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Moukhtarian TR, Fletcher S, Walasek L, Patel K, Toro C, Hurley-Wallace AL, Kershaw C, Russel S, Daly G, Tang NKY, Meyer C. Digital CBT for insomnia and emotion regulation in the workplace: a randomised waitlist-controlled trial. Psychol Med 2025; 55:e52. [PMID: 39957531 PMCID: PMC12080640 DOI: 10.1017/s0033291725000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 01/21/2025] [Accepted: 01/24/2025] [Indexed: 02/18/2025]
Abstract
BACKGROUND Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia. However, scaling this proven effective intervention to areas of high need remains a challenge, necessitating sensitive adaptation and evaluation. METHODS A randomised waitlist-controlled trial evaluated the efficacy of a hybrid digital CBT-I and emotion regulation (dCBT-I + ER) intervention delivered through workplaces. Participants with at least mild insomnia and depression or anxiety symptoms were randomised to the intervention or waitlist control groups. The intervention was delivered via a web-based platform and four video-conferencing therapy sessions. Participants tracked their sleep using actigraphy and a sleep diary that was used to pace the intervention delivered. Assessments occurred at baseline and 8 weeks post-randomisation, measuring insomnia, depression, anxiety, psychological well-being, quality of life, and work productivity. RESULTS Of the 159 participants (mean age 43.6 ± 9.4 years, 76.7% female, 80.5% white), 80 received the intervention and 79 were in the control group. The intervention group showed significant improvements in insomnia (F1, 134 = 71.46, p < .0001); depression (F1, 134 = 35.67, p < .0001); and anxiety (F1, 134 = 17.63, p < .0001), with large effect sizes (d = 0.7-1.5). Sleep diary data supported these findings, whereas actigraphy data did not. Improvements in psychological well-being were significant (F1, 132.13 = 10.64, p < 0.001), whereas quality of life, work productivity, and satisfaction outcomes were not. CONCLUSIONS This study suggests that a hybrid dCBT-I + ER intervention, delivered via workplaces, effectively improves insomnia, depression, and anxiety. It holds promise as a scalable solution, warranting further investigation into its long-term efficacy and economic impact.
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Affiliation(s)
- Talar R. Moukhtarian
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
| | - Sophie Fletcher
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, UK
| | | | - Carla Toro
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
| | - Anna L. Hurley-Wallace
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Charlotte Kershaw
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
| | - Sean Russel
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
| | - Guy Daly
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- The British University in Egypt, Cairo, Egypt
| | | | - Caroline Meyer
- Warwick Medical School, Division of Health Sciences, Mental Health and Wellbeing group, University of Warwick, Coventry, UK
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Walton TF, Ree MJ, Fueggle SN, Bucks RS. A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean? Sleep Med 2025; 126:32-66. [PMID: 39626529 DOI: 10.1016/j.sleep.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 10/16/2024] [Accepted: 11/10/2024] [Indexed: 01/29/2025]
Abstract
STUDY OBJECTIVES To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis. METHOD We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses). RESULTS Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison. CONCLUSIONS Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed.
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Affiliation(s)
- Tom F Walton
- School of Psychological Science, The University of Western Australia, Australia
| | - Melissa J Ree
- School of Psychological Science, The University of Western Australia, Australia
| | - Simone N Fueggle
- Department of Psychology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Australia; Office of the Deputy Vice Chancellor, Research, The University of Western Australia, Australia.
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Moulder Z, Sweetman A, Lovato N, Micic G, Lack L, Scott H. Sleep-wake state discrepancy does not impair the efficacy of cognitive behavioural therapy for insomnia: Findings from a large clinic sample. J Sleep Res 2024; 33:e14142. [PMID: 38246601 DOI: 10.1111/jsr.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
The current study determined the extent to which sleep-wake state discrepancy impairs the efficacy of cognitive behavioural therapy for insomnia in a real-world clinical sample. Sleep-wake state discrepancy occurs when there is an inconsistency between a person's subjective and objective sleep, and is a common phenomenon amongst patients with insomnia. Limited information is available on the effectiveness of cognitive behavioural therapy for insomnia in treating patients who experience significant sleep-wake state discrepancy in "real-world" samples. In the present study, all patients with insomnia received cognitive behavioural therapy for insomnia through an outpatient insomnia program (N = 386; mean age = 51.96 years, SD = 15.62; 65.97% [N = 254] female). Prior to treatment, participants completed a polysomnography sleep study and sleep diary, which was used to calculate sleep-wake state discrepancy. At pre-treatment, post-treatment and 3-month follow-up, participants completed the Insomnia Severity Index and other questionnaires, and 1 week of sleep diaries from which sleep-onset latency, wake after sleep onset and other sleep variables were calculated. There were no differences in self-reported sleep-onset latency, wake after sleep onset or Insomnia Severity Index scores at post-treatment or 3-month follow-up between quintiles of sleep-wake state discrepancy. These results indicate that sleep-wake state discrepancy at pre-treatment does not predict treatment response to cognitive behavioural therapy for insomnia. Future research could examine multi-night assessments of sleep-wake state discrepancy to determine whether variations in discrepancy may relate to pre-treatment insomnia severity and cognitive behavioural therapy for insomnia outcomes.
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Affiliation(s)
- Zoe Moulder
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Gorica Micic
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Maltezos A, Perrault AA, Walsh NA, Phillips EM, Gong K, Tarelli L, Smith D, Cross NE, Pomares FB, Gouin JP, Dang-Vu TT. Methodological approach to sleep state misperception in insomnia disorder: Comparison between multiple nights of actigraphy recordings and a single night of polysomnography recording. Sleep Med 2024; 115:21-29. [PMID: 38325157 DOI: 10.1016/j.sleep.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE To provide a comprehensive assessment of sleep state misperception in insomnia disorder (INS) and good sleepers (GS) by comparing recordings performed for one night in-lab (PSG and night review) and during several nights at-home (actigraphy and sleep diaries). METHODS Fifty-seven INS and 29 GS wore an actigraphy device and filled a sleep diary for two weeks at-home. They subsequently completed a PSG recording and filled a night review in-lab. Sleep perception index (subjective/objective × 100) of sleep onset latency (SOL), sleep duration (TST) and wake duration (TST) were computed and compared between methods and groups. RESULTS GS displayed a tendency to overestimate TST and WASO but correctly perceived SOL. The degree of misperception was similar across methods within the GS group. In contrast, INS underestimated their TST and overestimated their SOL both in-lab and at-home, yet the severity of misperception of SOL was larger at-home than in-lab. Finally, INS overestimated WASO only in-lab while correctly perceiving it at-home. While only the degree of TST misperception was stable across methods in INS, misperception of SOL and WASO were dependent on the method used. CONCLUSIONS We found that GS and INS exhibit opposite patterns and severity of sleep misperception. While the degree of misperception in GS was similar across methods, only sleep duration misperception was reliably detected by both in-lab and at-home methods in INS. Our results highlight that, when assessing sleep misperception in insomnia disorder, the environment and method of data collection should be carefully considered.
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Affiliation(s)
- Antonia Maltezos
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Aurore A Perrault
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada.
| | - Nyissa A Walsh
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Emma-Maria Phillips
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Kirsten Gong
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Lukia Tarelli
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Dylan Smith
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - Nathan E Cross
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Florence B Pomares
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Jean-Philippe Gouin
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada.
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Wang S, Jülich ST, Lei X. Latent profile of the insomnia severity index: A longitudinal study. Sleep Med 2024; 115:202-209. [PMID: 38368737 DOI: 10.1016/j.sleep.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
STUDY OBJECTIVES To identify the distinct classification of insomnia symptoms and to explore their association with sleep problems and depression. METHODS Latent profile analysis was used to examine patterns of insomnia symptoms in two samples. Discovery and replication samples comprised 1043 (Mean age at baseline = 18.95 ± 0.93 years, 62.2% females) and 729 (Mean age at baseline = 18.71 ± 1.02 years, 66.4% females) college students, respectively. Participants completed measures of sleep problems (insomnia symptoms, sleep quality, susceptibility to insomnia, perceived consequences of insomnia, dream recall frequency, and percentage of recurring nightmares) and other psychological variables (rumination and depression). Binary logistic regression was used to analyze the effects of different types of insomnia symptoms at baseline on sleep problems and depression two years later. RESULTS Four classes of insomnia symptoms were identified, and classified as "non-insomnia" (class 1, 45.7%), "mild subjective symptoms but severe subjective feelings" (class 2, 23.9%), "severe subjective symptoms but mild subjective feelings" (class 3, 22.0%), and "high insomnia risk" (class 4, 8.4%), respectively. Compared with the group classified as non-insomnia group, other classifications significantly predicted insomnia two years later, only class 4 significantly predicted depression, and class 3 significantly predicted susceptibility to insomnia, after adjusting gender, insomnia, depression, and susceptibility to insomnia at baseline. CONCLUSIONS The findings highlighted the importance of identifying the patterns of insomnia symptoms, and the need for tailored intervention to improve sleep problems. Additionally, when screening for insomnia symptoms, simplified screening using Insomnia Severity Index (ISI) dimensions or items should be considered.
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Affiliation(s)
- Shuo Wang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, 400715, China
| | - Simon Theodor Jülich
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, 400715, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, 400715, China; Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, 400715, China.
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Simor P, Polner B, Báthori N, Bogdány T, Sifuentes Ortega R, Peigneux P. Reduced REM and N2 sleep, and lower dream intensity predict increased mind-wandering. Sleep 2024; 47:zsad297. [PMID: 37976037 DOI: 10.1093/sleep/zsad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/17/2023] [Indexed: 11/19/2023] Open
Abstract
Mind-wandering is a mental state in which attention shifts from the present environment or current task to internally driven, self-referent mental content. Homeostatic sleep pressure seems to facilitate mind-wandering as indicated by studies observing links between increased mind-wandering and impaired sleep. Nevertheless, previous studies mostly relied on cross-sectional measurements and self-reports. We aimed to combine the accuracy of objective sleep measures with the use of self-reports in a naturalistic setting in order to examine if objective sleep parameters predict the tendency for increased mind-wandering on the following day. We used mobile sleep electroencephalographic (EEG) headbands and self-report scales over 7 consecutive nights in a group of 67 healthy participants yielding ~400 analyzable nights. Nights with more wakefulness and shorter REM and slow wave sleep were associated with poorer subjective sleep quality at the intraindividual level. Reduced REM and N2 sleep, as well as less intense dream experiences, predicted more mind-wandering the following day. Our micro-longitudinal study indicates that intraindividual fluctuations in the duration of specific sleep stages predict the perception of sleep quality as assessed in the morning, as well as the intensity of daytime mind-wandering the following hours. The combined application of sleep EEG assessments and self-reports over repeated assessments provides new insights into the subtle intraindividual, night-to-day associations between nighttime sleep and the next day's subjective experiences.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Bertalan Polner
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
- Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands
| | - Noémi Báthori
- Department of Cognitive Science, Faculty of Natural Sciences, Budapest University of Technology and Economics
| | - Tamás Bogdány
- Doctoral School of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
| | - Rebeca Sifuentes Ortega
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN affiliated at Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Belgium
| | - Philippe Peigneux
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN affiliated at Center for Research in Cognition and Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), Belgium
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Stephan AM, Siclari F. Reconsidering sleep perception in insomnia: from misperception to mismeasurement. J Sleep Res 2023; 32:e14028. [PMID: 37678561 DOI: 10.1111/jsr.14028] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
So-called 'sleep misperception' refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of sleep. It is unknown whether this subjective-objective mismatch truly reflects an abnormal perception of sleep, or whether it results from the inability of standard sleep recording techniques to capture 'wake-like' brain activity patterns that could account for feeling awake during sleep. Here, we systematically reviewed studies reporting sleep macro- and microstructural, metabolic, and mental correlates of sleep (mis)perception. Our findings suggest that most individuals tend to accurately estimate their sleep duration measured with polysomnography (PSG). In good sleepers, feeling awake during sleep is the rule at sleep onset, remains frequent in the first non-rapid eye movement sleep cycle and almost never occurs in rapid eye movement (REM) sleep. In contrast, there are patients with insomnia who consistently underestimate their sleep duration, regardless of how long they sleep. Unlike good sleepers, they continue to feel awake after the first sleep cycle and importantly, during REM sleep. Their mental activity during sleep is also more thought-like. Initial studies based on standard PSG parameters largely failed to show consistent differences in sleep macrostructure between these patients and controls. However, recent studies assessing sleep with more refined techniques have revealed that these patients show metabolic and microstructural electroencephalography changes that likely reflect a shift towards greater cortical activation during sleep and correlate with feeling awake. We discuss the significance of these correlates and conclude with open questions and possible ways to address them.
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Affiliation(s)
- Aurélie M Stephan
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Francesca Siclari
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
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Chan JW, Feng H, Zhang J, Chan NY, Li TMH, Chau SW, Liu Y, Li SX, Wing YK. Objective and subjective sleep in patients with non-seasonal major depressive disorder and eveningness - Results from a randomized controlled trial of bright light therapy. Sleep Med 2023; 112:132-140. [PMID: 37857115 DOI: 10.1016/j.sleep.2023.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES This study examines the (dis)agreement between objective and subjective sleep and their prospective changes in a randomized controlled trial of bright light therapy (BLT) in patients with major depressive disorder (MDD) and eveningness. METHODS A total of 93 adults were randomized to receive either 30-min daily of 10,000 lux BLT or 50lux placebo dim red light therapy (DRL group) for a total of 5 weeks. Actigraphic data were collected at the baseline and during the last week of treatment. (Dis)Concordance of diary and actigraphic sleep parameters were assessed by partial correlations and Bland-Altman plots, and the associations between these discrepancies to depression severity was assessed by linear regression models. Changes of sleep parameters were assessed by linear mixed models. RESULTS Significant correlations were found between subjective sleep timings and chronotype to actigraphic parameters. Discrepancies between diary- and actigraphic-measures were observed, and patients with more severe depressive symptoms were associated with a greater under-estimation of total sleep time (TST). A greater advance in the diary-based time to fall sleep and rise time were achieved in the BLT group as compared to the DRL group, while diary-based wake after sleep onset (WASO), TST and sleep efficiency (SE) comparably improved with time in both groups. There was no significant difference between the two groups in the actigraphic parameters after treatment. CONCLUSIONS In this study, we found that depression severity influenced subjective report of sleep. BLT led to a greater advance in subjective sleep timings when compared to the placebo group.
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Affiliation(s)
- Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Hongliang Feng
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Tim Man Ho Li
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Steven Wh Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region of China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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Frase L, Nissen C, Spiegelhalder K, Feige B. The importance and limitations of polysomnography in insomnia disorder-a critical appraisal. J Sleep Res 2023; 32:e14036. [PMID: 37680011 DOI: 10.1111/jsr.14036] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.
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Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kamp KJ, Yoo L, Clark-Snustad K, Winders S, Burr R, Buchanan D, Barahimi M, Jacobs J, Heitkemper M, Lee SD. Relationship of Sleep Health and Endoscopic Disease Activity in Inflammatory Bowel Disease: Endoscopic Disease Activity and Sleep. Gastroenterol Nurs 2023; 46:465-474. [PMID: 37540793 PMCID: PMC10838363 DOI: 10.1097/sga.0000000000000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/14/2023] [Indexed: 08/06/2023] Open
Abstract
Among adults with inflammatory bowel disease (IBD), self-reported sleep disturbances are associated with active symptoms, but the association between sleep measures and endoscopic disease activity is unknown. This study aimed to (1) compare sleep-wake behaviors among IBD patients based on endoscopic and clinical disease activity and (2) describe associations between actigraphy, self-reported sleep measures, and symptoms of fatigue, anxiety, and depression. Participants wore a wrist actigraph for 10 consecutive days and completed self-reported sleep questionnaires (Pittsburgh Sleep Quality Index [PSQI] and Patient-Reported Outcome Measures System [PROMIS] Sleep Disturbance and Sleep Interference questionnaires). Clinical and endoscopic disease activity were assessed. Based on actigraphic recordings ( n = 26), average total nighttime sleep was 437 minutes and sleep efficiency was 84%. Objective sleep measures did not differ based on endoscopic or clinical disease activity. Individuals with active clinical disease had higher PROMIS Sleep Disturbance (57.3 vs. 49.7, d = 1.28) and PROMIS Sleep-Related Impairment (58.1 vs. 52.8, d = 0.51) compared with those with inactive clinical disease. Self-reported sleep was significantly associated with anxiety, depression, and fatigue. Further research is needed to better characterize the relationship between sleep and endoscopic disease activity, and determine underlying mechanisms related to poor sleep in the IBD population.
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Affiliation(s)
- Kendra J Kamp
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Linda Yoo
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Kindra Clark-Snustad
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Samantha Winders
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Robert Burr
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Diana Buchanan
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Mitra Barahimi
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Jeffrey Jacobs
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Margaret Heitkemper
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
| | - Scott D Lee
- Kendra J. Kamp, PhD, RN, is Assistant Professor at University of Washington, Seattle
- Linda Yoo, PhD, BSN, is student at University of Washington, Seattle
- Kindra Clark-Snustad, DNP, APRN, is Teaching Associate at University of Washington, Seattle
- Samantha Winders, PhD, RN, is Postdoctoral Fellow at University of Washington, Seattle
- Robert Burr, PhD, is Research Professor at University of Washington, Seattle
- Diana Buchanan, PhD, RN, is Associate Professor at University of Washington, Seattle
- Mitra Barahimi, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Jeffrey Jacobs, MD, is Clinical Assistant Professor at University of Washington, Seattle
- Margaret Heitkemper, PhD, RN, is Professor at University of Washington, Seattle
- Scott D. Lee, MD, is Associate Professor at University of Washington, Seattle
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11
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Wang H, Wang S, Yu W, Lei X. Consistency of chronotype measurements is affected by sleep quality, gender, longitude, and latitude. Chronobiol Int 2023; 40:952-960. [PMID: 37491913 DOI: 10.1080/07420528.2023.2237118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/14/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023]
Abstract
Chronotype has received increasing research attention. However, there remains some confusion about the influence of gender, age, sleep quality, insomnia severity, longitude, and latitude on the consistency of the chronotype measured by the different tools. Chronotype measurement indicators were collected from 421 participants. The midpoint of sleep for actigraphy (MSF_A), sleep diary (MSF_D), and Munich Chronotype Questionnaire (MCTQ) (MSFsc) on free days and the Morningness-Eveningness Questionnaire (rMEQ) scores were used to measure the chronotype. In addition, demographic information, Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) were also collected. A significant correlation was identified between the questionnaires (MSF_D, MSFsc, rMEQ) and actigraphy (MSF_A) as measures of chronotype. MSF_A was associated with sleep latency and sleep disturbance in the PSQI subdimensions. The correlation between MS_D and sleep disturbance was significant. Both rMEQ and MSFsc were significantly correlated with PSQI (total scores and daytime dysfunction) and ISI. The consistency of all chronotype measurements for the questionnaires and actigraphy was influenced by gender. Among them, MSF_D is also affected by age, while only the latitude and sleep disturbance effect was found in the MSFsc. The influence of age, gender, sleep quality, and latitude should be emphasized when measuring the chronotype using self-reported methods.
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Affiliation(s)
- Haien Wang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Shuo Wang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Wenqing Yu
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China
- Ministry of Education, Key Laboratory of Cognition and Personality (Southwest University), Chongqing, China
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12
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Liguori C, Mombelli S, Fernandes M, Zucconi M, Plazzi G, Ferini-Strambi L, Logroscino G, Mercuri NB, Filardi M. The evolving role of quantitative actigraphy in clinical sleep medicine. Sleep Med Rev 2023; 68:101762. [PMID: 36773596 DOI: 10.1016/j.smrv.2023.101762] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Actigraphy has a consolidated role in Insomnia and Circadian Rhythm Sleep-Wake Disorders (CRSWD) and recent studies have highlighted the use of actigraphy for narcolepsy and REM sleep behaviour disorder (RBD). This review aims at summarising the results of studies published over the last decade regarding the use of actigraphy. Thirty-five studies proved eligible, and results were analysed separately for insomnia, narcolepsy and RBD. Actigraphy showed to consistently differentiate insomnia patients from healthy controls. Furthermore, the application of advanced analytical techniques has been shown to provide both unique insights into the physiology of insomnia and sleep misperception and to improve the specificity of actigraphy in detecting wakefulness within sleep periods. Regarding narcolepsy, several studies showed that actigraphy can detect peculiar sleep/wake disruption and the effects of pharmacological treatments. Finally, although the number of studies in RBD patients is still limited, the available evidence indicates a reduced amplitude of the activity pattern, sleep-wake rhythm dysregulation and daytime sleepiness. Therefore, the potential use of these markers as predictors of phenoconversion should be further explored. In conclusion, quantitative actigraphy presents a renewed interest when considering the possibility of using actigraphy in clinical sleep medicine to diagnose, monitor, and follow sleep disorders other than CRSWD.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
| | - Samantha Mombelli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Milan, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
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13
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Carney AE, Wescott DL, Carmona NE, Carney CE, Roecklein KA. The role of beliefs about sleep in nightly perceptions of sleep quality across a depression continuum. J Affect Disord 2022; 311:440-445. [PMID: 35597468 PMCID: PMC9523734 DOI: 10.1016/j.jad.2022.05.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Poor sleep quality is common in depression, but complaints of poor sleep quality are not necessarily tied to objective sleep, and the construct of sleep quality remains poorly understood. Previous work suggests that beliefs about sleep may influence sleep quality appraisals, as might sleep variability from night to night. OBJECTIVE We tested whether beliefs about sleep predict daily sleep quality ratings above and beyond nightly variability of actigraphy and diary-assessed sleep over the course of multiple nights. METHODS Eighty-eight participants aged 18-65 years across a depressive continuum completed sleep diaries and reported their sleep quality and mood each morning; actigraphy was also completed for 67 of those participants. Multilevel models were used to test previous night's total sleep time and sleep efficiency as predictors of self-reported sleep quality (VAS-SQ) and mood (VAS-M), and whether unhelpful beliefs about sleep predicted VAS-SQ and VAS-M above and beyond the sleep variables. RESULTS Individuals across a depression continuum with greater unhelpful beliefs about sleep reported worse sleep quality and worse mood upon awakening, even when accounting for nightly variation in actigraphy or diary assessed total sleep time and sleep efficiency. CONCLUSIONS These results suggest that people are influenced by unhelpful sleep beliefs when making judgements about sleep quality and mood, regardless of how well they slept the previous night. Working with these unhelpful sleep beliefs in cognitive behavioral therapy can thus promote better sleep and mood in people across the depressive continuum.
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Affiliation(s)
- Alison E Carney
- Department of Psychology, Ryerson University, Toronto, ON, Canada.
| | - Delainey L Wescott
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Nicole E Carmona
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Colleen E Carney
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Kathryn A Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States of America
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14
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Yoon G, Lee MH, Oh SM, Choi JW, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med 2022; 18:1789-1795. [PMID: 35383568 PMCID: PMC9243288 DOI: 10.5664/jcsm.9974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In the present study, factors associated with sleep perception were identified by comparing clinical characteristics and polysomnographic variables between insomnia patients with negative and positive sleep state misperception (NSSM and PSSM, respectively). METHODS Self-reported and objective sleep measures were retrospectively collected, including the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and a questionnaire on "morning feeling" after nocturnal polysomnography in 150 patients with insomnia. Based on the misperception index (MI), participants were classified into NSSM (MI > 0, n = 115) and PSSM (MI < 0, n = 35) groups. RESULTS The PSSM group had more N3 sleep on nocturnal polysomnography than the NSSM group (P = .002). The NSSM group showed a higher PSQI score (P < .001), longer self-reported sleep-onset latency (SOL) (P = .001), and a greater SOL discrepancy (P = .001). Self-reported feelings of tiredness and morning awakenings in the morning were higher in the NSSM group (P = .029 and P = .038). The MI negatively correlated with a proportion of N3 sleep (P = .005) and positively correlated with PSQI (P < .001), morning awakenings (P = .01), self-reported SOL (P < .001), and SOL discrepancy (P < .001) in patients with insomnia. Multiple regression analysis showed that N3 sleep, PSQI, and morning awakenings were significantly associated with MI in patients with insomnia. CONCLUSIONS The proportion of slow-wave sleep and self-reported measures may be associated with perception of sleep in patients with insomnia. Objective and self-reported characteristics of patients with insomnia should be carefully evaluated and managed because they may influence the perception of sleep. CITATION Yoon G, Lee MH, Oh SM, Choi J-W, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med. 2022;18(7):1789-1795.
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Affiliation(s)
- Gahui Yoon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Mi Hyun Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - So Young Yoon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
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15
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Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med 2022; 97:13-26. [DOI: 10.1016/j.sleep.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
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16
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Liang Y, Zhao X, Zhang C, Liu G, Lu B, Han L, Tong F, Luo X, Hu C, Liu H. Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study. Front Neurol 2022; 13:836949. [PMID: 35463154 PMCID: PMC9021819 DOI: 10.3389/fneur.2022.836949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Data on sleep parameters by polysomnography (PSG) in patients with anxiety-related disorders are limited. Although the disturbance and risk factors of sleep misperception have been implicated in psychopathology, its role in anxiety-related disorders remains unclear. This retrospective study aimed to explore the characteristics and sleep parameters in patients with anxiety-related disorders and different sleep perception types, and to explore the associated factors for sleep misperception. Methods Patients with anxiety-related disorders who had complaint of insomnia for more than 3 months were collected at Wuhan Mental Health Center between December 2019 and July 2021. Patients underwent a two-night PSG monitoring and completed a self-reported sleep questionnaire. Behaviors were assessed using 30-item Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Patients were divided into normal sleep perception (NSP), positive sleep perception abnormality [PSPA; overestimation of total sleep time (TST) >60 min], and negative sleep perception abnormality (NSPA; underestimation of TST >60 min) groups. PSG indicators and NOSIE-30 scores were compared among groups using the one-way analysis of variance and the Kruskal-Wallis test. Multiple linear regression analysis was performed to determine the associated factors for misperception index. Results The subjective and objective TST were 5.5 ± 1.9 h and 6.4 ± 1.7 h in 305 patients, respectively. Sixty-nine (22.6%) had PSPA, 80 (26.2%) had NSP, and 156 (51.1%) had NSPA. Subjective TST and objective sleep parameters were significantly different among groups. No statistical differences in NOSIE-30 subscale and total scores were observed among groups. Sex, rapid eye movement (REM)/TST (%), sleep efficiency, number of awakenings, Non-rapid eye movement of stage 2 sleep (NREM)/TST (%), REM spontaneous arousal times, sleep latency, diagnosis, social competence, and manifest psychosis were associated with sleep misperception. Conclusion Sleep misperception is common in patients with anxiety-related disorders. Various sleep perception types have different PSG profiles, but similar personal and social behaviors. These data may be helpful to conduct personalized treatment.
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Affiliation(s)
- Yingjie Liang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xu Zhao
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Changyong Zhang
- Department of Psychiatry, Wuhan Wudong Hospital (Wuhan Second Mental Hospital), Wuhan, China
- *Correspondence: Changyong Zhang
| | - Guangya Liu
- Outpatient Office, Wuhan Jinyintan Hospital, Wuhan, China
- Guangya Liu
| | - Baili Lu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Li Han
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Fang Tong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xinyu Luo
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Chuang Hu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Hui Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Sleep Disorder, Wuhan Hospital for Psychotherapy, Wuhan, China
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17
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The Effect of Cognitive Behavioural Therapy for Insomnia (CBT-I) on Subjective–Objective Sleep Discrepancy in Individuals with Co-Morbid Insomnia and Sleep Apnoea: A Randomised Controlled Trial. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People with insomnia frequently underestimate the duration of their sleep compared to objective polysomnography-measured sleep duration. Cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia and also reduces the degree of sleep underestimation. Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder characterised by frequent narrowing (hypopnoea) and closure (apnoea) of the upper airway during sleep. Comorbid insomnia and sleep apnoea (COMISA) is a prevalent and debilitating disorder. No study has investigated subjectively (sleep diary) versus objectively (polysomnography) measured sleep discrepancies (SOSD) in individuals with COMISA before or following CBT-I. This randomised waitlist-controlled trial investigated SOSD in 145 participants with COMISA before and 6-weeks after CBT-I (n = 72) versus control (n = 73). All participants were studied prior to continuous positive airway pressure treatment for sleep apnoea. At baseline, participants underestimated their total sleep time (mean ± SD −51.9 ± 94.1 min) and sleep efficiency (−9.6 ± 18.3%), and overestimated sleep onset latency (34.5 ± 86.1 min; all p = < 0.001). Mixed models indicated a main effect of time on reduction of SOSD in both groups, but no between-group difference in the reduction of any SOSD parameters. These findings may indicate that untreated OSA contributes to a discrepancy between perceived and objective sleep parameters in people with COMISA that is not amenable to CBT-I alone (ACTRN12613001178730).
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18
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Ahn JS, Bang YR, Jeon HJ, Yoon IY. Effects of subjective-objective sleep discrepancy on the response to cognitive behavior therapy for insomnia. J Psychosom Res 2021; 152:110682. [PMID: 34864239 DOI: 10.1016/j.jpsychores.2021.110682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to evaluate the clinical correlates of sleep discrepancy and how subjective-objective sleep discrepancy (SD) affects the results of cognitive behavioral therapy for insomnia (CBT-I) in patients with insomnia disorder. METHODS A total of 33 patients aged >55 years with insomnia disorders participated in this prospective cohort study. Sleep discrepancy (SD) was defined as the difference between the sleep duration derived from the PSG and self-report questionnaires. SD > 2 h was classified as high SD. Self-report questionnaires, and polysomnography (PSG) were performed before 4 weeks of group CBT-I. Statistical analyses were performed to investigate the association of SD with baseline characteristics and CBT-I results, and compare intergroup difference of pre and post-treatment of high SD and low SD. RESULTS Patients in the high SD group reported poor subjective sleep, such as lower sleep quality, shorter sleep duration, longer sleep latency, and lower sleep efficiency. However, they had longer sleep duration, higher sleep efficiency in the PSG. There were 35% males in low SD group, but no males in high SD group. After 4 weeks of group CBT-I, SD was positively associated with the effect of CBT-I on subjective total sleep time (r = 0.499, p < 0.006) and sleep efficiency (r = 0.463, p = 0.01) after adjusting age, sex and apnea-hypopnea index. CONCLUSION The results of this study suggest that patients in the high SD group may respond better to CBT-I than those in lower SD group. Evaluation of SD may help clinicians to decide tailored treatment strategies for treating insomnia disorders.
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Affiliation(s)
- Jun Seok Ahn
- Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young Rong Bang
- Department of Psychiatry, Dong-A University Hospital, Busan, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, School of Medicine, Seoul, Republic of Korea.
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Dietch JR, Taylor DJ. Evaluation of the Consensus Sleep Diary in a community sample: comparison with single-channel electroencephalography, actigraphy, and retrospective questionnaire. J Clin Sleep Med 2021; 17:1389-1399. [PMID: 33666165 PMCID: PMC8314633 DOI: 10.5664/jcsm.9200] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES The Consensus Sleep Diary (CSD) was developed by experts to promote standardization of sleep diary data across the field, but studies comparing the CSD with other assessments of sleep parameters are scarce. This study compared the CSD with 3 other methods to assess sleep duration, efficiency, and timing. METHODS Participants (n = 80) were community adults (mean age = 32.65 years, 63% female) who completed the time-stamped CSD and used single-channel electroencephalography (EEG) and actigraphy for 7 days at home, then completed a retrospective sleep questionnaire. Total sleep time (TST), sleep efficiency (SE), and sleep midpoint were compared using correlations, Bland-Altman plots, and limits of agreement (adjusted for repeated measures). RESULTS Correlations between the CSD and all methods on TST were large (rs = .63-.75). Adjusted CSD average TST was 40 minutes greater than with EEG and 31 minutes greater than with actigraphy. Correlations between CSD, actigraphy, and EEG for SE were small (rs = .18), and there was a medium correlation with questionnaire (r = .42). Adjusted CSD average SE was 7% greater than EEG and 6% greater than actigraphy; both demonstrated heteroscedasticity. Sleep midpoint correlations between CSD and all methods were large (r = .92-.99). Adjusted CSD was, on average, 6 minutes later than EEG and 1 minute later than actigraphy. Questionnaire-derived sleep parameters demonstrated nonconstant bias; lesser values had positive bias and greater values had negative bias. CONCLUSIONS The time-stamped CSD led to meaningful overestimations of TST and SE as measured by objective/inferred methods. However, sleep timing was rather accurately assessed with the CSD in comparison to objective/inferred measures. Researchers should carefully consider which sleep assessment methods are best aligned with their research question and parameters of interest, as methods do not demonstrate complete agreement.
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Affiliation(s)
- Jessica R. Dietch
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
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Hrehová L, Mezian K. Non-pharmacologic treatment of insomnia in primary care settings. Int J Clin Pract 2021; 75:e14084. [PMID: 33555081 DOI: 10.1111/ijcp.14084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/05/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Prevalence of insomnia is higher in females and increases with higher age. Besides primary insomnia, comorbid sleep disorders are also common, accompanying different conditions. Considering the possible adverse effects of commonly used drugs to promote sleep, a non-pharmacologic approach should be preferred in most cases. Although generally considered first-line treatment, the non-pharmacologic approach is often underestimated by both patients and physicians. OBJECTIVE To provide primary care physicians an up-to-date approach to the non-pharmacologic treatment of insomnia. METHODS PubMed, Web of Science, and Scopus databases were searched for relevant articles about the non-pharmacologic treatment of insomnia up to December 2020. We restricted our search only to articles written in English. MAIN MESSAGE Most patients presenting with sleep disorder symptoms can be effectively managed in the primary care setting. Primary care physicians may use pharmacologic and non-pharmacologic approaches, while the latter should be generally considered first-line treatment. A primary care physician may opt to refer the patient to a subspecialist for refractory cases. CONCLUSIONS This paper provides an overview of current recommendations and up-to-date evidence for the non-pharmacologic treatment of insomnia. This article emphasizes the importance of cognitive-behavioral therapy for insomnia, likewise, exercise and relaxation techniques. Complementary and alternative approaches are also covered, eg, light therapy, aromatherapy, music therapy, and herbal medicine.
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Affiliation(s)
- Laura Hrehová
- Institute of General Practice, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Trimmel K, Eder HG, Böck M, Stefanic-Kejik A, Klösch G, Seidel S. The (mis)perception of sleep: factors influencing the discrepancy between self-reported and objective sleep parameters. J Clin Sleep Med 2021; 17:917-924. [PMID: 33393901 PMCID: PMC8320481 DOI: 10.5664/jcsm.9086] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Self-reported perception of sleep often differs from objective sleep study measures, but factors predicting the discrepancy between self-reported and objective sleep parameters are controversial, and a comparison of laboratory vs ambulatory polysomnography (PSG) is lacking. METHODS We retrospectively analyzed PSGs conducted between 2012 and 2016. Linear regression was applied to predict the discrepancy between self-reported and objective sleep parameters (total sleep time, sleep efficiency, sleep latency, using age, sex, arousal index, type of sleep disorder, and PSG type [laboratory vs ambulatory] as regressors). RESULTS A total of 303 PSGs were analyzed (49% women, median age 48 years), comprising patients with insomnia (32%), sleep-related breathing disorders (27%), sleep-related movement disorders (15%), hypersomnia/narcolepsy (14%), and parasomnias (12%). Sleep disorder was the best predictor of discrepancy between self-reported and objective total sleep time, and patients with insomnia showed higher discrepancy values compared to all other patient groups (P < .001), independent of age and PSG type (P > .05). Contributory effects for higher discrepancy values were found for lower arousal index. Patients with insomnia underestimated both total sleep time (median discrepancy: 46 minutes, P < .001) and sleep efficiency (median discrepancy: 11%, P < .001). No significant predictor for discrepancy of sleep latency was found. CONCLUSIONS Misperception of sleep duration and efficiency is common in sleep lab patients, but most prominent in insomnia, independent of age, sex, or laboratory vs ambulatory recording setting. This underlines the role of PSG in patients with a clinical diagnosis of insomnia and its use in cognitive behavioral therapy.
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Affiliation(s)
- Karin Trimmel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hans Gerhard Eder
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Marion Böck
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - Gerhard Klösch
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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