title: Examining the Variability of Sleep Patterns during Treatment for Chronic Insomnia: Application of a Location-Scale Mixed Model.
abstract: The purpose of this study was to introduce a novel statistical technique called the location-scale mixed model that can be used to analyze the mean level and intra-individual variability (IIV) using longitudinal sleep data.
  
  
  
  We applied the location-scale mixed model to examine changes from baseline in sleep efficiency on data collected from 54 participants with chronic insomnia who were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR; n = 19), an 8-week Mindfulness-Based Therapy for Insomnia (MBTI; n = 19), or an 8-week self-monitoring control (SM; n = 16). Sleep efficiency was derived from daily sleep diaries collected at baseline (days 1-7), early treatment (days 8-21), late treatment (days 22-63), and post week (days 64-70). The behavioral components (sleep restriction, stimulus control) were delivered during late treatment in MBTI.
  
  
  
  For MBSR and MBTI, the pre-to-post change in mean levels of sleep efficiency were significantly larger than the change in mean levels for the SM control, but the change in IIV was not significantly different. During early and late treatment, MBSR showed a larger increase in mean levels of sleep efficiency and a larger decrease in IIV relative to the SM control. At late treatment, MBTI had a larger increase in the mean level of sleep efficiency compared to SM, but the IIV was not significantly different.
  
  
  
  The location-scale mixed model provides a two-dimensional analysis on the mean and IIV using longitudinal sleep diary data with the potential to reveal insights into treatment mechanisms and outcomes.
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Ong
authors.affiliation: Department of Public Health Sciences, University of Chicago, Chicago, IL.
authors.forename: Donald
authors.initials: D
authors.lastname: Hedeker
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL.
authors.forename: James K
authors.initials: JK
authors.lastname: Wyatt
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, CA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D064866:Mindfulness / Q000379:methods*; D057566:Self Report; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology / Q000628:therapy*; D013315:Stress, Psychological / Q000150:complications / Q000517:prevention & control; D016896:Treatment Outcome
keywords: cognitive-behavior therapy; insomnia; location-scale mixed model; mindfulness meditation; sleep variability