Nonrestorative sleep in healthy, young adults without insomnia: associations with executive functioning, fatigue, and pre-sleep arousal

Objectives: Previous research suggests that nonrestorative sleep (NRS), even in the absence of insomnia symptoms or other sleep disorders, may be associated with daytime dysfunction. This study examined the association between NRS and daytime dysfunction in healthy adults screened for insomnia and sleep apnea. Design: Multi-day assessment approach. Setting: Community-based adults and college students. Participants: Healthy young adults without insomnia and sleep apnea (n = 79; 68% female, mean age = 27.5, SD = 6.5). Measurements: Laboratory protocol included a behavioral assessment of executive functioning (EF), self-report of prior month sleep-related daytime dysfunction, and depressive symptoms in the prior two weeks. Subsequently, participants completed an experience sampling assessment that included morning ratings of NRS, repeat affect ratings throughout the day via palm-pilot, nighttime ratings of pre-sleep arousal and EF disturbances, ambulatory cardiac impedence monitoring, and wrist actigraphy. Results: NRS was significantly associated with poorer performance on behaviorally-assessed EF, perceived EF difficulties, daily ratings of fatigue, and past-month reported daytime dysfunction. These associations remained significant after controlling for age and sleep duration (measured by actigraphy). NRS was also associated with increased sympathetic nervous system activation prior to bedtime. Further, reported pre-sleep arousal was associated with NRS, and this association was mediated by perceived EF difficulties. Conclusions: Findings indicate that, even among healthy, young adults without insomnia or sleep apnea, NRS is associated with poorer cognitive functioning and may be a precursor to insomnia. (c) 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.