Psychophysiology, 36 ~1999!, 233 – 244. Cambridge University Press. Printed in the USA.

Copyright © 1999 Society for Psychophysiological Research

How many nights are enough? The short-term stability

of sleep parameters in elderly insomniacs
and normal sleepers

WILLIAM K. WOHLGEMUTH,a JACK D. EDINGER,a,b ANA I. FINS,c

and ROBERT J. SULLIVAN, JR.b,d
a
Duke Sleep Disorders Center, Duke University, Durham, NC, USA
b
Durham VA Medical Center, Durham, NC, USA
c
Department of Psychiatry, University of Miami, Miami, FL, USA
d
Duke Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA

Abstract
Temporal stability is an important fundamental quality when measuring sleep parameters, yet it has been infrequently
assessed. Generalizability theory was used to estimate the short-term temporal stability of five variables commonly used
to characterize insomnia: sleep onset latency, total sleep time, wake after sleep onset, time in bed, and sleep efficiency.
Estimates were calculated for 32 elderly primary insomniacs and 32 elderly normal sleepers, both in the lab and at home,
using both sleep logs and polysomnography ~PSG!. A week of recording using either PSG or sleep logs was typically
sufficient to achieve adequate stability ~defined as G coefficient of at least 0.80! with some notable exceptions: ~a! when
using log-derived measures with insomniacs, a 3-week average was necessary for wake after sleep onset and ~b! more
than a 2-week average was necessary for sleep onset latency. Because of the substantial commitment involved in the
physiological recording of sleep, alternative forms of aggregation are considered with the intent of improving temporal
stability.
Descriptors: Night-to night variability, Generalizability theory, Temporal stability, Sleep assessment

Sleep variables that are used for clinical decision making or re-
search analyses should demonstrate the fundamental property of
stability over time. Temporal stability is important for two reasons:
~a! if sleep variables represent characteristic dispositional traits in
individuals, then stability, by definition, is expected; and ~b! the
correlations among sleep measures are necessarily attenuated when
using unstable measures. Each of these are reasons are discussed in
more detail below.
If sleep variables do not represent dispositional traits but in-
stead represent fluctuating, transient states, then temporal stability
from one night to the next would not be expected. The distinction
between traits and states is made with some psychological vari-
ables. Traits, such as intelligence or personality, are hypothesized
to be consistent from one day to the next or from one situation to
the next. States, such as fear or anger, can be transient and may be
present on one day or in one situation but gone the next. Some
variables, such as anxiety, exhibit characteristics of both states and
traits ~Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983!. That
The study was supported by grants VA0009-1992-1994 from the Vet-
eran’s Administration and R01MH48187 from the National Institutes of
Health.
Address reprint requests to: Dr. William K. Wohlgemuth, Duke Uni-
versity Medical Center, Box 2908, Durham, NC 27710. E-mail: wkw@geri.
duke.edu.
is, there is a stable trait level of anxiety within an individual, upon
which an anxiety state may be superimposed.
Some biological variables have both state and trait character-
istics. For example, a loud, startling noise or soothing music may
cause a transient increase or decrease in blood pressure, perhaps
raising it to hypertensive levels or decreasing it to normotensive
levels. However, the blood pressure will recover to its character-
istic level after the auditory stimulus ceases. It would not be proper
to begin or end an antihypertensive regimen based on one transient
reading. Multiple readings are needed so that transient factors will
cancel each other out, and an accurate blood pressure measurement
can be attained.
With respect to sleep, if, for example, it is hypothesized that
individuals have a stable, inherent biological need for a particular
amount of sleep each night, then total sleep time ~TST! should be
similar from one night to the next. If, however, it is hypothesized
that TST represents a transient state and is purely dependent on
fluctuating daily0nightly circumstances, then TST should not be
similar from night to night. Perhaps, like anxiety or blood pressure,
there exists both a trait and state component of TST such that
transient factors may be superimposed on trait levels leading to a
greater or lesser sleep need on any given night. If both state and
trait components of TST exist, it is important to measure each
adequately.
A second reason for studying the temporal stability of sleep is
a well-known principle from psychometrics: validity coefficients

233
234
~correlations! are limited by the reliability of the variables used in
calculating the correlation ~Nunnally & Bernstein, 1994!. As the
reliability of a variable decreases, the observed correlation be-
tween that variable and others is necessarily attenuated. To the
extent that measures of sleep are unstable, empirical relationships
between sleep variables and other variables may be underesti-
mated. If TST, for example, cannot predict itself well, how can
TST be expected to relate to another variable with which it may
have a plausible theoretical relationship?
The sleep of insomniacs frequently is quite variable from night
to night ~Coates et al., 1982; Edinger, Marsh, McCall, Erwin, &
Lininger, 1991!. In fact, some researchers have claimed that this
night-to-night variability is one of the critical elements leading to
the self-definition of insomnia ~Frankel, Coursey, Buchbinder, &
Snyder, 1976!. Night-to-night variability, however, is problematic
when measuring variables used to empirically document insomnia.
Large fluctuations in TST or sleep onset latency ~SOL!, for exam-
ple, indicate that assessment of just one night may not adequately
represent an insomniac’s sleep. That is, variables obtained from
one night may not be reproducible on the next. If an insomniac
sleeps for 5 hr one night but 9 hr the next, which amount is
presumed to be more accurate? It is important to determine, then,
how many nights need to be averaged to achieve stable, represen-
tative, and reproducible estimates of sleep parameters.
The recognition of the instability of sleep measures is not lim-
ited to insomniacs. Researchers ~Clausen, Sersen, & Lidsky, 1974;
Moses, Lubin, Naitoh, & Johnson, 1972! also have questioned the
reproducibility of sleep parameters in normal sleepers. Moses et al.
~1972! pointed out that in the studies of the consistency of sleep
characteristics, the similarity of group means from one night to the
next is typically noted. Group means, however, do not indicate the
relative fluctuation of the individuals within that group. A better
assessment of individual subject stability from night to night is a
stability coefficient, which indicates changes in the rank ordering
of individuals from one night to the next. Both Clausen et al.
~1974! and Moses et al. ~1972! recommended that more attention
be paid to the reliability of sleep measures that are thought to
represent traits.
In the present analysis, we focused on five variables that are
particularly relevant in characterizing and defining the nature of an
insomnia complaint ~American Sleep Disorders Association, 1990!
and commonly reported outcome variables following an insomnia
treatment ~Morin, Culbert, & Schwartz, 1994; Murtagh & Green-
wood, 1995!. These variables are SOL, TST, wake after sleep onset
~WASO!, time in bed ~TIB!, and sleep efficiency ~SE%!.
In previous research, the impact of night-to-night variability of
sleep on the measurement process has been addressed infrequently.
Relatively few quantitative estimates of stability are available for
polysomnographically ~PSG! derived measures and even fewer
from sleep log measures. We present here a brief review of the
literature concerning the stability of sleep parameters ~SOL, TST,
WASO, TIB, and SE%!. Stability estimates, using both objective
~PSG! and subjective ~sleep log! methods from both home-based
and laboratory evaluations in normal sleepers and insomniacs, also
are reviewed.
Assessment Using PSG
In no studies to date have stability coefficients been estimated from
laboratory-based, PSG-derived sleep measures recorded from in-
somniacs. In contrast to the lack of laboratory PSG data for in-
somniacs, several studies have been conducted with noncomplaining
normal sleepers. These published reports indicate that one night of
W.K. Wohlgemuth et al.
recording is not representative or reproducible. Bootzin et al. ~1995!,
who studied 30 elderly subjects, found stability coefficients of
PSG-derived SOL, WASO, TST, and SE% of 0, .39, .46 and .48,
respectively. Moses et al. ~1972!, using a controlled sleep period of
10:30 p.m. to 6:00 a.m. in 17–21-yr-old Navy recruits found the
stability of PSG-derived SOL, WASO, and TST to be .20, 0, and
.13, respectively. Clausen et al. ~1974! found the stability of PSG-
derived TST of 10 young adults to be .31. Coates, Rosekind,
Strossen, Thoresen, and Kirmil-Gray ~1979! studied eight pur-
ported normal sleepers ~subjects completed an insomnia treatment
program 1 yr earlier! in both the laboratory and at home. They
applied generalizability theory to three nights of PSG recording to
estimate variance components for subjects, occasions, raters, and
the interactions among those components. Generalizability coeffi-
cients ~used to estimate stability! of SOL, WASO, TST, and
SE% based on lab recordings were .24, .87, .52, and .75, respec-
tively, and based on home recordings were .39, .22, .52, and .23,
respectively.
With regard to home-based PSG, Coates et al. ~1982! assessed
the stability of sleep parameters in 12 insomniacs and 12 normal
sleepers ranging in age from 20 to 60 yr. The stability of SOL and
WASO for normal sleepers was .58 and .72, respectively, and for
insomniacs was .70 and .67, respectively.
Assessment Using Sleep Logs
Stability estimates generated from laboratory-based sleep logs have
not been reported for either insomniacs or normal sleepers. Coates
et al. ~1982! have been the analyses to assess the stability mea-
surements derived from sleep logs. The stability of home-recorded
SOL and WASO for normal sleepers was .58 and .37, respectively,
and for insomniacs was .93 and .64, respectively.
As is evident from these published reports, none of these vari-
ables are representative when recorded for only one night. The
stability coefficients range from a low of 0 to a high of .93, with
most values being less than .70. Coates et al. ~1979, 1982! reported
the highest coefficients; however, they used relatively small sam-
ple sizes ~8 and 12, respectively! and the widest age range. Addi-
tionally, potential participants with periodic limb movement disorder
~PLMD! and restless legs syndrome ~RLS! were excluded, which
may have made the sample more homogenous and less subject to
error variance. None of the reported studies tested the same sleep-
ers in both the laboratory and the home setting to assess the effects
of environmental factors on stability measures. Coates et al. ~1982!
reported stability coefficients for insomniacs but only in the home
setting. Investigation of the stability of laboratory measures of
insomniacs has never been reported, and research on the stability
of home measures of normal subjects is incomplete. The current
study was undertaken to address the following specific questions:
~a! Which assessment technique ~PSG or logs! provides more sta-
ble measures? ~b! Which setting ~home or lab! provides more
stable measures? ~c! How many nights need to be averaged to
achieve adequate stability? These questions are considered for both
insomniacs and normal sleepers.
Statistical Model
Reliability is defined as the proportion of true variance in the
observed variance of a measure. For instance, if the stability co-
efficient is .80, then 80% of the observed variance is true score
variance and 20% is error variance ~Nunnally & Bernstein, 1994!.
Several types of reliability exist ~i.e., interrater, internal consis-
tency, and temporal stability!. In the present analysis, we focused
on temporal stability, which is that proportion of observed variance
Short-term stability of sleep
that is stable over time. Generalizability theory ~Brennan, 1983;
Cronbach, Gleser, Nanda, & Rajaratnam 1972; Shavelson & Webb,
1991; Shavelson, Webb, & Rowley, 1989! is the most comprehen-
sive theory of reliability and applies the random effects analysis of
variance ~ANOVA! model to the study of multiple sources of error.
Sources of error are called facets ~similar to factors in experimen-
tal research! and levels within facets are called conditions. The
average score an individual would get over all conditions of a facet
is called a universe score, which is analogous to a true score in
classical reliability theory.
In sleep research, there are many potential sources of error that
may contribute to the variability among subjects in an overnight
PSG. This study will focus on the error due to night-to-night fluc-
tuations of an individual’s sleep. The statistical model used in the
current study is ~for explicit calculation of the variance compo-
nents for this design, see Shavelson & Webb, 1991; see also Llabre
et al., 1988, for a useful appendix!
s 2 ~TSTpn ! 5 sp2 1 sn2 1 spn,
2
e,
where s 2 ~TSTpn ! represents the observed variance in total sleep
time and p, n, and e represent persons, nights, and error, respec-
tively. The observed variance can be broken down into its com-
ponents; sp2 , sn2 , and spn,2
e represent the variance components,
which, because they are independent of each other, can be summed
to equal the observed variance. This is a one-facet design with
nights as the facet. Each of the variance components can be inter-
preted with substantive meaning. For example, if the researcher is
studying the stability of TST, the variance component for persons
~sp2 ! quantifies individual differences in TST and is an estimate of
true error-free variance. In the present analysis, sp2 is the portion of
the variance that is stable from one night to the next. This quantity
is estimated by averaging TST across all of the nights for each
subject in the design. The variance component for nights ~sn2 !
represents systematic variance that may impact measurement of
TST from night to night. This quantity is estimated by averaging
TST across all subjects on each night. sn2 reflects the extent to
which there is variability among the group means from one night
to the next. As such, it will detect any variance due to a systematic
first night effect. Finally, the residual variance component ~spn, 2
e!
reflects the change in relative standing among subjects’ TST from
one night to the next. The subscript for the residual contains both
the interaction of persons and nights and random error because
these terms are confounded by the design and cannot be estimated
separately. If TST represents a stable trait, there should not be
much change in the relative ordering of a group of subjects from
night to night. These variance components are useful in determin-
ing which facet or interaction of facets are contributing to the
instability of the measurement.
The G coefficient can be constructed from these variance com-
ponents so that the proportion of true variance relative to observed
variance can be determined. The formula for the G coefficient is
sp2
S D
G5 . Table 1. Subject Demographics
spn,
2
e
sp2 1
nn'
The nn' in the denominator represents the number of nights that will
be averaged together for a particular variable. For example, to
estimate the stability of TST based on 1 week of recording, nn'
would be 7. It is apparent that as nn' increases, the error component
235
~spn,
2
e ! decreases, leading to an overall increase in the G coeffi-
cient. By increasing nn' , it becomes possible to estimate the number
of nights required to sufficiently decrease error so that stability
reaches the desired level. With this formula, calculation of the G
coefficients is straightforward once the variance components are
obtained. For example, if we want to know the stability of TST and
if sp2 5 85, spxo 2
5 180, and nn' is 1, then the G coefficient would
be 850@85 1 ~18001!# 5 .32. The denominator of the coefficient
~nn' ! can be increased until the desired stability is reached. For
1 week of recording, the G coefficient is 850@85 1 ~18007!# 5 .77.
Although ANOVA methodology is used in a generalizability
analysis, the typical interpretation of useful variance and nuisance
variance from experimental research is reversed. As is evident
from the G coefficient ratio, the researcher is most interested in
maximizing variability due to individual differences ~sp2 ! and min-
imizing any systematic variability ~sn2 ! or relative fluctuations
over time ~spn, 2
e !. In traditional experimental research designs, the
opposite is true. That is, the researcher wants to maximize sys-
tematic sources of variance or interactions while minimizing dif-
ferences among individuals.
Method
Subjects
Thirty-two insomniacs and 32 noncomplaining normal sleepers
were recruited for the study. Insomniacs complained of difficulty
initiating sleep ~n 5 3!, problems maintaining sleep ~n 5 12!, a
combination of these problems ~n 5 14!, or chronic poor sleep
quality with daytime fatigue ~n 5 3! for greater than 6 months.
Normal sleepers were matched for age and gender and had no
sleep complaints. Using the SCID-P for DSM-III-R ~1987!, all
subjects were screened to rule out any history or current symptoms
of psychiatric disorders. A medical history was taken and a phys-
ical exam was conducted, including a thyroid blood test to rule out
any current medical disorder that could cause sleep problems.
Subjects were required to be free of any psychotropic medication
during the study and for at least 2 weeks prior to beginning the
protocol. Seven of the insomniacs reported using sedative hypnot-
ics, but only three of these insomniacs reported using sedative
hypnotics more than once a week. Any subject with an apnea0
hypopnea index greater than 15 events0hr on the first study night
was excluded. Subjects with PLMD were not excluded from the
sample. As reported by Edinger et al. ~1997!, the insomniacs and
normal sleepers did not differ in either periodic limb movements
~PLMs! per hour or PLM-related arousals per hour. Table 1 in-
cludes the demographic characteristics of the sample.
Polysomnography
All home PSG ~HPSG! and laboratory PSG ~LPSG! studies were
conducted using the Oxford Medilog 9000 ~Oxford Medical, Clear-
water, FL! recorders. Research at the Duke Sleep Disorders Center
Subject M0F Age ~ years! Education ~ years!
Insomniacs 16016 67.7 ~4.8! 13.9 ~3.1!
Normal Sleepers 16016 67.5 ~5.7! 14.4 ~2.8!
Note: Values are M ~SD).
236 W.K. Wohlgemuth et al.

has shown that the Medilog produces technically acceptable re- Table 2. Means (6 SDs) Averaged over Three Nights
cordings ~Hoelscher et al., 1987!. Other research has suggested
that manually reduced data from the Medilog and standard labo- Home Laboratory
ratory sleep monitoring equipment ~i.e., polygraph! produce com-
Variables PSG Logs PSG Logs
parable measures of such parameters as SOL, WASO, TST, TIB,
SE%, sleep stage architecture, REM latency, and REM activity Normals
~Ancoli-Israel, Kripke, Mason, & Messin, 1981; Edinger et al., SOL 21.0 6 12.0 23.0 6 21.1 19.0 6 15.1 22.1 6 16.8
1989; Edinger, Marsh, McCall, Erwin, & Lininger, 1990; McCall, ~31! ~27! ~32! ~32!
Erwin, Edinger, Krystal, & Marsh, 1992; Sewitch and Kupfer, WASO 91.0 6 43.6 65.0 6 44.6 68.2 6 32.9 49.3 6 44.1
~31! ~26! ~32! ~28!
1985!. TST 365.2 6 46.3 386.6 6 67.5 356.6 6 43.7 370.5 6 53.6
All subjects underwent three consecutive nights of HPSG and ~31! ~26! ~32! ~28!
LPSG. A standard monitoring montage, including two electro- TIB 473.3 6 61.5 466.6 6 62.3 440.8 6 48.9 446.2 6 46.5
encephalogram channels ~C3–M2 , O z–Cz !, one chin electromyo- ~31! ~28! ~32! ~32!
SE% 77.6 6 7.2 81.7 6 10.6 81.0 6 6.5 83.9 6 10.9
gram ~EMG! channel, two electrooculogram channels to monitor ~31! ~26! ~32! ~28!
eye movements ~left eye–M1 , right eye–M2 !, two channels to mon- Insomniacs
itor anterior tibialis EMG ~right and left legs!, and one channel to SOL 28.7 6 24.0 33.4 6 20.4 28.7 6 25.7 43.9 6 36.1
monitor air flow ~oral0nasal thermistor!, was used for all HPSG ~31! ~27! ~30! ~29!
and LPSG studies. WASO 83.8 6 51.7 84.0 6 38.7 76.5 6 33.5 74.5 6 41.3
~31! ~25! ~30! ~22!
All Medilog recordings were scored directly on the screen of TST 353.7 6 52.9 355.9 6 77.5 351.7 6 52.2 333.5 6 69.2
the Medilog scanner by experienced polysomnographers using stan- ~31! ~23! ~30! ~21!
dard scoring criteria ~Rechtshaffen & Kales, 1968!. This scoring TIB 460.6 6 43.7 469.6 6 47.9 451.1 6 46.5 455.0 6 48.4
procedure was used because it allows for both rapid scanning of ~31! ~27! ~30! ~30!
SE% 77.1 6 10.1 74.5 6 11.0 77.9 6 8.2 73.4 6 11.4
sleep data and screen-by-screen editing with more difficult studies
~31! ~23! ~30! ~21!
~such as those with more leg movements throughout the night!.
Moreover, previous research has shown that screen scoring pro- Note: Sample sizes given in parentheses.
duces estimates of standard sleep parameters that are comparable
to those obtained from conventional epoch-by-epoch scoring of
records on paper ~Hoelscher, McCall, Powell, Marsh, & Erwin,
1989!. Scorers were blind to the dates on which the studies were and 2 chart the proportion of total variance ~sp2 1 sn2 1 spn, 2
e!
performed, the type of subject from whom the study was obtained, attributable to true individual differences ~sp !. For example, when
2

and the location of the study ~home vs. laboratory!. In addition, considering SOL for normals at home the variance components are
scoring reliability checks were conducted with a small subset ~n 5 sp2 5 84.6, sn2 5 7.2, and spn, 2
e 5 178.3. Thus the total variance
1

20! of the PSGs. Scorer 1 randomly selected and blindly scored 10
records previously scored by Scorers 2 and 3, with overall agree-
ment rates of 91% and 93%, respectively.
Sleep Logs
Each morning following a PSG, subjects were required to com-
plete a standard sleep log based on their subjective self-report of
the previous night’s sleep. From the sleep log it was possible to
derive subjective measures of SOL, WASO, TST, TIB, and SE%.
Procedure
After giving consent, subjects who met inclusion criteria were
scheduled for three consecutive nights of LPSG and another three
consecutive nights of HPSG monitoring. The study order was ran-
domly determined so that one-half of the subjects in each group
~normals and insomniacs! underwent LPSG first whereas the other
half underwent HPSG first. All sleep studies were scheduled so the
home and laboratory PSGs were separated by at least 4 but not
more than 30 intervening days. During both LPSG and HPSG
studies, subjects were instructed to maintain customary home bed-
times and waketimes. In addition, all HPSG studies were sched-
uled for nights when subjects planned to have no overnight
houseguests. Subjects were instructed to abstain from alcoholic
beverages and to not consume caffeinated substances after 6:00
p.m. on study nights.
is 84.6 1 7.2 1 178.3 5 270.1, and the proportion of sp2 in sp2 1
sn2 1 spn,
2
e is 84.60~84.6 1 7.2 1 178.3! 5 .31. Higher proportions
indicate greater stability. Inspection of the systematic variance com-
ponents ~sn2 ! indicated that variability due to nights represents a
very small proportion of the overall observed variance. Only TIB
for insomniacs at home contributed greater than 5% to the total
observed variance. Thus, systematic sources of variance, which
include the first night effect, did not appear to adversely affect the
measurement stability of these five variables.
Random sources of variance ~spn, 2
e !, however, constituted a
large part of the observed variance for each of the five variables
analyzed. In fact, in 31 of 40 variance component decompositions,
the random variance component comprised more than half of the
observed variance. This indicates substantial random fluctuation in
the rank ordering of subjects from one night to the next. Random
fluctuations from night to night were limited to neither insomniacs
nor normal sleepers, the home setting nor laboratory, PSG nor
sleep logs. Although, some settings and methods provided more
stable measures than did others, no setting or technique provided
measures that were stable enough to require only one night of
recording.
PSG Versus Logs
Inspection of Figure 1 indicates that in normal sleepers the stability
of sleep logs was greater ~the white bars are higher than the black

Results
Means and standard deviations averaged over the three nights in
each setting ~lab and home! are reported in Table 2. Figures 1
1
The complete tables of the components of variance for each variable
~SOL, WASO, TST, TIB, and SE%! for each type of sleeper ~normal and
insomniac! in each setting ~home and lab! are not presented here but are
available on request from the first author.
Short-term stability of sleep
Figure 1. sp2 0~sp2 1 sn2 1 spn,
2
e ! for normal sleepers using PSG and logs at home and in the lab.
bars! than that of PSG when assessing WASO, TST, TIB, and
SE%. The proportion of sp2 for sleep logs was greater than vari-
ance due to persons for PSG regardless of whether the recording
took place at home or in the lab. However, when assessing SOL in
normal sleepers, PSG was more stable.
For insomniacs ~see Figure 2!, the picture is less clear. When
assessing WASO and SE%, PSG was more stable regardless of the
setting. For TST and TIB, PSG was more stable only in the lab.
Sleep logs for TST and TIB were more stable at home. For SOL,
PSG was more stable at home but logs were more stable in the lab.
Home Versus Lab
In normal sleepers, the stability of SOL and WASO was greater in
the lab regardless of method ~both black and white bars for SOL-L
are higher than their respective bars for SOL-H!; however, TST,
TIB, and SE% were more stable at home regardless of the method.
For insomniacs, SOL and WASO were, as with normal sleepers,
more stable in the lab. However, unlike for normal sleepers, TIB
was more stable in the lab. The stability of TST and SE% for
Figure 2. sp2 0~sp2 1 sn2 1 spn,
2
e ! for insomniacs using PSG and logs at home and in the lab.
237
insomniacs depended on the method of assessment. For TST, PSG
was more stable in the lab but logs were more stable at home. For
SE%, PSG was more stable at home but logs were more stable in
the lab.
Simultaneous graphic representations of stability coefficients
for the same sleepers in different settings are shown in Fig-
ures 3–7. The stability coefficients for up to 2 weeks for each of the
five sleep variables ~TST, SOL, WASO, TIB, and SE%! is repre-
sented for each method ~sleep logs and PSG! separately. Each one
of the four lines on the figure represents the unique sleeper–setting
combination and documents the expected increase in the stability
coefficient by averaging more nights. The numbers represent es-
timates of expected G coefficients. These estimates are extrapo-
lated from the variance components calculated from the sample of
three nights for each subject in each setting. Subjects were not
actually recorded for 14 nights.
Although PSG or sleep logs may be slightly more stable for a
particular variable in a particular sleeper–setting combination, the
overall pattern of stability coefficients for PSG versus sleep logs
238
Figure 3. Sleep onset latency using PSG and logs.
does not indicate the superiority of one method over another. Fig-
ures 3–7 indicate that the stability coefficients of PSG-derived
measures are not systematically greater than log-derived measures
but, instead, are comparable, with a few exceptions. Specifically,
when considering all sleeper–setting combinations, the stability
coefficient of SOL for both the sleep logs and PSG based on one
night of recording fell into the .25–.30 range. For WASO, using
both the sleep logs and PSG, coefficients clustered around .50,
with the exception of insomniacs completing sleep logs at home,
for which the coefficient was .10. For TST, the coefficients for
both the sleep logs and PSG clustered around .35, except for nor-
mal sleepers completing sleep logs at home, for which the coeffi-
cient was .60. For TIB, sleep log coefficients were higher than
PSG coefficients in normal sleepers but were comparable in in-
W.K. Wohlgemuth et al.
somniacs. Coefficients for SE% clustered around .40 for PSG.
Coefficients derived from sleep logs were similar to those from
PSG ~around .40! in normal sleepers, but the SE% for insomniacs
using sleep logs was lower than that for PSG ~around .20!.
Number of Nights for Adequate Stability
Unrepresentative measures based on a single night of recording do
not indicate that reproducible measures are unattainable. To obtain
stable measures, however, requires averaging each variable over
multiple nights so that random influences are reduced to only a
minor portion of the observed variance. Figures 3–7 indicate how
many nights need to be averaged to achieve adequate stability
~although the selection of an adequate threshold value for a sta-
bility coefficient is arbitrary, coefficients of .80 are generally rec-
Short-term stability of sleep
Figure 4. Wake after sleep onset using PSG and logs.
ommended for research purposes; see Nunnally & Bernstein, 1994!.
In general, the stability curves for PSG-derived variables are more
tightly clustered together than are the log-derived measures. Thus,
for PSG-derived measures, the relative proportion of true score
variance and error variance is similar among all four sleeper–
setting combinations when using PSG. That is, the G coefficients
are all quite similar. Two exceptions to the clustering of PSG-
derived stability coefficients are TIB when insomniacs are re-
corded at home and SE% when normal sleepers are recorded in the
lab. For sleep logs, the lack of clustering indicates that the relative
proportion of true score to error variance ~i.e., G coefficient! is
contingent on the type of sleeper and the setting.
For each of the five variables being considered, the greatest
gain in stability in nearly all cases was made in the first few nights.
The gain in stability to be made from averaging more nights di-
239
minished after approximately five to seven nights. For example,
when considering SOL derived from PSG, the stability coefficient
for each subject–setting combination increased by approximately
.35 when averaging over 7 nights versus 1 night, but averaging
over 14 nights only increased the coefficient by another .10. Thus,
for SOL not much gain is expected by extending the assessment
process beyond the first week.
With regard to the measures derived from the PSG, a coefficient
of .80 is possible for all subject–setting combinations with 5 nights
of recording for WASO, 10 nights for SOL, and 11 nights for TST.
TIB required 4 nights for all combinations except for insomniacs at
home, where 16 nights of recording were necessary. SE% required
6 nights, except for normals in the lab, who required 11 nights.
Because the stability curves are not closely clustered together
when using measures derived from sleep logs, the decision about
240
Figure 5. Total sleep time using PSG and logs.
the number of nights is more complicated—it depends on the type
of sleeper and the setting. For example, after averaging a week of
records, the stability of SOL for insomniacs in the lab was nearly
.80, but the stability coefficient was only about 0.50 for normal
sleepers at home. As with the PSG-derived measures, in most
instances, there were diminishing gains after averaging about a
week of log-derived measures.
Because subjects typically record sleep logs in 1-week ep-
ochs, it is most useful to consider sleep log measures in weekly
units. For WASO, TST, TIB, and SE%, averaging a week of
recording was sufficient for adequate stability ~i.e., stability co-
efficients $ .80! for all sleeper–setting combinations, with two
exceptions: both insomniacs and normals at home. Insomniacs
in the home setting required more than a week of averaging for
W.K. Wohlgemuth et al.
SOL, WASO, TIB, and SE%. For WASO, 21 and 36 nights
were needed for stability coefficients of .70 and .80, respec-
tively. For TIB and SE%, 10 and 12 nights, respectively, were
needed for a coefficient of .80. Normals in the home setting
required more than a week of recording for TST and SE%. For
TST and SE%, 10 and 14 nights, respectively, were needed for
a coefficient of .80.
Averaging only 1 week of data is not sufficient for SOL. In the
laboratory setting, 2 weeks of recording were sufficient to reach
adequate stability for both normal sleepers and insomniacs, but not
in the home setting. For normal sleepers at home, 17 and 29 nights
were needed for stability coefficients of .70 and .80, respectively.
For insomniacs at home, 10 and 17 nights were needed for stability
coefficients of .70 and .80, respectively.
Short-term stability of sleep
Figure 6. Time in bed using PSG and logs.
To summarize, most measures derived from sleep logs have a
stability of .80 when averaging over a 2-week assessment. How-
ever, when using log-derived WASO for insomniacs, 3 weeks needed
to be averaged for a coefficient of .70 and more than 5 weeks were
needed for a coefficient of .80. In addition, when using log-derived
SOL for insomniacs, about 2.5 weeks needed to be averaged for a
coefficient of .80. Therefore, if a researcher were studying insom-
nia using SOL and WASO derived from a sleep log, a minimum of
3 weeks of logs should be completed. If the researcher were not
interested in SOL among normal sleepers in their homes, 2 weeks
of recording would be sufficient to reach a stability coefficient of
.80 for all variables. However, if SOL were an important variable
in the study ~i.e., comparison of SOL between normal sleepers and
insomniacs at home!, 3 weeks would be required for a coefficient
of .70 and 4 weeks would be required for a coefficient of .80.
241
Discussion
The present results indicating that one night of recording is not
sufficient for adequate stability is not new ~Bootzin et al., 1995;
Clausen et al., 1974; Coates et al., 1979, 1982; Moses et al., 1972!.
Furthermore, the instability of the measures reported in this study
is not due to a systematic error facet, such as the first night effect.
Instead, the instability is due to random, unpredictable fluctuations
from one night to the next. Multiple nights of recording are needed
to overcome the instability due to random error. The decision about
the number of nights to record sleep depends on the type of sleeper
and the setting where the recording is made, especially when using
log-derived measures. A particular research question and study
population should guide the investigator in choosing which stabil-
ity coefficients are most important. For example, will the data
242
Figure 7. Sleep efficiency using PSG and logs.
collection take place at home or in the lab? Will insomniacs, nor-
mal sleepers, or both be included in the sample? What will be the
primary outcome measure~s!? The number of nights required for
adequate stability depends on the answers to these questions.
The comparability of the stability coefficients using two meth-
ods of assessment ~PSG and sleep logs! does not provide evidence
that one method or another leads to superior stability. Instead, the
generally low coefficients, regardless of the method used, indicate
that the particular variable being studied, but not the assessment
method, is influenced by random factors. That is, PSG, by provid-
ing “hard” biological measures, is not necessarily more stable than
the “soft” self-report measures. However, the PSG data were more
consistent among subject–setting combinations than were the sleep
log data, as indicated by the closely clustered G coefficient curves
for the PSG data and the more divergent G coefficient curves for
the sleep-log data. This finding implies that the random night-to-
W.K. Wohlgemuth et al.
night variability of measures based on bioelectric signals ~i.e.,
PSG! is similar among elderly insomniacs and normal sleepers in
both the home and lab settings. Furthermore, the random night-to-
night variability of measures based on the process of subjectively
recalling, interpreting, and reporting a prior night’s sleep ~i.e.,
sleep logs! does depend on the specific sleeper–setting combina-
tion, with measures from insomniacs having more random variability.
Sleep measures must have adequate stability because quantita-
tive relationships among variables are limited by the stability co-
efficient. Some of the equivocal or null results reported in the sleep
literature may be partially due to the use of unstable measures. For
example, Stepanski ~1994! in a summary of the insomnia treatment
literature, mentioned that positive outcomes have been found using
sleep logs, but these results have not been corroborated by PSG
measures. Perhaps not enough nights of PSG have been recorded
and averaged to allow sensitive detection of positive outcomes.
Short-term stability of sleep
When interpreting these results, several limitations should be
considered. These present results were obtained from elderly sleep-
ers, which typically have more fragmented sleep then younger
sleepers. Such fragmentation may increase night-to-night variation
in this subgroup, and therefore the stability estimates may not be
representative of the entire population. Also, because these record-
ings were made using ambulatory equipment, subjects were less
restricted than those using traditional PSG recording devices. The
fewer constraints imposed by the ambulatory methodology may
have increased nightly variability such that these results cannot be
generalized to data obtained from the traditional laboratory setting.
Also, subjects were recruited as research volunteers and may not
be representative of the clinical insomniac population. Therapeutic
change for patients who spontaneously present to a clinic for treat-
ment is greater than that for patients who are actively recruited for
participation ~Murtagh & Greenwood, 1995!. These data are based
on estimates from three nights of recording. Subsequent research is
needed to empirically verify these estimates by averaging actual
data collected over several weeks.
To better understand the instability of these sleep measures, it
is useful to speculate on the possible sources of this random night-
to-night variation. Webb ~1988! presented a theoretical behavioral
model through which predictions of sleep function could be made.
Webb hypothesized that sleep measures are a function of three
dispositional constructs: sleep demand, circadian tendencies, and
behavioral facilitators and inhibitors. Sleep demand is related to
amount of wakefulness before sleep. Circadian tendencies are re-
lated to the timing of sleep within the 24-hr day. Behavioral fa-
cilitators and inhibitors are individual behaviors that increase or
decrease the likelihood of sleep. Webb ~1988, p. 493! stated that
“sleep behavior may be delayed, interrupted or terminated, or fa-
cilitated by a vast range of voluntary or involuntary, consciously or
unconsciously determined responses.” Furthermore, “From these
considerations, it follows that the prediction of sleep behaviors is
a formidable but sensible process” ~p. 495!. Based on Webb’s
analysis, on any given night for any given individual, there prob-
ably are numerous contributions to the random variability of sleep
measures. Thus, measures from one night probably do not predict
the next night’s sleep very well. A few nights of averaging are
necessary so that most of the random state factors involved in a
sleep assessment are canceled out and sleep traits can emerge.
The night-to-night variability of sleep may be one of the crucial
elements in the discomfort experienced by insomniacs. The present
investigation was designed to determine the number of nights nec-
essary to minimize this night-to-night variability so that stable
measures can be obtained. As such, we neglected the assessment of
the frustrating nightly variability experienced by insomniacs. If
night-to-night variability is a trait of insomniacs, then, as with
other trait measures, this nightly variability should be reproduc-
ible. Night-to-night variability requires a somewhat different, yet
appropriate, operationalization. The most obvious candidate to rep-
resent this nightly variability of a measure over several nights is
the standard deviation of that measure. To assess the nightly vari-
ability of SOL, for instance, the standard deviation could be cal-
culated over three nights. If this nightly variability were reproducible,
it would be expected that the next three nights would produce a
similar standard deviation. Thus, the standard deviations of SOL
~not the raw scores! from the two consecutive sets of three nights
would become the raw data for a generalizability analysis ~as
performed in the present study! to calculate variance components
and G coefficients. Unfortunately, the present data set does not
include enough nights to allow the investigation of the stability of
243
standard deviations. However, future research should focus on this
important issue.
It may be possible to increase the reproducibility of one night
of recording ~either PSG or sleep logs! by exerting more control
over the assessment process and reducing random factors. Some
experimental control was exerted in the present study by banning
alcohol and the use of caffeine after 6:00 p.m. on study nights.
Also, subjects were required not to take sleeping pills for at least
2 weeks prior to data collection. However, many other random
possibilities exist. For example, we did not assess whether the
study participants had bed partners at home. Those with regular
bed partners may have had more night-to-night variation ~because
of partner movement, snoring, etc.! and less stability in sleep pa-
rameters than those without bed partners. In the current data set, no
subjects had bed partners while they were in the lab. Furthermore,
several sleep parameters were less stable in the lab, which provides
evidence that having a bed partner does not systematically de-
crease the stability of sleep. It may not be desirable to control all
aspects of subjects’ sleep so that random variability is greatly
reduced. If such experimental control is exerted, the sleeping con-
ditions may be too contrived to be ecologically valid.
The necessity for recording and averaging multiple nights of
sleep to produce stable measures is most problematic when using
PSG. PSG is a technically demanding, labor intensive, and costly
procedure from the experimenter’s perspective and is usually aver-
sive from the subject’s perspective when recording over multiple
nights. Each additional night of PSG recording represents substan-
tial commitment from both experimenter and subject. However,
keeping sleep logs is not technically demanding and is relatively
inexpensive; thus, keeping additional logs entails only a longer
time commitment. An alternative to either PSG or logs may be
actigraphy, which is less obtrusive and less demanding than PSG
and can provide objective corroboration to the subjective impres-
sions that are reported by participants. Future investigations should
include an assessment of the stability of actigraphy measures or
other alternatives ~e.g., Nightcap!.
It is not clear how to resolve the problem of requiring multiple
nights of recording using a costly procedure ~PSG! to obtain ad-
equate stability; however, one method, which is quite common in
psychological testing ~Spielberger et al., 1983!, entails aggregating
over a set of items that measure a common construct. This proce-
dure effectively cancels out interitem variance so that a represen-
tative, reproducible assessment of the underlying construct is made.
Buysse, Reynolds, Monk, Berman, and Kupfer ~1989! used such a
technique in developing the Pittsburgh Sleep Quality Index. Indi-
vidual items are combined into subcomponents, and the subcom-
ponents are combined into a global scale. The stability of the
global scale is greater that the stability of any subcomponent scale.
The increase in stability from the component to the global scale is
a demonstration of the usefulness of aggregation. Latent constructs
may exist ~such as sleep quality! within a set of daily recorded
sleep variables, and by aggregating across several sleep variables
~i.e., items!, a representative, reproducible assessment of the latent
construct can be made. Such a procedure could make multiple
replications of the measurement process unnecessary. Other inves-
tigators ~e.g., Edinger et al., 1996! have used a factor analytic
procedure to generate latent constructs from a set of PSG variables.
The factors are meaningful combinations of separate PSG vari-
ables ~i.e., items! that through aggregation may be more stable than
any of the separate variables. Perhaps one night of PSG would be
sufficiently stable if individual variables were combined into theo-
retically meaningful composites.
244
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~Received August 19, 1997; Accepted August 27, 1998!