Circadian Rhythms and Homeostatic Sleep Drive and Their Effect on Reward and Cognitive Control Systems in Adolescents (CARRS-P1)

Center for Adolescent Reward, Rhythms and Sleep Project 1

Adolescence is a time of heightened reward sensitivity and greater impulsivity. On top of this, many teenagers experience chronic sleep deprivation and misalignment of their circadian rhythms due to biological shifts in their sleep/wake patterns paired with early school start times, which may increase the risk for substance use (SU). However, what impact circadian rhythm and sleep disruption either together or independently have on the neuronal circuitry that controls reward and cognition, or if there are interventions that might help to modify these disruptions is unknown. Project 1 (P1), specifically examines homeostatic and circadian characteristics as mechanisms linking habitual sleep patterns, reward and cognitive control (at subjective, behavioral, and circuit levels), and longitudinal substance use risk.

Study Overview

• Status: Recruiting
• Conditions: Sleep
• Intervention / Treatment: Behavioral: Ultradian sleep/wake protocol

Detailed Description

P1 will study 200 adolescents ages 13-18 in a 48-h to 60-h laboratory study. Participants will monitor sleep patterns at home for 2 weeks with actigraphy and sleep diary, and will also complete fMRI measures of reward and cognitive control. This will be followed by a 48-to-60-hour laboratory visit. The laboratory session includes two nights of polysomnography (PSG) sleep studies (the second night of PSG was halted for all participants as of January 2026), separated by 28 h of an ultradian sleep/wake protocol-every 120-minutes, there will be an 80-minute period of waking, followed by a 40-minute sleep opportunity. (Prior to January 2026, participants had a 36-h ultradian sleep/wake protocol, which was then shortened to 28 hours). Participants will be in dim light conditions and temporal isolation for the first 28 h of the ultradian sleep/wake protocol. Physiological circadian measures include salivary melatonin; core body temperature (CBT); and molecular rhythms from hair follicle cells (examined in Project 3). Physiological sleep homeostatic measures include waking EEG theta power, slow-wave sleep rebound following the ultradian sleep/wake protocol (for participants enrolled prior to January 2026), and repeated sleep latency on the sleep opportunities. Behavioral tests (Reward Anti-Saccade task to index cognitive control with/without reward modulation; Psychomotor Vigilance Test) and self-reports of mood/sleepiness will be collected every 2 h. Longitudinal on-line surveys will assess substance use every 6 months for the life of the grant.

• Study Type: Interventional
• Enrollment (Estimated): 200
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ronette Blake, MS; Phone Number: (412) 443-3704; Email: blakerg2@upmc.edu
• Study Contact Backup: Name: Sarah Aerni; Phone Number: 412-551-110; Email: aernise2@upmc.edu

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15213
      • Recruiting
      • Western Psychiatric Hospital
      • Contact: Ronette Blake, MS; Phone Number: 412-443-3704; Email: blakerg2@upmc.edu
      • Principal Investigator: Peter L. Franzen, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 13 years to 15 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 13-18 years
• Currently enrolled in a traditional high-school (not cyber- or home-schooled) [school closures during the COVID-19 pandemic are an exception to this]
• Physically and psychiatrically healthy
• Provision of written informed consent and assent

Exclusion Criteria:

• outside age range above
• have a history of alcohol, cannabis, or illicit drug use greater than weekly use in the past year
• have serious medical or neurological disorders, including history of seizures
• have serious psychiatric disorders (e.g. bipolar disorder and schizophrenia)
• taking antidepressants (SSRIs/SSNIs are OK) or medications known to impact sleep/wake function - some medications may be okay if willing and able to discontinue prior to and/or for laboratory procedures
• have sleep disorders other than insomnia or Delayed Sleep Phase Disorder
• have MRI contraindications (i.e., metal in the body; claustrophobia)
• first degree relative with bipolar disorder
• frequent headaches or migraines
• inability to swallow pills/capsules.
• pregnancy
• participants with observed Obstructive Sleep Apnea via Apnealink, as indicated by an Apnea Hypopnea Index (AHI) of greater than 5
• Less than 80 lbs. or a BMI of greater than 35

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Ultradian Sleep/Wake protocol; 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). The ultradian sleep/wake protocol will last for 28-36 h, during which every 120-minutes, there will be an 80-minute period of waking, followed by a 40-minute sleep opportunity. Prior to 2026, a repeat night of sleep will occur at the end of the 36-hour ultradian sleep/wake protocol. As of 2026, the repeat sleep study is no longer being conducted, and the ultradian protocol was shortened to 28 hours.

Behavioral: Ultradian sleep/wake protocol; 120-minute schedule, consisting of 80 minutes awake followed by a 40 minute sleep opportunity for up to 36 hours

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in EEG delta power across overnight polysomnography on the night preceding vs. following the 36-hour ultradian sleep/wake protocol.	Change in the slope of EEG delta power (0.5 - 4 Hz) across NREM periods (frontal leads) on the night preceding vs. following the 36-h ultradian sleep/wake protocol (as measured by polysomnography). This procedure is no longer being collected as of January 2026.	The first night of sleep preceding the 36-hour ultradian sleep/wake protocol vs the night of sleep following the ultradian sleep/wake protocol
Change in slope of waking EEG theta power	Assessed every 2 hours across the ultradian sleep/wake protocol	Every 2 hours during the ultradian sleep/wake protocol, up two 36 hours
Melatonin onset	Endogenous circadian phase estimate of the rise in evening melatonin levels from saliva samples collected over the ultradian protocol (every 30 - 60 minutes) under dim light conditions.	The first 28-hours of the ultradian sleep/wake protocol

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Substance use	Frequency-based self-reports of substance use.	Every 6 months for the duration of the study, up to 4.5 years
Circadian pattern of Core Body Temperature (CBT)	Minimum of CBT	Measured continuously across the ultradian sleep/wake protocol, up two 36 hours.
Melatonin amplitude	Amplitude of the 24-hour melatonin period to estimate endogenous circadian phase	Collected every 30-60 minutes across the ultradian sleep/wake protocol, up two 36 hours
Sleep latency	Time until sleep onset (first 30-second epoch of N2 sleep) as assessed by polysomnography	During the 40-minute sleep opportunities collected every two hours across the ultradian sleep/wake protocol, up two 36 hours
Influence of sleep and circadian measures on neural correlates of impulse control	This outcome will be measured during the Stop Signal Task, which is a computerized an fMRI behavioral task. It will be assessed by activation within the Executive Control Network, specifically, activation is defined as bold signal in regions of the Executive Control Network (particularly the inferior frontal gyrus) on correct Stop trials versus correct Go trials.	Measures from the ultradian sleep/wake protocol in relation to an fMRI scan measured 1 to 2 weeks earlier.
Influence of sleep and circadian measures on neural correlates of reward anticipation and reward outcome.	This outcome will be measured during the Money Incentive Delay Task, which is a computerized an fMRI behavioral task. It will be assessed by activation within the reward network, specifically, activation is defined as bold signals in regions of the reward network (particularly the ventral striatum) on reward anticipation trials versus no money trials.	1 to 2 weeks before to immediately after the ultradian sleep/wake protocol.
Performance on the Psychomotor Vigilance Task	This outcome will be measured during the Psychomotor Vigilance Task, specifically lapses (reaction times > 500 ms) on this sustained attention task.	Collected every 2 hours during the ultradian sleep/wake protocol, up two 36 hours.
Performance on the Reward Anti-Saccade task	This outcome will be measured during the Reward Anti-Saccade task, which measures the ability to look away from a target (an anti-saccade).	Collected every two hours during the ultradian sleep/wake protocol, up two 36 hours.

Collaborators and Investigators

• Sponsor: University of Pittsburgh
• Collaborators: National Institute on Drug Abuse (NIDA)
• Investigators: Principal Investigator: Peter L. Franzen, PhD, University of Pittsburgh

Study record dates

Study Major Dates

• Study Start (Actual): March 4, 2022
• Primary Completion (Estimated): March 31, 2030
• Study Completion (Estimated): May 31, 2030

Study Registration Dates

• First Submitted: August 31, 2021
• First Submitted That Met QC Criteria: April 14, 2022
• First Posted (Actual): April 20, 2022

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 2, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: sleep; adolescence; substance use; reward sensitivity and motivation; circadian phase and alignment; homeostatic sleep drive; ultradian sleep/wake schedule
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: STUDY20030237; P50DA046346 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Current and future investigators, both internal and external, may have access to de-identified data; however only group data would be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No