This research study is being done to compare different methods of addressing sleep problems before total knee replacement surgery. These methods include Cognitive Behavioral Therapy and light exposure.

This research is being done to evaluate whether combining Cognitive Behavioral Therapy for Insomnia (talk therapy for insomnia) with Morning Bright Light exposure is more effective than Morning Negative Ion exposure combined with either Cognitive Behavioral Therapy for Insomnia or Sleep / Knee Osteoarthritis Education to reduce pain following total knee replacement surgery. This knowledge is needed to develop better ways to manage pain after surgery. Sleep problems are often not treated before or after surgery, so this may differ from the typical care received by adding a focus on sleep. People with knee osteoarthritis, who are 60 years old and older, who are scheduled to have unilateral (one knee) total knee replacement surgery for osteoarthritis and who have trouble falling or staying asleep, may join this study.

There are two possible devices that are being compared in this study.

• If the participants are in the Morning Bright Light exposure group, the participants will use the Re-timer®, a wearable bright light exposure device. This device is commercially available and in use by the general population. This device meets international ultraviolet and blue light hazard safety standards. The light intensities used in this study are greater than most indoor light, but much dimmer than sunlight on a bright day.
• If the participants are in the Negative Ionizer exposure group, the participants will use the IonPacific,"ionMi,"a wearable negative ionizer. This device is also commercially available and in use by the general population.

There have been reports of improved sleep and daytime symptoms associated with poor sleep for both Morning Bright Light and Negative Ionizer exposures. The use of Re-timer and IonMi in this research study is investigational. The word "investigational" means that the Re-timer and IonMi are not approved for marketing by the Food and Drug Administration (FDA).

Participation includes:

A virtual and in person screening and training visit 4, 1-hour long telehealth sessions scheduled each week before surgery 2, 30-minute telehealth sessions, 2-weeks after surgery and 3-months after surgery

This study will be using "blinding" which means only a few members of the study team will know what group / sleep program the participants have been assigned to until the study ends. In case of an emergency, the study doctor can quickly find out which sleep health program the participants have been assigned to receive.

During parts of the study, the device the participants are using may be deactivated in order to test the effects of an active study device compared to a deactivated device. At the end of the study, the team can provide information about the timing of device deactivation.

The participants will not be asked to change the clinical care currently being received for knee osteoarthritis.

Inclusion Criteria:

• People with knee osteoarthritis,
• 60 years old and older,
• scheduled to have unilateral (one knee) total knee replacement surgery for osteoarthritis and
• have trouble falling or staying asleep

Exclusion Criteria:

• currently using medications to help sleep
• have completed Cognitive Behavioral Therapy for Insomnia
• used either Bright Light or Negative Ion exposures in the past year
• have an inflammatory rheumatologic disorder, seizure disorder
• serious mental health disorder, Bipolar I disorder, substance or alcohol use disorder
• serious sleep or circadian rhythm disorder, untreated sleep apnea
• are pregnant or lactating
• have retinal pathology
• history of eye surgery (Lasik or cataract okay if more than 3 months ago)
• are taking disease-modifying antirheumatic drugs
• taking photosensitizing medications
• are unwilling to discontinue over the counter sleep aids (for example, melatonin) for at least 2 weeks before enrolling

Final de-identified, anonymized data sets underlying all publications resulting from the proposed research involving human subjects will be shared with legitimate academic researchers and other community members with a legitimate scientific interest in the research. Where practicable, sharing will take place under a written agreement between the principal investigators prohibiting the recipient from identifying or re-identifying (or taking steps to identify or re-identify) any individual whose data are included in the data sets. Study documentation (e.g., study protocols) will be made accessible via clinicaltrials.gov and via communication with the principal investigators to facilitate interpretation of the scientific data. Codebooks, other study documentation and deidentified data will be made available on the National Institute on Aging (NIA) National Archive of Computerized Data on Aging data (NACDA) repository.

The research community will have access to the data when the award ends. De-identified data will be provided after the requesters sign a Letter of Agreement detailing the purpose of the sharing request, information about the requesters and the requesters affiliations, mechanisms by which the data will be kept secure, and access restricted to the study team. The agreements will also state the recipient will not attempt to identify any individual whose data are included and will not share the data with anyone outside of the research team. NACDA make data available via public-use files (which would require agreement to NACDA's Terms of Use) or via restricted-use files (which would require a signed Restricted Data Use Agreement between the requestor's institution and the Johns Hopkins University as well as an application to request access).

Pll data sharing will follow the guidelines and rules of the NIH and Johns Hopkins University's Institutional Review Board (IRB). Deidentified data will be managed as indicated in the informed consent. The Informed Consent will notify participants that the data will be shared. De-identified data will be share to the extent indicated in the informed consent. Final curated, de-identified, anonymized data sets underlying publications resulting from the proposed research involving human subjects will be generated and will be shared only to the extent indicated in the informed consent. Requesters will sign a Letter of Agreement with the Johns Hopkins University detailing the requesters planned uses of the data and mechanisms by which the data will be kept secure, and access restricted to the requesters study team with appropriate credentials and training in data security. NACDA's application for restricted-use data will be followed.

Only the interventionist and biostatistician will have access to group assignment