Characterizing daily patterns of sleep, stress, presleep worry, and mood in adolescents with and without insomnia symptomatology.
Two months of continuous wearable tracking and daily diary ratings.
Ninety-three adolescents (59 girls; 16-19 years old) with (N = 47; 26 with clinical and 21 with sub-clinical) and without (N = 46; control) DSM-5 insomnia symptomatology.
Fitbit Charge 3 tracked sleep, heart rate, and steps. Evening electronic diaries collected ratings of daily stress, presleep worry, and mood.
While sleep duration (control: 6.88 ± 1.41 hours; insomnia: 6.92 ± 1.28 hours), architecture, timing, and night-to-night variability were similar between groups, the insomnia group reported higher levels of stress and worry, being mainly related to “school”. At the intraindividual level, stress and worry predicted shorter sleep duration and earlier wake up times, which, in turn, predicted higher stress the following day. Moreover, higher-than-usual stress predicted higher sleep-time heart rate, with a more consistent effect in adolescents with insomnia. Results were overall consistent after controlling for covariates and several robustness checks.
There is a bidirectional relationship between daily stress and sleep, with daily stress negatively impacting sleep, which in turn leads to more stress in adolescents with and without insomnia symptoms. Findings also highlight the complexity of insomnia in adolescence, in which the core clinical features (perceived sleep difficulties) and the critical factors (stress/worry) implicated in the pathophysiology of the disorder are not necessarily reflected in objective sleep indicators.
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- Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special Issue.J Youth Adolesc. 2015; 44: 239-270https://doi.org/10.1007/s10964-014-0248-y
- Changes in sleep as a function of adolescent development.Neuropsychol Rev. 2011; 21: 5-21https://doi.org/10.1007/s11065-010-9155-5
- The mediating role of cortical thickness and gray matter volume on sleep slow-wave activity during adolescence.Brain Struct Funct. 2018; 223: 669-685https://doi.org/10.1007/s00429-017-1509-9
- Age-related differences in sleep architecture and electroencephalogram in adolescents in the National Consortium on Alcohol and Neurodevelopment in Adolescence Sample.Sleep. 2016; 39: 1429-1439https://doi.org/10.5665/sleep.5978
- A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice.Sleep Med Rev. 2014; 18: 521-529https://doi.org/10.1016/j.smrv.2014.03.006
- Associations among sleep, daily experiences, and loneliness in adolescence: evidence of moderating and bidirectional pathways.J Adolesc. 2014; 37: 145-154https://doi.org/10.1016/j.adolescence.2013.11.009
- Rise and fall of sleep quantity and quality with student experiences across the first year of university.J Res Adolesc. 2011; 21: 342-349https://doi.org/10.1111/j.1532-7795.2010.00679.x
- Daily variation in adolescents’ sleep, activities, and psychological well-being.J Res Adolesc. 2006; 16: 353-378https://doi.org/10.1111/j.1532-7795.2006.00498.x
- Toward a better understanding of the reciprocal relations between adolescent psychological need experiences and sleep.Personal Soc Psychol Bull. 2021; 47: 377-394https://doi.org/10.1177/0146167220923456
- Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference.Pediatrics. 2006; 117: e247-e256https://doi.org/10.1542/peds.2004-2629
- Insomnia disorder in adolescence: diagnosis, impact, and treatment.Sleep Med Rev. 2018; 39: 12-24https://doi.org/10.1016/j.smrv.2017.06.009
- Re-thinking insomnia disorder in adolescents: the importance of an accurate diagnosis.Sleep. 2021; 44https://doi.org/10.1093/sleep/zsab221
- Clinical characterization of insomnia in adolescents – an integrated approach to psychopathology.Sleep Med. 2022; 93: 26-38https://doi.org/10.1016/j.sleep.2022.03.010
- Insomnia is associated with cortical hyperarousal as early as adolescence.Sleep. 2016; 39: 1029-1036https://doi.org/10.5665/sleep.5746
- Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents.Brain Behav Immun. 2017; 61: 110-116https://doi.org/10.1016/j.bbi.2016.12.026
- Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies.Sleep Med Rev. 2014; 18: 195-213https://doi.org/10.1016/j.smrv.2013.04.001
- Hyperarousal and insomnia: state of the science.Sleep Med Rev. 2010; 14: 9-15https://doi.org/10.1016/j.smrv.2009.05.002
- Evaluating the use of commercially available wearable wristbands to capture adolescents’ daily sleep duration.J Res Adolesc. 2019; 29: 613-626https://doi.org/10.1111/jora.12467
- Sensors capabilities, performance, and use of consumer sleep technology.Sleep Med Clin. 2020; 15: 1-30https://doi.org/10.1016/j.jsmc.2019.11.003
- Sleep difficulties among mexican adolescents: subjective and objective assessments of sleep.Behav Sleep Med. 2022; 20: 269-289https://doi.org/10.1080/15402002.2021.1916497
- Diagnostic and Statistical Manual of Mental Disorders: DSM-5.5th ed. American Psychiatric Publishing, 2013
- Accuracy of wristband Fitbit models in assessing sleep: systematic review and meta-analysis.J Med Internet Res. 2019; 21 (doi:10.2196/16273): e16273
- Performance of Fitbit Charge 3 against polysomnography in measuring sleep in adolescent boys and girls.Chronobiol Int. 2021; 38: 1010-1022https://doi.org/10.1080/07420528.2021.1903481
- A standardized framework for testing the performance of sleep-tracking technology: step-by-step guidelines and open-source code.Sleep. 2021; 44: 1-12https://doi.org/10.1093/sleep/zsaa170
- Night-to-night sleep variability in older adults with and without chronic insomnia.Sleep Med. 2010; 11: 56-64https://doi.org/10.1016/j.sleep.2009.02.010
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, 2018 (Available at)Accessed on October 10th 2022)
- Using the gamma generalized linear model for modeling continuous, skewed and heteroscedastic outcomes in psychology.Curr Psychol. 2017; 36: 225-235https://doi.org/10.1007/s12144-015-9404-0
Bates D, Mächler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. arXiv Prepr arXiv14065823. Published online June 23, 2014. http://arxiv.org/abs/1406.5823. Accessed on October 10th 2022
- AIC model selection using Akaike weights.Psychon Bull Rev. 2004; 11: 192-196https://doi.org/10.3758/BF03206482
- Actigraphy in the assessment of insomnia: a quantitative approach.Sleep. 2009; 32: 767-771https://doi.org/10.1093/sleep/32.6.767
- Insomnia phenotypes based on objective sleep duration in adolescents: depression risk and differential behavioral profiles.Brain Sci. 2016; 6: 59https://doi.org/10.3390/brainsci6040059
- Insomnia disorder: state of the science and challenges for the future.J Sleep Res. 2022; : 1-18https://doi.org/10.1111/jsr.13604
- Paradoxical insomnia and subjective–objective sleep discrepancy: a review.Sleep Med Rev. 2018; 40: 196-202https://doi.org/10.1016/j.smrv.2018.01.002
- Insomnia and its symptoms in adolescents: comparing DSM-IV and ICSD-II diagnostic criteria.J Clin Sleep Med. 2012; 08: 295-299https://doi.org/10.5664/jcsm.1918
- A community-based study on the association between insomnia and hypothalamic-pituitary-adrenal axis: sex and pubertal influences.J Clin Endocrinol Metab. 2014; 99: 2277-2287https://doi.org/10.1210/jc.2013-3728
- Prevalence of insufficient, borderline, and optimal hours of sleep among high school students – United States.J Adolesc Heal. 2007; 46 (2010): 399-401https://doi.org/10.1016/j.jadohealth.2009.10.011
- National Sleep Foundation's updated sleep duration recommendations: final report.Sleep Heal. 2015; 1: 233-243https://doi.org/10.1016/j.sleh.2015.10.004
- Sex- and age-dependent differences in autonomic nervous system functioning in adolescents.J Adolesc Heal. 2018; 62: 184-190https://doi.org/10.1016/j.jadohealth.2017.09.010
- 0858 teenage girls report higher impact of sleepiness during school and personal activities than teenage boys.Sleep. 2018; 41 (A318-A318)https://doi.org/10.1093/sleep/zsy061.857
- Effects of exercise on the resting heart rate: a systematic review and meta-analysis of interventional studies.J Clin Med. 2018; 7: 503https://doi.org/10.3390/jcm7120503
- Protective and risk factors for adolescent sleep: a meta-analytic review.Sleep Med Rev. 2015; 21: 72-85https://doi.org/10.1016/j.smrv.2014.08.002
- A virtual reality-based mind–body approach to downregulate psychophysiological arousal in adolescent insomnia.Digit Heal. 2022; 8https://doi.org/10.1177/20552076221107887
Published online: December 24, 2022
Accepted: November 15, 2022
Received in revised form: October 20, 2022
Received: May 30, 2022
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