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 fluoxetine (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 efficiency occurring in the laboratory. In contrast, sleep diaries indicated a slight worsening of sleep in the laboratory compared to home, with significantly more awakenings in the laboratory compared to the week at home before and after the laboratory night.

Conclusions: The differences between objective and subjective sleep measurements seen in depressed insomniacs may be influenced by the monitoring setting and measurement modality.

Clinical trial information: ClinicalTrials.gov Identifier: NCT00247624.

Keywords: First night effect; actigraphy; depression; insomnia; reverse first night effect; sleep diaries.

Figure 1

Changes in sleep onset latency over course of study

Figure 2

Changes in number of awakenings (diaries) and wake bouts (actigraphy) over course of study

Figure 3

Changes in wake time after sleep onset over course of study

Figure 4

Changes in total sleep time over course of study