Abstract
Objectives
Characterizing daily patterns of sleep, stress, presleep worry, and mood in adolescents
with and without insomnia symptomatology.
Design
Two months of continuous wearable tracking and daily diary ratings.
Setting
Free-living conditions.
Participants
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.
Measurements
Fitbit Charge 3 tracked sleep, heart rate, and steps. Evening electronic diaries collected
ratings of daily stress, presleep worry, and mood.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: December 24, 2022
Accepted:
November 15,
2022
Received in revised form:
October 20,
2022
Received:
May 30,
2022
Identification
Copyright
© 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
