Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2002. / Vita. Includes bibliographical references (leaves 128-135).

Breast cancer is a major health problem and comprises the largest population of cancer survivors in the United States, estimated at 2.9 million women, accounting for 22% of all cancer survivors (National Cancer Institute, 2013). The advances in breast cancer screening, diagnosis and treatment has increased the importance of survivorship needs. A major concern among breast cancer survivors (BCS) is sleep disturbances. This study used an innovative approach to examine ethnic and racial disparities in sleep disturbances present in BCS. In addition, this study also explored sleep disturbances across different races/ethnicities. This study was a secondary data analysis of baseline data from the supplement study of the MBSR Symptom Cluster Trial for Breast Cancer Survivors/ 1R01CA131080, conducted by Dr. Lengacher. Sleep was measured using the Pittsburgh Sleep Quality Index, sleep diary (subjective), and sleep actigraphy (objective). The sample consists of 79 women who had been diagnosed with breast cancer (Stage 0, I, II, III), completed lumpectomy and/or mastectomy, and were within 2 weeks to 2 years post radiation and/or chemotherapy treatment. The aims for this study were to: 1) explore racial/ethnic differences in objectively measured sleep patterns among BCS; 2) estimate and compare the correlation between objective and subjective sleep quality by racial/ethnic groups among BCS; 3) examine which sleep actigraphy measure appears to have the strongest relationship with physical and psychological symptoms; and 4) explore whether these relationships (i.e. between objective sleep and self-reported symptoms) appear to be modified by race/ethnicity. The first aim was conducted using analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Results indicated that white, non Hispanic BCS had improved objective sleep quality compared to minority BCS. The second aim was conducted using Pearson's correlation with significant correlations found between subjective and objective sleep onset latency (r= .310, p= .016), and total sleep time (TST) (r= .328, p= .011) for the white, non-Hispanic group. The third aim was conducted using Pearson's correlation with significant correlations between sleep onset latency and depression (r= .247, p= .029); sleep efficiency and depression (r= -.233, p= .040); sleep efficiency and fatigue (r= -.207, p= .045); and WASO and pain (r= .277, p= .014). There were no significant correlations between the anxiety score and actigraphy parameters. Using the significant correlations from the results of the third aim, multiple regression analysis was conducted with age as a covariate to test the fourth aim. The main effect of depression on sleep efficiency was significant (p= .044) with less depression associated with higher sleep efficiency. The interaction term, depression by race/ethnicity, had a non-significant effect on sleep efficiency (p= .299). The main effect of pain on WASO was significant (p= .008), and increased pain was associated with longer WASO. The interaction term, race/ethnicity by pain, had a non-significant effect on WASO (p= .148). The main effect of depression predicting sleep onset latency was significant (p= .027), and the interaction term, depression by race/ethnicity, had a trend towards a significant effect (p= .092) on predicting sleep onset latency. The interaction between depression and race/ethnicity predicting sleep onset latency was further decomposed using multiple regression. The average sleep onset latency was longer in the minority group with high depression levels (42 minutes) compared to the white, non-Hispanics with high depression levels (29 minutes). Race modified the effect of depression on sleep onset latency in this sample of BCS. These finding suggest that the experience of objective sleep disturbances is different among races/ethnicities. Additional research is needed to further explore racial/ethnic differences in subjective and objective sleep disturbances and its impact on physical and psychological symptoms among BCS. As the number of BCS continue to rise, it is becoming increasingly important to recognize sleep disturbances and their potential physical and psychological effects early in BCS, specifically in different races and ethnicities. It is anticipated that these findings may contribute to improved symptom management for women of different races and ethnicities.

A presente tese se organiza em torno da seguinte questão: o que caracteriza a expressão autobiográfica, narrativa, vocal e motora na depressão e seus subtipos melancólica e não-melancólica? A fim de investigar esta questão, foram realizados três estudos. O Estudo I investigou a relação entre diferentes dimensões do afeto (estado afetivo positivo/negativo, depressão e neuroticismo) e características do relato de eventos autobiográficos (especificidade e coerência narrativa de eventos). Nesse estudo, 78 estudantes universitários relataram por escrito três eventos autobiográficos e responderam aos instrumentos: 1) Inventário de Depressão de Beck (BDI); 2) Escala de Afetos Positivos e Negativos (PANAS); e 3) Escala Fatorial de Ajustamento Emocional/Neuroticismo (EFN). O Estudo II investigou a relação entre escore de depressão e variáveis verbais (prosódia e coerência narrativa), verificando também se existem diferenças no padrão prosódico-narrativo da depressão nãomelancólica e melancólica. Participaram 17 pacientes com diagnóstico de depressão, avaliados através dos seguintes instrumentos: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D); 3) Beck Depression Inventory – BDI); 4) The CORE Assessment of Psychomotor Change, e 5) Relato verbal de três eventos de vida. O Estudo III teve como objetivo avaliar diferenças na atividade motora entre indivíduos com depressão melancólica e não-melancólica. A amostra foi composta por 15 pacientes com diagnóstico de depressão. A severidade dos sintomas depressivos foi avaliada utilizando a HAM-D e o BDI. O CORE foi utilizado para avaliar a melancolia, e a atividade motora foi mensurada através de actigrafia. Os resultados da tese sugerem uma revisão da noção de que afetos mais prolongados teriam maior impacto em variáveis narrativas, dado que o estado afetivo foi o único preditor da coerência narrativa. Concluiu-se que a recordação de eventos inespecíficos e a dificuldade de reavaliação de experiências constituem mecanismos basais na depressão, explicando a persistência de memórias dolorosas e crenças negativas inflexíveis. A melancolia caracterizou-se por uma diminuição na movimentação do corpo e na amplitude da frequência vocal, atestando a lentificação do movimento como um critério crucial para a identificação do subtipo melancólico de depressão. / This dissertation is organized around the following question: what characterizes the autobiographical narrative, vocal, and motor expression in depression and its melancholic and non-melancholic subtileza? In order to investigate this question, three studies were performed. Study I investigated the relationship between different dimensions of affect (positive and negative affective state, depression, and neuroticism) and some features of autobiographical narrative (specificity, and narrative coherence of events). In this study, 78 college students wrote three autobiographical events and answered to three instruments: 1) Beck Depression Inventory (BDI), 2) Positive and Negative Affect Scale (PANAS); and 3) Factorial Scale of Neuroticism (EFN). Study II investigated: 1) the relationship between the depression score, and verbal variables (prosody and narrative coherence); and 2) differences in the prosodicnarrative pattern of individuals with non-melancholic and with melancholic depression. The sample consisted of 17 patients with major depressive disorder, who were assessed using the following instruments: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D), 3) Beck Depression Inventory - BDI), 4) The CORE Assessment of Psychomotor Change, and 5) Verbal report of three life events. Study III aimed to evaluate differences in motor activity between individuals with melancholic and non-melacholic depression. The sample was composed by 15 patients with diagnostic of major depressive episode. The measurement of the severity of depressive symptoms was made using the HAM-D and BDI. The CORE instrument was used to assess melancholia, and motor activity was measured by actigraphy. Altogether, the three studies that compose this dissertation suggest a revision of the notion that long lasting affects would have major impact on narrative variables, once the affective state was the only predictor of narrative coherence. We conclude that the recollection of nonspecific events and ressignification impairment are core mechanisms in depression, explaining the persistence of painful memories and inflexible negative beliefs. The melancholia was characterized by a decrease in body movement and amplitude of vocal frequency, confirming that lentification of movement is a crucial criteria for melancholic subtype of depression.

abstract: Physical activity is critical for optimal health and has emerged as a viable option to improve sleep. Moderate- and vigorous-intensity physical activity comparisons to improve sleep in non-exercising adults with sleep problems is limited. The purpose was to determine the effects of moderate- or vigorous-intensity exercise on sleep outcomes and peripheral skin temperature compared to a no-exercise control. The exercise intensity preference also was determined. Eleven women (46.9±7.0 years) not participating in regular exercise and self-reporting insomnia completed a graded maximal exercise test followed by a crossover trial of three randomly assigned conditions separated by a 1-week washout. Participants performed moderate-intensity [MIC, 30 minutes, 65-70% maximum heart rate (HRmax)] or high-intensity (HIT, 20 minutes, 1-minute bouts at 90-95% HRmax alternating with 1-minute active recovery) treadmill walking or a no-exercise control (NEC) on two consecutive weekdays 4-6 hours prior to typical bed time. A dual-function wrist-worn accelerometer/temperature monitor recorded movement and skin temperature from which sleep-onset latency (SOL), sleep maintenance, sleep efficiency, total sleep time (TST), and peripheral skin temperature changes were calculated. Participants self-reported sleep outcomes weekly, enjoyment of exercise the morning after HIT and MIC, and exercise intensity preference upon completing all conditions. Mixed models analysis of variance examined differences between and within conditions controlling for demographic characteristics and habitual physical activity. HIT resulted in up to a 90-minute TST increase on night four (448 minutes, 95% CI 422.4-474.2) compared to nights one-three. MIC nights three (43.5 minutes, 95% CI 30.4-56.6) and four (42.1 minutes 95% CI 29.0-55.2) showed nearly a 30-minute SOL worsening compared to nights one-two. No other actigraphy-measured sleep parameters differenced within or between conditions. Self-reported sleep outcomes, peripheral skin temperature change, and exercise enjoyment between conditions were similar (p>0.05). More participants preferred lower (n=3) to higher (n=1) intensity activities. Early evening high-intensity and moderate-intensity exercise had no effect on sleep outcomes compared to a control in non-exercising adults reporting sleep complaints. Sleep benefits from HIT may require exercise on successive days. Participants indicated partiality for lower intensity exercise. More information on timing and mode of physical activity to improve sleep in this population is warranted. / Dissertation/Thesis / Doctoral Dissertation Physical Activity, Nutrition and Wellness 2016

A presente tese se organiza em torno da seguinte questão: o que caracteriza a expressão autobiográfica, narrativa, vocal e motora na depressão e seus subtipos melancólica e não-melancólica? A fim de investigar esta questão, foram realizados três estudos. O Estudo I investigou a relação entre diferentes dimensões do afeto (estado afetivo positivo/negativo, depressão e neuroticismo) e características do relato de eventos autobiográficos (especificidade e coerência narrativa de eventos). Nesse estudo, 78 estudantes universitários relataram por escrito três eventos autobiográficos e responderam aos instrumentos: 1) Inventário de Depressão de Beck (BDI); 2) Escala de Afetos Positivos e Negativos (PANAS); e 3) Escala Fatorial de Ajustamento Emocional/Neuroticismo (EFN). O Estudo II investigou a relação entre escore de depressão e variáveis verbais (prosódia e coerência narrativa), verificando também se existem diferenças no padrão prosódico-narrativo da depressão nãomelancólica e melancólica. Participaram 17 pacientes com diagnóstico de depressão, avaliados através dos seguintes instrumentos: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D); 3) Beck Depression Inventory – BDI); 4) The CORE Assessment of Psychomotor Change, e 5) Relato verbal de três eventos de vida. O Estudo III teve como objetivo avaliar diferenças na atividade motora entre indivíduos com depressão melancólica e não-melancólica. A amostra foi composta por 15 pacientes com diagnóstico de depressão. A severidade dos sintomas depressivos foi avaliada utilizando a HAM-D e o BDI. O CORE foi utilizado para avaliar a melancolia, e a atividade motora foi mensurada através de actigrafia. Os resultados da tese sugerem uma revisão da noção de que afetos mais prolongados teriam maior impacto em variáveis narrativas, dado que o estado afetivo foi o único preditor da coerência narrativa. Concluiu-se que a recordação de eventos inespecíficos e a dificuldade de reavaliação de experiências constituem mecanismos basais na depressão, explicando a persistência de memórias dolorosas e crenças negativas inflexíveis. A melancolia caracterizou-se por uma diminuição na movimentação do corpo e na amplitude da frequência vocal, atestando a lentificação do movimento como um critério crucial para a identificação do subtipo melancólico de depressão. / This dissertation is organized around the following question: what characterizes the autobiographical narrative, vocal, and motor expression in depression and its melancholic and non-melancholic subtileza? In order to investigate this question, three studies were performed. Study I investigated the relationship between different dimensions of affect (positive and negative affective state, depression, and neuroticism) and some features of autobiographical narrative (specificity, and narrative coherence of events). In this study, 78 college students wrote three autobiographical events and answered to three instruments: 1) Beck Depression Inventory (BDI), 2) Positive and Negative Affect Scale (PANAS); and 3) Factorial Scale of Neuroticism (EFN). Study II investigated: 1) the relationship between the depression score, and verbal variables (prosody and narrative coherence); and 2) differences in the prosodicnarrative pattern of individuals with non-melancholic and with melancholic depression. The sample consisted of 17 patients with major depressive disorder, who were assessed using the following instruments: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D), 3) Beck Depression Inventory - BDI), 4) The CORE Assessment of Psychomotor Change, and 5) Verbal report of three life events. Study III aimed to evaluate differences in motor activity between individuals with melancholic and non-melacholic depression. The sample was composed by 15 patients with diagnostic of major depressive episode. The measurement of the severity of depressive symptoms was made using the HAM-D and BDI. The CORE instrument was used to assess melancholia, and motor activity was measured by actigraphy. Altogether, the three studies that compose this dissertation suggest a revision of the notion that long lasting affects would have major impact on narrative variables, once the affective state was the only predictor of narrative coherence. We conclude that the recollection of nonspecific events and ressignification impairment are core mechanisms in depression, explaining the persistence of painful memories and inflexible negative beliefs. The melancholia was characterized by a decrease in body movement and amplitude of vocal frequency, confirming that lentification of movement is a crucial criteria for melancholic subtype of depression.

A presente tese se organiza em torno da seguinte questão: o que caracteriza a expressão autobiográfica, narrativa, vocal e motora na depressão e seus subtipos melancólica e não-melancólica? A fim de investigar esta questão, foram realizados três estudos. O Estudo I investigou a relação entre diferentes dimensões do afeto (estado afetivo positivo/negativo, depressão e neuroticismo) e características do relato de eventos autobiográficos (especificidade e coerência narrativa de eventos). Nesse estudo, 78 estudantes universitários relataram por escrito três eventos autobiográficos e responderam aos instrumentos: 1) Inventário de Depressão de Beck (BDI); 2) Escala de Afetos Positivos e Negativos (PANAS); e 3) Escala Fatorial de Ajustamento Emocional/Neuroticismo (EFN). O Estudo II investigou a relação entre escore de depressão e variáveis verbais (prosódia e coerência narrativa), verificando também se existem diferenças no padrão prosódico-narrativo da depressão nãomelancólica e melancólica. Participaram 17 pacientes com diagnóstico de depressão, avaliados através dos seguintes instrumentos: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D); 3) Beck Depression Inventory – BDI); 4) The CORE Assessment of Psychomotor Change, e 5) Relato verbal de três eventos de vida. O Estudo III teve como objetivo avaliar diferenças na atividade motora entre indivíduos com depressão melancólica e não-melancólica. A amostra foi composta por 15 pacientes com diagnóstico de depressão. A severidade dos sintomas depressivos foi avaliada utilizando a HAM-D e o BDI. O CORE foi utilizado para avaliar a melancolia, e a atividade motora foi mensurada através de actigrafia. Os resultados da tese sugerem uma revisão da noção de que afetos mais prolongados teriam maior impacto em variáveis narrativas, dado que o estado afetivo foi o único preditor da coerência narrativa. Concluiu-se que a recordação de eventos inespecíficos e a dificuldade de reavaliação de experiências constituem mecanismos basais na depressão, explicando a persistência de memórias dolorosas e crenças negativas inflexíveis. A melancolia caracterizou-se por uma diminuição na movimentação do corpo e na amplitude da frequência vocal, atestando a lentificação do movimento como um critério crucial para a identificação do subtipo melancólico de depressão. / This dissertation is organized around the following question: what characterizes the autobiographical narrative, vocal, and motor expression in depression and its melancholic and non-melancholic subtileza? In order to investigate this question, three studies were performed. Study I investigated the relationship between different dimensions of affect (positive and negative affective state, depression, and neuroticism) and some features of autobiographical narrative (specificity, and narrative coherence of events). In this study, 78 college students wrote three autobiographical events and answered to three instruments: 1) Beck Depression Inventory (BDI), 2) Positive and Negative Affect Scale (PANAS); and 3) Factorial Scale of Neuroticism (EFN). Study II investigated: 1) the relationship between the depression score, and verbal variables (prosody and narrative coherence); and 2) differences in the prosodicnarrative pattern of individuals with non-melancholic and with melancholic depression. The sample consisted of 17 patients with major depressive disorder, who were assessed using the following instruments: 1) Mini International Neuropsychiatric Interview (MINI-Plus), 2) Hamilton Depression Rating Scale (HAM-D), 3) Beck Depression Inventory - BDI), 4) The CORE Assessment of Psychomotor Change, and 5) Verbal report of three life events. Study III aimed to evaluate differences in motor activity between individuals with melancholic and non-melacholic depression. The sample was composed by 15 patients with diagnostic of major depressive episode. The measurement of the severity of depressive symptoms was made using the HAM-D and BDI. The CORE instrument was used to assess melancholia, and motor activity was measured by actigraphy. Altogether, the three studies that compose this dissertation suggest a revision of the notion that long lasting affects would have major impact on narrative variables, once the affective state was the only predictor of narrative coherence. We conclude that the recollection of nonspecific events and ressignification impairment are core mechanisms in depression, explaining the persistence of painful memories and inflexible negative beliefs. The melancholia was characterized by a decrease in body movement and amplitude of vocal frequency, confirming that lentification of movement is a crucial criteria for melancholic subtype of depression.

INTRODUÇÃO: A atividade física regular trás benefício à saúde, reduzindo a obesidade, morbidades e a mortalidade e, em pacientes asmáticos, a atividade física melhora os sintomas da doença. Apesar disso, ainda existe divergência na literatura se crianças asmáticas são fisicamente ativas, e isto parece depender do método empregado, da gravidade da doença e do controle clínico. OBJETIVO: Comparamos a atividade física de vida diária (AFVD) entre crianças com diferentes gravidades da asma e identificamos fatores que possam dificultar a realização das AFVD. MÉTODO: Estudo transversal com 121 crianças, sendo 79 asmáticas das quais (32 asma persistente leve, 24 asma persistente moderada, 23 asma persistente grave) e 42 controles, de ambos os sexos, com idade entre 7 a 12 anos. As crianças asmática estavam em tratamento médico há, no mínimo, 6 meses e com a doença controlada. O nível de AFVD foi monitorado com um acelerômetro durante 6 dias (4 dias da semana e 2 de final de semana). A função pulmonar e as barreiras que dificultam a realização da AFVD também foram avaliadas. RESULTADOS: Os nossos resultados mostraram que o número total de passos, e as atividades realizadas em intensidade moderada foram similares entre as crianças com as diferentes gravidades da asma. O percentual de crianças asmáticas fisicamente ativas foi similar quando comparado com as crianças sem asma (respectivamente, 51,9% vs. 50%; p>0,05). Não foi observada diferença nos parâmetros funcionais da função pulmonar (obstrução fixa, resposta ao broncodilatador e variabilidade do VEF1) entre as crianças asmáticas fisicamente ativas e as sedentárias (p>0,05). Porém, foi observado um maior percentual de crianças com sobrepeso ou obesidade entre os asmáticos sedentários quando comparado às crianças fisicamente ativas (respectivamente, 24,1% vs. 11,1%; p<0,05). As barreiras ambientais foram as mais relatadas pelas crianças com e sem asma (p>0,05), porém este fator foi relatado em maior proporção pelas crianças asmáticas sedentárias quando comparado àquelas fisicamente ativas (respectivamente, 34,2% vs. 14,6%; p<0,05). CONCLUSÕES: As crianças asmáticas com a doença controlada tiveram o mesmo nível de AFVD entre as diferentes gravidades da doença e que seus pares sem asma. A gravidade da doença, fatores ligados à função pulmonar e a percepção da doença como barreira para atividade física pareceu não estar associadas ao sedentarismo. As barreiras ambientais foram as mais relatadas pelas crianças com e sem asma, porém, nas crianças asmáticas sedentárias essas barreiras pareceram ser ainda mais relevantes / BACKGROUND: Regular physical activity promotes health benefits by reducing obesity, morbidity and mortality, and who has asthma, physical activity improves the symptoms of disease. Nevertheless, there is disagreement in the literature whether asthmatic children are physically active, and this seems to depend on the method used, severity of disease and clinical control. OBJECTIVE: We compared Daily Physical Activity (DPA) among children of different severity levels of asthma and we have identified factors that may hinder DPA. METHOD: Cross-Sectional study with 121 children, 79 with asthma (32 mild persistent asthma, 24 moderate persistent asthma, 23 severe persistent asthma) and 42 children without asthma, of both sexes, aged between of 7 and 12 years. The asthmatic children were under medical treatment for at least 6 months and the disease controlled. DPA was monitored with an accelerometer for 6 days (4 weekdays and 2 weekends). Pulmonary function and barriers that hinder DPA were also assessed. RESULTS: Our results showed that the total number of steps, and the activities performed at moderate intensity were similar between children with different severities of asthma. The percentage of physically active children with asthma was similar when compared with children without asthma (respectively, 51,9% vs. 50%; p>0,05). There was no difference in respiratory function parameters (fixed obstruction, bronchodilator response and variability of FEV1) among the asthmatic children physically active and sedentary (p> 0.05). However, we found that sedentary asthmatic children were more overweight or obese than physically active asthmatic children (respectively, 24,1% vs. 11,1%; p<0,05). The environmental barriers were the most frequently reported by children with and without asthma (p> 0,05), but this factor was reported in a higher proportion by sedentary asthmatic children compared to those physically active (respectively, 34,2% vs. 14,6%; p<0,05). CONCLUSIONS: Clinically controlled asthmatic children had the same level of DPA between different severities of asthma and their peers without asthma. The severity of disease, factors related to lung function and perception of disease as a barrier to physical activity did not seem be associated with sedentary lifestyle. The environmental barriers were the most frequently reported by children with and without asthma, however in sedentary asthmatic children these barriers seemed to be even more relevant

The thesis presents a series of papers exploring catatonic symptoms and circadian rest-activity levels in autistic spectrum disorders (ASD). The thesis is presented in paper-based format and encompasses a literature review, an empirical paper and a critical appraisal. Paper 1 is a systematic review of available treatments for autistic catatonia. Catatonic symptoms are thought to occur in around 8% of young people with ASD, and it has been suggested that biological timing abnormalities may play a key role in the development of these difficulties. Twenty two papers were included in the final review, detailing treatment of a total of 28 cases of autistic catatonia. Both adult and paediatric cases were included. The range of treatments described encompassed electroconvulsive therapy, various psychotropic medications, behavioural and sensory therapies. The review highlights limitations in the available literature and suggests avenues for future research. Paper 2 explores circadian patterns in activity using actigraphy. A case series of 8 young people with an ASD diagnosis were recruited from specialist schools and asked to wear an actigraph for one week. Parents completed questionnaire measures of ASD traits and symptoms of autistic catatonia. Findings indicated a high degree of variability in circadian rest-activity cycles, both between participants and across the week. The study findings have implications for future research into circadian rest-activity levels in this population, as well as possible therapeutic applications. The final paper in the thesis presents a critical appraisal of the research, including discussion of strengths and limitations of the work, theoretical and clinical implications and directions for future research. Some personal reflections on the process of conducting the research are also included.

Both sleep diaries and actigraphy have been recommended to assess sleep in research and clinical settings. Investigators have traditionally used sleep diaries that were completed daily by participants and collected weekly but have recently begun using sleep diaries that are both completed and collected daily. No research had previously assessed the agreement between daily-collected sleep diaries and actigraph data over one week. Undergraduate students were randomly assigned to use daily- or weekly-collected sleep diaries. Sleep parameters obtained from these measures were compared to each other via concordance with concurrent actigraph data. It was hypothesized that daily-collected sleep diaries would have greater concordance with actigraphy than weekly-collected sleep diaries. Results indicated that daily-collected sleep diaries provided more reliable data than weekly-collected sleep diaries, but the differences were not statistically significant. Additional aims examined self-reported sleep diary adherence, the participation day number, and day of the week. There were trends for the Daily group to have better adherence. Overall concordance did not change based on the day number or day of the week. Both sleep diaries yield comparable sleep parameter data, suggesting that clinicians and researchers can use either method to estimate sleep parameters.

Accurate assessment of sleep-wake patterns is important for sleep researchers and clinicians. Actigraphs are low-cost, non-intrusive, wrist-worn activity detectors used to estimate sleep-wake patterns in a natural environment for several nights. Although actigraphy shows good sensitivity (sleep detection), it has consistently demonstrated poor specificity (wakefulness detection while lying in bed relatively motionless). Because insomnia is characterized by wakefulness in bed, actigraphy may not be a valid objective measure of wakefulness for this group. It is possible that refinement of actigraphy software settings for sleep/wake algorithms might improve specificity. The current studies investigated this hypothesis by comparing wake parameters from 48 combinations of actigraphy settings to determine which sleep/wake algorithms best inform insomnia diagnosis and treatment. In the first study, none of the 48 actigraphy setting combinations consistently discriminated between adults with insomnia (n = 69) and non-insomnia (n = 80) on all three wake parameters, and no setting clearly discriminated between groups for the composite variable, total wake time. Similarly, in the second study, no setting combinations consistently discriminated between adults treated for insomnia (n = 18) and controls with untreated insomnia (n = 26) on all three wake parameters. Although two setting combinations discriminated between groups for the composite variable, total wake time, the values were extreme which raises validity concerns. Therefore, no actigraphy setting recommendations can be made based on the current findings. This research offers insights about the effects of actigraphy software settings on actigraphy specificity as it pertains to the diagnosis and treatment of insomnia.