Nonrestorative Sleep as a Distinct Component of Insomnia

Roth, Thomas; Zammit, Gary; Lankford, Alan; Mayleben, David; Stern, Theresa; Pitman, Verne; Clark, David B.; Werth, John

doi:10.1093/sleep/33.4.449

Cited by 96 publications

(56 citation statements)

References 11 publications

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“…In primary insomnia, the disorder has an unknown physical, mental or environmental cause (APA, 2008; WHO, 2008). Non‐restorative sleep (subjectively perceived poor sleep quality) is a distinct pathology which might occur independently of difficulties falling asleep or poor sleep maintenance (Roth et al, 2010). Daytime impairment in insomnia may include, but is not limited to, problems such as fatigue, memory impairment, mood disturbances, proneness for errors, tension headaches and gastrointestinal symptoms in response to sleep loss (Edinger et al, 2004).…”

Section: Melatonin In the Treatment Of Circadian Rhythm And Sleep Dismentioning

confidence: 99%

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

Zisapel

2018

British J Pharmacology

550

350

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In mammals, a central circadian clock, located in the suprachiasmatic nuclei (SCN) of the hypothalamus, tunes the innate circadian physiological rhythms to the ambient 24 h light–dark cycle to invigorate and optimize the internal temporal order. The SCN‐activated, light‐inhibited production of melatonin conveys the message of darkness to the clock and induces night‐state physiological functions, for example, sleep/wake blood pressure and metabolism. Clinically meaningful effects of melatonin treatment have been demonstrated in placebo‐controlled trials in humans, particularly in disorders associated with diminished or misaligned melatonin rhythms, for example, circadian rhythm‐related sleep disorders, jet lag and shift work, insomnia in children with neurodevelopmental disorders, poor (non‐restorative) sleep quality, non‐dipping nocturnal blood pressure (nocturnal hypertension) and Alzheimer's disease (AD). The diminished production of melatonin at the very early stages of AD, the role of melatonin in the restorative value of sleep (perceived sleep quality) and its sleep‐anticipating effects resulting in attenuated activation of certain brain networks are gaining a new perspective as the role of poor sleep quality in the build‐up of β amyloid, particularly in the precuneus, is unravelled. As a result of the recently discovered relationship between circadian clock, sleep and neurodegeneration, new prospects of using melatonin for early intervention, to promote healthy physical and mental ageing, are of prime interest in view of the emerging link to the aetiology of Alzheimer's disease.Linked ArticlesThis article is part of a themed section on Recent Developments in Research of Melatonin and its Potential Therapeutic Applications. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.16/issuetoc

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Section: Melatonin In the Treatment Of Circadian Rhythm And Sleep Dismentioning

confidence: 99%

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

Zisapel

2018

British J Pharmacology

550

350

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“…Subjective sleep quality is also central to complaints of non-restorative sleep, which was included as a subtype of insomnia until publication in the DSM-5. Research by Roth and colleagues has shown that complaints of non-restorative sleep are stable and separable from those of difficulty initiating or maintaining sleep, though still associated with comparable levels of functional impairment [3]. In the general population, non-restorative sleep complaints are quite common [4] and associated with a variety of physical and mental conditions [5].…”

Section: Introductionmentioning

confidence: 99%

When a gold standard isn’t so golden: Lack of prediction of subjective sleep quality from sleep polysomnography

Kaplan

Hirshman

Hernandez

et al. 2017

Biological Psychology

151

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Background Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. Methods Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. Results Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. Conclusions Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to subjective ratings of prior-night sleep quality. Though they explained relatively little of the variance, sleep efficiency, total sleep time and sleep stage transitions were among the most important objective correlates.

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“…Research identifying characteristics of sleep disturbances and the emotional associations of sleep loss is needed and continues to be understudied (Kahn et al, 2013;Ohayon, 2005;Roth et al, 2010;Vernon, Dugar, Revicki, Treglia, & Buysse, 2010;Wilkinson & Shapiro, 2012).…”

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confidence: 99%

Associations between sleep disturbances, personality, and trait emotional intelligence

Emert

Tutek

Lichstein

2017

Personality and Individual Differences

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Insomnia is defined by difficulty falling asleep, staying asleep, or waking earlier than desired with inability to return to sleep. Complaints of nonrestorative sleep (NRS) are often associated with insomnia but can occur independently. Fragmented sleep and NRS have been shown to relate to one's mood, one's ability to process their own or others' emotions, and can lead to changes in cognitions and behaviors. Personality traits related to increases in anxiousness may play a role in the development and maintenance of sleep disorders and associated daytime impairment of NRS. The relations between sleep disturbance, personality traits, and trait emotional intelligence are underrepresented in the current literature and findings have been mixed. This study addressed some inconsistencies by identifying associations between the Big Five personality traits, trait emotional intelligence (TEI), complaints of NRS, and disrupted sleep associated with insomnia. We predicted that neuroticism would relate to poorer sleep and that conscientiousness and TEI would be associated with better sleep. Openness to experience, extraversion, and agreeableness are not often discussed in the literature, but were expected to associate similarly as conscientiousness. Results provided support for the idea that trait characteristics are associated with insomnia severity and restorative sleep quality. These findings indicated that personality and TEI may play a role in development and maintenance of sleep disorders and daytime impairment of NRS; higher conscientiousness, lower neuroticism, and higher TEI possibly demonstrate a protective role to experiencing negative effects of poor sleep.

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Nonrestorative Sleep as a Distinct Component of Insomnia

Abstract: This study confirms that NRS can occur independently of other components of insomnia. Daytime symptoms were as severe in individuals with NRS-only as those whose NRS symptoms were combined with DIS or DMS.

Cited by 96 publications

References 11 publications

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

When a gold standard isn’t so golden: Lack of prediction of subjective sleep quality from sleep polysomnography

Associations between sleep disturbances, personality, and trait emotional intelligence

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