Objective vs. Subjective Measurements of Sleep in Depressed Insomniacs: First Night Effect or Reverse First Night Effect?

Abstract

Study Objectives: This study examined changes in sleep parameters between the laboratory and the home setting before and after laboratory monitoring in depressed insomniacs undergoing treatment. Methods: This study was a post hoc analysis of a double-blind, randomized, placebo-controlled clinical trial performed with 60 depressed, insomniac outpatients. Patients underwent actigraphic monitoring along with sleep diaries over a continuous 2-week period. After one week of baseline monitoring, subjects spent one night in the laboratory with concurrent actigraphic and PSG monitoring with sleep diaries. Actigraphic monitoring and sleep diaries were continued for another week at home, along with initiation of open-label fl uoxetine (FLX). Results: Actigraphically recorded laboratory sleep during the night in the laboratory was found to be improved relative to actigraphically recorded sleep at home, with less wake time and greater sleep time and sleep effi ciency occurring in the laboratory. In contrast, sleep diaries indicated a slight worsening of sleep in the laboratory compared to home, with signifi cantly more awakenings in the laboratory compared to the week at home before and after the laboratory night. Conclusions S C I E N T I F I C I N V E S T I G A T I O N SM any individuals experience worse sleep during their fi rst night in a sleep laboratory than on successive nights. This "fi rst night effect" (FNE) is typically characterized by increased sleep onset latency, increased REM latency, a lower percentage of REM stage sleep, and lower sleep effi ciency as measured by polysomnography (PSG). While many studies have observed the FNE phenomenon in normal subjects and in those with depression or insomnia, 1-3 others have observed a reduced or absent FNE. [4][5][6] It has been suggested that factors such as the location of monitoring or pleasantness of the laboratory environment may attenuate this effect, or that individual variability may cancel out differences for entire samples. 5,7-10Many studies observing a FNE have also noted a "paradoxical" or "reverse" fi rst night effect (RFNE) in some of their subjects.11-14 The RFNE is characterized by the observation of decreased sleep onset latency, decreased REM latency, a higher percentage of REM, and greater sleep effi ciency in the fi rst night at the laboratory relative to successive nights, as measured by PSG.13 For insomniacs who demonstrate this phenomenon, several explanations have been proposed. Hauri et al. suggested that maladaptive reinforcements are formed between the insomniac's sleeping problems and their normal sleep environment. 13,15 This conditioned arousal reaction to their normal sleep environment does not generalize to the novel sleep environment of the laboratory, where they fall asleep more easily. Alternatively, de la Pena proposed that some insomniacs require a higher level of waking sensory stimulation to induce sleep, and the greater sensory stimulation of the novel laboratory environment improves their sleep. 16Studies investigating sleep ...

Identifying Insomnia in Early Pregnancy: Validation of the Insomnia Symptoms Questionnaire (ISQ) in Pregnant Women

“…33 The methods used to validate the ISQ (sleep diaries and/or actigraphy) are more commonly used than PSG when diagnosing insomnia, as well as when ascertaining sleep in pregnant women. 66 Actigraphy is significantly correlated with PSG on most variables, 101,102 but PSG only captures 1 to 2 nights of sleep which is insufficient to diagnose insomnia. 103 Sleep diaries and actigraphy are commonly used to provide a detailed, prospective account about quantitative sleep disturbances and their variability.…”

A novel approach using actigraphy to quantify the level of disruption of sleep by in-home polysomnography: the MrOS Sleep Study

“…Unlike many other studies examining the FNE [5–7,9,14,43,44], participants in the MrOS Sleep Study were not selected based on disease status. This allowed for examination of characteristics that may be associated to the FNE.…”

“…If recordings were performed in a laboratory rather than an in-home setting, sleep disruption could also be due to discomfort associated with sleeping in an unfamiliar environment [3,4]. The FNE may be more pronounced among certain patient subgroups, such as in patients with depression [5], anxiety disorders [6,7], or insomnia [8–10], or in older patients [11,12], or minorities [13]. Concerns about FNE have led to conducting PSG on multiple nights, sometimes excluding data from the first night [9,10,14].…”

“…All studies but one [5] have used PSG on all nights to measure sleep quality and estimate the FNE. While PSG is the “gold standard” for sleep assessment, using PSG to measure the sleep disruption caused by PSG may underestimate the true effect.…”

Eszopiclone: Review and Clinical Applications in Chronic and Comorbid Insomnia

“…The findings that eszopiclone improved overall depression symptoms as reflected in HAM-D total score and percent responders are consistent with the previously reported study by Fava and colleagues (2006). McCall and McCall (2012) did a post hoc analysis of this 2010 study and examined changes in sleep parameters in the laboratory and home before and after laboratory monitoring in depressed insomniacs. Mean actigraphy values demonstrated significantly improved sleep time and sleep efficiency and decreased wake time in the laboratory compared to home setting.…”