The dream of better sleep treatments

Graphic of man sleeping up right in bed with the moon behind him.

A closer look at patient biomarkers may provide clues to the mysterious mechanisms of sleep disorders and chronic health conditions

By Jessica Binkley Lain

You can’t just wake someone up in the middle of the night and ask how they’re feeling or what’s going on in their sleep.

— Sara Mithani, PhD, RN

Sara Mithani, PhD, RNThroughout her career as a nurse and researcher, Sara Mithani, PhD, RN, assistant professor in the School of Nursing, made note of an interesting commonality among many of her patients. She found that individuals with varied health issues — from cardiovascular disease to cancer to mental health issues — would all describe a similar complaint: difficulty with their sleep.

“I was struck by the interplay between various health conditions and their connection to sleep quality and disturbance,” Mithani said. “We dedicate about a third of our lives to sleep, and it influences not only our daily well-being, but also our long-term health trajectories. But, despite how much we know, sleep still has a lot of mysteries.” Mithani’s curiosity about this mystery led her down the path of sleep disorder research.

Collection to connection

Researching sleep is complicated, as the very nature of it makes it difficult to study.

“You can’t just wake someone up in the middle of the night and ask how they’re feeling or what’s going on in their sleep,” Mithani said.

For that reason, Mithani’s research is focused on finding biomarkers of patients with sleep disorders. Her research employs a proteomic approach to understand the clinical and mechanistic presentations of sleep disorders in long-term chronic health conditions. By investigating the biomarkers, Mithani and her team examine the connections between physiological changes, the clinical symptoms of patients and the long-term impacts on their health.

“One significant observation among individuals with sleep disorders is their heightened risk for a range of health problems,” Mithani said. Apart from experiencing difficulty sleeping, these patients often face increased risk of developing conditions like diabetes, hypertension, anxiety, other mental health issues and even cognitive impairment, she said.

Mithani works closely with an interdisciplinary team to collect blood and saliva samples to study which proteins, such as neurological, immune and inflammatory proteins, are being dysregulated. She aims to understand the underlying mechanisms involved in sleep disorders like insomnia and obstructive sleep apnea.

“There are a lot of layers to parse through to determine if the sleep disorder is a secondary diagnosis or the primary,” she said, which is why her research looks at the biomarkers.

Sleep to live healthier

Recent findings in sleep research are revealing the integral role of sleep for neurocognitive functioning, Mithani noted. Quality sleep is not only necessary to be alert and functional throughout the day, but it also is critical for eliminating the neurotoxins from the brain each night. Inadequate or dysregulated sleep for prolonged periods cumulatively may lead to early presentations of neurocognitive deficits, Mithani said.

“This is worrying because many patients share that they are not sleeping well or feel they do not sleep well,” she said. On the other hand, individuals with obstructive sleep apnea, for instance, may go undiagnosed for years because they think they’re sleeping fine, unaware that their sleep is disrupted. Then there are people with insomnia who know they have trouble sleeping, but they often brush it off as normal and try to ignore their symptoms.

“It’s encouraging to see society now placing greater importance on sleep health, recognizing its role in overall well-being,” Mithani said. “It’s crucial for health care providers to advocate for sleep health, as it directly impacts not just daily lives, but also the long-term physical and mental well-being of the patients we serve.”

A new gold standard

Collaborating with her clinician colleagues, Mithani’s investigation uses a personalized methodology. Along with biological samples, the research team collects information about a patient’s symptoms and their particular medical history.

Mithani examines various trends such as changes in the trajectory of sleep-related symptoms. She also studies patients who have similar experiences but different sleep presentations, medical histories or pathways that put certain individuals at higher risk, and any underlying genetic differences that are exacerbating their symptoms. All this research aims to identify patients who are likely to respond well to specific treatments for sleep disorders and assess how these treatments affect their physiological health.

Gold standard treatments for sleep disorders, typically behavioral therapy, pharmacotherapy, or a combination, can vary among individuals. So, what works best for one person may not be as effective for another, Mithani noted. While these treatments are considered best practice based on general efficacy, personalized approaches are necessary for optimal outcomes.

“The gold standards in science and health care are not static and can evolve over time in response to new discoveries and emerging research,” she said. “The dream for sleep health research would be to develop personalized interventions tailored to each person’s unique sleep needs, personal history, genetics, lifestyle and environments.”


Biobehavioral Laboratory and biobank

Chun-Liang Chen, PhD, (right), professor and director of the Biobehavioral Laboratory and biobank
Chun-Liang Chen, PhD, (right), professor and director of the Biobehavioral Laboratory and biobank.

The Biobehavioral Laboratory within the School of Nursing offers comprehensive services for researchers in need of wet lab and behavioral suite facilities. Classified as a Biosafety Level 2 facility by the university’s Department of Environmental Health and Safety, the wet lab specializes in conducting assays involving saliva and blood and is equipped to manage various biological samples from local and national studies.

The lab also provides storage and testing services, including specimen collection, diagnostic ordering and neuropsychological testing using advanced tools such as the Wisconsin Card Sorting Test. The lab’s active collaboration with LabCorp ensures that assays beyond its capabilities can be seamlessly conducted. For inquiries and collaborations, email laboratory director Chun-Liang Chen, PhD, at ChenC4@uthscsa.edu.


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