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University of Pittsburgh Department of Psychiatry

Dr. Martica Hall’s Groundbreaking Research Ties Sleep to Effects on Physical Health

Martica Hall, PhD, Professor of Psychiatry, doesn’t spend her days forging new ground in oil field exploration like her father did, but she certainly is doing so in the field of dreams we call sleep. Dr. Hall was born in Venezuela and her dad’s work as a geologist in the oil business kept her family overseas, living in Bolivia, Argentina, Venezuela and Colombia, until she moved to Miami for high school. Likely inheriting her dad’s adventurous and inquisitive spirit, Dr. Hall has made it her life’s work to probe unanswered questions about sleep and its effects on physical health. “A geologist, my dad looked for oil in remote and often unmapped locations throughout South America—places others had not thought to explore. Perhaps some of his pioneering spirit has stuck with me as I search for answers to outside-the-box questions about sleep and health,” she said. And she has not come up empty-handed—her quest to bring together the once disparate fields of behavioral medicine and sleep medicine has led Dr. Hall to become one of the leading experts in this field.

A Wake-Me-Up Moment. Dr. Hall’s interest in the field of sleep medicine began when she was in graduate school, studying stress and the immune system with her mentor, Andrew Baum, PhD, a leader in psychoneuroimmunology research. At that time, research on the links between psychological stress, the immune system, and health focused primarily on mechanisms that occurred or happened to be assessed during wakefulness such as reactivity to psychological stress and coping styles.  Her own work focused on intrusive thoughts as a mechanism that sustains psychological stress in the long term, increasing vulnerability to stress-related decrements in health. Dr. Hall experienced a wake-me-up moment when a chance conversation with a neuroscience postdoc, who was studying rapid eye movement sleep and long-term potentiation, got Dr. Hall thinking about sleep as a pathway through which psychological stress might impact the immune system. In the pre-internet days of the early 1990’s, Dr. Hall ran a search of the National Library of Health Medicine database and, to her surprise, found few publications on sleep and the immune system.  Yet, the literature that Dr. Hall did manage to find was intriguing. A sophisticated and methodical research program led by Dr. James Krueger, in collaboration his postdoctoral fellows, Drs. Mark Opp and Linda Toth, demonstrated strong bi-directional associations between sleep and the immune system.  These data reinforced Dr. Hall’s hunch that sleep might be an important link between psychological stress, the immune system, and health. Hooked, Dr. Hall knew she wanted to follow this line of inquiry. After finishing her PhD in Biological and Health Psychology at the University of Pittsburgh, she moved across campus to the Department of Psychiatry, for postdoctoral training in clinical sleep medicine.

Exploring the Frontiers of Sleep Medicine. Dr. Hall joined the Department of Psychiatry faculty in 1998 after completing her postdoctoral fellowship with Daniel Buysse, MD, UPMC Endowed Chair in Sleep Medicine.  In the ensuing 20 years, Dr. Hall’s program of research has continued to evolve and probe questions about how psychological stress affects sleep and how stress-related sleep disturbances, in turn, affect health across the lifespan. Her work has shaped the fields of behavioral medicine and sleep research, introducing innovative methods and analytic strategies, including her pioneering work in ambulatory polysomnography and wrist activity, which allow researchers to evaluate habitual and ecologically-valid sleep, and the study of heart rate variability during sleep, which provides continuous and non-invasive measures of autonomic nervous system activity during sleep, which is important for understanding mechanisms through which disturbed sleep influences cardiovascular disease, diabetes, and accelerated biological aging.  In addition to the six R01/U01 grants on which Dr. Hall is currently working, she has led or collaborated on more than 15 National Institutes of Health- (NIH-) funded grants. This work has contributed to the establishment of clinical sleep medicine as an integral part of the biomedical field and to prioritization of sleep research funding at the NIH. Her current grants include the following:

  • Sleep in Retirement Study (The SIR Study) - The National Institute on Aging- (NIA-) funded Sleep in Retirement (SIR) Study looks at what Dr. Hall calls the biological “scarring” of shift work, or the long-term effects of shift work on physiology and health that persist into retirement. Current estimates suggest that more than 15 million Americans regularly work at night, in permanent or rotating night shift positions. “The problem is that we are biologically adapted to function on the 24-hour cycle of day and night, with sleep occurring at night. Yet, we are a society that runs 24 hours a day,” said Dr. Hall. “Men and women who work shifts that occur when their body is telling them that it should be asleep suffer biological consequences that may cast a long biological shadow.” With Dr. Buysse, the study’s co-principal investigator, Dr. Hall is examining these individuals’ cardiovascular and metabolic health and the integrity of their sleep and circadian systems. “Virtually any health problem you can think of is more prevalent in those who have worked shifts throughout their career. The increased morbidity and mortality in shift workers is astounding,” said Dr. Hall. In addition, she and Meryl Butters, PhD, Associate Professor of Psychiatry, have extended the scope of the SIR Study to collect pilot data on the long-term effects of shift work on neuropsychological functioning and risk for Alzheimer’s Disease.  

  • SWAN Sleep Study. As an early career investigator in the Department of Psychiatry, Dr. Hall initiated and led an ancillary sleep study to the NIA-funded Study of Women’s Health Across the Nation (SWAN), a large, multisite study of menopause. Together with colleagues at the University of Pittsburgh, University of Michigan, Rush University, and the University of California, Davis, Dr. Hall used ambulatory polysomnography, wrist actigraphy, and self-report questionnaires to document how, and why, sleep changes during the menopausal transition and the impact of menopause-related sleep disturbances on mental and physical health.  The original and competing renewal of the SWAN sleep study have led to more than 30 peer-reviewed manuscripts on sleep and health in midlife women. As a collaborator on the ongoing U01 SWAN study led by Dr. Karen Matthews, Dr. Hall has led efforts to collect wrist actigraphy data and characterize sleep health in a larger, more diverse sample of the SWAN cohort. These data will allow Dr. Hall, other SWAN investigators, and their trainees to more fully characterize the causes and consequences of menopause-related sleep disturbances as women transition from pre- to post-menopause.  Given that sleep is a modifiable behavior, the work of Dr. Hall and her SWAN colleagues may identify strategies to reduce menopause-related sleep disturbances and enhance successful aging in women. 

  • R01s in Sleep and Cardiovascular Health and Disease. Dr. Hall is collaborating on four other R01 projects funded by the National Heart Lung and Blood Institute (NHLBI) that focus on the effects of sleep on cardiovascular disease and mortality. According to Dr. Hall, each of these studies focuses on a “different piece of the puzzle of sleep and cardiovascular disease.” This first study is a collaboration with Matthew Burg, PhD at Yale University and looks at the interplay between sleep duration with hostility and anger and their interactive effects on the cardiovascular system. She collaborates on a second project with Viola Vaccarino, MD, PhD from Emory University using twin pairs from the Vietnam Era Twin Registry to study interactions among sleep and post-traumatic stress disorder and their effects on ischemic heart disease using PET imaging of the heart. In a third study led by Dr. Meredith Wallace, Drs. Hall and Buysse are working with colleagues at Harvard and the University of California, San Francisco, to apply cutting-edge statistical techniques to large, archival datasets to characterize sleep as a multidimensional construct, called sleep health, to examine the effects of sleep health on mortality in older adults. Dr. Hall’s newest R01 collaboration is with Dr. Steven A. Shea, PhD, a researcher at the Oregon Health Sciences University, in which they will use a sophisticated laboratory protocol to disentangle the effects of sleep and circadian rhythms on blood pressure in African American and European American adults, to better understand the mechanisms that underlie race differences in diurnal blood pressure and risk for hypertension.

Future Dreams. Like her father, Dr. Hall continues to dream of questions that lie just beyond our horizon of understanding. Thus far, her work has advanced our understanding of the biobehavioral processes, or mechanisms, through which sleep influences health and functioning.  Dr. Hall’s work has continued to emphasize the importance of racial/ethnic differences in sleep as a means of identifying and ameliorating disparities in health, including cardiovascular disease, diabetes, and Alzheimer’s Disease.  These “diseases of aging” may share common upstream mechanisms, as measured by cellular and molecular indices of accelerated aging.  Dr. Hall has several new lines of research in development that build on her previous work. These projects include a collaboration with colleagues in Pittsburgh and at the University of Toronto and the University of California, Los Angeles to develop a study to evaluate the additive and synergistic effects of disturbed sleep and major depressive disorder on gene expression and cellular and molecular aging, a project examining the role of slow-wave sleep in race differences in hypertension, and an R01 proposal to follow up early signals from the SIR Study of cognitive decline in shift workers. 

Much like her early inspiration drawn from Dr. Krueger’s research on sleep and the immune system, Dr. Hall’s long-term plan, or dream, is to inspire high-impact research on the pathways through which sleep influences and is influenced by health and functioning.  A dedicated mentor, Dr. Hall co-directs the Translational Sleep Medicine T32 training program with Dr. Buysse and trains students across the academic continuum including undergraduates, graduate and medical students, postdocs, and junior faculty. Beyond the University of Pittsburgh, she has led national and international training workshops and has obtained numerous grants to support travel awards for trainees to attend and participate in scientific conferences. In her current capacity as President of the Academy of Behavioral Medicine Research, Dr. Hall is actively developing career and leadership development opportunities for mid-career researchers to better support and advance the next generation of behavioral medicine researchers, teachers, and policy-makers. Whether in sleep research, specifically, or behavioral medicine, more broadly, Dr. Hall dreams of training as many successful researchers as she can to carefully and persistently explore important questions that remain just over the horizon.

   

Dr. Hall mentors a large group of trainees in the Mechanisms and Moderators of Sleep Health Laboratory at the University of Pittsburgh. These trainees develop conceptual models which they then test using a large cache of archival data related to sleep and health. Dr. Ryan Brindle, who has just transitioned from postdoc to Assistant Professor of Psychology at Washington and Lee University, is focused on psychological stress and sleep and their effects on cardiovascular disease. Vivianne Oyefusi, a second-year medical student at the University of Pittsburgh, is evaluating race, sleep and disparities in hypertension. Marissa Bowman is a graduate student in the dual Clinical and Health Psychology Program at the University of Pittsburgh; her research with Dr. Hall is focused on the interplay between sleep, depression, and cardiovascular disease.  
 

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Written for UPMC Children’s Hospital of Pittsburgh newsletter Pediatric Insights

Future Olympian Racewalker Partners With Children’s Hospital to Control Epilepsy

At age 18, Trevor Barron of Bethel Park is considered one of the best amateur racewalkers in the world. He won the gold medal in racewalking in the Junior Olympics four years in a row and plans to qualify to compete in the 2012 Summer Olympics in London. However, he’s jumped a few hurdles to get to where he is today. In 2000, at age 8, Trevor was diagnosed as having gelastic seizures, a relatively uncommon form of epilepsy. To manage his condition along this journey, he and his family have partnered with Children’s Hospital of Pittsburgh of UPMC literally every step of the way.

The Barrons saw the first signs of Trevor’s illness when, as an otherwise healthy child, he would burst out into uncontrollable laughter at inappropriate times. This often resulted in the inability to control his bladder. Recognizing that something may be awry, his parents, Bruce and Nancy Barron, took him to see a urologist. When Trevor received a clean bill of health, they were somewhat relieved, but concern struck again when he periodically began to notice some strange “tingling” throughout his body.

A member of the Mt. Lebanon Swim Team, Trevor first experienced this tingling while in the pool and held onto a lane rope until the feeling passed. The coaches didn’t notice, and Trevor continued to swim. The situation escalated when, at a Cub Scout meeting, Trevor noticed the tingling again and fell off a railing, hitting his head on a concrete walkway. About an hour later, Trevor had his first full-blown seizure, which lasted about 20 seconds.  An emergency room exam at Children’s revealed that Trevor had no brain damage, but he was advised to schedule an appointment with a pediatric neurologist. Following evaluation by Dr. Shelley Williams, MD at Children’s, Trevor’s seizures were diagnosed. With use of Tegratol, Trevor’s episodes gradually decreased and he was able to lead a normal life. When he felt a seizure coming on, he could assume a safe position and then continue on with whatever he was doing at the time.

During second and third grades, Trevor was homeschooled and kept up a rigorous academic program. He refused to allow his epilepsy, or more specifically the slow mental processing speed that commonly accompanies the dysfunctional brain activity that produces seizures, to interfere with his achievements. By the time he returned to public school in grade 4, his standardized test scores were in the 93rd percentile and he was enrolled in advanced math. He also kept a full extracurricular schedule, participating in athletics, Cub Scouts, trumpet and art classes, and church activities. For about five years, Trevor’s condition was just a minor hindrance, and it was during this time that his interest in track and field sparked.

At age nine, he would tag along to practice with his dad, who was the track team’s coach, and sister, Tricia, who was a talented runner. In 2001, she qualified at a meet to travel to Sacramento, Calif. for a competition. “Trevor wanted to be on that plane with us, and the following year he was,” said Bruce. Having tried almost every track and field event, he found his niche in racewalking. In 2002, Trevor qualified for USAFT Junior Olympics and in 2003 won the gold medal at the Junior Olympics. He was hooked. Trevor also continued to swim and at age nine won over western Pennsylvania’s top ten-year-olds in both the 50- and 100-meter butterfly races at a championship meet. In eighth grade, Trevor enjoyed the notoriety of being both a star swimmer and cross-country runner, but he eventually would find that his athletic drive was put to better use on land rather than in the pool. Coaches became concerned about Trevor’s safety after he had a seizure at a meet, one in the pool, and several at practice. He was no longer permitted to participate on the swim team, but this did not hinder him. In fact, it forced him to prioritize his racewalking training. The family’s openess about Trevor’s condition has provided solace to many other athletes. “A mother of a young girl on our track team told me that she was afraid to tell us that her daughter had epilepsy until she heard about Trevor,” said Bruce. “We hope that the seeing him face his challenge head on will help other athletes encountering such obstacles to pursue their goals.”

Trevor continued to racewalk, dealing with the occasional seizure, but in 2006 his medication began to fail to control his seizures, requiring a dosage increase. At one point, he was taking twice the usual adult dose.  After he failed a second medication, Dr. Deborah Holder, MD, a pediatric epileptologist and director of Children’s Pediatric Epilepsy Surgery Program (Dr. Williams had moved to Syracuse, NY), evaluated Trevor.  Dr. Holder recommended that Trevor undergo brain mapping, a procedure during which EEG electrode grids are placed directly onto the brain to map seizure activity and locate their origin. It was determined that the seizures were coming from his left frontal lobe and that there was no abnormality in his brain. Because Trevor had failed two medications and there was only point of seizure origination, he qualified for surgery. “Even though the seizure-generating matter was intertwined with his motor strip, we were sure that we could successfully remove it without limiting Trevor’s mobility, “said Dr. Holder. “We did not plan to resect all of this material because Trevor did not want to risk having any weaknesses that would hinder his goals, so he is still at slight risk for more seizures.” Dr. Holder, being a former swimmer, understood what it meant to Trevor to be able to continue his racewalking.

Dr. David Adelson, MD, Trevor’s neurosurgeon, performed the second surgery successful ly in August, but afterwards Trevor experienced some speech problems and then, more seizures. This sometimes occurs following surgery as a result of brain irritation, and Trevor was admitted again for 10 days. The frequency of Trevor’s seizures—he was having up to 40 in one night—made it necessary for him to take phenobarbital. “Trevor did not react well to this drug, which produced manic-depressive behavior and some intellectul deficit,” said Bruce. “The period following hospitalization was difficult, as he began having real difficulty with school at this point. He was emotionally drained because he could not concentrate clearly or complete schoolwork as well as usual. The guidance counselor even proposed that he skip the school year,” said Bruce. Trevor would not hear of it. Pushing himself even harder than usual, he maintained his grades and returned to athletics by late September, while still taking one epilepsy medication.  In October, he was the fastest runner on the high school’s track team.  “Dr. Holder firmly reassured us that these difficulties would subside as Trevor continued to recover, and she was right,” said Bruce. “I am happy to know that we are able to provide this kind of reassurance to parents,” said Dr. Holder. “Parents and the patient usually undergo a huge amount of stress when faced with something as serious as brain surgery, but this is what we do every day.”

Trevor has been seizure-free since September 2006. He was homeschooled his junior and senior years of high school so he could train with his coach, Tim Seaman of San Diego, Calif., a two-time Olympian. Having graduated in May, Trevor still remains under Seaman’s guidance, racewalking an average of two hours daily. Racewalking requires a type of “strut” that may appear odd to one not familiar with the sport, and although it has not caught the collective interest in America, it’s more widespread in Europe, Russia, and China. In fact, the National Collegiate Athletic Association does not even recognize racewalking as an event. “People are judgmental, but I don’t let it bother me. Racewalking has allowed me to make friends all over the world,” said Trevor. “These opportunities are priceless and are what makes the sport so valuable to me.” Most recently, Trevor traveled to Italy to train with friends and competed in his first serious 20-kilometer competition in Tuusula near Helsinki in Finland. His score actually beat the Olympic B standard, but qualifying period for the Olympics does not start until 2011. A man of few words, Trevor’s soft-spoken manner does not give way to the fierce determination that lies underneath. Perhaps this is exactly what fuels his success—channeling his energy to all the right places. Always looking ahead, he plans to attend college for computer science/programming or biology alongside his racewalking training.

PR article written for Presley Ridge of Pittsburgh

Family of Eleven Thrives Through Pressley Ridge Foster Care and Adoption Services: You Can Always Do More Than You Think

November is recognized as National Adoption Awareness Month, with a particular focus on adoption of children currently in foster care. Activities and observances are held across the nation to celebrate adoption as a positive way to build families and shed light on children in need of permanent families. National Adoption Day also occurs in November, and thousands of adoptions are finalized simultaneously in courthouses across the country. To truly understand and appreciate the impact of adoption, read on to learn more about the Stohrer family and their journey from fostering to adopting through Pressley Ridge’s services.

When most of us think about setting a table for 13, we’re envisioning the Thanksgiving turkey or holiday ham, with extended family filling the seats. But for Amy and Matt Stohrer of Lebanon, PA, this is just a normal dinnertime. The couple has adopted nine children ages 2-17, comprised of a group of five siblings, twins, and two other single children. Add in two foreign exchange students from Korea, four cats, a dog, and a fish, and you’ve got a lot on your plate! Yet, this is just what the Stohrers wanted, and through Pressley Ridge’s foster care and adoption services for children who have experienced trauma in their life, they were able to create their family.

Amy and Matt have opened their home to about 25 children, including a number of sibling groups, since 2008, when they started to foster children in New Hampshire. When Matt’s 23-year military career brought them to Pennsylvania, they purchased a five-bedroom home, knowing that slowly but surely, they would fill it to capacity. Amy always knew her life was headed in this direction. “From a pretty young age, something in me knew that I wanted to foster and adopt children someday,” she said. “Our case manager wondered why we had a big house before we actually had any kids, but I told her it’s all for them, before we even knew who they were.”

The couple adopted their first group of siblings through Pressley Ridge in 2014 and continued to foster several more sibling groups and adopt more children. “One group spent more than a year in our home and then was returned to their family, and although this it was difficult to let them go—you really grown to love these kids—we were able to provide the care and affection they needed,” said Matt. “The way we see it, the child loses every time if no one steps up. There are so many kids out there that need a family, and the truth is that you can always do more than you think you can.”

As with all parents, the Stohrers gained more and more experience, and adjusting to a life where the kids far outnumber the adults became easier with time. Running such a large household takes a lot of planning and good organizational skills, and Amy handles the bulk of responsibility during the day while Matt, a sergeant, teaches leadership courses at Fort Indiantown Gap’s noncommissioned officers academy—a handy skill for a father of nine.

As one can imagine, just feeding such a crowd three times a day is a huge job. “The kids help get their own breakfast, lunch, and snacks, which are kind of grab and go, and we all sit down to eat dinner together each night,” said Amy. “I’m used to cooking for so many people, and they pretty much like whatever I make—but of course their favorite is pizza!” The kids go to the local preschool and public school district and participate in sports and other activities, like any other students. In addition, the daily schedule sometimes includes visits with the children’s biological parents, appointments, and therapy. She finds a bit of downtime during the day when everyone is napping, but things rev up again around 3 pm when school lets out. The family now runs so smoothly that Matt even got to spend a bit of time away at the family’s cabin, hunting with some friends. “All of the kids really enjoy outdoor activities, like biking and running, so one of our favorite things to do is to pile in our oversized van and head to the cabin for the weekend!” says Amy. “It’s a great outlet for everyone and gives us all an opportunity to both relax a little and let off some energy.”

The couple disputes the common perception that families who adopt children who have experienced trauma typically have problems, saying that this has not been their experience at all. “Fear should not prevent people considering adoption from following their heart and reaching out to help these kids. We have seen our kids thrive because they come into a stable and safe home, where their basic needs of food, care, a clean bed, and access to a doctor and dentist are met,” said Matt. “They have been living without these basic necessities, and to see them do so well once these needs are met is amazing.”

 

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Pressley Ridge Helps Families Become Families

Throughout the entire fostering and adoption experience Pressley Ridge offers training and continuing education on caring for children and interacting with those who have experienced trauma in their lives.

Pressley Ridge’s foster care services are designed to provide children and youth with a safe, secure and stable setting in a quality, certified foster home. The ultimate goal is to prevent or reduce a child’s trauma by ensuring they are safe and well cared for by a trained foster parent and to assist in achieving permanency through reunification, adoption, or permanent legal custodianship. Services offered by the organization are:

  • Treatment foster care provides an alternative to institutional placement for children and youth suffering from serious emotional disturbances.

  • Traditional foster care services provide dependent children and youth with a secure and stable setting in a quality home environment. 

  • Families choosing Foster to Adopt give a child in the foster care system permanency through an eventual adoption.

  • Young parents are placed together with their child in a supportive foster home. 

  • Specialized foster care meets the needs of teens and the families supporting them. 

  • As a state-approved, licensed agency, adoptions are handled in-house.

If you think you might be ready to open your heart and home but still have questions, check out our list of frequently asked questions.  Or contact us at (412) 872-9400 or email info@pressleyridge.org.

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