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Comparative Study
. 2025 Mar 11;48(3):zsae301.
doi: 10.1093/sleep/zsae301.

Comparative analysis of sleep physiology using qualitative and quantitative criteria for insomnia symptoms

Ruda Lee  1 , Olivia Larson  1 , Sammy Dhaliwal  2 , Kibum Moon  3 , Bethany Gerardy  4 , Philip de Chazal  5 , Peter A Cistulli  6   7 , Ning-Hung Chen  8 , Fang Han  9   10 , Qing Yun Li  11 , Greg Maislin  12 , Nigel McArdle  13   14   15 , Thomas Penzel  16 , Richard J Schwab  12 , Sergio Tufik  17 , Ulysses J Magalang  18 , Bhajan Singh  13   14   15 , Thorarinn Gislason  10   19 , Allan I Pack  12 , Brendan T Keenan  12 , Magdy Younes  4   20 , Philip Gehrman  2   21
Affiliations
Comparative Study

Comparative analysis of sleep physiology using qualitative and quantitative criteria for insomnia symptoms

Ruda Lee et al. Sleep. .

Abstract

Despite decades of research, defining insomnia remains challenging due to its complex and variable nature. Various diagnostic systems emphasize the chronic nature of insomnia and its impact on daily functioning, relying heavily on patient self-reporting due to limitations in objective measures such as polysomnography (PSG). Discrepancies between subjective experiences and objective PSG results highlight the need for more nuanced approaches, such as electroencephalogram (EEG) spectral analysis, which reveals distinct patterns of high-frequency activity in individuals with insomnia. This study explores EEG markers of insomnia by integrating subjective reports with objective physiological markers, specifically ORP (Odds-Ratio-Product) and spectral features, to address inconsistencies found in previous research and clinical settings. Qualitative and quantitative definitions of insomnia are contrasted to highlight differences in sleep architecture and EEG characteristics. The research aims to determine whether groups defined by weekly frequency and daily duration of symptoms have different distribution patterns and which physiological characteristics best distinguish insomnia patients from controls. Our findings suggest that ORP, as a dependent variable, captures the most significant differences in the independent variables across the model. Elevated beta power in insomnia patients indicates increased cortical arousal, supporting the perspective of insomnia as a hyperarousal disorder. Future research should focus on using ORP to enhance the understanding of sleep disturbances in insomnia. Comprehensive evaluation of insomnia requires integrating qualitative, quantitative, and neurophysiological data to fully understand its impact on sleep architecture and quality.

Keywords: EEG spectral analysis; hyperarousal; insomnia; odds-ratio-product (ORP); sleep architecture; sleep/wake physiology.

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Conflict of interest statement

Dr Thomas Penzel reports relationships with Bayer, Bioproject, Cerebra, Idorsia, Jazz Pharmaceuticals, Sleepimage, Lowenstein Medical, Philips, and the National Sleep Foundation, including consulting or advisory roles and speaking and lecture fees. Dr Bhajan Singh has received speaking and lecture fees from SomnoMed Australia. Dr Peter A. Cistulli reports relationships with ResMed and SomnoMed, including consulting or advisory roles and funding grants, as well as consulting or advisory roles with Signifier Medical Technologies, Bayer, and Sunrise Medical. Dr Richard J. Schwab reports funding grants from ResMed, Inspire, and CryOSA, consulting or advisory roles with Eli Lilly, and patents with royalties paid to UpToDate and Merck Manual. Dr Magdy Younes is the inventor of ORP, holds a patent on the method, and receives royalties from Cerebra Health for the licensed technology. Other authors declare that they have no known competing financial interests that could have appeared to influence the work reported in this paper. Dr Richard J. Schwab reports his position on the Medical Advisory Board for eXciteOSA. Other authors declare that they have no known personal relationships or other nonfinancial interests that could have appeared to influence the work reported in this paper.

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