An investigation of the relationship between sleep and fatigue in those with and without insomnia

There is currently mixed evidence for the relationship between poor sleep and daytime fatigue. It is well documented that retrospective measures of insomnia and fatigue are highly correlated with one another. However, other studies fail to demonstrate a link between objectively less sleep and fatigue; that is, individuals with shorter sleep times do not necessarily report increased fatigue. As such, the relationship between these two constructs remains unclear. The current investigation will help to elucidate the complex relationship between sleep and fatigue among those with and without insomnia by advancing the existing literature in two important ways. First, this study proposed to examine the temporal relationship between sleep and fatigue across two weeks, thereby investigating whether sleep and fatigue occur in accordance with one anotherover time. Second, this study utilized a multi-method approach by collecting subjective (i.e.,sleep diary) and objective (i.e., actigraphy) measures of sleep, as well as retrospective (i.e.,visual analogue scales: VAS) and prospective (i.e., momentary ratings) measures of fatigue. Two separate hierarchical linear models were used to test whether sleep (measured by sleep quality and total sleep time) predicted daytime fatigue on the VAS and actigraph, respectively. The secondary objective asked whether cognitive-behavioural variables (i.e., maladaptive sleep beliefs, fear and avoidance of fatigue, and fatigue-based rumination) may help account for the relationship between sleep and fatigue using mediation. The results of the primary analyses suggested that sleep quality significantly predicted VAS fatigue ratings, whereas total sleep time was a significant predictor of fatigue within- but not between-persons. No significant relationships were found between objective measures of sleep and momentary fatigue ratings. Finally, each of the cognitive-behavioural variables, with the exception of avoidance of fatigue, were significant mediators of the relationship between sleep and fatigue. The results demonstrated that compared to sleep quantity, our perception of sleep may play a more important role in predicting reports of daytime fatigue. These findings could help decrease the burden that individuals with insomnia place on their total sleep times, and instead, treatment could focus on challenging maladaptive sleep-related cognitions, which ultimately could lessen the overall sleep-related anxiety.