Searching for the daytime impairments of primary insomnia

Shekleton, Julia A; Rogers, Naomi L.; Rajaratnam, Shanthakumar M W

doi:10.1016/j.smrv.2009.06.001

Cited by 215 publications

(188 citation statements)

References 96 publications

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“…36 Those with extreme eveningness preference (delayed sleep phase disorder), who tend to sleep at an earlier circadian phase than normal, 37 may be at particular risk of sleep disruption if attempting to sleep during the WMZ. Similarly, given that a subset of traditional insomnia diagnoses may also be due to altered circadian phase, 3,38 the misalignment of the WMZ may not only contribute to the underlying sleep pathology but may also contribute to the variability seen in the daytime performance of such patients, 1 particularly among individuals whose insomnia is associated with elevated homeostatic sleep pressure. The current results emphasize that the WMZ should be taken into account when investigating the potential neurobehavioral deficits associated with CRSDs and insomnia, particularly sleep onset insomnia, as a failure to detect symptoms of impaired cognitive functioning may reflect measurements taken during the WMZ.…”

Section: Discussionmentioning

confidence: 99%

Improved Neurobehavioral Performance during the Wake Maintenance Zone

Shekleton

Rajaratnam²,

Gooley

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: Although impairment of daytime functioning is a symptom of many sleep disorders, there are limited data on their nature for some patient groups. The role of the circadian system on impaired functioning, specifi cally the wake maintenance zone (WMZ)-a ~3-h window of reduced sleep propensity that occurs shortly before the onset of melatonin synthesis-has received little attention. The study examined the infl uence of the WMZ on neurobehavioral performance under normal conditions and following sleep deprivation. Methods: Thirty-one adults (8 F; 18-29 y) completed an inpatient protocol including a baseline day (8-h sleep:16-h wake) and a ~50-h constant routine (CR), including regular assessment of plasma melatonin and neurobehavioral performance (i.e., auditory and visual psychomotor vigilance tests [aPVT, vPVT], Digit Symbol Substitution Test [DSST], and subjective sleepiness). Results: Performance in the 3 hours before the onset of melatonin secretion (i.e., the expected WMZ) was signifi cantly improved compared to performance during a 3-hour block earlier in the biological day, despite a longer time awake. The improvement during WMZ was most prominent after extended wakefulness (i.e., day 2 of the CR). Conclusions: These results suggest that alignment of circadian phase with respect to sleep-wake timing may affect cognitive performance, particularly when homeostatic sleep pressure is high, and especially when performance is assessed in the evening, near the predicted WMZ. The potential contribution of the WMZ to sleep-onset insomnia complaints should be assessed further, using objective neurobehavioral testing and simultaneous circadian phase measurement. Keywords: Cognition, sleep regulation, circadian, performance, melatonin, two-process model, PVT, DLMO Citation: Shekleton JA; Rajaratnam SMW; Gooley JJ; Van Reen E; Czeisler CA; Lockley SW. Improved neurobehavioral performance during the wake maintenance zone. J Clin Sleep Med 2013;9(4): 353-362. http://dx.doi.org/10.5664/jcsm.2588 S C I E N T I F I C I N V E S T I G A T I O N ST he assessment of daytime neurobehavioral impairments in sleep disordered patients has produced inconsistent results, particularly in patients with insomnia.1 In other sleep disorder populations, such as circadian rhythm sleep disorders (CRSDs), there is a paucity of investigations into the daytime impairments associated with the disorders.2 Yet, reports of daytime impairment are a core symptom in the diagnosis of many sleep disorders. The circadian system is known to modulate alertness and performance patterns, and is known to be dysregulated in CRSD. One mechanism by which the circadian system may manifest in the daytime impairments in these patients is via altered timing or amplitude of the wake maintenance zone (WMZ).The WMZ has previously been described as a 2-to 3-h window of reduced sleep propensity that occurs immediately prior to the evening onset of melatonin secretion and under normal conditions, occurs several hours prior to bedtime. 3,4 This window is c...

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Section: Discussionmentioning

confidence: 99%

Improved Neurobehavioral Performance during the Wake Maintenance Zone

Shekleton

Rajaratnam²,

Gooley

et al. 2013

Journal of Clinical Sleep Medicine

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“…Sleepiness in insomnia has been investigated over the last years, producing contradictory findings (Shekleton, Rogers, & Rajaratnam, 2010). Some studies found that excessive daytime sleepiness is a major symptom in insomnia, whereas other studies were not able to significantly relate diurnal sleepiness with insomnia (Buysse et al, 2007;Shekleton et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Some studies found that excessive daytime sleepiness is a major symptom in insomnia, whereas other studies were not able to significantly relate diurnal sleepiness with insomnia (Buysse et al, 2007;Shekleton et al, 2010). Despite that, sleepiness is an important topic in insomnia research.…”

Section: Introductionmentioning

confidence: 99%

“…This might be explained by the close relationship between sleep-wake regulation process and stress system regulation. As hyperarousal is a 24-h construct (Marques, Gomes, Clemente, Santos, & Castelo-Branco, 2016), even the sleep deprivation or poor sleep quality that individuals present will not be noticeable because of the generalized over activity of physiological, emotional and cognitive systems (Riemann et al, 2010;Shekleton et al, 2010). However, the fatigue level may be significant but it is often misinterpreted as sleepiness by the patients (Cluydts et al, 2002;Shen, Barbera, & Shapiro, 2006).…”

Section: Introductionmentioning

confidence: 99%

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DSPS-4: a Brief Measure of Perceived Daytime Sleepiness

2017

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Sleepiness is a key issue in sleep medicine but its definition remains ambiguous and difficult to address. Some studies have reported that sleepiness should be conceptualized as a multidimensional construct. One of these dimensions is sleepiness propensity accurately assessed by the Epworth Sleepiness Scale. However, in the literature, data on other important sleepiness dimensions, such as sleepiness perception, are lacking. In an attempt to fulfil the literature gaps, this study aims at presenting data regarding the development of a brief self-report instrument to assess daytime sleepiness perception, the Daytime Sleepiness Perception Scale (DSPS-4). A sample of 692 undergraduate Medicine students was initially enrolled. The sample was randomly split in order to perform independent exploratory (EFA) and confirmatory factor analyses (CFA). A one-factor solution was examined. The DSPS-4 showed good indicators of reliability and validity. The CFA confirmed the one-factor structure of the DSPS-4. The unidimensional structure of the scale was invariant for both sexes. Results highlight the usefulness of DSPS-4 to measure and assess sleepiness perception at daytime. The short length of this scale enables its incorporation in routine assessment protocols for example regarding insomnia complaints.However, more studies are now required to check its suitability for other samples, specifically well-defined clinical groups.

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“…However, as far as we know, there is no validated self-reporting tool about which researchers are in consensus for accurately measuring daytime impairments due to insomnia (Ohayon & Lemoine, 2004;Shekleton et al, 2010). One of the main reasons for this overdiagnosis of insomnia is that we used « daytime impairment » related to insomnia, including various items such as fatigue.…”

Section: Japanese General Population Sample Re-analysedmentioning

confidence: 99%