David Minors

The meaning of good sleep: a longitudinal study of polysomnography and subjective sleep quality

SUMMARY  The present study sought to investigate the meaning of subjectively good sleep, using a longitudinal and intraindividual design. Eight subjects slept in an isolation unit according to an irregular schedule of 6h sleeps and 1h naps, designed to give normal amounts of time in bed (1/3 of total), but variable sleep quality. Eight sleeps and eight naps were used for longitudinal simple and multiple regression analyses with standard polysomnographical sleep variables as predictors and subjective sleep quality as dependent variables. The results showed that subjective sleep quality (and related variables) was closely related to sleep efficiency, but not sleep stages. At least 87% efficiency was required for ratings of ‘rather good’ sleep. In addition, sleep quality ratings improved with closeness (of the awakening) to the circadian acrophase (17.00–21.00 hours) of the rectal temperature rhythm. The subjective ease of awakening differed from most other other variables in that it was related to low sleep efficiency. Objective and subjective homologues of sleep length and sleep latency showed high mean intraindividual correlations (r= 0.55 and 0.64, respectively). It was concluded that objective measures of sleep continuity were closely reflected in perceived sleep quality and that sleep quality essentially means sleep continuity.

The Subjective Meaning of Good Sleep, An Intraindividual Approach Using the Karolinska Sleep Diary

The present experiment used an intraindividual design to investigate the meaning and measurement of “good sleep.” Each of 16 subjects slept in an isolation unit according to a schedule (15 sleeps) designed to give variable quality of sleep. Self-rated sleep measures (from the Karolinska Sleep Diary) were obtained after each sleep and subjected to intraindividual regression analyses across time. Most subjective sleep measures showed a strong covariation across conditions. Subjective quality of sleep mainly involved variables of sleep continuity, in particular, perceived calmness of sleep and sleep efficiency. “Sleep quality,” “calm sleep,” “ease of falling asleep,” and ability to “sleep throughout” the time allotted strongly covaried and formed an index of sleep quality. Self-rated ease of awakening deviated from the general pattern and was associated with poor sleep quality. So was reported dreaming (related to awakenings). It was concluded that most subjective sleep measures tend to covary across conditions and that “good sleep” is mainly a question of sleep continuity.

Masking in Humans: The Problem and Some Attempts to Solve IT

Different types of masking are discussed together with an account of the masking effect that the sleep-wake cycle exerts upon the circadian rhythms of body temperature and urinary excretion. The relative importance to masking of the several components of differences between sleeping and wakefulness are then assessed. Means to deal with the problem of masking fall into two major categories. These attempt to minimise masking effects by protocols such as constant routines or control days, and mathematical models which separate results obtained in the presence of masking influences into endogenous and exogenous components. (The problem of the extent to which masking influences can render the endogenous component of a rhythm an impure reflection of the internal oscillator is considered also.) These different techniques are compared with respect to their usefulness and assumptions. Finally, a brief speculation is given of the usefulness of masking.

Good sleep — its timing and physiological sleep characteristics

SUMMARY The present study used short sleep episodes to explore the relation between subjective sleep quality, timing and physiological content of sleep. Eight subjects participated in 18 4‐h sleep episodes to provide 4, 8, and 12 h of prior time awake before bedtimes at six different times of day in a sleep laboratory insulated from environmental disturbances. The results were analysed by ANOVAs and multiple regression techniques. Subjective sleep quality, calmness of sleep, ease of falling asleep, ability to ‘sleep through’, number of awakenings, and sleep latency showed a significant pattern of ‘better’ sleep with increasing prior time awake and with closeness to the circadian minimum (nadir) of rectal temperature (morning hours). ‘Ease of awakening’ in contrast, ‘decreased’ with increasing time awake and with closeness to the nadir/ morning hours. Multiple regression analysis showed that subjective sleep quality was predicted by subjective calmness of sleep and ease of falling asleep, among the subjective measures, and by total sleep time (TST) and slow‐wave sleep (SWS – stages 3 +4) among the physiological sleep measures. The subjective ease of awakening was predicted by slow‐wave sleep (negatively) and the circadian maximum of rectal temperature. The results indicate that the duration of wakefulness prior to sleep and the timing of sleep determine its physiological expression, which in turn determines its subjective impression.

Investigating the Endogenous Component of Human Circadian Rhythms: A Review of Some Simple Alternatives to Constant Routines

Several types of constant routine are accepted as an important means by which the endogenous component of circadian rhythms can be studied. Nevertheless, they are impracticable to perform and unsuitable for routine use in many individuals. We describe a group of simple methods with which rhythms measured in normal circumstances can be dissociated into the components due to masking and the internal clock. Each method is best suited to a particular type of experimental condition. Results from a variety of protocols are analysed by these and conventional methods to assess the validity of the new methods.

Circadian Rhythms and Masking: An Overview

Masking, as is well known, enables an organism to act immediately and in an appropriate way to changes of the environment, integrating with internally produced rhythmicity. It now appears that masking can be used to cover a far wider range of problems than was originally intended. To separate masking effects from the effects due to an internal oscillator, several techniques have been used. Such protocols, however, like the constant routine protocol, often replace one form of masking by another. The situation becomes even more complex when one realizes that the output of an internal oscillator modifies the input. The question might be asked whether it is possible to study the properties of the internal oscillator in vivo at all. This article attempts to produce a framework for future discussions.

Chronobiology and meal times: internal and external factors

Although homeostatic mechanisms remain of utmost importance, rhythmic changes are present also. The main ones have a period of 24 h (circadian) or about 2-3 h (ultradian). Circadian rhythms are derived from a body clock, found in the base of the brain, and from the pattern of our sleep-wake cycle, including activity and meal times. These rhythms promote the regular changes between an active wake period and a recuperative sleep period. Ultradian rhythms are also widespread and reflect external (lifestyle) and internal factors. The internal factors include biochemical need and some sort of oscillator; but details of how many oscillators, and exactly where they are, remain to be established. Food intake, appetite, digestion and metabolism have been shown to illustrate these principles. Moreover, these principles become important when special circumstances exist as far as meal times are concerned; the particular difficulties of night workers is a good example.

The Difference Between Activity When in Bed and Out of Bed. I. Healthy Subjects and Selected Patients

The activity records of five groups of healthy or ill subjects have been measured for 4-26 days by an accelerometer placed on the nondominant wrist. These data, together with a record of times retiring to/rising from bed, have been used to produce a series of dichotomy indices for comparing the amounts of activity when in bed and out of bed. Reliable differences between individuals were found, with healthy subjects showing a greater degree of dichotomy than one subject with delayed sleep phase syndrome or three subjects with colorectal cancer. The method is convenient for extended data collection and offers the possibility of describing an individuals activity profile in a variety of circumstances.

A COMPARISON OF SOME DIFFERENT METHODS FOR PURIFYING CORE TEMPERATURE DATA FROM HUMANS

Nine healthy females were studied about the time of the spring equinox while living in student accommodations and aware of the passage of solar time. After 7 control days, during which a conventional lifestyle was lived under a 24h “constant routine,” the subjects lived 17 × 27h “days” (9h sleep in the dark and 18h wake using domestic lighting, if required). Throughout the experiment, recordings of wrist activity and rectal (core) temperature were taken. The raw temperature data were assessed for phase and amplitude by cosinor analysis and another method, “crossover times,” which does not assume that the data set is sinusoidal. Two different purification methods were used in attempts to remove the masking effects of sleep and activity from the core temperature record and so to measure more closely the endogenous component of this rhythm; these two methods were “purification by categories” and “purification by intercepts.” The former method assumes that the endogenous component is a sinusoid, and that the masking effects can be estimated by putting activity into a number of bands or categories. The latter method assumes that a temperature that would correspond to complete inactivity can be estimated from measured temperatures by linear regression of these on activity and extrapolation to a temperature at zero activity. Three indices were calculated to assess the extent to which exogenous effects had been removed from the temperature data by these purification methods. These indices were the daily variation of phase about its median value; the ratio of this variation to the daily deviation of phase about midactivity; and the relationship between amplitude and the square of the deviation of phase from midactivity. In all cases, the index would decrease in size as the contribution of the exogenous component to a data set fell. The purification by categories approach was successful in proportion to the number of activity categories that was used, and as few as four categories produced a data set with significantly less masking than raw data. The method purification by intercepts was less successful unless the raw data had been “corrected” to reflect the direct effects of sleep that were independent of activity (a method to achieve this being produced). Use of this purification method with the corrected data then gave results that showed least exogenous influences. Both this method and the purification by categories method with 16 categories of activity gave evidence that the exogenous component no longer made a significant contribution to the purified data set. The results were not significantly influenced by assessing amplitude and phase of the circadian rhythm from crossover times rather than cosinor analysis. The relative merits of the different methods, as well as of other published methods, are compared briefly; it is concluded that several purification methods, of differing degrees of sophistication and ease of application to raw data, are of value in field studies and other circumstances in which constant routines are not possible or are ethically undesirable. It is also concluded that such methods are often somewhat limited insofar as they are based on pragmatic or biological, rather than mathematical, considerations, and so it is desirable to attempt to develop models based equally on mathematics and biology. (Chronobiology International, 17(4), 539–566, 2000)

Variation in meals and sleep-activity patterns in aged subjects; its relevance to circadian rhythm studies.

The study was performed upon a sample of aged and non-institutionalized subjects. Information was obtained by questionnaires and diaries on personal factors during a typical week. A random subset was subjected to a more detailed analysis of the composition of their meals. Results showed that increasing age was correlated with: a decreased day-by-day variability in an individuals time of retiring, rising and eating meals; earlier sleep times; increased frequency of daytime naps and nocturnal awakenings; and decreased physical activity. These results occurred both in subjects living alone and in those living with company. Day-by-day differences in the composition of meals tended to decrease with age. When differences between individuals were considered then these tended to increase with age. Some implications of these findings for studies of circadian rhythmicity in aged subjects--in whom the timing of circadian rhythms becomes more erratic and amplitude falls--are discussed.