Sleep Continuity, Stability and Cyclic Organization Are Impaired in Insomniacs: A Case-Control Study

The possibility of distinguishing insomniacs from good sleepers based on polysomnography (PSG) remains an open question. While these groups show modest differences in traditional PSG parameters, some studies suggest that finer measures may be more useful. Here we assess differences between good sleepers (GS), poor sleepers (PS) and insomniacs (IN) in classical PSG measures as well as in sleep continuity, stability and cyclic organization. PSG-monitored sleep (two nights) of 17 IN (diagnosed through a standard clinical interview; Pittsburgh Sleep Quality Index (PSQI) >= 5, Insomnia Severity Index (ISI) > 14) was compared to that of 33 GS (PSQI < 5) and 20 PS (PSQI >= 5, ISI <= 14). Compared to GS, IN were impaired in sleep macrostructure (sleep latency, sleep efficiency, WASO%) and in continuity, stability and organization, whereas PS only showed disrupted continuity and stability. Spindle parameters were comparable between IN and GS, but the former displayed enhanced power in fast frequency bands. Our findings support the hypothesis of a continuum between individuals with self-reported poor sleep and insomniacs. Further, they add to extant data on impaired sleep continuity, stability and organization in poor sleepers and elderly individuals, underlining the utility of including these measures in standard sleep assessments.