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Nonrestorative sleep mediates eveningness and insomnia severity

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Abstract

Possessing an evening circadian preference is associated with greater subjective sleep disturbance. The present study sought to determine whether day-to-day restoration from sleep upon waking mediates the relation between eveningness and general insomnia symptomology, as well as whether this association occurs independently of quantitative sleep impairment. Late adolescent college students (N = 164) completed retrospective measures of chronotype and insomnia severity, as well as daily restorative sleep questionnaires and sleep diaries over a 2-week sampling period. Path analysis examined the direct effects of chronotype, restorative sleep, and nighttime sleep efficiency on insomnia symptomology, and the indirect effect of chronotype through restorative sleep. Chronotype’s indirect effect via restorative sleep accounted for 66.18% of its total effect on insomnia severity, and its non-significant direct path was thus discarded. The final specified path model displayed strong fit to the data and predicted insomnia severity from two pathways: greater eveningness via nonrestorative sleep as a mediator, and lower sleep efficiency. Lack of restoration from sleep upon waking is a potent mediator of the established relation between eveningness and self-reported insomnia severity. Future studies may generalize this finding to other populations, particularly those vulnerable to circadian phase delay or disruption.

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References

  1. Morin CM, Benca R. Chronic insomnia. Lancet. 2012;379:1129–41.

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text rev. 4th ed. Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  4. Stone KC, Taylor DJ, McCrae CS, Kalsekar A, Lichstein KL. Nonrestorative sleep. Sleep Med Rev. 2008;12:275–88.

    Article  PubMed  Google Scholar 

  5. Vernon MK, Dugar A, Revicki D, Treglia M, Buysse D. Measurement of non-restorative sleep in insomnia: a review of the literature. Sleep Med Rev. 2010;14:205–12.

    Article  PubMed  Google Scholar 

  6. Wilkinson K, Shapiro C. Nonrestorative sleep: Symptom or unique diagnostic entity? Sleep Med. 2012;13:561–9.

    Article  PubMed  Google Scholar 

  7. Ohayon MM. Prevalence and correlates of nonrestorative sleep complaints. Arch Intern Med. 2005;165:35–41.

    Article  PubMed  Google Scholar 

  8. Ohayon MM, Roth T. What are the contributing factors for insomnia in the general population? J Psychosom Res. 2001;51:745–55.

    Article  CAS  PubMed  Google Scholar 

  9. Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC. Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiat. 2006;60:1364–71.

    Article  PubMed  Google Scholar 

  10. Roth T, Zammit G, Lankford A, Mayleben D, Stern T, Pitman V, Clark D, Werth JL. Nonrestorative sleep as a distinct component of insomnia. Sleep. 2010;33:449–58.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Drake CL, Hays RD, Morlock R, Wang F, Shikiar R, Frank L, Downey R, Roth T. Development and evaluation of a measure to assess restorative sleep. J Clin Sleep Med. 2014;10:733–41.

    PubMed  PubMed Central  Google Scholar 

  12. Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: a comprehensive review. Chronobiol Int. 2012;29:1153–75.

    Article  PubMed  Google Scholar 

  13. Adan A, Natale V, Caci H, Prat G. Relationship between circadian typology and functional and dysfunctional impulsivity. Chronobiol Int. 2010;27:606–19.

    Article  PubMed  Google Scholar 

  14. Fernández-Mendoza J, Ilioudi C, Montes MI, Olavarrieta-Bernadino S, Aguirre-Berrocal A, José J, Vela-Bueno A. Circadian preference, nighttime sleep and daytime functioning in young adulthood. Sleep Biol Rhythm. 2010;8:52–62.

    Article  Google Scholar 

  15. Giannotti F, Cortesi F, Sebastiani T, Ottaviano S. Circadian preference, sleep and daytime behaviour in adolescence. J Sleep Res. 2002;11:191–9.

    Article  PubMed  Google Scholar 

  16. Goldstein D, Hahn CS, Hasher L, Wiprzycka UJ, Zelazo PD. Time of day, intellectual performance, and behavioral problems in morning versus evening type adolescents: Is there a synchrony effect? Pers Indiv Differ. 2007;42:431–40.

    Article  Google Scholar 

  17. Kitamura S, Hida A, Watanabe M, Enomoto M, Aritake-Okada S, Moriguchi Y, Kamei Y, Mishima K. Evening preference is related to the incidence of depressive states independent of sleep-wake conditions. Chronobiol Int. 2010;27:1797–812.

    Article  PubMed  Google Scholar 

  18. Lemoine P, Zawieja P, Ohayon MM. Associations between morningness/eveningness and psychopathology: an epidemiological survey in three in-patient psychiatric clinics. J Psychiat Res. 2013;47:1095–8.

    Article  PubMed  Google Scholar 

  19. Merikanto I, Lahti T, Puolijoki H, Vanhala M, Peltonen M, Laatikainen T, Vartiainen E, Salomaa V, Kronholm E, Partonen T. Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes. Chronobiol Int. 2013;30:470–7.

    Article  PubMed  Google Scholar 

  20. Urbán R, Magyaródi T, Rigó A. Morningness–eveningness, chronotypes and health-impairing behaviors in adolescents. Chronobiol Int. 2011;28:238–47.

    Article  PubMed  Google Scholar 

  21. Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int. 2006;23:497–509.

    Article  PubMed  Google Scholar 

  22. Tutek J, Emert SE, Dautovich ND, Lichstein KL. Association between chronotype and nonrestorative sleep in a college population. Chronobiol Int. 2016;33:1293–304.

    Article  PubMed  Google Scholar 

  23. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.

    Article  PubMed  Google Scholar 

  24. Schweitzer PK. Drugs that disturb sleep and wakefulness. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. St. Louis: Saunders; 2010. pp. 542–60.

    Google Scholar 

  25. Terman M, Rifkin JB, Jacobs J, White TM. Morningness–eveningness questionnaire (revised). New York: New York State Psychiatric Institute; 2001.

    Google Scholar 

  26. Horne JA, Östberg O. A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. Int J Chronobiol. 1976;4:97–110.

    CAS  PubMed  Google Scholar 

  27. Di Milia L, Adan A, Natale V, Randler C. Reviewing the psychometric properties of contemporary circadian typology measures. Chronobiol Int. 2013;30:1261–71.

    Article  PubMed  Google Scholar 

  28. Duffy JF, Dijk DJ, Hall EF, Czeisler CA. Relationship of endogenous circadian melatonin and temperature rhythms to self-reported preference for morning or evening activity in young and older people. J Invest Med. 1999;47:141–50.

    CAS  Google Scholar 

  29. Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012;35:287–302.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34:601–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schumacker RE, Lomax RG. A beginner’s guide to structural equation modeling. 4th ed. New York: Routledge; 2016.

    Google Scholar 

  32. Bentler PM, Chou CH. Practical issues in structural modeling. Sociol Methods Res. 1987;16:78–117.

    Article  Google Scholar 

  33. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55.

    Article  Google Scholar 

  34. Lack LC, Bootzin RR. Circadian rhythm factors in insomnia and their treatment. In: Perlis ML, Lichstein KL, editors. Treating sleep disorders: principles and practice of behavioral sleep medicine. Hoboken: Wiley; 2003. pp. 305–43.

    Google Scholar 

  35. Lack LC, Wright HR. Treating chronobiological components of chronic insomnia. Sleep Med. 2007;8:637–44.

    Article  PubMed  Google Scholar 

  36. Smith MR, Eastman CI. Shift work: Health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment. Nat Sci Sleep. 2012;4:111–32.

    PubMed  PubMed Central  Google Scholar 

  37. Paksarian D, Rudolph KE, He JP, Merikangas KR. School start time and adolescent sleep patterns: results from the US national comorbidity survey-adolescent supplement. Am J Public Health. 2015;105:1351–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Fabbian F, Zucchi B, De Giorgi A, Tiseo R, Boari B, Salmi R, Cappadona R, Gianesini G, Bassi E, Signani F, Raparelli V. Chronotype, gender and general health. Chronobiol Int. 2016;33:863–82.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Joshua Tutek.

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Permissions for this study come from the University of Alabama Institutional Review Board for research involving human subjects. Protocol Approval Number: 15-OR-237. Participants provided their consent online to participate before completing study procedures.

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The authors have no conflicts of interest to report.

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Tutek, J., Albright, A.E. & Lichstein, K.L. Nonrestorative sleep mediates eveningness and insomnia severity. Sleep Biol. Rhythms 17, 73–78 (2019). https://doi.org/10.1007/s41105-018-0192-4

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  • DOI: https://doi.org/10.1007/s41105-018-0192-4

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