Affiliative Parent-Adolescent Bedtime and Waketime Interactions are Associated with Adolescent Sleep.

OBJECTIVES: The current study examined whether evening and morning affiliation (i.e., warmth) and autonomy (i.e., more or less in charge) around sleep routines predicted adolescent sleep on weekdays. METHOD: Participants were 28 parent (Mage = 43.19; 85.17% mothers) and adolescent (Mage = 12.34 years) dyads who completed the same electronic diaries morning and evening for 10 days, with a total number of 221 nights observed across dyads. Sleep duration and sleep quality were assessed via the Pittsburgh Sleep Diary; degree of affiliation and autonomy around bedtime and waketime routines were assessed with single items on a visual analog scale. Multilevel modeling was utilized to evaluate the effects of more or less affiliation or autonomy on sleep outcomes (i.e., duration and quality) between and within dyads. RESULTS: Across all participants, adolescents who reported more affiliative interactions with their parent around bedtime and waketime slept longer and had better sleep quality at night. Further, when adolescents experienced greater than average affiliative interactions with their parent than was typical for them, they had better sleep quality that night. Adolescent sleep quality and duration were not impacted by whether or not adolescents were in charge of their bedtime and waketime routines. CONCLUSIONS: Findings support parents' role in social and emotional security and highlight the importance of affiliative parent interactions around the sleep period for optimal sleep for young adolescents.

Maternal Sleep Health, Social Support, and Distress: A Mixed-Methods Analysis of Mothers of Infants and Young Children in Rural US.

OBJECTIVES: The purpose of this study was to explore sleep health in rural maternal populations through a social-ecological framework and identify risk and protective factors for this population. METHODS: 39 individuals who are mothers of infants or children under the age of 5 years completed an online survey, 35 of which completed a subsequent semi-structured interview. Recruitment was limited to one rural community and was in partnership with community healthcare providers. Results were integrated using a convergent, parallel mixed-methods design. RESULTS: Poor sleep health and high prevalence of insomnia symptoms in rural mothers were evident and associated with social support and maternal distress. Qualitative content from interviews indicated that well-established precipitating and perpetuating factors for insomnia may contribute to poor maternal sleep health. Results also revealed a gap in knowledge and language surrounding sleep health among rural mothers. CONCLUSIONS: Sleep health is challenged during the transition to motherhood and rural mothers have less access to specialized perinatal and behavioral health care than their urban counterparts. In this sample, poor sleep was attributable to distress in addition to nocturnal infant and child sleep patterns which has implications for psychoeducation and promotion of sleep health in mothers. Sleep is a modifiable health indicator that is associated with several other maternal health outcomes and should be considered an element of a comprehensive maternal health for prevention and intervention across individual, interpersonal, and societal domains of the social-ecological model of sleep health.

Yours, mine, or ours? Dyadic sleep hygiene and associations with sleep quality, emotional distress, and conflict frequency in mixed-gender, bed-sharing couples.

Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples' sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners' sleep hygiene is related to worse relational, psychological, and sleep outcomes. In a sample of 143 mixed-gender, bed-sharing couples, each partner completed an online questionnaire consisting of the Sleep Hygiene Index (for themselves and their partner), PROMIS sleep disturbance scale, conflict frequency, PHQ-4 for anxiety and depressive symptoms, and the Perceived Stress Scale. Paired samples t-tests between partners were conducted using total and individual-item Sleep Hygiene Index scores to examine similarities and differences. Intraclass correlation coefficient (ICC) scores of dyadic reports were conducted to examine the level of agreement between each partner's sleep hygiene. Finally, we examined associations between one's own sleep hygiene and their report of their partner's sleep hygiene with both partner's sleep quality, emotional distress, and conflict frequency in a dyadic structural equation model with important covariates and alternative model tests. The results revealed a significant difference between men's (M = 14.45, SD = 7.41) and women's total score self-report sleep hygiene ([M = 17.67, SD = 8.27]; t(142) = -5.06, p < 0.001) and partners only had similar sleep hygiene for 5 out of the 13 items. Examining dyadic reports of sleep hygiene revealed that partners had moderate agreement on their partners' sleep hygiene (0.69-0.856). The results from the dyadic structural equation model revealed that poorer sleep hygiene was associated with one's own poor sleep quality, higher emotional distress, and more frequent relational conflict. For both men and women a poorer report of a partner's sleep hygiene was associated with one's own report of higher relationship conflict. Finally, men's poorer report of a partner's sleep hygiene was related better to their own sleep quality but was related to poorer sleep quality for their partners. These results have implications for sleep promotion and intervention efforts as well as for couple relationship functioning.

Age Trends in Actigraphy and Self-Report Sleep Across the Life Span: Findings From the Pittsburgh Lifespan Sleep Databank.

OBJECTIVE: Sleep changes over the human life span, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human life span. METHODS: The Pittsburgh Lifespan Sleep Databank consists of harmonized participant-level data from sleep-related studies conducted at the University of Pittsburgh (2003-2019). We included data from 1065 (n = 577 female; 21 studies) Pittsburgh Lifespan Sleep Databank participants aged 10 to 87 years without a major psychiatric, sleep, or medical condition. All participants completed wrist actigraphy and the self-rated Pittsburgh Sleep Quality Index. Main outcomes included actigraphy and self-report sleep duration, efficiency, and onset/offset timing, and actigraphy variability in midsleep timing. RESULTS: We used generalized additive models to examine potentially nonlinear relationships between age and sleep characteristics and to examine sex differences. Actigraphy and self-report sleep onset time shifted later between ages 10 and 18 years (23:03-24:10 [actigraphy]; 21:58-23:53 [self-report]) and then earlier during the 20s (00:08-23:40 [actigraphy]; 23:50-23:34 [self-report]). Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s (07:48-06:52 [actigraphy]; 07:40-06:41 [self-report]). Self-report, but not actigraphy, sleep duration declined between ages 10 and 20 years (09:09-07:35). Self-report sleep efficiency decreased over the entire life span (96.12-93.28), as did actigraphy variability (01:54-01:31). CONCLUSIONS: Awareness of age trends in multiple sleep dimensions in healthy individuals-and explicating the timing and nature of sex differences in age-related change-can suggest periods of sleep-related risk or resilience and guide intervention efforts.

Socio-Ecological Context of Sleep: Gender Differences and Couples' Relationships as Exemplars.

PURPOSE OF REVIEW: We summarized recent findings on insufficient sleep and insomnia, two prominent sleep issues that impact public health. We demonstrate the socio-ecologial impact of sleep health with findings on gender and couples' relationships as exemplars. RECENT FINDINGS: Robust gender differences in sleep duration and insomnia are due to biological and socio-ecological factors. Gender differences in insufficient sleep vary by country of origin and age whereas gender differences in insomnia reflect minoritized identities (e.g., sexual, gender). Co-sleeping with a partner is associated with longer sleep and more awakenings. Gender differences and couples' sleep were affected by intersecting social and societal influences, which supports a socio-ecological approach to sleep. Recent and seminal contributions to sleep health highlight the importance of observing individual sleep outcomes in a socio-ecological context. Novel methodology, such as global measures of sleep health, can inform efforts to improve sleep and, ultimately, public health.

Social-ecological considerations for the sleep health of rural mothers.

Using a social-ecological framework, we identify social determinants that interact to influence sleep health, identify gaps in the literature, and make recommendations for targeting sleep health in rural mothers. Rural mothers experience unique challenges and protective factors in maintaining adequate sleep health during the postpartum and early maternal years. Geographic isolation, barriers to comprehensive behavioral medicine services, and intra-rural ethno-racial disparities are discussed at the societal (e.g., public policy), social (e.g., community) and individual levels (e.g., stress) of the social-ecological model. Research on sleep health would benefit from attention to methodological considerations of factors affecting rural mothers such as including parity in population-level analyses or applying community-based participatory research principles. Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers.

Worry and Rumination Have Distinct Associations with Nighttime versus Daytime Sleep Symptomology.

Objective: To assess whether worry and rumination differ in predicting nighttime sleep disturbance versus daytime sleep-related impairment, as assessed using short forms from the Patient Reported Outcomes Measurement Information System (PROMIS). Participants: Adults recruited from the United States population (N = 459) via an online crowdsourcing service. Methods: Factor analysis explored whether items comprising validated measures of worry and rumination loaded onto separate factors. Hierarchical multiple regression models entered worry and rumination in a stepwise fashion to assess their relative strength in predicting PROMIS sleep disturbance and sleep-related impairment, after controlling for 17 covariates. All analyses were run twice using sleep-specific and general measures of worry and rumination. Results: Worry and rumination items loaded onto separate factors. In the regression analysis of sleep-specific cognition, only worry entered the model predicting sleep disturbance, whereas rumination entered after worry in the model predicting sleep-related impairment. In the analysis of general cognition, both cognitive process variables significantly predicted the PROMIS outcomes. Worry was the stronger predictor of sleep disturbance, whereas rumination was the stronger predictor of sleep-related impairment. Conclusions: Worry and rumination were observed to be distinct constructs that separately contributed to predicting daytime sleep-related impairment. Future studies should more closely examine how cognitive processes relate to insomnia symptomology during the day.

Family Dynamics in Sleep Health and Hypertension.

PURPOSE OF REVIEW: Present a conceptual model and review the recent literature on family dynamics, sleep, and hypertension. RECENT FINDINGS: Family dynamics predict hypertension and hypertension risk, in part, due to shared health behaviors. Sleep health behaviors (sleep duration, quality, and efficiency) predict hypertension risk in children and youth and are emerging as a family-level health behavior. Importantly, both family dynamics and sleep are modifiable. Family members influence one another's sleep through their physical presence and through psychological and emotional mechanisms. Family members' sleep patterns may also be coregulated. Negative family dynamics are associated with poor sleep health and predict greater cardiovascular risk. Sleep health behaviors in the family context may also interact with family dynamics to dampen or exacerbate hypertension risk factors in children and youth. This review proposes that promoting sleep health in a family context could be one way to reduce long-term hypertension risk.

Development of the Couples' Sleep Conflict Scale: A new tool to assess conflict around sleep in romantic relationships.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the Couples' Sleep Conflict Scale, a new measure designed to identify the extent of conflict around sleep in romantic relationships. METHODS: Data from an individual sample (N = 158) and dyadic sample (N = 143 mixed-gender couples) in romantic relationships were used to examine the psychometric properties of the Couples' Sleep Conflict Scale, including internal consistency, convergent and divergent validity, and whether the factor structure differed between couples with concordant and discordant chronotypes. RESULTS: Results revealed that the Couples' Sleep Conflict Scale fit a 1-factor solution of 5 items, a summed or mean score can be used, and that it is reliable for both men and women. In addition, more relational sleep conflict was associated with both their own and their partners' poorer sleep hygiene, worse sleep quality, and more daytime sleepiness as well as more general relationship conflict, lower relationship satisfaction, and higher anxious and avoidant attachment. Finally, we found partial measurement invariance for factor loadings, intercepts, and latent variable variances between couples with concordant vs. discordant chronotypes. CONCLUSION: The Couples' Sleep Conflict Scale is a brief measure that can be used in both research and in health care settings to examine how sleep-related conflict can affect both sleep and relationship quality among couples.

The effects of poor sleep on cognitive, affective, and physiological responses to a laboratory stressor.

BACKGROUND: Recent research suggests that poor sleep may be associated with altered stress regulation. PURPOSE: This study aims to examine the associations between prior-night and prior-month sleep measures and affective, cognitive, and physiological responses to a laboratory stressor. METHODS: Ninety-eight (50 % female) young adults completed measures of sleep quality in the context of a laboratory stress study. Measures included positive (PA) and negative affects (NA) and blood pressure (BP) reactivity, as well as change in pre-sleep arousal. RESULTS: Prior-month poor sleep quality and sleep disturbances predicted dampened BP reactivity. Both prior-night and prior-month sleep quality predicted greater decrease in PA. Sleep-associated monitoring predicted NA reactivity and prolonged cognitive and affective activation. Prior-month sleep continuity predicted greater cognitive pre-sleep arousal change, and prior-month sleep quality, daytime dysfunction, and disturbances predicted prolonged cognitive and affective activation. CONCLUSION: Findings suggest that inadequate sleep confers vulnerability to poor cognitive, affective, and physiological responses to stress.

Self-efficacy contributes to individual differences in subjective improvements using CPAP.

PURPOSE: Continuous positive airway pressure (CPAP) improves depressive symptoms and daytime sleepiness in patients with obstructive sleep apnea (OSA). However, there is variability in response to CPAP. This study examined individual differences in the daily associations between CPAP use and improvements in affect and sleepiness patients beginning CPAP. METHODS: This observational repeated measures study involved 31 CPAP-naïve patients diagnosed with obstructive sleep apnea at an academic sleep disorders center. Patients completed pre-treatment assessments of OSA knowledge, expectations for CPAP, and treatment self-efficacy as well as a repeated daily assessment of positive affect and negative affect, sleepiness/fatigue, and CPAP adherence for 10 days beginning the first week of treatment. Data were analyzed using multilevel modeling. RESULTS: Nightly CPAP adherence predicted improvements in next-day positive affect, negative affect, and sleepiness/fatigue. The apnea-hypopnea index (AHI), treatment self-efficacy, and outcome expectancies were significant moderators of day-to-day improvement. Higher self-efficacy and lower AHI were associated with a stronger relationship between adherence and next-day improvements in positive affect and sleepiness. Very high-outcome expectances were associated with a weaker relationship between adherence and next-day improvements in sleepiness. Subjective sleepiness at pre-treatment did not give moderate improvements in next-day affect. CONCLUSIONS: Although CPAP use predicted daily improvements in affect and sleepiness for the majority of patients, patients with lower AHI, greater treatment self-efficacy, and moderate outcome expectancies reported stronger daily benefits from CPAP. For patients with high-treatment efficacy, adherence may be reinforced by a stronger link between adherence and daily improvements.

Appraisals of insomnia identity in a clinical sample.

BACKGROUND: Insomnia identity, the conviction that one has insomnia, occurs independently of sleep quality or quantity, and is associated with numerous negative health outcomes. Little is known about factors influencing insomnia identity. This study planned to evaluate insomnia identity, perceived sleep experience, and sleep parameters. METHOD: Individuals seeking treatment for an insomnia complaint reported demographics, insomnia identity ratings, and daily sleep diaries. Insomnia complaint and insomnia identity were independently crossed with sleep diary data yielding: complaining good (n = 10) and poor sleepers (n = 51), and good (n = 7) and poor sleepers (n = 40) with insomnia identity. Participants were additionally classified as with (n = 50) and without (n = 14) insomnia identity. Group differences and predictors of insomnia identity were assessed. RESULTS: Complaining poor sleepers and poor sleepers with insomnia identity reported significantly poorer sleep ratings compared to their counterparts. Insomnia identity severity was predicted by worse sleep quality comparisons and increased helplessness. Analyses revealed poorer sleep parameters among those with an insomnia identity versus without. DISCUSSION: Group differences may reflect variation in perceived sleep assessment and insomnia identity rating. Results further indicated that not all who complain of insomnia (and seek treatment) endorse insomnia identity. Implications of results and future study directions on insomnia identity are discussed.

Nightly sleep-wake concordance and daily marital interactions.

OBJECTIVE: We and others have found that couples' sleep is a shared and dyadic process. Couples' sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples' relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose of this study was to examine daily positive and negative interpersonal interactions to determine how they predict, and are predicted by, nightly sleep-wake concordance. METHOD: Participants were 48 heterosexual couples between 18 and 45 years of age who shared a bed with their spouse. Couples completed questionnaires and daily assessments of positive and negative interactions. Each member of the dyad wore wrist actigraphs for 10 days. Sleep-wake concordance was calculated as the percentage of time couples were awake or asleep throughout the night at one-minute intervals. Multilevel modeling with lagged effects determined bidirectional and lagged associations between concordance and couples' daily interactions. RESULTS: Couples had more negative interactions than their usual following nights with higher concordance than their usual (but not vice versa) and this was more pronounced for well-adjusted couples. In contrast, across all couples, more positive interactions and perceived warmth and support from partners were associated with higher concordance. CONCLUSIONS: Our findings demonstrate that the valence of sleep-wake concordance depends on relationship quality characteristics (eg, marital adjustment). Future research on relationships, sleep, and health should consider couples' shared sleep behaviors as one mechanism by which relationships are associated with long-term health outcomes.

Relationship quality and CPAP adherence in patients with obstructive sleep apnea.

The prospective influence of relationship support and conflict on adherence to continuous positive airway pressure (CPAP) was examined over the first 3 months of CPAP treatment in 42 married, male patients with obstructive sleep apnea (OSA). CPAP adherence reports were available for 23 patients. Patient ratings of marital conflict predicted average nightly adherence (beta = -0.357, p < .05), but ratings of marital support did not predict adherence. Three-month follow-up ratings of marital support and conflict, subjective sleepiness, depression, and functional impairment were available for 16 patients from the first sample. Six additional patients without adherence reports provided baseline and 3-month follow-up questionnaire data, which resulted in a total of 22 patients with follow-up questionnaire data. Following 3 months of CPAP, patients reported decreased marital conflict (d = 0.43, p < .05), sleepiness (d = 1.13, p < .001), depression (d = 0.73, p < .001), and functional impairment (d = 1.48, p < .001). These findings highlight the importance of evaluating marital conflict for OSA patients and suggest marital conflict may be a target for interventions to improve CPAP adherence.

Brief Behavioral Treatment of Insomnia.

Cognitive behavioral treatment for insomnia (CBTI) is an effective treatment of insomnia; however, there are insufficient CBTI providers for the 10% to 25% of the population who have insomnia. Brief behavioral treatment for insomnia (BBTI) is a 4-session manualized treatment paradigm administrable in medical settings by nonpsychologist health professionals. BBTI is effective in reducing symptoms of insomnia, such as sleep onset latency, wake after sleep onset, and sleep efficiency. In some cases, BBTI resulted in full remission from insomnia. Ongoing clinical trials are further testing the efficacy of BBTI using alternative treatment deliveries and in primary medical care settings.

Young adolescent sleep is associated with parental monitoring.

OBJECTIVES: Insufficient sleep can increase risk for adverse psychological and physical outcomes. Parental monitoring of daily activities is associated with youth health behaviors. We examined parental monitoring of waking and bedtime behaviors and sleep in a community sample of high-risk youth. METHODS: One-hundred sixty-five 10- to 14-year-olds from low-socioeconomic status families participated (11.8 years ±1.16, 52% female; 78% Black/African American). Parents and youth evaluated parental monitoring of waking activities. Parent expectations about bedtime and parent knowledge about adolescent's bedtime and sleep routine were independently rated. Youth sleep was assessed via parent report and actigraphy over 7 days. RESULTS: More parental knowledge about bedtime was associated with longer parent-reported sleep duration (ß = .18, P < .05). Parental monitoring of waking activities (youth reported) was associated with more actigraph-assessed sleep over 7 days (B = 2.73, SE = .91), weekdays (B = 2.44, SE = .01), and weekends (B = 3.88, SE = .1.41, all Ps < .05), whereas parent reported monitoring was associated with more sleep on weekdays only (B = 2.10, SE = .87, P < .05). Parental knowledge and expectations about bedtime behaviors were not associated with actigraph-assessed sleep (P values > .05). Parental monitoring of waking and bedtime behaviors was not associated with sleep duration variability (P values > .05). CONCLUSIONS: Parental monitoring of waking activities may indirectly influence adolescent sleep via increased structure and felt security in the parent-adolescent relationship. Youth perception of monitoring may be particularly relevant for youth sleep duration.

Sleep-Wake Concordance in Couples Is Inversely Associated With Cardiovascular Disease Risk Markers.

Aim: To determine whether interdependence in couples' sleep (sleep-wake concordance i.e., whether couples are awake or asleep at the same time throughout the night) is associated with two markers of cardiovascular disease (CVD) risk, ambulatory blood pressure (BP) and systemic inflammation. Methods: This community-based study is a cross-sectional analysis of 46 adult couples, aged 18-45 years, without known sleep disorders. Percent sleep-wake concordance, the independent variable, was calculated for each individual using actigraphy. Ambulatory BP monitors measured BP across 48 h. Dependent variables included mean sleep systolic BP (SBP) and diastolic BP (DBP), mean wake SBP and DBP, sleep-wake SBP and DBP ratios, and C-reactive protein (CRP). Mixed models were used and were adjusted for age, sex, education, race, and body mass index. Results: Higher sleep-wake concordance was associated with lower sleep SBP (b = -.35, SE = .01) and DBP (b = -.22, SE = .10) and lower wake SBP (b = -.26, SE = .12; all p values < .05). Results were moderated by sex; for women, high concordance was associated with lower BP. Men and women with higher sleep-wake concordance also had lower CRP values (b = -.15, SE = .03, p < .05). Sleep-wake concordance was not associated with wake DBP or sleep/wake BP ratios. Significant findings remained after controlling for individual sleep quality, duration, and wake after sleep onset. Conclusions: Sleep-wake concordance was associated with sleep BP, and this association was stronger for women. Higher sleep-wake concordance was associated with lower systemic inflammation for men and women. Sleep-wake concordance may be a novel mechanism by which marital relationships are associated with long-term CVD outcomes.

Affiliative interpersonal behaviors during stress are associated with sleep quality and presleep arousal in young, healthy adults.

OBJECTIVES: This study examined the association between stress-related interpersonal behaviors, presleep arousal (PSA), and sleep quality. METHODS: Sixty-four participants (53% female) described a recent stressful interpersonal event that was coded for overall degree of affiliation (warmth vs hostility) and autonomy (independence vs interdependence). Cognitive and somatic PSA and sleep quality were examined using regression with affiliation and autonomy scores as predictors. Specific interpersonal behaviors that comprise overall affiliation were also examined. RESULTS: More affiliation (warmth) was associated with lower cognitive PSA (ß=-.32) and better sleep quality (ß=-.28). Autonomy was not associated with sleep quality or PSA. The specific behavior trust in others was associated with better sleep quality (rs=-.25). CONCLUSIONS: Behaviors during stress reflect underlying dimensions of interpersonal security. Findings underscore importance of interpersonal frameworks for understanding associations between stress and sleep, and provide support for the anthropological theory that interpersonal security is necessary for healthy sleep.

Exploring heart and soul: effects of religiosity/spirituality and gender on blood pressure and cortisol stress responses.

The current study investigated gender effects on the influence of self-reported religiosity and spirituality on cardiovascular and cortisol responses to a laboratory stressor among young adults. Participants with higher composite religiosity/spirituality scores, religiosity, levels of forgiveness and frequency of prayer showed lower cortisol responses. Greater composite religiosity/spirituality, religiosity, frequency of prayer and attendance at services were associated with lower blood pressure in males and elevated blood pressure in females. Findings suggest that spiritual and/or religious individuals may experience a protective effect against the neuroendocrine consequences of stress, though cardiovascular benefits may vary by gender. This work represents an important step in the convergence of multiple realms of research by linking physiological measures with indicators of individual belief systems.

Sleep Concordance in Couples is Associated with Relationship Characteristics.

STUDY OBJECTIVES: Coregulation of biological systems is a defining feature of normative attachment in close adult relationships. Sleep is a shared, intimate biological process between couples; however, sleep is usually examined at the individual level. We examined minute-by-minute concordance in couples' actigraphy-defined sleep-wake patterns, and how attachment style and marital satisfaction relate to concordance. DESIGN: Couples completed measures of avoidant and anxious attachment styles and relationship functioning and wore wrist actigraphs for 10 days. Minute-by-minute concordance of sleep and wake (i.e., the percentage of epochs in which both partners were asleep, or both were awake) was calculated for each sleep period. Mixed modeling was used to account for measurement occasions across time. RESULTS: Percent concordance ranged from 53-88% and was not associated with couples' sleep quality or circadian preference. For wives, neither anxious nor avoidant attachment was associated with sleep-wake concordance. For husbands, anxious attachment style was associated with higher concordance, but was moderated by wives' marital satisfaction. High marital satisfaction in wives was associated with higher concordance, regardless of husbands' attachment style. In couples in which wives reported low satisfaction, concordance was higher when husbands had an anxious attachment style. Avoidant attachment style in husbands was not related to concordance. CONCLUSIONS: Sleep concordance provides a unique measure of couples' cosleep and varies depending on attachment style and relationship satisfaction.