Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Apr 1;34(4):531-9.
doi: 10.1093/sleep/34.4.531.

Moving beyond average values: assessing the night-to-night instability of sleep and arousal in DSM-IV-TR insomnia subtypes

M Montserrat Sánchez-Ortuño  1 , Colleen E Carney, Jack D Edinger, James K Wyatt, Andrea Harris
Affiliations

Moving beyond average values: assessing the night-to-night instability of sleep and arousal in DSM-IV-TR insomnia subtypes

M Montserrat Sánchez-Ortuño et al. Sleep. .

Abstract

Study objectives: We explored differences between individuals with DSM-IV-TR diagnoses of primary insomnia (PI) and insomnia related to a mental disorder (IMD) by using serial measurements of self-reported sleep variables (sleep onset latency, SOL; wake after sleep onset, WASO; total sleep time, TST; sleep efficiency, SE), and visual analogue scale ratings of 2 forms of bedtime arousal (cognitive and emotional). Furthermore, we sought to examine the relationship between sleep and arousal within each diagnostic subgroup.

Design: Between-group and within-group comparisons.

Setting: Duke and Rush University Medical Centers, USA.

Participants: One hundred eighty-seven insomnia sufferers (126 women, average age 47.15 years) diagnosed by sleep specialists at 2 sleep centers as PI patients (n=126) and IMD patients (n=61).

Interventions: N/A.

Measurements and results: Multilevel models for sleep measures indicated that IMD displayed significantly more instability across nights in their TST (i.e., larger changes) than did PI patients. With respect to pre-sleep arousal, IMD patients exhibited higher mean levels of emotional arousal, as well as more instability on the nightly ratings of this measure. Within the PI group, correlational analyses revealed a moderate relationship between the 2 arousal variables and SOL (r values 0.29 and 0.26), whereas the corresponding correlations were negligible and statistically nonsignificant in the IMD group.

Conclusions: We found a number of differences on nighttime variables between those diagnosed with primary insomnia and those diagnosed with insomnia related to a mental disorder. These differences imply different perpetuating mechanisms involved in their ongoing sleep difficulties. Additionally, they support the categorical distinctiveness and the concurrent validity of these insomnia subtypes.

Keywords: DSM-IV-TR; arousal; concurrent validity; insomnia related to a mental disorder; instability; measurement; primary insomnia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chart of self-reported total sleep time across nights for two age- and gender-matched patients
Figure 2
Figure 2
Chart of visual analogue scale ratings (Anxious) across nights for two age- and gender-matched patients
See this image and copyright information in PMC

References

    1. American Psychiatric Association., American Psychiatric Association. Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders : DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000.
    1. Moul D, Nofzinger E, Pilkonis P, Houck P, Miewald J, Buysse D. Symptom reports in severe chronic insomnia. Sleep. 2002;25:553–63. - PubMed
    1. Nowell P, Buysse D, Reynolds CF, et al. Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders. Am J Psychiatry. 1997;154:1412–6. - PubMed
    1. Buysse DJ, Reynolds CF, Hauri PJ, et al. Diagnostic concordance for DSM-IV sleep disorders - a report from the apa/nimh DSM-IV field trial. Am J Psychiatry. 1994;151:1351–60. - PubMed
    1. Buysse D, Reynolds C, Kupfer D, et al. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep. 1994;17:630–7. - PubMed

Publication types

MeSH terms