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Wu A, Pu Y, Zhao Y, Luo X, Fang L, Zhang B. Rasch analysis of the pre-sleep arousal scale in patients with acute insomnia disorder. Sleep Med 2024; 119:329-334. [PMID: 38749257 DOI: 10.1016/j.sleep.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Hyperarousal plays an essential role in the initiation and maintenance of insomnia, highlighting the need for a tool that measure the hyperarousal state during the early course of insomnia. Pre-sleep Arousal Scale (PSAS) is a self-report questionnaire to evaluate subjective pre-sleep arousal of insomnia. The aim of this study was to examine the psychometric properties of the PSAS among patients with acute insomnia disorder (AID) using Rasch analysis. METHODS Totally 170 patients with AID from 31 public hospitals in China were recruited and completed the test. The psychometric properties of the PSAS were tested using Rasch analysis by Winsteps v5.4.1.0, including unidimensionality, local item independence, item fit, category diagnostics, reliability, item-person maps and differential item functioning (DIF) by age and gender. RESULTS According to Rasch analysis, somatic and cognitive subscales were unidimensional and basically demonstrated good item-fit statistics. 4-point Likert scale may be more appropriate for PSAS. All items have a good reliability and separation. No gender and age bias were detected for the scale. However, the person arousal level is not well matched to item difficulty. CONCLUSION The present study further reveals appropriate psychometric properties of the PSAS in patients with AID and provides suggestions for refinements and supplements to the PSAS.
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Affiliation(s)
- Aike Wu
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China
| | - Yiqi Pu
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China
| | - Yuhan Zhao
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China
| | - Xue Luo
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China
| | - Leqin Fang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Mental Health of the Ministry of Education, Guangzhou, China.
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Türkarslan KK, Canel Çınarbaş D, Nicassio PM. The psychometric properties of the Turkish version of the Pre-sleep Arousal Scale. Sleep Biol Rhythms 2024; 22:75-84. [PMID: 38476852 PMCID: PMC10899935 DOI: 10.1007/s41105-023-00483-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/01/2023] [Indexed: 03/14/2024]
Abstract
Purpose The aim of the present study was to examine the psychometric properties of the Turkish version of the Pre-sleep Arousal Scale (PSAS), which measures pre-sleep arousal, a significant predictor of insomnia symptoms. Methods 651 participants were recruited via social media and the Internet. Confirmatory factor analysis was conducted in the total sample (65.28% females; Mage1 = 28.09 ± 14.00). Convergent, divergent, incremental, and known-groups validity and internal consistency coefficients were assessed in a subsample of 556 participants (62.77% females; Mage2 = 29.25 ± 14.81). A second separate sample of 88 participants (80.68% females; Mage3 = 22.19 ± 4.98) was used to evaluate three-week test-retest reliability. Results The results of factor analysis confirmed the two-factor structure of the Turkish PSAS with cognitive (PSAS-C) and somatic (PSAS-S), similar to the original scale. The correlations of the PSAS with convergent and divergent measures showed that the Turkish form had good convergent and acceptable divergent validity. PSAS-C and PSAS-S were able to explain an 18% additional variance in insomnia severity beyond depression and anxiety, an 18% additional variance in depression beyond insomnia severity, and a 35% additional variance in anxiety beyond insomnia severity. Moreover, insomnia patients had significantly higher PSAS-C and PSAS-S scores than good sleepers. Finally, the PSAS, PSAS-C, and PSAS-S had satisfactory internal consistency coefficients (α = 0.92, 0.91, and 0.86, respectively) and three-week test-retest correlations (ICC = 0.82, 0.82, and 0.71, respectively). Conclusion The Turkish form of the PSAS was a valid and reliable measure of pre-sleep arousal and can be utilized in sleep studies. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-023-00483-z.
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Affiliation(s)
| | | | - Perry M. Nicassio
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute, Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, USA
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Hamilton NA, Russell J, Hamadah K, Youngren W, Toon A, Nguyen TA, Joles K. Screening for Comorbidity of Sleep Disorders in Career Firefighters. J Occup Environ Med 2024; 66:43-50. [PMID: 37853663 DOI: 10.1097/jom.0000000000002993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The purpose of this study was to assess the prevalence and sequelae of insomnia, obstructive sleep apnea (OSA), and comorbid OSA and insomnia (COMISA). METHOD In the morning, after a shift end, Midwest career firefighters ( N = 89) in a midsized city completed an electronic battery of questionnaire to screen for OSA, daytime sleepiness, insomnia, presleep arousal, nightmares, mental and physical health symptoms, and a one-night sleep diary. RESULTS Prevalence of firefighters exceeding screening thresholds: OSA: 54%; insomnia: 30%; COMISA: 17%; four or more nightmares per month: 15%. Firefighters who met criteria for COMISA had shorter total sleep time, less restful and worse sleep quality, higher depression and anxiety symptoms, and presleep arousal symptoms than firefighters without self-reported sleep problems. CONCLUSIONS Many firefighters are at elevated risk of individual behavioral sleep disorders, COMISA, and daytime dysfunction.
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Affiliation(s)
- Nancy A Hamilton
- From the University of Kansas, Lawrence, Kansas (N.A.H., J.R., K.H., W.Y., A.T., T.A.N.); and Lawrence, Douglas County Fire and Medical, Lawrence, Kansas (K.J.)
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Lynn SJ, McDonald CW, Sleight FG, Mattson RE. Cross-validation of the ego dissolution scale: implications for studying psychedelics. Front Neurosci 2023; 17:1267611. [PMID: 38116073 PMCID: PMC10729006 DOI: 10.3389/fnins.2023.1267611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Ego dissolution, variously called Ego-Loss, self-loss, and ego disintegration, is a hallmark of psychedelic drug use. We cross-validated the 10-item Ego Dissolution Scale, which we developed to assess ego dissolution in everyday life, and we included comparator variables that expanded our original assessment of construct validity. Methods Undergraduate college student volunteers (N = 527) completed the measures online. Results We replicated the original two factor structure (i.e., subfactors: Ego-Loss and Unity/connectedness with others, the world, universe), and we determined that the total score (Cronbach's α = 0.79) and subfactors (Ego-Loss = 78; Unity = 0.83) possessed adequate-to-good reliability and strong convergent validity (e.g., mindfulness, hallucination-predisposition, sleep variables, personality variables, positive/negative affect transliminality, dissociation/depersonalization), while neuroticism, social desirability did not correlate highly with ego dissolution. We identified distinct patterns of relations of measures associated with the Ego-Loss vs. Unity subfactors. Discussion We discuss the implications of the use of the EDS for studying everyday aspects of ego dissolution, the long-term effects of psychedelic use, and the value of using the scale in conjunction with measures of the acute effects of psychedelics.
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Affiliation(s)
- Steven Jay Lynn
- Psychology Department, Binghamton University, State University of New York, Binghamton, NY, United States
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5
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Spina MA, Andrillon T, Quin N, Wiley JF, Rajaratnam SMW, Bei B. Does providing feedback and guidance on sleep perceptions using sleep wearables improve insomnia? Findings from "Novel Insomnia Treatment Experiment": a randomized controlled trial. Sleep 2023; 46:zsad167. [PMID: 37294865 PMCID: PMC10485571 DOI: 10.1093/sleep/zsad167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/08/2023] [Indexed: 06/11/2023] Open
Abstract
STUDY OBJECTIVES Insomnia is a disorder diagnosed based on self-reported sleep complaints. Differences between self-reported and sensor-based sleep parameters (sleep-wake state discrepancy) are common but not well-understood in individuals with insomnia. This two-arm, parallel-group, single-blind, superiority randomized-controlled trial examined whether monitoring sleep using wearable devices and providing support for interpretation of sensor-based sleep data improved insomnia symptoms or impacted sleep-wake state discrepancy. METHODS A total of 113 (age M = 47.53; SD = 14.37, 64.9% female) individuals with significant insomnia symptoms (Insomnia Severity Index(ISI) ≥10) from the community were randomized 1:1 (permuted block randomization) to receive 5 weeks (1) Intervention (n = 57): feedback about sensor-based sleep (Fitbit and EEG headband) with guidance for data interpretation and ongoing monitoring, and (2) Control (n = 56): sleep education and hygiene. Both groups received one individual session and two check-in calls. The ISI (primary outcome), sleep disturbance (SDis), sleep-related impairment (SRI), depression, and anxiety were assessed at baseline and post-intervention. RESULTS In total, 103 (91.2%) participants completed the study. Intention-to-treat multiple regression with multiple imputations showed that after controlling for baseline values, compared to the Control group (n = 51), the Intervention group (n = 52) had lower ISI (p = .011, d = 0.51) and SDis (p = .036, d = 0.42) post-intervention, but differences in SRI, depression, anxiety, and sleep-wake state discrepancy parameters (total sleep time, sleep onset latency, and wake after sleep onset) were not meaningful (P-values >.40). CONCLUSIONS Providing feedback and guidance about sensor-based sleep parameters reduced insomnia severity and sleep disturbance but did not alter sleep-wake state discrepancy in individuals with insomnia more than sleep hygiene and education. The role of sleep wearable devices among individuals with insomnia requires further research. CLINICAL TRIAL REGISTRATION The Novel Insomnia Treatment Experiment (NITE): the effectiveness of incorporating appropriate guidance for sleep wearables in users with insomnia. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378452, Australia New Zealand Clinical Trials Registry: ACTRN12619001636145.
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Affiliation(s)
- Marie-Antoinette Spina
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Thomas Andrillon
- School of Philosophical, Historical, and International Studies, Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Støre SJ, Tillfors M, Angelhoff C, Norell-Clarke A. A robot intervention for adults with ADHD and insomnia-A mixed-method proof-of-concept study. PLoS One 2023; 18:e0290984. [PMID: 37656707 PMCID: PMC10473504 DOI: 10.1371/journal.pone.0290984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVE To investigate individual effects of a three-week sleep robot intervention in adults with ADHD and insomnia, and to explore participants' experiences with the intervention. METHODS A proof-of-concept study with a mixed-methods design (n = 6, female = 4) where a repeated ABA single-case study was combined with interviews. Data were collected with the Consensus Sleep Diary, wrist actigraphy, questionnaires on symptoms of insomnia, arousal, emotional distress, and ADHD, and through individual interviews. RESULTS Visual analysis of the sleep diary and actigraphy variables did not support any effects from the robot intervention. Half of participants reported clinically relevant reductions on the Insomnia Severity Index from pre- to post-intervention. No changes regarding ADHD or arousal. Thematic analysis of the interviews resulted in three themes: (1) A pleasant companion, (2) Too much/not enough, and (3) A new routine. CONCLUSION Adjustments of the intervention ought to be made to match the needs of patients with both ADHD and insomnia before the next trial is conducted.
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Affiliation(s)
- Siri Jakobsson Støre
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Maria Tillfors
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria’s Child and Youth Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Annika Norell-Clarke
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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7
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Støre SJ, Tillfors M, Wästlund E, Angelhoff C, Andersson G, Norell A. Mind, Body and Machine: Preliminary Study to Explore Predictors of Treatment Response After a Sleep Robot Intervention for Adults with Insomnia. Nat Sci Sleep 2023; 15:567-577. [PMID: 37465662 PMCID: PMC10351520 DOI: 10.2147/nss.s408714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction The study aimed to explore characteristics of responders to a sleep robot intervention for adults with insomnia, and the likelihood that participants responded to the intervention. Methods Data from the intervention and the control group in a randomized waitlist-controlled trial (n = 44) were pooled together after both had undergone the intervention. A repeated measures ANOVA and Friedman tests were used to explore changes over time. Differences in baseline characteristics between responders (n = 13), defined as a reduction of -5 on the Insomnia Severity Index from pre- to post-intervention, and non-responders (n = 31) were analyzed with t-tests and chi-square tests. Finally, logistic regression models were estimated. Results Baseline anxiety was the only statistically significant difference between responders and non-responders (p = 0.03). A logistic regression model with anxiety and sleep quality as predictors was statistically significant, correctly classifying 83.3% of cases. Discussion The results imply that people with lower anxiety and higher sleep quality at baseline are more likely to report clinically significant improvements in insomnia from the sleep robot intervention.
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Affiliation(s)
- Siri Jakobsson Støre
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Region Värmland, Sweden
| | - Maria Tillfors
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Region Värmland, Sweden
| | - Erik Wästlund
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Region Värmland, Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria’s Child and Youth Hospital, Linköping University Hospital, Linköping, Region Östergötland, Sweden
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Region Östergötland, Sweden
| | - Gerhard Andersson
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Region Östergötland, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Region Östergötland, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Region Stockholm, Sweden
| | - Annika Norell
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Region Örebro län, Sweden
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Region Skåne, Sweden
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Dressle RJ, Riemann D, Spiegelhalder K, Frase L, Perlis ML, Feige B. On the relationship between EEG spectral analysis and pre-sleep cognitive arousal in insomnia disorder: towards an integrated model of cognitive and cortical arousal. J Sleep Res 2023:e13861. [PMID: 36815625 DOI: 10.1111/jsr.13861] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/06/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
According to the hyperarousal model, insomnia is characterised by increased arousal in the cortical, cognitive, and physiological domains. However, the interaction between these arousal domains is poorly understood. The present observational case-control study aimed to investigate cortical arousal during the night, pre-sleep cognitive arousal and the relationship between these two domains. A total of 109 patients with insomnia disorder (ID) and 109 age-and gender matched healthy controls were investigated on two sleep laboratory nights. Electroencephalographic (EEG) spectral power during non-rapid eye movement (NREM) and REM sleep was analysed as a measure of cortical arousal. In addition, patients completed the Pre-Sleep Arousal Scale (PSAS), which consists of two subscales, one for cognitive arousal (PSAS-CA) and one for self-reported somatic arousal (PSAS-SA). The relationship between the subscale scores and EEG spectral power was calculated by multi- and univariate analyses of variance. During NREM and REM sleep, patients with ID showed significantly increased spectral power in the EEG gamma band. In addition, patients with ID showed significantly increased scores on both subscales of the PSAS. The PSAS-CA score was significantly associated with increased NREM and REM gamma power, whereas PSAS-SA was associated with decreases in NREM and REM gamma power. Consistent with our hypothesis, patients with ID showed increased cortical and cognitive arousal. Moreover, there was an association between these two arousal domains, which may indicate that cortical arousal during the night is (at least in part) elicited by pre-sleep worry and rumination.
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Affiliation(s)
- Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine University of Freiburg, Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine University of Freiburg, Freiburg, Germany
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Støre SJ, Tillfors M, Wästlund E, Angelhoff C, Andersson G, Norell‐Clarke A. The effects of a sleep robot intervention on sleep, depression and anxiety in adults with insomnia—A randomized waitlist‐controlled trial. J Sleep Res 2022; 32:e13758. [PMID: 36285420 DOI: 10.1111/jsr.13758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/01/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
The study objective was to assess if a 3-week intervention with the Somnox sleep robot had effects on symptoms of insomnia, somatic arousal, and/or concurrent symptoms of depression and anxiety in adults with insomnia, compared with a waitlist-control group. The participants (n = 44) were randomized to a 3-week intervention with the sleep robot (n = 22), or to a waitlist-control group (n = 22). The primary outcome measure was the Insomnia Severity Index administered at baseline, mid-intervention, post-intervention and at 1-month follow-up. Secondary outcome measures were the Pre-Sleep Arousal Scale, and the Hospital Anxiety and Depression Scale. Additionally, sleep-onset latency, wake time after sleep onset, total sleep time and sleep efficiency were measured the week prior to and the last week of the intervention, both subjectively with the Consensus Sleep Diary and objectively with wrist actigraphy. Mixed-effects models were used to analyse data. The effect of the sleep robot on the participants' insomnia severity was not statistically significant. The differences between the intervention group and the control group on the measures of arousal, anxiety and depression were also not statistically significant, and neither were the sleep diary and actigraphy variables. In conclusion, a 3-week intervention with daily at-home use of the robot was not found to be an effective method to relieve the symptom burden in adults with insomnia.
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Affiliation(s)
- Siri Jakobsson Støre
- Department of Social and Psychological Studies Karlstad University Karlstad Sweden
| | - Maria Tillfors
- Department of Social and Psychological Studies Karlstad University Karlstad Sweden
| | - Erik Wästlund
- Department of Social and Psychological Studies Karlstad University Karlstad Sweden
| | - Charlotte Angelhoff
- Crown Princess Victoria's Child and Youth Hospital and Department of Biomedical and Clinical Sciences (BKV) Linköping University Linköping Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Annika Norell‐Clarke
- Department of Social and Psychological Studies Karlstad University Karlstad Sweden
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
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Pre-Sleep Cognitive Arousal Is Unrelated to Sleep Misperception in Healthy Sleepers When Unexpected Sounds Are Played during Non-Rapid Eye Movement Sleep: A Polysomnography Study. Brain Sci 2022; 12:brainsci12091220. [PMID: 36138955 PMCID: PMC9497057 DOI: 10.3390/brainsci12091220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: It is well-established that environmental noise can disrupt sleep, and cause a mismatch between subjective and objective sleep, which is known as “sleep misperception”. Naturalistic studies indicate that pre-sleep cognitive arousal and sleep misperception are associated in the context of noise. However, it is not known if this is the case when ecologically valid noises are specifically played during non-rapid eye movement (NREM) sleep, which is susceptible to noise-related disruption. The present study evaluated if pre-sleep cognitive arousal was associated with sleep misperception in healthy normal sleepers, when unexpected ecologically valid common nocturnal noises were played during NREM sleep. Methods: Eighteen healthy sleepers (Mage = 23.37 years, SDage = 3.21 years) participated. Sleep was measured objectively on three consecutive nights using polysomnography, in a sleep laboratory environment, and subjectively, through participant estimates of total sleep time (TST). Night 1 was a baseline night where no noises were played. On Night 2, noises, which were chosen to be representative of habitual nocturnal noises heard in home environments, were played to participants via in-ear headphones after 5 min of objective sleep. Results: Unexpectedly, habitual pre-sleep cognitive arousal was not associated with subjective–objective TST discrepancy on Night 2. Conclusions: These results suggest that in healthy sleepers, when ecologically valid noises are played unexpectedly during NREM sleep in an unfamiliar sleep laboratory environment the subjective experience of sleep is not associated with pre-sleep cognitive arousal, or negatively impacted by noise exposure.
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Goodhines PA, Svingos AM, Gerish S, Park A, Gellis LA. Randomized controlled trial of cognitive refocusing versus stimulus control treatment for college insomnia: feasibility of a brief, electronic-based, and peer-led approach. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-13. [PMID: 35943968 PMCID: PMC9908774 DOI: 10.1080/07448481.2022.2109031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/27/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Performance of Cognitive Refocusing Treatment for Insomnia (CRT-I) relative to stimulus control treatment (SCT) remains unknown among college students. This pilot trial compared single-session, electronic-based, peer-led CRT-I to SCT, and as well as awareness-based (AC) and no-treatment (NTC) controls. PARTICIPANTS College students (N = 82; Mage=18.59 [SD = 0.78]; 58% female; 61% White; 16% Hispanic) with insomnia symptoms were randomly assigned to CRT-I (n = 12), SCT (n = 14), and AC (n = 14) conditions, or non-randomly recruited to NTC (n = 42). METHODS All participants completed baseline and one-month follow-up surveys, and reported daily task enactment (except NTC). RESULTS Feasibility ratings were comparable across conditions. Within-group treatment effects revealed greater improvements in (a) insomnia symptom severity among CRT-I (d = 1.13) and SCT (d = 1.66) groups relative to AC (d = 0.90) and (b) pre-sleep cognitive arousal among CRT-I (d = 0.94) and SCT (d = 1.42) groups relative to AC (d = 0.75). CONCLUSIONS Brief, electronic-based, peer-led CRT-I and SCT interventions appear feasible and potentially efficacious for college insomnia.
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Affiliation(s)
| | - Adrian M Svingos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Samantha Gerish
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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12
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Sharman RL, Perlis ML, Bastien CH, Barclay NL, Ellis JG, Elder GJ. Pre-Sleep Cognitive Arousal Is Negatively Associated with Sleep Misperception in Healthy Sleepers during Habitual Environmental Noise Exposure: An Actigraphy Study. Clocks Sleep 2022; 4:88-99. [PMID: 35323164 PMCID: PMC8947652 DOI: 10.3390/clockssleep4010010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
Specific noises (e.g., traffic or wind turbines) can disrupt sleep and potentially cause a mismatch between subjective sleep and objective sleep (i.e., “sleep misperception”). Some individuals are likely to be more vulnerable than others to noise-related sleep disturbances, potentially as a result of increased pre-sleep cognitive arousal. The aim of the present study was to examine the relationships between pre-sleep cognitive arousal and sleep misperception. Sixteen healthy sleepers participated in this naturalistic, observational study. Three nights of sleep were measured using actigraphy, and each 15-s epoch was classified as sleep or wake. Bedside noise was recorded, and each 15-s segment was classified as containing noise or no noise and matched to actigraphy. Participants completed measures of habitual pre-sleep cognitive and somatic arousal and noise sensitivity. Pre-sleep cognitive and somatic arousal levels were negatively associated with subjective−objective total sleep time discrepancy (p < 0.01). There was an association between sleep/wake and noise presence/absence in the first and last 90 min of sleep (p < 0.001). These results indicate that higher levels of habitual pre-sleep arousal are associated with a greater degree of sleep misperception, and even in healthy sleepers, objective sleep is vulnerable to habitual bedside noise.
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Affiliation(s)
- Rachel L. Sharman
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford OX3 9DU, UK;
| | - Michael L. Perlis
- Behavioral Sleep Medicine Program, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA;
| | - Célyne H. Bastien
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche CERVO, Québec, QC G1E 1T2, Canada
| | - Nicola L. Barclay
- Sleep Universal Ltd., Oxford OX1 2JD, UK;
- Northumbria Sleep Research, Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Jason G. Ellis
- Northumbria Sleep Research, Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
| | - Greg J. Elder
- Northumbria Sleep Research, Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
- Correspondence:
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13
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Beck J, Loretz E, Rasch B. Stress dynamically reduces sleep depth: temporal proximity to the stressor is crucial. Cereb Cortex 2022; 33:96-113. [PMID: 35196708 PMCID: PMC9758584 DOI: 10.1093/cercor/bhac055] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 11/12/2022] Open
Abstract
The anticipation of a future stressor can increase worry and cognitive arousal and has a detrimental effect on sleep. Similarly, experiencing a stressful event directly before sleep increases physiological and cognitive arousal and impairs subsequent sleep. However, the effects of post- vs. pre-sleep stress on sleep and their temporal dynamics have never been directly compared. Here, we examined the effect of an anticipated psychosocial stressor on sleep and arousal in a 90-min daytime nap, in 33 healthy female participants compared to an anticipated within-subject relaxation task. We compared the results to an additional group (n = 34) performing the same tasks directly before sleep. Anticipating stress after sleep reduced slow-wave activity/beta power ratio, slow-wave sleep, sleep spindles, and slow-wave parameters, in particular during late sleep, without a concomitant increase in physiological arousal. In contrast, pre-sleep psychosocial stress deteriorated the same parameters during early sleep with a concomitant increase in physiological arousal. Our results show that presleep cognitions directly affect sleep in temporal proximity to the stressor. While physiological arousal mediates the effects of presleep stress on early sleep, we suggest that effects during late sleep originate from a repeated reactivation of mental concepts associated with the stressful event during sleep.
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Affiliation(s)
- Jonas Beck
- Department of Psychology, University of Fribourg, Rue P.-A-de-Faucigny 2, CH-1700 Fribourg, Switzerland
| | - Erna Loretz
- The Siesta Group Schlafanalyse GmbH, Schlosshofer Strasse 11, 1210 Vienna, Austria
| | - Björn Rasch
- Corresponding author: Department of Psychology, University of Fribourg, Rue P.-A-de-Faucigny 2, CH-1700 Fribourg, Switzerland.
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Gorgoni M, Scarpelli S, Mangiaruga A, Alfonsi V, Bonsignore MR, Fanfulla F, Ferini-Strambi L, Nobili L, Plazzi G, De Gennaro L. Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy. Sleep Med 2021; 88:46-57. [PMID: 34731828 PMCID: PMC8577578 DOI: 10.1016/j.sleep.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/18/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023]
Abstract
Objective The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, and many studies point to large modifications in several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during the pandemic has been substantially overlooked. Since hyperarousal represents one of the main factors for the development and the perpetuation of chronic insomnia disorder, the assessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinically relevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and pre-sleep arousal in an Italian sample during the COVID-19 lockdown. Methods We used an online survey to collect self-reported sociodemographic, environmental, clinical, sleep, and sleep-related data. Our final sample included 761 participants. Results Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results show that almost half of the sample suffered from clinically relevant levels of at least one component (ie, cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleep quality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related measures, depressive and event-related stress symptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components. Moreover, specific sociodemographic and environmental variables were uniquely related to sleep quality, cognitive or somatic pre-sleep arousal. Conclusions These findings suggest that the assessment of specific sleep-related factors (ie, pre-sleep arousal), together with more global measures of sleep quality, may be crucial to depict the complex impact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.
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Affiliation(s)
- Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Francesco Fanfulla
- Sleep Medicine Unit, Clinical and Scientific Maugeri Institutes, Scientific Institute of Pavia IRCCS Pavia, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Medical and Surgical Neuroscience and Rehabilitation (DINOGMI), University of Genoa, Genoa, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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Norell-Clarke A, Hagström M, Jansson-Fröjmark M. Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship? Front Psychol 2021; 12:677538. [PMID: 34234716 PMCID: PMC8255681 DOI: 10.3389/fpsyg.2021.677538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: According to the Cognitive Model of Insomnia, engaging in sleep-related cognitive processes may lead to sleep problems over time. The aim was to examine associations between five sleep-related cognitive processes and the incidence of insomnia, and to investigate if baseline anxiety and depression influence the associations. Methods: Two thousand three hundred and thirty-three participants completed surveys on nighttime and daytime symptoms, depression, anxiety, and cognitive processes at baseline and 6 months after the first assessment. Only those without insomnia at baseline were studied. Participants were categorized as having or not having incident insomnia at the next time point. Baseline anxiety and depression were tested as moderators. Results: Three cognitive processes predicted incident insomnia later on. Specifically, more safety behaviors and somatic arousal at Time 1 increased the risk of developing insomnia. When investigating changes in the cognitive processes over time, reporting an increase of worry and safety behaviors also predicted incident insomnia. Depressive symptoms moderated the association between changes in worry and incident insomnia. Conclusion: These findings provide partial support for the hypothesis that cognitive processes are associated with incident insomnia. In particular, safety behaviors, somatic arousal, and worry increase the risk for incident insomnia. Preventative interventions and future research are discussed.
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Affiliation(s)
- Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, The Centre for Psychotherapy, Education & Research, Region Stockholm, Stockholm, Sweden
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16
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Puzino K, Amatrudo G, Sullivan A, Vgontzas AN, Fernandez-Mendoza J. Clinical Significance and Cut-Off Scores for the Pre-Sleep Arousal Scale in Chronic Insomnia Disorder: A Replication in a Clinical Sample. Behav Sleep Med 2020; 18:705-718. [PMID: 31545084 DOI: 10.1080/15402002.2019.1669604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In contrast to pre-sleep cognitive arousal, self-reported pre-sleep somatic arousal is a rather elusive construct for which little validity has been provided. Thus, the clinical significance of somatic symptoms during the pre-sleep period remains unknown. Participants: 248 patients (45.0 ± 16.7 years old, 65.3% female) with a diagnosis of chronic insomnia disorder, out of 388 consecutive patients evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Hershey Sleep Research & Treatment Center. Methods: Participants completed the Pre-sleep Arousal Scale assessing cognitive (PSAS-C) and somatic (PSAS-S) arousal as well as the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress Test (FIRST), Arousal Predisposition Scale (APS), and Depression Anxiety Stress Scale (DASS). Multivariable stepwise regression assessed which clinical factors were independently associated with greater PSAS-C and PSAS-S scores. Receiver operating characteristic analysis determined the predictive value for identifying sleep reactivity (FIRST≥18) and clinical anxiety (DASS-A ≥ 10) and clinically useful cutoff scores. Results: The strongest correlates of PSAS-S were DASS-A (β = 0.64) and chronic pain (β = 0.11), while those of PSAS-C were FIRST (β = 0.29) and a history of stroke (β = 0.10). A PSAS-S score of 14.8 (AUC = 0.87, 95%CI = 0.83-0.91) and a PSAS-C score of 24.5 (AUC = 0.82, 95%CI = 0.76-0.88) showed the best balance in specificity and sensitivity to identify clinical anxiety and sleep reactivity, respectively. Conclusions: Self-reported pre-sleep somatic symptoms are a marker of comorbid anxiety and, potentially chronic pain, impacting nighttime sleep. The optimal cutoff scores of 14 and 20 proposed herein can help clinicians with case formulation, with tailoring BSM treatments and their targets.
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Affiliation(s)
- Kristina Puzino
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Gregory Amatrudo
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Alanna Sullivan
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
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Kalmbach DA, Buysse DJ, Cheng P, Roth T, Yang A, Drake CL. Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder. Sleep Med 2020; 71:151-160. [PMID: 32247571 PMCID: PMC8212183 DOI: 10.1016/j.sleep.2019.11.1184] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. METHODS In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. RESULTS Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. CONCLUSIONS Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Daniel J Buysse
- Center for Sleep and Circadian Science, Departments of Psychiatry and Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Alexander Yang
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
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Lemyre A, Belzile F, Landry M, Bastien CH, Beaudoin LP. Pre-sleep cognitive activity in adults: A systematic review. Sleep Med Rev 2020; 50:101253. [DOI: 10.1016/j.smrv.2019.101253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 11/09/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
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Ali RM, Zolezzi M, Awaisu A. A Systematic Review of Instruments for the Assessment of Insomnia in Adults. Nat Sci Sleep 2020; 12:377-409. [PMID: 32753991 PMCID: PMC7342485 DOI: 10.2147/nss.s250918] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Self-reported sleep instruments remain the most practical methods for the assessment of insomnia in clinical practice. This systematic review aims to identify, describe and summarize the psychometric properties of questionnaires available for the assessment of insomnia in the adult population. In addition, the review also aimed to identify sleep instruments available in the Arabic language. METHODS A systematic literature search was conducted using the following electronic databases: PubMed, EMBASE, ProQuest Central, SCOPUS, and Google Scholar. The quality assessment of the instruments was conducted using two established international criteria. RESULTS One hundred and seven articles were selected for inclusion, from which 31 instruments were identified and categorized based on the constructs they assess as: (1) screening for insomnia (n=14); (2) measuring the consequences of insomnia (n=8); (3) assessing the cognitive aspects of insomnia (n= 5); and (4) assessing sleep hygiene (n= 4). The review of the psychometric properties showed that the Insomnia Severity Index and the Functional Outcomes of Sleep Questionnaire were the most extensively evaluated instrument. Criterion validity and reliability measures were the most commonly reported properties. Only four of the identified instruments were available in Arabic. DISCUSSION Overall, the findings of this study indicate ample availability of sleep instruments. However, psychometric testing for several of the available sleep instruments remains incomplete, particularly responsiveness and interpretability. Our findings suggest that future studies should focus on reporting more psychometric measures to ensure the trustworthiness of these instruments.
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Affiliation(s)
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
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20
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Marcusson-Clavertz D, West M, Kjell ONE, Somer E. A daily diary study on maladaptive daydreaming, mind wandering, and sleep disturbances: Examining within-person and between-persons relations. PLoS One 2019; 14:e0225529. [PMID: 31774836 PMCID: PMC6880993 DOI: 10.1371/journal.pone.0225529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
Cross-sectional and experimental research have shown that task-unrelated thoughts (i.e., mind wandering) relate to sleep disturbances, but there is little research on whether this association generalizes to the day-level and other kinds of task-unrelated mentation. We employed a longitudinal daily diary design to examine the within-person and between-person associations between three self-report instruments measuring mind wandering, maladaptive daydreaming (a condition characterized by having elaborate fantasy daydreams so insistent that they interfere with daily functioning) and sleep disturbances. A final sample of 126 participants self-identified as experiencing maladaptive daydreaming completed up to 8 consecutive daily reports (in total 869 daily observations). The scales showed acceptable-to-excellent within-person reliability (i.e., systematic day-to-day change) and excellent between-person reliability. The proportion of between-person variance was 36% for sleep disturbances, 57% for mind wandering, and 75% for maladaptive daydreaming, respectively (the remaining being stochastic and systematic within-person variance). Contrary to our pre-registered hypothesis, maladaptive daydreaming did not significantly predict sleep disturbances the following night, B = -0.00 (SE = 0.04), p = .956. Exploratory analyses indicated that while nightly sleep disturbances predicted mind wandering the following day, B = 0.20 (SE = 0.04), p < .001, it did not significantly predict maladaptive daydreaming the following day, B = -0.04 (SE = 0.05), p = .452. Moreover, daily mind wandering did not significantly predict sleep disturbances the following night, B = 0.02 (SE = 0.05), p = .731. All variables correlated at the between-person level. We discuss the implications concerning the differences between maladaptive daydreaming and mind wandering and the possibility of targeting sleep for mind wandering interventions.
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Affiliation(s)
- David Marcusson-Clavertz
- Department of Psychology, Lund University, Lund, Sweden
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
- * E-mail:
| | - Melina West
- Department of Psychological Sciences, University of Connecticut, Connecticut, United States of America
| | | | - Eli Somer
- School of Social Work, University of Haifa, Israel
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21
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Jansson-Fröjmark M, Harvey AG, Flink IK. Psychometric properties of the Insomnia Catastrophizing Scale (ICS) in a large community sample. Cogn Behav Ther 2019; 49:120-136. [PMID: 30896297 DOI: 10.1080/16506073.2019.1588362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The purpose was to investigate the psychometric properties of the Insomnia Catastrophizing Scale (ICS) including factorial validity and internal consistency as well as discriminative and convergent validity. Associations with sleep parameters and daytime impairment are also examined. Drawn from a randomly selected sample of the general population, 1615 participants completed a survey on insomnia-related nighttime and daytime symptoms, health outcomes and psychological processes, including the ICS. A one-factor solution was supported for both the nighttime catastrophizing (11 items) and daytime catastrophizing (6 items) subscales. Both subscales displayed high internal consistencies (α > 0.90) and accounted for 59.1-70.1% of the variance. The insomnia disorder group had significantly higher scores than participants without insomnia on the two subscales and on the individual items. Cutoffs were established for both subscales with acceptable sensitivity and specificity. Both subscales displayed adequate convergent validity with measures indexing worry, cognitive pre-sleep arousal and anxiety. The two subscales were also significantly associated with nighttime and daytime insomnia symptoms. The ICS is a reliable and valid scale for the assessment of insomnia-related catastrophizing. Future research is needed to examine the test-retest reliability and treatment sensitivity of the ICS.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Ida K Flink
- Center for Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden
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22
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Puzino K, Frye SS, LaGrotte CA, Vgontzas AN, Fernandez-Mendoza J. Am I (hyper)aroused or anxious? Clinical significance of pre-sleep somatic arousal in young adults. J Sleep Res 2019; 28:e12829. [PMID: 30714242 DOI: 10.1111/jsr.12829] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Self-reported somatic arousal remains a challenging clinical construct, particularly because only a subset of patients report symptoms such as racing heart, palpitations or increased body temperature interfering with their sleep. It is unclear whether self-reported somatic arousal is a marker of hyperarousal or co-morbid clinical anxiety in individuals with insomnia. Participants included 196 young adults aged 20.2 ± 1.0 years old who were predominantly females (75%). About 39% of the sample reported subthreshold insomnia, and about 8% reported clinically significant insomnia, based on their Insomnia Severity Index. Participants completed the Pre-Sleep Arousal Scale, Beck Anxiety Inventory, Beck Depression Inventory, Arousal Predisposition Scale, and Ford Insomnia Response to Stress Test. Multivariable stepwise regression assessed which factors were independently associated with pre-sleep cognitive (Pre-Sleep Arousal Scale-Cognitive) and somatic (Pre-Sleep Arousal Scale-Somatic) arousal. Receiver-operating characteristic analysis assessed the predictive value to identify clinically significant anxiety (Beck Anxiety Inventory ≥ 20), insomnia (Insomnia Severity Index ≥ 15) and arousability (Arousal Predisposition Scale ≥ 32). Beck Anxiety Inventory (β = 0.42) was the best single correlate of Pre-Sleep Arousal Scale-Somatic, while Insomnia Severity Index (β = 0.33) was of Pre-Sleep Arousal Scale-Cognitive. A Pre-Sleep Arousal Scale-Somatic score of 12 or more identified those with clinically significant anxiety with 65% specificity and 65% sensitivity, while a cut-off score of 14 increased its sensitivity (86%). Self-reported pre-sleep somatic arousal may be an index of co-morbid clinical anxiety in individuals with insomnia. These findings aid clinicians with assessment and treatment, particularly in the absence of clinical guidelines indicating when somatically focused relaxation techniques should be included as part of multicomponent cognitive behavioural treatment of insomnia.
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Affiliation(s)
- Kristina Puzino
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sara S Frye
- College of Education, University of Arizona, Tucson, Arizona, USA
| | - Caitlin A LaGrotte
- College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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Kalmbach DA, Cheng P, Arnedt JT, Anderson JR, Roth T, Fellman-Couture C, Williams RA, Drake CL. Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education. Sleep Med 2018; 55:124-134. [PMID: 30785053 DOI: 10.1016/j.sleep.2018.11.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/19/2018] [Accepted: 11/28/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia; as well as whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious. MATERIALS AND METHODS Single-site, randomized controlled trial. 117 postmenopausal women (56.34 ± 5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to three treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at baseline, posttreatment, and six-month follow-up. RESULTS CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until six months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects. CONCLUSIONS CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov. REGISTRATION NCT01933295.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - J Todd Arnedt
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jason R Anderson
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Reg A Williams
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.
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Ruivo Marques D, Allen Gomes A, Nicassio PM, Azevedo MHPD. Pre-Sleep Arousal Scale (PSAS): psychometric study of a European Portuguese version. Sleep Med 2018; 43:60-65. [DOI: 10.1016/j.sleep.2017.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/17/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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25
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Čapková K, Vaculík M, Ellis J, Šipula M. The impact of pre-sleep arousal state and strategy to control unwanted thoughts on sleep quality. ANXIETY STRESS AND COPING 2018; 31:338-347. [PMID: 29295628 DOI: 10.1080/10615806.2017.1421843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE It has been questioned whether elevated pre-sleep cognitive arousal contributes to poor sleep or whether it is the use of maladaptive thought control strategies, used to manage this cognitive arousal, that are responsible. The study aimed to examine how these factors - cognitive arousal (with and without anxiety) and maladaptive thought control strategies contribute to perceived sleep quality (SQ). DESIGN 129 "healthy adults" (46 males, 83 females) were exposed to picture-stimuli eliciting either anxious cognitive arousal or non-anxious cognitive arousal at bedtime. The groups were then randomly split and briefed to use either a cognitive distraction or cognitive suppression thought control strategy or no instructions were given (controls). Subjective SQ was measured immediately on waking. RESULTS Induced anxious cognitive arousal was associated with lower SQ compared to non-anxious cognitive arousal. Analyses revealed a significant interaction between arousal and the strategies used to control unwanted thoughts on SQ. When experiencing anxious cognitive arousal, the strategy of distraction was associated with poorer sleep outcomes. CONCLUSION The findings suggest that the efficacy of differing thought control strategies vary depending upon whether cognitive arousal elicits anxiety or not. With that in mind, clinical implications in terms of augmenting the treatment of insomnia are discussed.
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Affiliation(s)
- Klára Čapková
- a Department of Psychology , Masaryk University , Brno , Czech Republic
| | - Martin Vaculík
- a Department of Psychology , Masaryk University , Brno , Czech Republic
| | - Jason Ellis
- b Department of Psychology , Northumbria Centre for Sleep Research, Northumbria University , Newcastle upon Tyne , UK
| | - Miroslav Šipula
- a Department of Psychology , Masaryk University , Brno , Czech Republic
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Norell-Clarke A, Tillfors M, Jansson-Fröjmark M, Holländare F, Engström I. How Does Cognitive Behavioral Therapy for Insomnia Work? An Investigation of Cognitive Processes and Time in Bed as Outcomes and Mediators in a Sample With Insomnia and Depressive Symptomatology. Int J Cogn Ther 2017. [DOI: 10.1521/ijct.2017.10.4.304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Annika Norell-Clarke
- Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden
| | - Maria Tillfors
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Fredrik Holländare
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
- University Health Care Research Centre, Region Örebro County, Örebro, Sweden
| | - Ingemar Engström
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Exelmans L, Van den Bulck J. Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal. J Clin Sleep Med 2017; 13:1001-1008. [PMID: 28728618 DOI: 10.5664/jcsm.6704] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/12/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To investigate the prevalence of binge viewing, its association with sleep and examine arousal as an underlying mechanism of this association. METHODS Four hundred twenty-three adults (aged 18-25 years old, 61.9% female) completed an online survey assessing regular television viewing, binge viewing, sleep quality (Pittsburgh Sleep Quality Index), fatigue (Fatigue Assessment Scale), insomnia (Bergen Insomnia Scale), and pre-sleep arousal (Pre-Sleep Arousal Scale). Regression analyses were conducted. Mediation analysis was performed using PROCESS Macro. RESULTS There were 80.6% who identified themselves as a binge viewer. Among those who binge viewed (n = 341), 20.2% had binge viewed at least a few times a week during the past month. Among poor sleepers (Pittsburgh Sleep Quality Index > 5), 32.6% had a poor sleep quality associated with being a binge viewer. Higher binge viewing frequency was associated with a poorer sleep quality, increased fatigue and more symptoms of insomnia, whereas regular television viewing was not. Cognitive pre-sleep arousal fully mediated these relationships. CONCLUSIONS New viewing styles such as binge viewing are increasingly prevalent and may pose a threat to sleep. Increased cognitive arousal functions as the mechanism explaining these effects. Measures of media exposure should take into account the user's level of engagement with media. Interventions aimed at (1) alerting viewers about excessive viewing duration and (2) reducing arousal before sleep may be useful ways to tackle sleep problems in binge viewers.
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Affiliation(s)
- Liese Exelmans
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Jan Van den Bulck
- Department of Communication Studies, University of Michigan, Ann Arbor, Michigan
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Henry AL, Kyle SD, Chisholm A, Griffiths CEM, Bundy C. A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis. Br J Dermatol 2017; 177:1052-1059. [PMID: 28314054 DOI: 10.1111/bjd.15469] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Research suggests that sleep disturbance is common in psoriasis. While several sleep investigations have been conducted in psoriasis populations, many have methodological shortcomings, and no study has examined multiple dimensions of sleep-wake functioning. Moreover, research has yet to be performed comprehensively examining the range of physical and psychological factors that may affect sleep in people with psoriasis. OBJECTIVES To characterize sleep disturbance using validated measures and to identify physical and psychological predictors of sleep quality in people with psoriasis. METHODS An online survey was conducted (186 respondents; mean age 39·2 years) comprising validated measures assessing sleep [Pittsburgh Sleep; Quality Index (PSQI), Berlin Questionnaire, Pre-Sleep Arousal Scale]; chronotype (Morningness-Eveningness Questionnaire); mood (Hospital Anxiety and Depression Scale); itch (5-D Itch Scale); and psoriasis severity (Simplified Psoriasis Index). Group comparisons and regression analyses were used to examine predictors of poor sleep. RESULTS The mean PSQI score was 9·2 ± 4·3, with 76·3% scoring above the threshold for poor sleep (≥ 6 on the PSQI) and 32·5% scoring 'positive' for probable obstructive sleep apnoea (OSA). Poor sleep and high likelihood of OSA were associated with more severe psoriasis (P < 0·05; η = 0·07; η2 = 0·005). Cognitive arousal (β = 0·26, P = 0·001), itch (β = 0·26, P < 0·001) and depression (β = 0·24, P = 0·001) were the most robust predictors of poor sleep quality, which, together with somatic arousal (β = 0·17, P = 0·022), accounted for 43% of variance in PSQI scores. CONCLUSIONS Poor sleep is common in psoriasis and associated with psychological and physical factors. Rates of probable OSA are also high. Given the importance of restorative sleep for health, sleep complaints should receive greater clinical attention in the management of psoriasis.
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Affiliation(s)
- A L Henry
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.,Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - S D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, U.K
| | - A Chisholm
- Department of Psychological Sciences, University of Liverpool, Liverpool, U.K
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, U.K.,Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.,Salford Royal NHS Foundation Trust, Manchester, U.K
| | - C Bundy
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, U.K.,Manchester Centre for Health Psychology, University of Manchester, Manchester, U.K.,Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
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Baron KG, Gunn HE, Wolfe LF, Zee PC. Relationships and CPAP adherence among women with obstructive sleep apnea. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0011-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Peterman JS, Carper MM, Elkins RM, Comer JS, Pincus DB, Kendall PC. The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. J Anxiety Disord 2016; 37:78-88. [PMID: 26735330 DOI: 10.1016/j.janxdis.2015.11.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/19/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
The present study examined (a) whether sleep related problems (SRPs) improved following cognitive-behavioral therapy (CBT) for youth with anxiety disorders, (b) whether variables that may link anxiety and SRPs (e.g., pre-sleep arousal, family accommodation, sleep hygiene) changed during treatment, and (c) whether such changes predicted SRPs at posttreatment. Youth were diagnosed with anxiety at pretreatment and received weekly CBT that targeted their principal anxiety diagnosis at one of two specialty clinics (N=69 completers, Mage=10.86). Results indicated that parent-reported SRPs improved from pre- to post-treatment and that treatment responders with regard to anxiety yielded greater SRP improvements than nonresponders. Parent report of bedtime resistance and sleep anxiety showed significant improvements. Youth reported lower rates of SRPs compared to their parents and did not demonstrate pre- to post-treatment changes in SRPs. Pre-sleep arousal and family accommodation decreased over treatment but did not predict lower SRPs at posttreatment. Higher accommodation was correlated with greater SRPs. Sleep hygiene evidenced no change and did not mediate links between accommodation and posttreatment SRPs.
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Cognitive Arousal, Unhelpful Beliefs and Maladaptive Sleep Behaviors as Mediators in Cognitive Behavior Therapy for Insomnia: A Quasi-Experimental Study. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9698-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hertenstein E, Nissen C, Riemann D, Feige B, Baglioni C, Spiegelhalder K. The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep. J Sleep Res 2015; 24:399-406. [DOI: 10.1111/jsr.12293] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabeth Hertenstein
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
| | - Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Center for Mental Disorders; University Medical Center Freiburg; Freiburg Germany
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Doos Ali Vand H, Gharraee B, Farid AAA, Bandi MG. Prediction of insomnia severity based on cognitive, metacognitive, and emotional variables in college students. Explore (NY) 2014; 10:233-40. [PMID: 25037666 DOI: 10.1016/j.explore.2014.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Insomnia is the most common sleep disorder whose origin is attributed to various variables. The current study aims to predict the symptoms of insomnia by investigating some of its predictors. METHODS Numerous variables such as depression and anxiety symptoms, worry, pre-sleep arousal (cognitive arousal and somatic arousal), dysfunctional cognitions, and metacognitive beliefs about sleep were assessed as insomnia predictors. A total of 400 students of Tehran University of Medical Sciences completed the Depression Anxiety Stress Scale (DASS), the Penn State Worry Questionnaire (PSWQ), the Pre-Sleep Arousal Scale (PSAS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10), the Metacognitions Questionnaire-Insomnia (MCQ-I), and the Insomnia Severity Index (ISI). RESULTS All variables were significantly correlated with insomnia symptoms (P < .001). Stepwise multiple regression analysis suggested a predictive model for insomnia including cognitive arousal, dysfunctional beliefs about sleep, metacognitive beliefs about sleep, and depressive symptoms. CONCLUSIONS The findings underline the significant role of cognitive and metacognitive variables for predicting insomnia symptoms. Moreover, the results suggest that metacognitive beliefs about sleep may need to be considered as a significant component in the context of insomnia.
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Affiliation(s)
- Hoda Doos Ali Vand
- Department of Clinical Psychology, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Banafsheh Gharraee
- Department of Clinical Psychology, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran.
| | - Ali-Asghar Asgharnejad Farid
- Department of Clinical Psychology, Tehran Institute of Psychiatry, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - MirFarhad Ghaleh Bandi
- Department of Psychiatry, Tehran Institute of Psychiatry-Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population. Behav Res Ther 2014; 54:38-48. [DOI: 10.1016/j.brat.2014.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 12/24/2022]
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Jansson-Fröjmark M, Harvey AG, Norell-Clarke A, Linton SJ. Associations between psychological factors and nighttime/daytime symptomatology in insomnia. Cogn Behav Ther 2012; 41:273-87. [PMID: 22439741 DOI: 10.1080/16506073.2012.672454] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms and nighttime and daytime symptoms. METHODS A cross-sectional examination in the general population was used. The study sample consisted of 1890 participants from the general population. The participants completed a survey on nighttime and daytime symptoms, health outcomes, and psychological factors. RESULTS Relative to poor and normal sleepers, the insomnia group had higher scores on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviors than the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviors (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance). CONCLUSION The findings indicate that psychological factors are linked to nighttime and daytime symptomatology in insomnia.
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