Menghini, L., Yuksel, D., Prouty, D., Baker, F. C., King, C., & de Zambotti, M. (2022). Wearable and mobile technology to characterize daily patterns of sleep, stress, presleep worry, and mood in adolescent insomnia. Sleep Health.
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.