Sleep, 6(1):67-71

© 1983 Raven Press, New York

Reevaluation of the Phenomena of the First

Night Effect

Gihan A. Kader and Phillip T. Griffin

Tulane Sleep Clinic, Department of Psychiatry and Neurology, Tulane Medical Center,
Tulane University, New Orleans, Louisiana, U.S.A,

Summary: Thirty subjects, who were between the ages of 24 and 60 years and
were free of sleep disorders, were evaluated for impotency by use of polysom-
nograms recorded over 2 consecutive nights. No statistical differences between
the first and second nights' recordings were found in latency to rapid eye
movement and stage 4 sleep, sleep efficiency, and movement time with or
without awakening. No differences were noted in times spent in different sleep
stages, nor between the first 3 h and the second 3 h of sleep across both nights
of polysomnography. This confirms previous findings that questioned the effi-
cacy of the first night effect. This study also emphasizes the need to compare
sleep disorder patients with matched normal controls. Key Words: First night
effect-Movement.

Some research findings have encouraged the clinician to disregard data from the first
night of sleep studies because of the longer latencies to stage 4 and rapid eye movement
(REM) sleep on the first night than on subsequent nights (1-4). The first night effect has
influenced the time invested in evaluating sleep disorder patients as well as the expense
of such evaluations (3,5-8). Recently, investigators have obtained controversial results
concerning this adaptation, showing a tendency toward adaptation during the second
night of evaluation, but without statistically significant differences in latencies or in
percentages of time spent in different stages (6-8).
The patient populations providing these various results were paid volunteers, except
that those of Mendels and Hawkins (2) and Kupfer et al. (6) were psychiatric inpatients.
The mean age of these subjects did not exceed the early 20s. Webb and Campbell (4)
compared healthy females in their 20s with those in their 50s; the comparison demon-
strated a longer sleep latency period, less REM and longer REM latency, and more
awakening with increasing age.
Coble et al. (7) maintained that the relative comfort of modern laboratories is respon-
sible for diminishing the first night effect. She is supported by Browman and Cartwright

Accepted for publication October 1982.

Address correspondence and reprint requests to Gihan A. Kader, M.D., Department of Psychiatry and
Neurology, Tulane Medical Center, 1430 Tulane Avenue, New Orleans, LA 70112, U.S.A.

67
68 G. A. KADER AND P. T. GRIFFIN

(8), who acknowledge that this environment reduces the first night effect in volunteers.
One might question the validity of a generalization based on data provided by normal
volunteers. Patients under stress may require a longer adaptation period than relaxed
volunteers. The present study was done to evaluate the presence of a first night effect in
patients studied for nocturnal penile tumescence (NPT). These patients were free from
known sleep disorders. Unlike the young healthy volunteer subjects of the earlier
studies, these patients were heterogeneous with regard to age and background.

METHODS
Thirty male subjects aged 24- 60 years were evaluated for impotence of 6 months to 5
years. All subjects completed a detailed questionnaire (in part adapted from one used
by Karacan et al. at Baylor University Sleep Center) of sexual history and per-
formance before and after impotence, previous illness, surgery, and history of sleep
disorders and abnormalities. All subjects had a complete examination and a serum
profile.
Subjects were studied for 2 or more successive nights for NPT measurements in the
sleep lab. These studies included three electroencephalogram (EEG) leads (F 4C4'
C40 2 , and T 40 2), eye monitors at outer canthi connected to ipsilateral ears, submental
electromyogram, chest electrocardiogram, respiration monitors from nostril and mouth
air flow and chest movements, and a penile tumescence gauge at the base or tip of the
penis. The records were scored blindly at epochs of 20 s by one observer and reviewed
by a second. Movement time and sleep stage scoring for 20 s were in accordance with
the guidelines of Rechtshaffen and Kales (9). Awakenings of 10 s or longer following
movement were considered an awakening following movement.
Sleep latencies were measured from lights-off to the first 2 min of continuous stage 1
sleep. Stage 4 and REM latency were measured from sleep onset to the respective stage
excluding all intervening periods of wakening. Total time awake included sleep latency
time and total time awake after sleep onset determined by EEG. Sleep efficiency repre-
sented total time asleep divided by total time in bed. All parameters were calculated by
a subject not familiar with the history or diagnosis of the patients. Statistical measures
were performed by an investigator not familiar with the patients' case histories.

TABLE 1. Sleep parameters for nights 1 and 2

Sleep Movement followed
latency Stage 4 Total no. Movement by awakening vs.
Sleep to latency REM Time of followed total number
speed stage 1 speed latency awake movements by awakening of movements
Night!
Mean 19.100 108.466 19.10 108.466 49.53 14.13 0.5836 0.518
SD 17.83 65.591 17.83 65.59 49.53 9.44 0.272 0.272
Night 2
Mean 14.100 100.60 14.10 100.600 60.70 15.30 0.453 0.453
SO 9.34 72.38 9.34 72.383 40.89 9.73 0.285 0.285

No significant difference was found between nights 1 and 2 in sleep efficiency, sleep latency to stage 1, REM latency,
stage 4 latency, or ratio of number of movements followed by awakening to total number of movements.

Sleep, Vol. 6, No.1, 1983

 REEVALUATION OF FIRST NIGHT EFFECT 69

TABLE 2. Means and t test results for lights-out and

lights-on for nights 1 and 2
Lights- Mean
off and -on (h) SD F Probability

Night 1
On 22.395 0.553 1.20
Off 5.618 0.472 0.28
Night 2
On 5.634 0.6024 0.02 0.88

RESULTS
A subject x night analysis of variance was performed for each dependent measure.
The latencies for sleep onset (2 min of stage 1), latency to stage 2, REM, and stage 4
were transformed to "speed" measures by taking the inverse of the latency. This was
done to reduce skew, thereby increasing the power of the F test (10).
The means for sleep latency to stage 1, REM latency, stage 4 latency, and the
proportion of movements followed by awakening to the total number of movements
across nights and to age were used as predictors of sleep efficiency in a multiple
regression analysis. Age and sleep latency to stage 1 were significant predictors of sleep
efficiency (F(1,2)4 = 6.12, P < 0.02; F(1,2)4 = 9.54, P < 0.01, respectively). Stage 4
latency, REM latency, and the proportion of movements followed by awakening to the
total number of movements were not significant (Table 1).
Times from lights-off to lights-on were not significantly different between nights 1
and 2 (Table 2). Sleep latencies calculated from lights-off to stage 2 sleep were not
statistically different on the first night as compared with the second night (Table 3).
Moreover, times spent in different stages of sleep were not different between nights in
the majority of subjects (Table 4). When the first 3 h of sleep were compared with the
last 3 h of sleep, no first night effect was noted. Analysis of the same parameters for
blocks of sleep hours across nights and with covariance for night interaction showed no
significant difference. As expected, more stage 4 was noted in the earlier part of the
night and more REM sleep was noted in the second half of the sleep period (Table 5).
The mean of sleep time for all subjects from lights-off to lights-on was an average of 7
h. Thus no sleep deprivation was present in tbese patients during the polysomnographic
evaluation.
DISCUSSION
The present study does not demonstrate a first night effect. However, lower sleep
latency values were noted in the older subjects. These findings emphasize the variation
TABLE 3. Sleep latency to stage 2 analysis for
nights 1 and 2
F Ratio Probability
Night Mean SD latency speed Latency Speed
I 14.4 27.81 0.25 0.26 0.619 0.612
2 11.2 19.13

Sleep, Vol. 6. No. I, 1983

70 G. A. KADER AND P. T. GRIFFIN

TABLE 4. Time spent in different stages

Subject Total time Total Stage I Stage 2 Stage 3 Stage 4 Stage 3+4 Stage REM
no. Night recorded sleep time time time time time time time

2 I 419 381 38 56 73 126 199 88

2 400 285 31 31 42 121 163 60
3 I 425 297 34 99 46 53 99 65
2 461 273 61 24 36 83 119 69
4 I 465 234 30 25 37 119 156 23
2 448 396 30 61 64 166 230 75
5 I 472 276 43 58 58 53 III 65
2 486 376 77 16 36 198 234 49
7 1 359 336 25 51 31 144 175 85
2 446 416 7 26 37 228 265 118
8 I 435 384 38 27 53 208 261 57
2 471 412 25 31 57 240 296 59
9 I 426 340 56 65 70 122 192 27
2 320 254 38 35 26 125 151 30
10 I 469 361 70 17 63 176 239 35
2 503 394x 31 48 80 163 243 72
13 1 444 433 49 29 34 174 208 147
2 472 429 136 32 40 139 179 82
14 I 407 381 53 45 52 122 174 109
2 418 337 48 50 35 125 160 79
15 I 444 420 20 II 28 286 314 75
2 437 412 6 9 33 292 325 72
16 I 361 309 32 150 23 52 75 52
2 438 356 47 129 33 86 119 61
17 I 462 416 13 33 41 221 262 109
2 503 368 13 21 30 243 273 61
18 I 391 322 7 12 15 200 215 88
2 389 335 23 26 54 152 206 80
19 I 449 370 65 94 62 45 107 104
2 485 339 31 72 96 78 174 62
20 1 430 391 13 46 90 165 255 77
2 454 369 26 80 51 123 174 89
22 1 474 449 32 151 27 75 102 164
2 466 403 x 24 52 116 69 185 143
23 I 397 350 24 140 59 53 112 74
2 408 366 16 241 13 33 46 63
24 I 441 388 10 40 156 161 317 21
2 437 413 5 7 97 272 369 37
25 I 507 468 23 9 116 295 411 25
2 495 451 39 27 170 157 327 58
26 1 424 295 7 60 44 166 210 18
2 519 369 13 74 75 167 242 40
27 I 453 337 17 25 87 132 219 76
2 464 352 31 26 52 194 246 49
28 1 428 369 34 68 91 59 150 117
2 485 431 17 83 131 95 226 105
29 I 444 376 II 85 65 159 224 56
2 447 358 19 136 55 121 176 27
30 I 462 423 8 41 150 162 312 62
2 378 345 11 17 91 145 236 81
31 I 424 325 19 68 101 107 208 30
2 433 339 17 53 155 97 252 17
32 1 416 293 145 39 51 27 78 31
2 350 186 50 12 49 25 74 50
33 1 403 378 76 48 108 121 229 25
2 486 440 91 58 143 91 234 57
34 I 455 248 20 31 75 115 190 7
2 402 271 24 8 91 120 211 28
35 I 450 405 12 40 56 208 264 88
2 438 380 12 76 58 156 214 78

Sleep, Vol. 6, No.1, 1983

 REEVALUATION OF FIRST NIGHT EFFECT 7I

TABLE 5. Analysis of sleep stage data for first 3 h of sleep vs. second 3 h of sleep
for nights 1 and 2
Frequency
of awakening Stage 0 Stage I Stage 2 Stage 3 Stage 4 REM
Night I vs. 2
F ratio 0.68 0.68 0.42 0.03 0.04 0.01 0.14
Probability 0.4177 0.41 0.52 0.85 0.83 0.94 0.711
Both nights
F ratio 0.03 0.03 1.13 1.51 3.86 21.49 11.16
Probability 0.8754 0.87 0.29 0.23 0.06 O.OOOla 0.002a
Night 0.90 0.90 0.25 1.65 3.49 0.46 1.57
Interaction 0.3520 0.35 0.62 0.21 0.07 0.50 0.222

a Significant p value <0.01.

in the sleep parameters of the elderly. Moreover, the study confirms findings of vari-
ability among a heterogeneous population (11) and of variability due to age differ-
ences (4).
The possibility remains that a prolonged adaptation occurs and is evident only after
several successive study nights. The number of polys om no graphic studies necessary to
account for adaptation may have to be assessed for each patient. The guidelines will
certainly depend on age but also may depend on the nature of the sleep disorder to be
evaluated. Further studies should be done to assess the various factors involved in
different diagnostic categories as compared with age-matched normal subjects.

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Sleep. Vol. 6. No.1. 1983