitive control

1-2 weeks

1 visit (in-person)

Laboratory Study

Participants undergo a 60-hour laboratory study including polysomnography and ultradian sleep/wake protocol

60 hours

1 visit (in-person)

Follow-up

Longitudinal online surveys to assess substance use

Up to 4.5 years

Online surveys every 6 months

What Are the Treatments Tested in This Trial?

Interventions

• Ultradian sleep/wake protocol

Trial Overview The study investigates how disrupted sleep patterns and circadian rhythms affect reward systems and cognitive control in adolescents, potentially influencing substance use risk. It involves an ultradian sleep/wake protocol to assess these effects at subjective, behavioral, and neural circuit levels.

How Is the Trial Designed?

Group I: Ultradian Sleep/Wake protocol Experimental Treatment 1 Intervention

This study uses an ultradian sleep/wake protocol to examine circadian and homeostatic sleep systems and their contributions to reward and cognitive control function. All participants will undergo the ultradian sleep/wake protocol following a night of sleep in the lab (measured with polysomnography) for 36 hours. The ultradian sleep/wake protocol will last for 36 h, during which every 120-minutes, there will be an 80-minute period of waking, followed by a 40-minute sleep opportunity. A repeat night of sleep will occur at the end of the 36-hour ultradian sleep/wake protocol.

Who Is Running the Clinical Trial?

University of Pittsburgh

Lead Sponsor

Trials

1,820

Recruited

16,360,000+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Published Research Related to This Trial

The regulation of sleep involves three processes: homeostatic, circadian, and ultradian, with the homeostatic process reflecting recovery during wakefulness and sleep.

Narcoleptic patients show a heightened sensitivity to homeostatic sleep regulation but have a weaker circadian process, leading to more frequent daytime sleep episodes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Regulation of sleep]. Besset, A.[2006]

Circadian rhythm sleep-wake disorders (CRSWD) significantly impair health and functioning, and accurate diagnosis can be achieved through a 14-day assessment using sleep diaries, logs, and actigraphy.

The most effective treatments for CRSWD include melatonin administration and light therapy, along with recommended behavioral interventions, which can be tailored based on the patient's circadian phase.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment guidelines for Circadian Rhythm Sleep-Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association. Part I. Physiology, assessment and therapeutic methods. Wichniak, A., Jankowski, KS., Skalski, M., et al.[2022]

Circadian rhythm sleep disorders arise from a mismatch between the body's natural rhythms and conventional sleep-wake schedules, which can disrupt optimal sleep and alertness.

Evaluating these disorders requires careful monitoring of sleep patterns over several days to weeks, highlighting the importance of understanding individual sleep-wake cycles for effective treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circadian rhythm sleep disorders. Kanathur, N., Harrington, J., Lee-Chiong, T.[2010]

The study confirmed that the REM-NREM sleep rhythm has a stable period over long-term observations, even under various conditions such as undisturbed sleep and altered sleep-wake cycles, involving 6 test subjects and 1 patient.

The ultradian REM sleep rhythm operates independently of the 24-hour day cycle, suggesting it is controlled internally and can drift daily, indicating a distinct mechanism from circadian rhythms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Studies on the stability of human ultradian rhythms (author's transl)]. Schulz, H., Dirlich, G., Zulley, J.[2006]

The study provides insights into the mechanisms behind the ultradian rhythm of REM sleep, showing that specific probabilities of sleep stage transitions can reproduce the typical 90-minute intervals of REM onset.

Increased transitions from light to deep NREM sleep were found to prolong the intervals between REM sleep, indicating that the dynamics of sleep stages play a crucial role in regulating REM sleep patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Markov modeling of sleep stage transitions and ultradian REM sleep rhythm. Kishi, A., Yamaguchi, I., Togo, F., et al.[2019]

In a study involving 9 young adults, a 15-minute waking and 5-minute sleeping schedule over 12 hours revealed a rhythmic pattern in stage 1 sleep, suggesting a potential ultradian rhythm in sleepiness with a frequency of about 14.4 cycles per day.

Both REM deprivation and total sleep deprivation disrupted the normal periodicity of stage 1 sleep and altered stage 2 sleep distribution, indicating that sleep deprivation can significantly affect sleep architecture and the body's natural sleep-wake cycles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrashort sleep-walking schedule. I. Evidence of ultradian rhythmicity in "sleepability'. Lavie, P., Scherson, A.[2019]

Recent guidelines and studies highlight effective treatments for various circadian rhythm sleep-wake disorders, including delayed sleep-wake phase disorder and shift work, emphasizing the importance of personalized approaches.

Innovative methods for estimating circadian phase, such as home saliva collection for melatonin onset and new light treatment technologies, show promise in improving treatment outcomes for these disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Circadian-Based Therapies for Circadian Rhythm Sleep-Wake Disorders. Burgess, HJ., Emens, JS.[2020]

In a study involving 10 healthy young men, the administration of risperidone altered the ultradian rhythm of REM sleep by prolonging the intervals between REM periods, which affected the transition probabilities between different NREM sleep stages.

The findings suggest that the transitions from light NREM sleep (N2) to deep NREM sleep (N3) are crucial in regulating the timing of REM sleep, indicating a potential mechanism behind the ultradian REM sleep rhythm.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

NREM sleep stage transitions control ultradian REM sleep rhythm. Kishi, A., Yasuda, H., Matsumoto, T., et al.[2021]

Circadian rhythm sleep-wake disorders (CRSWD) affect a significant number of people in the U.S., with estimates ranging from 800,000 to 3 million individuals, highlighting a critical need for improved diagnosis and treatment.

The workshop identified key areas for high-priority research in CRSWD, emphasizing the importance of understanding the mechanisms behind these disorders to enhance patient care and outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Duffy, JF., Abbott, SM., Burgess, HJ., et al.[2022]

Circadian rhythm sleep-wake disorders (CRSWD) are frequently misdiagnosed as insomnia or hypersomnia, highlighting the importance of thorough patient interviews and the use of sleep diaries and actigraphy for accurate diagnosis.

The recommended treatment for CRSWD includes chronotherapy methods such as melatonin, light therapy, and behavioral interventions, rather than relying on hypnotics or psychostimulants, which may only mask symptoms without addressing the underlying disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment guidelines for Circadian Rhythm Sleep - Wake Disorders of the Polish Sleep Research Society and the Section of Biological Psychiatry of the Polish Psychiatric Association. Part II. Diagnosis and treatment. Wichniak, A., Jankowski, KS., Skalski, M., et al.[2018]

In narcolepsy, while the homeostatic process of sleep is maintained, the circadian regulation of sleep/wake cycles is disrupted, leading to significant alterations in sleep patterns.

Patients with narcolepsy exhibit a strong ultradian rhythm, characterized by a 4-hour cycle of Slow Wave Activity and a longer 2-hour NREM/REM cycle, which contributes to the symptoms of the disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Circadian and ultradian cycles in narcolepsy]. Espa, F., Besset, A.[2006]

Citations

1. withpower.com withpower.com/trial/phase-sleep-2-2022-fbf70

Ultradian Sleep/Wake Protocol for Sleep Patterns In a study involving 9 young adults, a 15-minute waking and 5-minute sleeping schedule over 12 hours revealed a rhythmic pattern in stage 1 sleep, suggesting a ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8116400/

Circadian Rhythm Sleep–Wake Disorders Circadian rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors.

3. sciencedirect.com sciencedirect.com/topics/medicine-and-dentistry/ultradian-rhythm

Ultradian Rhythm - an overview Ultradian rhythms are biological rhythms shorter than a day, often with two peaks, and periods from fractions of hours to several hours.

4. nature.com nature.com/articles/s41467-024-52769-6

Diminished circadian and ultradian rhythms of human brain ... We show that functional circadian and ultradian rhythms are diminished in pathological tissue, independent of regional variations.

5. link.aps.org link.aps.org/doi/10.1103/PhysRevE.111.044215

Dynamical mechanism for the interplay of circadian ... The 90-minute ultradian rhythm is a hallmark of healthy human sleep, yet its governing mechanisms remain elusive. In this study, we develop ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9886819/

Treatment of Circadian Rhythm Sleep–Wake Disorders - PMC Nevertheless, owing to a lack of safety data, melatonin should be avoided during pregnancy and breastfeeding, and should also be administered with caution in ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S1878747923011790

Review Circadian Rhythm Sleep–Wake Disorders Circadian rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life.

8. aasm.org aasm.org/resources/clinicalguidelines/crswd-intrinsic.pdf

Clinical Practice Guideline for the Treatment of Intrinsic Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake ...

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2679862/

A Clinical Approach to Circadian Rhythm Sleep Disorders - PMC This review will focus on the clinical approach to the diagnosis and management of the various circadian rhythm sleep disorders.