How many nights are enough? The short‐term stability of sleep parameters in elderly insomniacs and normal sleepers

Wohlgemuth, William K.; Edinger, Jack D.; Fins, Ana I.; Sullivan, Robert

doi:10.1111/1469-8986.3620233

Cited by 124 publications

(68 citation statements)

References 10 publications

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“…Repeated assessments would provide a more reliable assessment of the regular sleep of the participants as well as the frequency with which they experienced sleep problems. The number of nights necessary for such reliability can vary from five nights to three weeks depending on the methodology (Acebo et al, 1999;Wohlgemuth et al, 1999). Objective measurements of sleep such as polysomnography and actigraphy would be useful.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Sleep and effort in adolescent athletes

Engle-Friedman

Palencar

Riela

2010

J Child Health Care

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Adolescents' sleep and next day effort was studied in 18 female competitive adolescent athletes. A subjective assessment of the previous night's sleep, their perception of the difficulty of the choices offered and the difficulty of tasks selected was completed before routine lessons. Sleep amount was related to the perception of the difficulty of the task, while awakenings were related to an avoidance of the least preferred maneuvers. Individuals who experienced the greatest number of awakenings and most time awake at night were more likely to select the least difficult of these tasks. Sleep disturbance in adolescence may magnify the challenges they experience and cause them to underestimate their ability to meet those challenges.

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Section: Limitations and Future Directionsmentioning

confidence: 99%

Sleep and effort in adolescent athletes

Engle-Friedman

Palencar

Riela

2010

J Child Health Care

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“…While significant selfreport differences in sleep time between older adults with and without insomnia complaints have been observed in most of these studies, the objective sleep findings have been more equivocal. Indeed, some studies have found no statistically significant differences in polysomnographic sleep parameters between older adults with and without insomnia (Bastien et al, 2003;Edinger et al, 1997;Wohlgemuth et al, 1999). These studies had approximately 30 or fewer older adults in each group, thus while there were potential clinically significant differences in some objective domains, they were not statistically significant.…”

Section: Introductionmentioning

confidence: 96%

“…Furthermore, the circadian output that influences sleep-wake cycles may be weaker in older adults, thus leading to more frequent objective sleep-to-wake transitions (Klerman et al, 2004). While several studies have compared the subjective and objective polysomnographic sleep characteristics of older adults with insomnia complaints, most have relied on a single-night polysomnography assessment (Bastien et al, 2003;Unruh et al, 2008), included middle-aged research study participants (Means et al, 2003), excluded study participants with other medical conditions (Edinger et al, 1997;Wohlgemuth et al, 1999), or did not include a control arm (Libman et al, 1997;Riedel and Lichstein, 1998;Riedel et al, 2001). While significant selfreport differences in sleep time between older adults with and without insomnia complaints have been observed in most of these studies, the objective sleep findings have been more equivocal.…”

Section: Introductionmentioning

confidence: 99%

Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms

Gooneratne

Bellamy

Pack

et al. 2010

Journal of Sleep Research

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SUMMARY Older adults have high prevalence rates of insomnia symptoms, yet it is unclear if these insomnia symptoms are associated with objective impairments in sleep. We hypothesized that insomnia complaints in older adults would be associated with objective differences in sleep compared to those without insomnia complaints. To test this hypothesis, we conducted a cross-sectional study in which older adults with insomnia complaints (cases, n=100) were compared to older adults without insomnia complaints (controls, n=100) using dual-night in-lab nocturnal polysomnography, study questionnaires and seven days of at-home actigraphy and sleep diaries. Cases were noted to have reduced objective total sleep time compared to controls (25.8 minutes +/− 8.56, p=0.003). This was largely due to increased wakefulness after sleep onset (WASO), and not increased sleep latency. When participants with sleep-related breathing disorder or periodic limb movement disorder were excluded, the polysomnography total sleep time difference became even larger. Cases also had reduced slow-wave sleep (5.10 +/− 1.38 vs 10.57 +/− 2.29 minutes, effect size −0.29, p=0.04). When comparing self-reported sleep latency and sleep efficiency to objective polysomnographic findings, cases demonstrated low, but statistically significant correlations, while no such correlations were observed in controls. Cases tended to under-estimate their sleep efficiency by 1.6% (+/− 18.4%), while controls over-estimated their sleep efficiency by 12.4% (+/− 14.5%). In conclusion, we noted that older adults with insomnia complaints have significant differences in several objective sleep findings relative to controls, suggesting that insomnia complaints in older adults are associated with objective impairments in sleep.

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“…Insomnia is commonly conceptualized as a periodic disorder characterized by sleep variability. Whereas some insomnia sufferers exhibit a somewhat constant pattern of poor sleep (Valliè res et al, 2011), the majority of insomnia sufferers show some night-to-night fluctuations, with poor nights of sleep followed typically by good ones, and vice versa (Perlis et al, 2010;Wohlgemuth et al, 1999). The putative mechanisms proposed to explain this phenomenon include voluntary behaviours, such as increasing time in bed to compensate for a previous poor night of sleep, as well as homeostatic processes, which lead eventually to ÔrecoveryÕ sleep after one or several poor nights (Espie, 2002).…”

Section: Introductionmentioning

confidence: 99%

Internight sleep variability: its clinical significance and responsiveness to treatment in primary and comorbid insomnia

Sánchez-Ortuño

Edinger

2012

Journal of Sleep Research

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SUMMARYAlthough sleep diary and actigraphy data are usually collected daily for 1 or 2 weeks, traditional analytical approaches aggregate these data into mean values. Internight variability of sleep often accompanies insomnia. However, few studies have explored the relevance of this ÔconstructÕ in the context of diagnosis, clinical impact, treatment effects and ⁄ or whether having Ôvariable sleepÕ carries any prognostic significance. We explored these questions by conducting secondary analyses of data from a randomized clinical trial. The sample included primary (PI: n = 40) and comorbid insomnia (CMI: n = 41) sufferers receiving four biweekly sessions of cognitive-behavioural therapy (CBT) or sleep hygiene education. Using the within-subject standard deviations of diary-and actigraphy-derived measures collected for 2-week periods [sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE)], we found that CMI sufferers displayed more variable self-reported SOLs and SEs than PI sufferers. However, higher variability in diary and actigraphy-derived measures was related to poorer sleep quality only within the PI group, as measured by the Pittsburgh Sleep Quality Index (PSQI). Within both groups, the variability of diary-derived measures was reduced after CBT, but the variability of actigraphy-derived measures remained unchanged. Interestingly, the variability of actigraphy measures at baseline was correlated with PSQI scores at 6-month follow-up. Higher SOL variability was associated with worse treatment outcomes within the PI group, whereas higher WASO variability was correlated with better treatment outcomes within the CMI group. Sleep variability differences across insomnia diagnoses, along with their distinctive correlates, suggest that mechanisms underlying the sleep disruption ⁄ complaint and treatment response in both patient groups are distinct. Further studies are warranted to support variability as a useful metric in insomnia studies.

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How many nights are enough? The short‐term stability of sleep parameters in elderly insomniacs and normal sleepers

Cited by 124 publications

References 10 publications

Sleep and effort in adolescent athletes

Sleep and effort in adolescent athletes

Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms

Internight sleep variability: its clinical significance and responsiveness to treatment in primary and comorbid insomnia

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