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Abstract
Daytime impairments feature in the diagnostic criteria for insomnia disorder yet are rarely assessed comprehensively in clinical practice and tend to focus on mood and subjective assessment of cognitive competence. In order to gain more information about the engagement in daily activities we developed the Sleep Impact on Activity Diary (SIAD). This initial investigation included 22 insomnia patients (15 females, aged 49.9 years, SD = 17.6) and 19 normal sleeper controls (13 females, aged 30.9 years, SD = 8.9). For 14 consecutive evenings, participants rated how their prior night-time sleep impacted their participation in 12 common daytime activities (e.g., work, self-care, leisure). They also rated how much effort each activity required (Range: 0–4). Overall, insomnia patients participated in only one fewer activity type per day (M = 7.48, SD = 1.34) than controls (M = 8.39, SD = 1.43) (p = 0.041, d = 0.66). More noteworthy, they reported that sleep negatively affected their participation more than controls (M = 1.56, SD = 0.92 versus M = 0.23, SD = 0.35; p = < 0.001, d = 1.90), and that activities required more effort (M = 1.58, SD = 0.64 versus M = 0.81, SD = 0.76; p = 0.001, d = 1.10). This pilot study with the SIAD suggests that, compared to good sleepers, insomnia patients participate in somewhat fewer activities but that their activities require considerably more effort and are adversely affected by their sleep. The SIAD tool promises to provide a more comprehensive picture of the everyday impact of insomnia. It remains to be validated on a much larger sample in a clinical treatment study.
Highlights
Symptoms of poor daytime functioning are a core component of chronic insomnia diagnoses [1,2]
In the attempt to develop greater ecological validity in measures of the reported impairments associated with insomnia, we developed the Sleep Impact on Activity Diary (SIAD)
The insomnia group was older than the control group and reported greater Insomnia Severity Index (ISI) scores than controls
Summary
Symptoms of poor daytime functioning are a core component of chronic insomnia diagnoses [1,2]. Insomnia patients frequently complain of low energy, poor mood, and difficulties with concentration [3] These subjective impairments, especially low energy/fatigue, are so severe that they are often the prompt for individuals to seek treatment [4,5]. Not all studies have found lower objective performance in cognitive tasks (e.g., divided and sustained attention, working memory) [6,7] This suggests a disparity between objective measures of cognitive performance, usually from experimental studies, and the subjective reports of negatively impaired daytime functioning. The SIAD aims to measure the pragmatic daytime functioning of individuals with respect to the types of activities engaged, whether the activity was negatively affected by their sleep and how much effort they felt was required in carrying out the activity. This may provide additional, useful information to clinically assess the consequences of poor sleep in those with insomnia and to monitor the daytime functioning benefits of insomnia treatment
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