Functional insomnia in relation to alexithymic features and cortisol hypersecretion in a community sample

Childhood maltreatment and insomnia in college students: The role of alexithymia and psychological distress

Insomnia, which is highly prevalent among college students, has been identified as one of the negative consequences of childhood maltreatment. While prior studies have uncovered distinct correlations between childhood maltreatment, insomnia, and other variables, the potential underlying mechanisms need to be further explored. This study focused on the chain-mediating role of alexithymia and psychological distress in the relationship between childhood maltreatment and insomnia. An online cross-sectional survey was conducted among Chinese college students, yielding 999 valid questionnaires that included demographic information, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Toronto Alexithymia Scale (TAS), the 21-item Depression Anxiety Stress Scales (DASS-21), and the Insomnia Severity Index (ISI). A chain-mediating model was then tested. The results revealed significant positive correlations between each pair of the four variables. Alexithymia and psychological distress separately mediated the link between childhood maltreatment and insomnia (effect of alexithymia was 0.06 with 95 % CI [0.03, 0.09]; effect of psychological distress was 0.24 with 95 % CI [0.19, 0.29]). Additionally, a chain-mediating effect of alexithymia and psychological distress was observed (chain-mediating effect was 0.12 with 95 % CI [0.09, 0.15]). The findings suggest that emotional interventions may mitigate the long-term effect of childhood maltreatment on sleep problems among college students, by improving the ability to recognize emotions and decreasing emotional problems.

Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations

Purpose

Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder.

Patients and Methods

From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia.

Results

The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients.

Conclusion

In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.

Sleep problems in adolescents with depression: Role of childhood trauma, alexithymia, rumination, and self-esteem

BACKGROUND

While sleep problems are common in adolescents with depression, the exact prevalence has not been reported. Although previous studies have shown that childhood trauma, alexithymia, rumination, and self-esteem are related to sleep problems, the interactions between these factors remain unclear.

METHODS

This study, conducted from March 1, 2021 to January 20, 2022, employed a cross-sectional design. The participants were 2192 adolescents with depression with a mean age of 15 years. The Chinese version of the Pittsburgh Sleep Quality Index, Childhood Trauma Questionnaire, Toronto Alexithymia Scale-20, Ruminative Response Scale, and Rosenberg Self-Esteem Scale were used to measure sleep problems, childhood trauma, alexithymia, rumination, and self-esteem, respectively. We used PROCESS 3.3 for SPSS to determine the chain mediating effect of alexithymia and rumination and the moderating effect of self-esteem in the relationship between childhood trauma and sleep problems.

RESULTS

Up to 70.71 % of adolescents with depression had sleep problems. Furthermore, alexithymia and rumination played a chain mediation role in the relationship between childhood trauma and sleep problems. Finally, self-esteem moderated the relationships between alexithymia and sleep problems and rumination and sleep problems.

LIMITATIONS

Owing to the study design, we cannot derive causal relationships between variables. Further, the self-reported data may have been influenced by subjective participant factors.

CONCLUSIONS

This study reveals potential ways of how childhood trauma influences sleep problems in adolescents with depression. These findings suggest that interventions targeting alexithymia, rumination, and self-esteem in adolescents with depression may be effective in reducing their sleep problems.

Do alexithymia and negative affect predict poor sleep quality? The moderating role of interoceptive sensibility

OBJECTIVES

Emotion-related hyperarousal is an important core pathology of poor sleep. Studies investigating the interplay of alexithymia and affective experiences in determining sleep quality have yielded mixed results. To disentangle the inconsistency, this study examined the concurrent predictive power of alexithymia, and negative and positive affect, while incorporating interoceptive sensibility (IS) as a possible moderator.

METHODS

A sample of 224 (70.10% were female) participants completed the Toronto Alexithymia Scale, Positive and Negative Affect Schedule, Pittsburgh Sleep Quality Index, Multidimensional Assessment of Interoceptive Awareness (MAIA), and Marlowe-Crowne Social Desirability Scale (for controlling response bias) using paper and pencil. A two-stage cluster analysis of the MAIA was used to capture IS characteristics. Stepwise regression was conducted separately for each IS cluster.

RESULTS

A three-group structure for IS characteristics was found. Higher alexithymia was predictive of poor sleep quality in the low IS group, while higher negative affect predicted poor sleep quality in the moderate and high IS groups. Additionally, alexithymia and positive affect were significantly different in the three IS groups, while negative affect and sleep quality were not.

CONCLUSIONS

Emotion and cognitive arousal may impact sleep quality differently in individuals with different levels of internal focusing ability, depending on physiological versus emotional self-conceptualization. The implications on pathological research, clinical intervention, study limitations and future directions are discussed.

Is alexithymia associated with sleep problems? A systematic review and meta-analysis

Alexithymia, a difficulty identifying and expressing emotions experienced by oneself or others, measurably harms quality of sleep. Research has observed the association between alexithymia and sleep problems; however, the cumulative effect of this association is still unknown. Therefore, this systematic review and meta-analysis was conducted to present scientific evidence regarding the relationship between alexithymia and sleep quality. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and using relevant keywords, we searched six databases: Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, EMBASE, and Science Direct. We selected observational studies on the association between alexithymia and sleep. We conducted meta-analysis using a random-effect model to calculate the effect size (ES) with Fisher's z transformation. Eligible studies (N = 26) in 24 papers included 7546 participants from 12 countries. The entire ES for the association between alexithymia and sleep was 0.44 (95 % CI: 0.31, 0.56). Additionally, patient populations had a larger ES (ES = 0.55; 95 % CI: 0.30, 0.79) than healthy populations (ES = 0.30; 95 % CI: 0.20, 0.41). The results of the present systematic review and meta-analysis revealed a significant association between alexithymia and sleep problems, especially among people with any medical condition.

Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder

STUDY OBJECTIVES

Idiopathic REM sleep behavior disorder (iRBD) is characterized by atypical REM sleep motor activity, vivid dreams and nightmares, and dream-enacting behaviors that can result in injuries to the patient and bed partner. It is also a known predictor of Parkinson disease (PD). Alexithymia has been associated with disturbances in sleep and dreaming (e.g., nightmares) and is a non-motor symptom of PD. We assessed alexithymia and disturbed dreaming in iRBD patients with the aim of determining if these two factors are elevated and interrelated among this population.

DESIGN

Questionnaire study of clinically diagnosed patients.

SETTING

Clinical sleep disorders center.

PATIENTS OR PARTICIPANTS

Thirty-two iRBD patients and 30 healthy age- and sex-matched control participants.

MEASUREMENTS AND RESULTS

Participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Dream Questionnaire, and the Beck Depression Inventory. iRBD patients obtained higher TAS-20 total scores (62.16 ± 13.90) than did controls (52.84 ± 7.62; F 1,59 = 10.44, P < 0.01), even when controlling for depressive symptoms, and more frequently attained the suggested cutoff for alexithymia than did controls (P < 0.01). iRBD patients obtained higher scores on the Difficulty Identifying Feelings alexithymia subscale. For both iRBD and control groups, the Difficulty Indentifying Feelings subscale correlated positively with the Nightmare Distress scale of the Dream Questionnaire.

CONCLUSIONS

Elevated alexithymia scores among idiopathic rapid eye movement sleep behavior disorder patients, and especially a difficulty in identifying feelings, parallels evidence of dysautonomia in this population. The higher incidence of distressing nightmares and the association of nightmares with alexithymia further extend similar findings for both clinical and non-clinical samples and suggest that an affect regulation disturbance may be common to the two sets of symptoms.

The high prevalence of alexithymia in hemodialyzed patients with secondary hyperparathyroidism unsuppressed by medical therapy is cured by parathyroidectomy

There are scanty data available on alexithymia in patients with end-stage renal disease, which point to an independent association with depression and social support. This study was devised to investigate the prevalence of alexithymia and sleep disorders in patients maintenance hemodialysis with insuppressible secondary hyperparathyroidism, who need parathyroidectomy (PTX), because previous data from our laboratories as well as those of others showed that this patient-group are the worst sleepers among hemodialysis patients with end-stage renal disease. A total of 40 patients needing PTX were enrolled and studied before the surgery. As for the control group, 80 patients on maintenance hemodialysis not needing PTX were enrolled. We measured alexithymia with the Toronto Alexithymia Score (TAS-20), sleep disorders with the Pittsburgh Sleep Quality Index (PSQI), and depression with Beck Depression Inventory (BDI), intact parathyroid hormone (iPTH), calcium, phosphate, use of antihypertensives, systolic and diastolic blood pressure, hemoglobin concentration, and albumin concentration. Patients needing PTX in comparison with those not needing PTX had significantly higher iPTH, calcium, and phosphate; they also had significantly higher systolic and diastolic blood pressure. They were more significantly alexithymic (P < .001), had more severe sleep disorders (P < .001), and were more depressed (P < .043). In multivariate analysis, BDI correlated significantly with iPTH concentration (r = 0.505, P < .001). A reduction of TAS-20 occurred after PTX which correlated with the number of patients on antihypertensive drugs, PSQI, BDI, hemoglobin concentration in the univariate and multivariate analysis. When TAS-20 and PSQI were adjusted for BDI (using analysis of variance) there was still a significant difference of TAS-20 and PSQI between patients needing PTX and not needing PTX (P < .001). This study confirms the high prevalence of sleep disorders in patients with unsuppressed secondary hyperparathyroidism and discloses a high prevalence of Alexithymia which is ameliorated by PTX. However, the correlation of Alexithymia with sleep disorders does not depend on depression.

The relationship between alexithymia, depression, and sleep complaints

The study assessed in normal subjects the hypothesis of a specific association between alexithymia and poor sleep quality, taking into consideration the contribution of depression. Five hundred fifty-four university students (480 F and 74 M) filled out the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI). TAS-20 scores were significantly correlated with many measures of self-rated poor sleep quality and also strongly correlated with depression scores. Any association between alexithymia and sleep complaints disappears when the contribution of depression is partialled out by multiple regressions, and only the well-known relationship between depression and impairment of sleep quality is confirmed.

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.

Are polysomnographic measures of sleep correlated to alexithymia? A study on laboratory-adapted sleepers

OBJECTIVE

Since recent findings have pointed to a correlation between alexithymia and measures of poor sleep quality during the first night of adaptation to a sleep laboratory, the aim of the current study was to assess the same relation in healthy laboratory-adapted sleepers. As a further measure of rapid eye movement (REM) sleep characteristics, REM density was also measured.

METHODS

Twenty-seven male subjects, without sleep or psychiatric disorders, filled out the 20-item Toronto Alexithymia Scale (TAS-20) and slept for two consecutive undisturbed nights. Polysomnography and REM density were measured in the postadaptation night.

RESULTS

Alexithymia scores did not correlate significantly with any polysomnographic variable or with REM density. Only the Externally Oriented Thinking (EOT) subscale showed a negative association with REM latency. Multiple regression on selected sleep measures as predictors confirmed these results.

CONCLUSION

Results do not extend to normal sleep the association previously found between alexithymia and a poor quality of sleep during the adaptation night in the sleep laboratory. The only polysomnographic measure showing an association, albeit little, with one facet of alexithymia was REM latency.

Quality of sleep during economic recession in Finland: a longitudinal cohort study

To assess the association between the economic recession of the 1990s in Finland and sleep behaviour, a longitudinal study was conducted in an adult Finnish population cohort. Baseline data were obtained by means of reports on sleep behaviour, health-related behaviour, health status, and objective laboratory tests in 1983-1987. The second screening conducted in 1992-1995, i.e. during economic recession, repeated data collection by postal questionnaires. The prevalences of various sleep symptoms including insomnia, daytime tiredness, fatigue, parasomnias and the use of hypnotics remained similar in the same age cohorts during economic recession. Alcohol consumption and snoring increased among the middle-aged (30-49 years), though snoring shows the greatest individual stability among various sleep symptoms. Despite some baseline differences in the sleep/health behaviour frequencies, the changes were independent of gender and socioeconomic class. The prevalences over eight years of insomnia and snoring show fair chronicity, whereas daytime tiredness and fatigue seem to be less chronic. Middle-aged participants who were stably employed at the initial screening but became unemployed during economic recession were studied separately. Prospectively unemployed persons suffered more from insomnia and used more hypnotics than the continuously employed. We conclude that the sleep quality of the general Finnish population has not drastically deteriorated during severe economic recession except among unemployed blue-collar workers.

Sleep characteristics of Japanese working men who score alexithymic on the Toronto Alexithymia Scale

This study examined the relationship of sleep characteristics including insomnia with scores on alexithymia in a sample of 171 Japanese working men. Levels of nonrestorative sleep and daytime sleepiness reported on a sleep questionnaire were significantly associated with scores on Depression and Confusion on the Profile of Mood States for Japanese men who had a high mean score on the Toronto Alexithymia Scale.

Alexithymia and impoverished dream recall in asthmatic patients: evidence from self-report measures

Early clinical impressions that alexithymia is associated with diminished dream recall have been supported by more recent research. The present study was designed to examine this association using self-report measures and a carefully screened clinical population. Thirty-three male and 43 female asthmatics from an outpatient clinic were administered the Toronto Alexithymia Scale, the Eysenck Personality Questionnaire, and a questionnaire concerning retrospective recall of dreams and nightmares. Multiple regression analyses revealed that, among men, dream recall was negatively related to alexithymia, especially to the TAS analytical mode of thinking subscale, independent of age and neuroticism. Among women, dream and nightmare recall were positively correlated with neuroticism. These results are consistent with early clinical observations of pensée opératoire, with some research findings, and with the notion that dream recall may be differentially associated with components of alexithymia in men and women patients.

How are alexithymia and physical illness linked? A review and critique of pathways

We review the empirical literature and critique four possible pathways linking alexithymia and physical illness; (a) alexithymia leads to organic disease through physiological or behavioral mechanisms: (b) alexithymia leads to illness behavior (physical symptoms, disability, excessive health care use) through cognitive or social mechanisms: (c) physical illness leads to alexithymia; and (d) both alexithymia and physical illness result from sociocultural or biological factors. Our review suggests that alexithymia is associated with tonic physiological hyperarousal, certain types of unhealthy behavior, and a biased perception and reporting of somatic sensations and symptoms. Alexithymia also appears to influence health care use, but in a complex fashion. Although trauma may give rise to alexithymia, whether physical illness such as chronic pain does so is not known, and there is little evidence that sociocultural or biological factors lead to both alexithymia and physical illness. We conclude that alexithymia probably influences illness behavior, but there is little support for the hypothesis that alexithymia leads to chronic organic disease, especially when one distinguishes organic disease from illness behavior.

Self-perceived fatigue and cortisol secretion in a community sample

The possible relation of cortisol secretion to self-perceived fatigue was examined in an adult community sample. Serum cortisol levels measured after the dexamethasone suppression test (DST) did not predict fatigue whereas depression assessed by the Beck Depression Inventory (BDI) and current medical treatment were significant and independent predictors. Confounding variables such as age, gender, body mass and social status were not predictive of fatigue. Of putative hypothalamic-pituitary-adrenal abnormalities hypersecretion of cortisol does not typify subjects with self-perceived fatigue.