Brief Report|Articles in Press

Smart Phone/Ecological Momentary Assessment of Sleep and Daytime Symptoms Among Older Adults With Insomnia

Published:February 01, 2023DOI:


      • What is the primary question addressed by this study?
        This is the first study examines the viability and provide insight with employing smart phone/ecological momentary assessment (EMA) to measure daytime symptoms of insomnia among older adults.
      • What is the main finding of this study?
        Over a 14-day study period in which participants completed an insomnia symptom questionnaire 4x/day (i.e., 56 total assessments) and relative to healthy sleepers, older adults with insomnia demonstrated worse daytime insomnia symptoms in all domains assessed: positive mood, negative mood, fatigue/sleepiness, and alert cognition. Further, among participants with insomnia and in lagged models across 14 nights and days, prior-night sleep was robustly associated with next-day insomnia symptoms, even after controlling for age and sex.
      • What is the meaning of the finding?
        These results highlight the viability of smart phone/EMA assessments among older adults as well as the potential for smart phone/EMA to provide insight into between-groups and within-individual relations between sleep and daytime mental health symptoms.



      To employ smart phone/ecological momentary assessment (EMA) methods to evaluate the impact of insomnia on daytime symptoms among older adults.


      Prospective cohort study


      Academic medical center


      Twenty-nine older adults with insomnia (M age = 67.5 ± 6.6 years, 69% women) and 34 healthy sleepers (M age = 70.4 ± 5.6 years, 65% women).


      Participants wore an actigraph, completed daily sleep diaries, and completed the Daytime Insomnia Symptoms Scale (DISS) via smart phone 4x/day for 2 weeks (i.e., 56 survey administrations across 14 days).


      Relative to healthy sleepers, older adults with insomnia demonstrated more severe insomnia symptoms in all DISS domains (alert cognition, positive mood, negative mood, and fatigue/sleepiness). A series of mixed model analyses were performed using the Benjamini-Hochberg procedure for correcting false discovery rate (BH-FDR) and an adjusted p-value <0.05. Among older adults with insomnia, all five prior-night sleep diary variables (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and sleep quality) were significantly associated with next-day insomnia symptoms (i.e., all four DISS domains). The median, first and third quintiles of the effect sizes (R2) of the association analyses were 0.031 (95% confidence interval (CI: [0.011,0.432]), 0.042(CI: [0.014,0.270]), 0.091 (CI:[0.014,0.324]).


      Results support the utility of smart phone/EMA assessment among older adults with insomnia. Clinical trials incorporating smart phone/EMA methods, including EMA as an outcome measure, are warranted.

      Key Words

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