'Young old' and 'old old' poor sleepers with and without insomnia complaints

OBJECTIVE: Sleep, psychological adjustment, health and insomnia complaints were examined in 277 community-dwelling seniors in order to identify characteristics that distinguish poor sleepers with complaints (likely to seek treatment) and those without complaints (unlikely to seek treatment). METHODS: Two weeks of sleep diaries and other sleep-related measures were collected. Young old (65-74 years) and old old (75+) participants were categorized as: good sleepers, poor sleepers with complaints (complainers), and poor sleepers without complaints (noncomplainers). RESULTS: In both age groups, complainers had poorer sleep than noncomplainers. Complainers also reported more depressive symptoms and had poorer health than noncomplainers. The old old slept longer each night, but took longer to fall asleep, napped more, and were more likely to complain of insomnia than the young old; otherwise, the young old/old old distinction did not explain sleep differences among the three types of sleepers. CONCLUSIONS: Implications for treating late-life insomnia include greater inclusion of the old old in treatment outcome research and more focus on the development of integrated intervention and prevention strategies that target health, depressive symptoms, and sleep.     

Functioning of the three attentional networks and vigilance in primary insomnia

BackgroundResults from cognitive measures in primary insomnia (PI) patients are not consistent with the difficulties in performing daily living tasks of which these patients complain about. Lack of sensitivity of the tests and the data concerning some cognitive functions may explain this discordance. The aim of the present investigation was to better characterize cognitive deficits of PI patients in order to further understand their cognitive complaints. We looked at attentional and executive function because of their high involvement in daily living tasks.MethodsA total of 21 PI patients and 16 good sleepers completed the Attentional Network Test (ANT). We only included untreated PI patients since sleep medication could be a confounding factor when assessing cognition.ResultsWhile PI patients, compared to good sleepers, were found to have a longer overall reaction time (RT) and perform more slowly in the incongruent flanker condition (ie, conflict situation) than in the congruent condition, no group effects were observed for the variables representing the three attentional networks (ie, alerting, orienting, and executive functions).ConclusionsThe present study revealed a conflict resolution deficit in untreated PI patients. This impairment may be linked to the prefrontal alterations reported in neuroimaging studies in these patients. Patients had also an impaired vigilance compared to good sleepers, likely due to the high cognitive load of the ANT. These results would serve to explain the complaints of PI patients about difficulties performing daily living tasks that are demanding and of long duration.     

Cognitive performance and sleep quality in the elderly suffering from chronic insomnia. Relationship between objective and subjective measures

OBJECTIVE: The objective of the present study was to evaluate the relationship between objective and subjective sleep quality and objective and subjective evaluation of cognitive performance in older adults suffering of chronic insomnia (using or not benzodiazepines, BZs) or self-reported good sleepers. METHODS: Three groups of participants 55 years and older were evaluated: 20 insomnia sufferers using BZs chronically, 20 drug-free insomnia sufferers and 20 good sleepers. Objective sleep (PSG) and subjective sleep (sleep diaries, SD) were measured. Objective measures of cognitive performance (attention/concentration, verbal/visual memory, executive function and psychomotor speed) and subjective perception of daily performance were evaluated. RESULTS: Correlational analysis revealed that objective and subjective measures of daytime performance are differentially related to sleep quality for the three groups. An objective good night of sleep is associated with better cognitive performance in good sleepers and drug-free individuals. On the other hand, the impression of having slept well is related to better cognitive performance in good sleepers and chronic insomnia sufferers using BZs. CONCLUSION: Daytime performance and sleep quality are related, but differently so for a good sleeper, an insomnia sufferer without treatment, or one using BZs to alleviate sleep difficulties.     

Daytime consequences of insomnia symptoms among outpatients in primary care practice: EQUINOX international survey

ObjectiveTo assess the daytime consequences in outpatients suffering from different insomnia symptoms in primary care practice.MethodsAn international cross-sectional survey was conducted in 5293 outpatients complaining of sleep disturbances in primary care practice. A sleep questionnaire addressing daytime consequences, insomnia symptoms, socio-demographic characteristics, and other sleep variables was administered by 647 physicians in 10 countries.ResultsOverall, 20–33% of subjects reported “severe” daytime impairments associated with sleep disturbances. Approximately 45% of patients complaining of sleep disturbances in primary care practice suffered from a combination of insomnia symptoms. Patients suffering from all insomnia symptoms reported the most severe daytime functioning impairments compared with patients suffering from initiation or maintenance insomnia only. Conversely, the majority of patients suffering from non-restorative sleep reported little daytime functioning impairments compared to the patients suffering from other combinations of insomnia symptoms. The strongest risk factor associated with “severe” daytime functioning impairments was sleep quality perception.ConclusionsPrimary insomnia disturbs subjective daytime functioning. A report of combined insomnia symptoms reflected the most damaging insomnia subtype and had a negative impact on a wide range of daytime functioning consequences.     

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.     

Assessment and prediction of outcome for a brief behavioral insomnia treatment program

This study examined (a) the efficacy, and (b) predictors of outcome of a brief (one to four sessions) behavioral treatment program for chronic insomnia. A total of 103 insomnia patients were treated, and outcome was assessed by a follow-up questionnaire. Outcome variables, including both nocturnal sleep parameters and measures of daytime functioning, showed significant improvement subsequent to treatment. Pretreatment sleep hygiene practices were significantly correlated with daytime fatigue and sleep latency outcome factors. Pre-and post-treatment complaints of daytime fatigue were associated with somatic complaints in general, but not with nocturnal sleep variables. Explanatory hypothesis are discussed.     

A two-year follow-up study on the symptoms of sleep disturbances/insomnia and their effects on daytime functioning

ObjectiveThis study attempts to identify changes in the symptoms of sleep disturbances/insomnia over a two-year course and their effects on daytime functioning.MethodsWe administered two population-based epidemiological surveys in 2005 and 2007 to participants from rural Japan.ResultsIn the first survey, 30.7% of the subjects reported sleep disturbances/insomnia. Among them, 60.9% reported sleep problems at the two-year follow-up. A comparison of sleep disturbances/insomnia, and subjective daytime functioning measures between the new incident cases and persistent poor sleepers revealed that the total score of persistent poor sleepers was significantly lower than that of new incident cases on the Pittsburgh Sleep Quality Index and physical quality of life (QoL) but not mental QoL. Longitudinal comparisons of the symptoms of sleep disturbances/insomnia in persistent poor sleepers revealed that sleep efficiency was significantly worse at follow-up. Exacerbation of the symptoms of sleep disturbances/insomnia at follow-up was observed in mild but not severe cases.ConclusionsSleep efficiency progressively worsens over time, and physical QoL can deteriorate as sleep disturbances/insomnia become chronic. Since the symptoms of sleep disturbances/insomnia and their daytime effects are exacerbated even in mild cases, early intervention and treatment are necessary.     

Catastrophic worry in primary insomnia

The present study aimed to provide an empirical test of the proposal that catastrophic worry about the consequences of not sleeping is common among patients with primary insomnia and serves to maintain the sleep disturbance. It was predicted that relative to good sleepers, patients with primary insomnia would catastrophize more and that catastrophizing would be associated with increased negative affect and increased perception of threat. A 'catastrophizing interview' was administered to 30 patients with primary insomnia and 30 good sleepers. Consistent with the predictions, the insomnia patients generated more catastrophes about the consequences of not sleeping and gave higher likelihood ratings than good sleepers. For the insomnia group, but not the good sleepers, the catastrophizing interview was associated with increased anxiety and discomfort. The limitations of the study, possibilities for future research, and clinical implications of these findings are discussed.     

Daytime consequences of insomnia complaints in the French general population

Insomnia is a frequent symptom in the general population; numerous studies have proven this. In the past years, classifications have gradually given more emphasis to daytime repercussions of insomnia and to their consequences on social and cognitive functioning. They are now integrated in the definition of insomnia and are used to quantify its severity. If the daytime consequences of insomnia are well known at the clinical level, there are few epidemiological data on this matter. The aim of this study was to assess the daytime repercussions of insomnia complaints in the general population of France. A representative sample (n=5,622) aged 15 or older was surveyed by telephone with the help of the sleep-EVAL expert system, a computer program specially designed to evaluate sleep disorders and to manage epidemiological investigations. Interviews have been completed for 80.8% of the solicited subjects (n=5,622). The variables considered comprised insomnia and its daytime repercussions on cognitive functioning, affective tone, daytime sleepiness and diurnal fatigue. Insomnia was found in 18.6% of the sample. The prevalence was higher in women (22.4%) than in men (14.5%, p<0.001) with a relative risk of 1.7 (95% confidence interval 1.5 to 2) and was twice more frequent for subjects 65 years of age or older compared to subjects younger than 45 years. Approximately 30% of subjects reporting insomnia had difficulties initiating sleep. Nearly 75% of insomnia complainers reported having a disrupted sleep or waking up too early in the morning and about 40% said they had a non-restorative sleep. Repercussions on daytime functioning were reported by most insomnia subjects (67%). Repercussions on cognitive functioning changed according age, number of insomnia symptoms and the use of a psychotropic medication. A decreased efficiency was more likely to be reported by subjects between 15 and 44 years of age (OR: 2.9), those using a psychotropic (OR: 1.5), those reporting at least three insomnia symptoms (OR: 1.4) and women (OR: 1.4). The highest probability of the appearance of concentration difficulties was found in subjects younger than 65 Years, having a depressive disorder and using a psychotropic (15-44 years: OR 19.1; 45-64 years: OR 46.6). Difficulties maintaining attention were 15 times higher in subjects aged between 45 and 64 who were using a psychotropic and had also a depressive disorder. Memory difficulties were three times more likely to be reported by subjects using a psychotropic. At the affective level, irritability was 10 times more likely to be reported by subjects younger than 65 Years who were also using a psychotropic and had a depressive disorder. Independent of the presence of a mental disorder and the use of a psychotropic, subjects between 15 and 44 Years were five times more likely to be irritable following a bad sleep. Feeling depressed after a bad night's sleep was 18 times more likely to occur in subjects aged between 45 and 64 who were using a psychotropic and had a depressive disorder. Feeling anxious after a bad night's sleep was seven times more likely to occur in subjects with a depressive disorder. Daytime sleepiness was reported by approximately 20% of insomnia subjects. This rate was relatively comparable among gender, age groups, presence/absence of a mental disorder and use or not of a psychotropic. However, taking into account the interaction between age, use of a psychotropic and the presence of a mental disorder, subjects younger than 65 years, using a psychotropic and having a depressive disorder were at least 10 times more likely to report daytime sleepiness. Subjects who were suffering the most diurnal symptoms of insomnia were those younger than 65 years. Several factors can be evoked to explain this fact. These subjects were, for the most part, likelier to have a stricter sleep/wake schedule because of constraints imposed by work, studies, child care, etc. Subjects older than 65 Years were generally retired and therefore less prone to sleepiness and to cognitive difficulties. Insomnia consequences were limited due to their inactivity. Complementary studies should be undertaken to describe the daytime repercussions of insomnia for this specific age group of the general population and to measure these repercussions.     

Vital exhaustion and perception of sleep.

Sleep complaints and unusual sleep durations have been found to increase the risk for coronary heart disease. One explanation states that insomnia and excess fatigue on final waking are predictive for myocardial infarction because they are part of a state of 'vital exhaustion'. Sleep complaints and sleep durations, however, are usually assessed with retrospective self-report procedures. Such procedures must be interpreted with reserve because in insomniacs, a consistent disparity in the perception of habitual and current sleep has been observed. This caused us to question whether this phenomenon is present in exhausted males also. Two approaches were used. The first one consisted of a retrospective assessment of subjective sleep characteristics, the second one of self-monitoring these sleep characteristics during 21 days. In the second week, subjects slept in a laboratory. No disparity was found in how exhausted males perceive their habitual and current sleep. It appeared that sleep quality is worse and sleep duration is shorter in exhausted males. They also feel more sleepy and take longer naps during the day, indicating that their daytime functioning is impaired. Sleeping in a laboratory reduced time asleep and midsleep wake. Sleep quality, however, was essentially the same as at home. These findings made us conclude that it is not the intrusion of nocturnal wake times per se but more likely the impaired daytime functioning which is the reason for exhausted males to complain about their sleep.     

The relationship between sleep and drug use characteristics in participants with cocaine or methamphetamine use disorders

The goal of this project was to evaluate the relationship between self-reported sleep habits, daytime sleepiness, and drug use variables in individuals with cocaine and methamphetamine (METH) use disorders. Participants with a cocaine or meth use disorder completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and a demographic/drug use form. Participants with a cocaine (N=51) or meth use disorder (N=85) were separated into those with either high or low sleep deficits. In participants with a cocaine use disorder, ANOVA revealed significantly higher ESS scores among those defined as “poor sleepers” (with a PSQI score >5) when compared to those defined as “good sleepers” (with a PSQI score ≤5). In addition, poor sleepers reported using cocaine for more days out of the past 30 when compared to good sleepers. Interestingly, good sleepers reported using more grams of cocaine/day compared to poor sleepers. In participants with a METH use disorder, ANOVA revealed significantly higher ESS scores among poor sleepers when compared to good sleepers. Finally, individuals with a METH use disorder that endorsed elevated daytime sleepiness also had significantly higher PSQI scores when compared to those with normal daytime sleepiness. The results indicate that drug use variables, such as recent and daily use, may affect sleep quality and daytime sleepiness in individuals with stimulant use disorders; however, further investigations (i.e. in cocaine and METH users that do not meet criteria for a cocaine or METH use disorder) must be conducted in order to provide more conclusive evidence of the impact these usage variables may have on these sleep characteristics.     

Subjective memory complaints in an elderly population with poor sleep quality

Objectives: The association between sleep disturbances and cognitive decline in the elderly has been putative and controversial. We evaluated the relation between subjective sleep quality and cognitive function in the Korean elderly.

Method: Among 459 community-dwelling subjects, 352 subjects without depression or neurologic disorders (mean age 68.2?±?6.1) were analyzed in this study. All the participants completed the Korean version of the consortium to establish a registry for Alzheimer's disease neuropsychological battery (CERAD-KN) as an objective cognitive measure and subjective memory complaints questionnaire (SMCQ). Based on the Pittsburgh sleep quality index, two types of sleepers were defined: ‘good sleepers’ and ‘poor sleepers’.

Results: There were 192 good sleepers (92 men) and 160 poor sleepers (51 men). Poor sleepers reported more depressive symptoms and more use of sleep medication, and showed higher SMCQ scores than good sleepers, but there was no difference in any assessments of CERAD-KN. In the regression analysis, depressive symptoms and subjective sleep quality were associated with subjective memory complaints (β = 0.312, p < 0.001; β = 0.163, p = 0.005).

Conclusion: In the elderly without depression, poor sleep quality was associated with subjective memory complaints, but not with objective cognitive measures. As subjective memory complaints might develop into cognitive disorders, poor sleep quality in the elderly needs to be adequately controlled.     

Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results

OBJECTIVES: This study examined the differences in heart rate variability (HRV) and daytime functioning between insomniacs and normal sleepers. METHODS: All participants underwent an interview, a medical examination, and a sleep measurement protocol during which they wore an actigraph and logged a sleep diary for a 7-day period to verify their eligibility. Included in the study were 18 insomniacs and 21 normal sleepers. During a laboratory session, these participants completed four paper-pencil tests of sleepiness, anxiety, fatigue, and concentration difficulty and the Wisconsin Card Sorting Test. Resting HRV was recorded under paced breathing. RESULTS: Neither did insomniacs experience cognitive impairment nor did they experience excessive daytime sleepiness compared with normal sleepers. However, insomniacs experienced higher frequency of fatigue [effect size (ES)=1.14, P=.002] compared with normal sleepers. There was also a trend toward higher trait anxiety score (ES=0.62) and concentration difficulty (ES=0.59) in insomniacs than in normal sleepers. Although a tendency toward lower resting high- frequency (HF) HRV (ES=-0.57) in insomniacs than in normal sleepers was noted, neither the resting low-frequency (LF) HRV nor the LF/HF ratio were different between groups. Subjective sleep estimates correlated to self-reported daytime consequences such as fatigue and concentration difficulty but not cognitive function. On the contrary, objective sleep estimates correlated to problem-solving/conceptualization and learning but not self-reported daytime consequences. CONCLUSIONS: Insomniacs are not sleepier during the day than normal sleepers. However, they may experience such a daytime symptom as fatigue although cognitive function remains unimpaired.     

Psychological and health-related quality of life factors associated with insomnia in a population-based sample

OBJECTIVE: This study examined the relationship of psychological and health-related quality of life variables to insomnia in a population-based sample. METHODS: Data were derived from a longitudinal epidemiological study assessing the natural history of insomnia. The present results are based on the first of four postal evaluations conducted over a 2-year period. Participants (n=953) completed questionnaires assessing sleep, psychological and personality variables, and health-related factors. Participants were categorized into three sleep status subgroups using an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and International Classification of Diseases, 10th Edition diagnostic criteria for insomnia: (1) insomnia syndrome (n=147), (2) insomnia symptoms (n=308), and (3) good sleepers (n=493). RESULTS: Compared to individuals with insomnia symptoms and good sleepers, individuals with insomnia syndrome presented lower quality of life and higher scores on measures of depression, anxiety, neuroticism, extraversion, arousal predisposition, stress perception, and emotion-oriented coping. The same pattern was observed for individuals with insomnia symptoms in comparison with good sleepers. An ordinal logistic regression analysis showed that the presence of a past episode of insomnia, higher depressive symptoms, and lower scores on the 12-item Short Form Health Survey vitality and role physical subscales were the most useful variables to predict subgroups membership. CONCLUSION: The findings indicate that insomnia is associated with increased psychological symptomatology and perceived stress, higher predisposition to arousal, and more impairment of health quality. Longitudinal follow-ups are now being conducted to assess the relative contribution of those variables in the development and natural course of insomnia.     

Daytime alertness in subjective and objective insomnia: some preliminary findings

Daytime performance and alertness were examined in two groups of patients with disorders of initiating and maintaining sleep (DIMS) and a control group of self-described good sleepers. Individuals complaining of disturbed sleep that was verified by polysomnographic indices (objective DIMS) and a group with complaints of disturbed sleep in the absence of objective findings (subjective DIMS) were compared with normal sleepers. Nocturnal polysomnographic recordings documented increased sleep latencies and decreased sleep efficiencies for the objective DIMS group and essentially normal sleep for the subjective DIMS group. However, the subjective DIMS group showed impaired daytime vigilance compared with both the objective DIMS and control groups. Additionally, the subjective DIMS group demonstrated an atypical daytime alertness and a tendency toward lowered arousal during vigilance task performance. Insomniacs without clear objective findings of disturbed sleep, therefore, showed decrements commonly seen following sleep loss or sleep disturbance, whereas insomniacs with evidence of disturbed nocturnal sleep did not differ from the control group in terms of waking function.     

Insomnia and daytime functioning

Results from the present review challenge the assumption that daytime functioning deficits are associated with insomnia. Objectively-measured daytime sleepiness is not elevated in people with insomnia, and most cognitive/psychomotor tasks do not indicate deficits in people with insomnia. In contrast, a number of studies have found that people with insomnia self-report daytime symptoms such as elevated fatigue, mood disturbance and reduced quality of life. Studies including both objective and subjective daytime measures have generally found agreement between the two types of measures, with both typically indicating a lack of daytime impairment. The present review also summarizes evidence suggesting that reported daytime difficulties are produced by factors other than poor sleep, such as physiological or psychological arousal or sleep need misperception.     

Global sleep dissatisfaction for the assessment of insomnia severity in the general population of Portugal

BACKGROUND AND PURPOSE: This study examines the prevalence and associated factors of insomnia symptoms and sleep dissatisfaction in the general population of Portugal. PATIENTS AND METHODS: We interviewed by telephone 1858 participants aged 18 years or older and representative of the general population of Portugal using the Sleep-EVAL system. Participation rate was 83%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to DSM-IV and ICSD classifications, associated and sleep/mental disorders and daytime consequences. RESULTS: Insomnia symptoms occurring at least 3 nights per week were reported by 28.1% of the sample and global sleep dissatisfaction (GSD) by 10.1%. Difficulty maintaining sleep was the most frequent symptom (21.0%); 29.4% of subjects with insomnia symptoms reported GSD. Daytime consequences, medical consultations for sleep and use of sleep medication were at least 2 times more frequent among subjects with insomnia symptoms and GSD compared to subjects with insomnia symptoms without GSD; insomnia diagnoses were also more frequent in the GSD group. CONCLUSIONS: The results show a severity gradation among subjects with only 1 insomnia symptom, those with 2 or 3 insomnia symptoms but without GSD and those with at least 1 insomnia symptom and GSD. Specific sleep or psychiatric disorders were identified for the majority of GSD subjects (86%); this rate dropped to 50.6% when only 1 insomnia symptom without GSD was reported. GSD appeared to be a good indicator of the presence of a sleep or psychiatric disorder and a good discriminator of the severity of sleep disturbances among subjects with insomnia symptoms.     

Insomnia and generalized anxiety disorder: effects of cognitive behavior therapy for gad on insomnia symptoms

Although clinical practice suggests that sleep complaints are frequent among patients with generalized anxiety disorder (GAD), frequency, severity, types of insomnia complaints, and relationship to GAD diagnosis severity in patients diagnosed using Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria are not well documented. Clinical data about the impact on insomnia symptoms of treating GAD worries are also lacking. The present study examined these aspects in 44 GAD patients who participated in a treatment study specifically addressing excessive worries through CBT interventions. All patients were assessed using a structured clinical interview and the Anxiety Disorder Interview Schedule-IV (ADIS-IV). They also completed anxiety and insomnia inventories, including the Insomnia Severity Index (ISI), a self-report measure which assesses insomnia type, severity and interference with daily life. Among this sample, 47.7% reported difficulties initiating sleep, 63.6% reported difficulties maintaining sleep, and 56.8% complained of waking too early in the morning. The majority of these patients (86.5%) reported never having experienced insomnia without having excessive worries. However, insomnia severity and GAD severity were not correlated. In this sample, patients with severe GAD did not necessarily report more severe insomnia symptoms. Regarding treatment impact on insomnia complaints, ISI post-treatment scores were significantly lower after treatment. Mean post-treatment scores almost reached ISI's "absence of clinical insomnia" category. Results indicate that this CBT package for GAD does have a significant impact on sleep quality even if sleep disturbances were not specifically addressed during treatment.     

Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors

Background and purposeSleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances.Participants and methodsOne hundred and seventy-seven children with complete data out of 180 (mean age 4.7) with ASD participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into “poor sleepers” (upper quartile on the total score of the CSHQ-ASD) and “good sleepers” (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress.ResultsThe two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress.ConclusionsThe finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.