Prospective study of predictors and consequences of insomnia: personality, lifestyle, mental health, and work-related stressors

Examining Anxiety and Insomnia in Internship Students and Their Association with Internet Gaming Disorder

Background: Internships are a mandatory graduation requirement to help medical students transition to the work environment. Some individuals are prone to anxiety in an unfamiliar environment, which is a public concern among young adults. Here, we investigated the mechanism between internet gaming disorder and anxiety and insomnia among internship students. Methods: A convenient sample of 267 internship students was collected in a cross-sectional study module between 17 July and 27 December 2022. The survey contained a 7-item Generalized Anxiety Disorder (GAD-7), Athens Insomnia Scale (AIS), and Internet Gaming Disorder Scale-Short-Form (IGDS9-SF). The association was estimated using Pearson's correlations, and network analysis was performed to characterize these associations. Results: Our results indicate that about 60% of participants exhibited mild to severe anxiety and insomnia, while 2.28% showed symptoms of internet gaming disorder. Also, we found a moderate association between anxiety and insomnia. An item-level analysis indicated that GAD_1 "feeling anxious" and GAD_5 "unable to sit still" are essential for gaming, and that GAD_2 "uncontrollable worrying" is crucial for insomnia. This indicated an interplay between these items, supported by our centrality analysis, where we found that GAD_1 and GAD_2 depicted high centrality. Conclusions: We found high rates of anxiety and insomnia in internship students and the association between selected symptoms of anxiety and insomnia. At the same time, low rates of internet gaming disorder could be attributed to a lack of time for entertainment and an increased awareness of its risks. Given these findings, an awareness of anxiety and insomnia risk should be emphasized.

Risk factors and consequences of mental health problems in nurses: A scoping review of cohort studies

Mental health problems in nurses are prevalent and impairing. To date, no literature has comprehensively synthesised cohort evidence on mental health among nurses. This scoping review aimed to synthesise the existing literature on the risk factors and consequences of mental health problems in nurses. A systematic search was conducted on PubMed, EMBASE, Epistemonikos database, Web of Science, CINAHL, and PsycINFO from inception to March 2023. We identified 171 cohort studies from 16 countries, mostly (95.3%) from high-income economies. This review indicated that nurses worldwide encountered significant mental health challenges, including depression, cognitive impairment, anxiety, trauma/post-traumatic stress disorder, burnout, sleep disorder, and other negative mental health problems. These problems were closely related to various modifiable risk factors such as nurses' behaviours and lifestyles, social support, workplace bullying and violence, shift work, job demands, and job resources. Moreover, nurses' mental health problems have negative effects on their physical health, behaviour and lifestyle, occupation and organisation, and intrapersonal factors. These findings provided an enhanced understanding of mental health complexities among nurses, and shed light on policy enactment to alleviate the negative impact of mental health problems on nurses. Addressing mental health among nurses should be a top priority.

Working From Home, Work-Life Balance, and Depression/Anxiety Among Korean Workers in the COVID-19 Pandemic Period: A Mediation Analysis

OBJECTIVE

We aimed to investigate the association between working from home (WFH), depression/anxiety, and work-family conflict (WFC) among Korean workers during the COVID-19 pandemic.

METHODS

We surveyed a total of 1074 workers online. Depression and anxiety were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and Beck Anxiety Inventory (BAI). Mediating effects of WFC on the relationship between WFH and depression/anxiety were examined.

RESULTS

The WFH group had higher depression and anxiety scores than the daily commuting group. As WFC increased, the CES-D and BAI scores also increased. A possible mediating effect of WFC on the relationship between WFH and high CES-D and BAI scores was found.

CONCLUSION

We observed a significant difference in depression/anxiety between WFH and daily commute workers, which was mediated by WFC, especially for young, child-growing, and precarious workers.

Examining the Impact of Different Components of Sleep Quality on Anxiety Among Family Carers of People with Dementia

Existing interventions for family carers of people with dementia tend to be less effective for anxiety than for depression. Therefore, identifying factors affecting carer anxiety is important to inform future interventions. This study conducted 2 multiple regression analyses using a sample of 91 family carers. The first regression model (∆R² = .24), exploring the impact of demographic variables and carer stressors, demonstrated that hours of caring (β = .33) and overall sleep quality (β = .28) were significant predictors of anxiety. To further investigate the impact of sleep quality, the second model (∆R² = .24) focussed on exploring the differential impact of various components of sleep quality on anxiety. Findings demonstrated that subjective sleep quality (β = .33) and sleep disturbances (β = .22) were significant predictors. Hours of caring per week, subjective sleep quality and sleep disturbances seem to be critical for treating anxiety in family carers. Future studies should investigate whether targeting these variables could improve carer anxiety.

Internet delivered, non-inferiority, two-arm, assessor-blinded intervention comparing mindfulness-based stress reduction and cognitive-behavioral treatment for insomnia: a protocol study for a randomized controlled trial for nursing staff with insomnia

BACKGROUND

Insomnia and poor sleep quality are highly prevalent conditions related to coronavirus disease 2019 (COVID-19) complications among clinical nurses. Although cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment, CBT-I suffers from several major drawbacks. This study investigates whether the application of the internet-delivered mindfulness-based stress reduction (iMBSR) intervention will produce effects that are non-inferior to the internet-delivered CBT-I (iCBT-I) intervention in reducing the severity of insomnia in clinical nurses with insomnia at the end of the study.

METHODS

This study protocol presents an internet-delivered, parallel-groups, assessor-blinded, two-arm, non-inferiority randomized controlled trial. The primary outcome is sleep quality, assessed by the Insomnia Severity Index. Secondary outcomes include depression, dysfunctional beliefs, five facets of mindfulness, and client satisfaction.

CONCLUSION

It is expected that this study may address several gaps in the literature. The non-inferiority study design is a novel approach to evaluating whether a standardized, complementary treatment (i.e., MBSR) is as practical as a gold standard treatment rather than its potential benefits. This approach may lead to expanded evidence-based practice and improve patient access to effective treatments.

TRIAL REGISTRATION

Trial registration number: ISRCTN36198096 . Registered on 24th May 2022.

Work-family conflict, financial issues and their association with self-reported health complaints among ready-made garment workers in Bangladesh: a cross-sectional study

OBJECTIVES

This study aims to quantify the degree of work-family conflict (WFC) and financial issues among ready-made garment (RMG) workers in Bangladesh and to investigate their potential associations with self-reported health outcomes.

METHODS

We conducted a cross-sectional survey among 1118 RMG workers in labor colonies in Dhaka, Bangladesh, in February and March 2021. Descriptive analyses were performed to characterize WFC (i.e., family life disturbing the job or facing problems in family due to the job) and financial issues (i.e., savings, debt, financial obligations, financial support). We ran multivariable Poisson regression models to examine possible associations between WFC and financial issues and workers' health (self-reported general health and 10 specific health complaints).

RESULTS

We found low levels of WFC, low levels of savings, moderate levels of debt, and high levels of financial obligations: virtually all workers agreed they had to keep their job to financially support their spouse, children or other relatives. Only about a third of workers expected they would be able to receive financial support in case of a job loss. Work-family conflict was positively associated with poor health but not consistently with specific symptoms. Financial support was negatively associated, whereas being indebted was weakly positively associated with poor health.

CONCLUSIONS

Our findings suggest low levels of WFC among RMG workers but high levels of financial obligations. Work-family conflict was positively associated with poor health, but not consistently with specific symptoms. Being indebted was weakly positively associated with poor health. Future prospective studies are needed to confirm these findings.

Workplace bullying and tiredness at work: A cross-lagged prospective study of causal directions and the moderating effects of a conflict management climate

OBJECTIVES

To prospectively investigate the reciprocal associations between tiredness at work (TAW) and exposure to bullying behaviors and to determine the role of conflict management climate (CMC) as a moderator of these associations.

METHODS

A two-wave national probability sample of employees in Sweden (18 months between waves, 921 participated at both waves) measuring TAW, workplace bullying, and CMC. Structural equation modelling was used to test four hypotheses about the longitudinal associations between feeling tired at work and bullying, and CMC as a moderator for the two directions.

RESULTS

In the analyses of cross-lagged effects, tiredness was significantly associated with an increase in subsequent bullying (β = 0.08, P = .01). Exposure to bullying was not associated with changes in tiredness. CMC moderated the association between tiredness and subsequent bullying (β = -0.13, 95% CI [-0.19, -0.08]), showing an increased risk of exposure to bullying behaviors following tiredness when CMC was low and decreased risk when CMC was high.

CONCLUSIONS

TAW is a risk factor for subsequent bullying. Finding ways to help employees to reduce tiredness not only will help them perform better at work but also reduce the risk of them becoming targets of bullying. A strong CMC can act as a buffer if a tired person provoke aggression from co-workers.

Associations between burnout symptoms and sleep among workers during the COVID-19 pandemic

Background

Methods

Results

Conclusion

Stability and Change of the Personality Traits Languidity and Flexibility in a Sample of Nurses: A 7-8 Years Follow-Up Study

The traits languidity (tendency to become tired/sleepy upon losing sleep) and flexibility (ability to sleep and work at odd times) have been implicated in shift work tolerance. However, there is a dearth of knowledge about their temporal stability. The aim of the present study was to explore these traits during a long follow-up (FU) period and identify factors related to potential changes in trait scores over time. In all, 1,652 nurses completed the Circadian Type Inventory-revised (CTI-r), which measures languidity and flexibility, at both 2008/2009 (baseline, BL) and again in 2016 (FU). The latent scores of these two constructs at BL, in addition to age, sex, childcare responsibility, marital status, night work status, and insomnia status, were regressed on the corresponding latent scores at follow-up using a structural equation modeling (SEM) approach. Stability was found for both languidity (rho = 0.59) and flexibility (rho = 0.58). Both composite scores declined significantly from baseline (20.62 and 12.48) to follow-up (19.96 and 11.77). Languidity at baseline was positively associated with languidity at follow-up (β = 0.89, p < 0.009). Undertaking childcare responsibility between baseline and follow-up was inversely related to languidity at follow-up (β = −0.09, p < 0.05). Starting night work was positively related to languidity at follow-up (β = 0.06, p < 0.05). Developing insomnia between baseline and follow-up (β = 0.15, p < 0.05) was positively, whereas remitting from insomnia during the same period was negatively (β = −0.11, p < 0.01) associated with languidity at follow-up. Flexibility at baseline was positively associated with flexibility at follow-up (β = 0.64, p < 0.05). Having childcare responsibility at baseline, but not at follow-up was inversely related to flexibility at follow-up (β = −0.05 p < 0.05). Becoming cohabitant with a partner between baseline and follow-up (β = −0.07, p < 0.05) was negatively associated with flexibility at follow-up. Starting night work between baseline and follow-up (β = 0.17, p < 0.01) and reporting night work at both baseline and follow-up (β = 0.18, p < 0.01) were both positively associated with flexibility at follow-up, whereas stopping working nights was negatively (β = −0.09, p < 0.05), associated with flexibility at follow-up. The personality traits languidity and flexibility show fairly high stability, albeit the mean scores were significantly reduced during the 7–8 years follow-up period. The results suggest that these personality traits are partly modifiable.

Dose-response effects of light therapy on sleepiness and circadian phase shift in shift workers: a meta-analysis and moderator analysis

Light therapy has been considered to be effective in mitigating sleepiness and regulating circadian phase shift in shift workers. However, the effective treatment dose of light therapy remains undetermined. We performed a meta-analysis of randomized experimental studies to determine the effect of light therapy doses on sleepiness and circadian phase shift in shift workers. An article search was performed in 10 electronic databases from inception to June 2020. Two raters independently screened and extracted data and reached consensus. Twenty-one eligible studies were included. Analyses were performed using random-effects models. Light therapy exerted significantly small to medium effects on sleepiness and large treatment effects on circadian phase shift. Moderator analyses performed with subgroup and metaregression analyses revealed that medium-intensity light therapy for a shorter duration more effectively reduced sleepiness at night, whereas higher-intensity light therapy more effectively induced phase shifting, but the required treatment duration remained inconclusive. This study provides evidence regarding the effect of light therapy in reducing sleepiness and shifting circadian phase in shift workers. Exposure to medium-intensity light for a short duration at night reduced sleepiness, whereas exposure to high-intensity light improved sleep by shifting their circadian phase.

International study of the prevalence and factors associated with insomnia in the general population

OBJECTIVES

Insomnia is a public health problem with many repercussions. It affects a significant proportion of the general population worldwide, but the estimated prevalences in different countries are difficult to compare due to the use of heterogeneous methodologies. The objectives of the study were to compare the prevalence of insomnia in the general population in different sites around the world and to identify sociodemographic and mental health associated factors, using the same tool and within a single study.

METHODS

This multicenter cross-sectional study is based on the Mental Health in the General Population survey (MHPG). It included several sites in France and 12 countries around the world with a representative sampling of the general population. The prevalence of short-term insomnia disorder was estimated by the occurrence within one month of at least one symptom, at a minimum frequency of three per week, with repercussions on everyday life.

RESULTS

Out of the 57,298 participants, 11.3% had a diagnosis of short-term insomnia disorder, with significant differences in prevalence between sites, ranging from 2.3% to 25.5%. Insomnia was significantly related to having mood disorders, anxiety disorders, substance use disorders and psychotic disorders. Insomnia was also more common among women, older adults, working participants and those who practice a religion.

CONCLUSIONS

The prevalence of insomnia was highly variable between sites, but the predictors appeared to be the same everywhere. Insomnia seemed to be more related to the presence of mood and anxiety disorders than a site-specific effect and thus may be a good indicator of mental health.

Prevalence of Shift Work Disorder: A Systematic Review and Meta-Analysis

Objectives: No systematic review or meta-analysis concerning the prevalence of shift work disorder (SWD) has been conducted so far. The aim was thus to review prevalence studies of SWD, to calculate an overall prevalence by a random effects meta-analysis approach and investigate correlates of SWD prevalence using a random-effects meta-regression.

Methods: Systematic searches were conducted in ISI Web of Science, PsycNET, PubMed, and Google Scholar using the search terms “shift work disorder” and “shift work sleep disorder.” No restrictions in terms of time frame were used. Included studies had to present original data on the prevalence of SWD in an occupational sample published in English. A total of 349 unique hits were made. In all, 29 studies were finally included from which two authors independently extracted data using predefined data fields. The meta-regression included four predictors (diagnostic criteria, study country, type of workers, and sample size).

Results: The overall prevalence of SWD was 26.5% (95% confidence interval = 21.0–32.8). Cochran Q was 1,845.4 (df = 28, p < 0.001), and the I² was 98.5%, indicating very high heterogeneity across the observed prevalence estimates. Diagnostic criteria (International Classification of Sleep Disorders-2 = 0, International Classification of Sleep Disorders-3 = 1) and sample size were inversely related to SWD prevalence.

Conclusions: The prevalence of SWD was high across the included studies. The between-study disparity was large and was partly explained by diagnostic criteria and sample size. In order to facilitate comparative research on SWD, there is a need for validation and standardization of assessment methodology as well as agreement in terms of sample restrictions.

Shift work disorder and related influential factors among shift workers in China

BACKGROUND

Shift work may cause insomnia and sleepiness in individuals. The present study aimed to exam shift work disorder (SWD), and to investigate their associations with individual characteristics.

METHODS

A total of 1833 shift workers were assessed using the Pittsburg Sleep Quality Index, Epworth Sleepiness Scale (ESS), Composite Scale of Morningness (CSM), Circadian Type Inventory (CTI), Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Anxiety Inventory (BAI) and other self-compiled socio-demographic questionnaires.

RESULTS

In the current sample, 17.1% shift workers have experienced insomnia symptoms, 20.9% were tested for daytime sleepiness, and 19.9% were categorized as having SWD. Logistics regressions revealed that history of mental disorders (OR = 2.04, 95% CI = 1.30-3.21), chronic physical illness (OR = 1.53, 95% CI = 1.17-1.99), CES-D scores (OR = 1.03, 95% CI = 1.02-1.05), BAI scores (OR = 1.04, 95% CI = 1.03-1.06), languid/vigorous tendencies (OR = 1.06, 95% CI = 1.03-1.10) were positively associated with the onset of SWD, while morningness (OR = 0.97, 95% CI = 0.94-0.99) decreased the odds of SWD onset.

CONCLUSIONS

These findings suggested that attention should be drawn to individuals with mental and chronic diseases in when scheduling work shifts. While SWD and its associates should be considered when providing psychological services to shift workers.

Relationship Between Shift Intensity and Insomnia Among Hospital Nurses in Korea: A Cross-sectional Study

Objectives

This study explored the relationship between shift intensity and insomnia among hospital nurses.

Methods

The participants were 386 female hospital nurses who underwent a special health examination for night workers in 2015. The Korean Insomnia Severity Index (ISI), indices of shift work intensity, and other covariates such as amount of exercise, level of alcohol consumption, employment duration, and hours worked were extracted from the health examination data. The indices for shift intensity were (1) number of 3 consecutive night shifts and (2) number of short recovery periods after a previous shift, both assessed over the prior 3 months. Multiple logistic regression analysis adjusted for the aforementioned covariates was performed to evaluate the association of shift intensity with insomnia, defined as an ISI score of ≥8.

Results

The nurses with insomnia tended to be younger (p=0.029), to have worked 3 consecutive night shifts more frequently (p<0.001), to have experienced a greater number of short recovery periods after the previous shift (p=0.021), and to have worked for more hours (p=0.006) than the nurses without insomnia. Among the other variables, no statistically significant differences between groups were observed. Experiences of 3 or more consecutive night shifts (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.29 to 4.20) and 3 or more short recovery periods (OR, 2.01; 95% CI, 1.08 to 3.73) were associated with increased odds of insomnia.

Conclusions

The results suggest that decreasing the shift intensity may reduce insomnia among hospital nurses working rotating shifts.

The Influence of Changes in Work Stressors and Coping Resources on Sleep Disturbances: Evidence from the OHSPIW Cohort Study

STUDY OBJECTIVES

We investigated whether changes in psychosocial work conditions affect the risk of sleep disturbances.

METHODS

Data pertaining to 2738 males and 1431 females were obtained from the Occupational Health Study of Petroleum Industry Workers (OHSPIW), a prospective cohort study of Chinese petroleum industry workers. The subjects were assessed with regard to work-related stressors, coping resources and sleep disturbances at baseline (2012) and follow-up (2018). The variations in work stressors and coping resources, which were assessed using the Occupation Stress Inventory-Reviewed (OSI-R), were calculated. Sleep disturbances were evaluated with the self-reported Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Increased work stressors (OR=1.57, 95% CI=1.24-1.99) and decreased coping resources (OR=2.03, 95% CI=1.48-2.78) were correlated with the likelihood of sleep disturbances in male and female workers. The primary risk factors included high role overload, increased responsibility, enhanced physical environment stressors, reduced self-care, and reduced rational coping. A reduction in work stressors was a protective factor against sleep disturbances in females only (OR=0.63, 95% CI=0.45-0.88). Coping resources had a modifying effect on the relationship between increased work stressors and sleep disturbances, with increased coping resources being associated with a lower odds of increased works stressors on sleep disturbances (OR=1.29, 95%CI=1.01-1.66) than decreased coping resources (OR=3.60, 95%CI=1.10-11.81).

CONCLUSIONS

Changes in work stressors and coping resources have a significant influence on the risk of sleep disturbances. Our findings highlight important precautionary strategies to abate adverse psychosocial working environments and to strengthen coping resources to prevent work-related sleep disturbances.

Associations between exposure to workplace bullying and insomnia: a cross-lagged prospective study of causal directions

Objective

Workplace bullying has been established as a significant correlate of sleep problems. However, little is known regarding the causal direction between bullying and sleep. The aim of this study was to examine temporal relationships between bullying and symptoms of insomnia.

Methods

Reciprocal and prospective associations between exposure to workplace bullying and symptoms of insomnia were investigated in a national probability sample comprising 1149 Norwegian employees. Data stemmed from a two-wave full panel survey study with a 6-month time interval between the baseline and follow-up assessments. Models with stabilities, forward-, reverse-, and reciprocal associations were tested and compared using Structural Equation Modelling. Analyses were adjusted for age, gender, and the stability in the outcome variables over time. Workplace bullying was assessed with the nine-item Short Negative Acts Questionnaire. Insomnia was assessed with a previously validated three item scale reflecting problems with sleep onset, sleep maintenance, and early morning awakening.

Results

The forward association model, which showed that exposure to workplace bullying prospectively increased levels of insomnia (b = 0.08; p < 0.001), had best fit with the data [CFI = 0.94; TLI = 0.93; RMSEA = 0.049 (0.046–0.052)]. The reverse association model where insomnia influences risk of being subjected to bullying was not supported.

Conclusion

Workplace bullying is a risk factor for later insomnia. There is a need for further studies on moderating and mediating variables that can explain how and when bullying influence sleep.

Impact of sleep quality on post-stroke anxiety in stroke patients

OBJECTIVE

To explore whether poor sleep is associated with post-stroke anxiety (PSA) in Chinese patients with acute ischemic stroke (AIS) and to verify whether poor sleep is a predictor of PSA.

METHODS

A total of 327 patients with AIS were enrolled and followed up for 1 month. Sleep quality within 1 month before stroke was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at admission. The patients were divided into the poor sleep group (PSQI > 7, n = 76) and good sleep group (PSQI ≤ 7, n = 251). One month after stroke, patients with obvious anxiety symptoms and a Hamilton Anxiety Scale score >7 were diagnosed with PSA.

RESULTS

Eighty-seven patients (26.6%) were diagnosed with PSA. Compared to the good sleep quality group, the incidence of PSA in patients with poor sleep quality was higher (42.1% vs. 21.9%, p = .001). Poor sleep quality is more common in patients with PSA (35.6% vs. 18.8%, p = .001). A logistic regression analysis indicated that poor sleep quality was significantly associated with PSA (OR: 2.265, 95% CI: 1.262-4.067, p = .003). After adjusting for conventional and identified risk factors, poor sleep quality was found to be independently associated with PSA (OR: 2.676, 95% CI: 1.451-4.936, p = .001).

CONCLUSIONS

Poor sleep quality before stroke was associated with PSA and may be an independent risk factor of PSA 1 month after AIS onset.

The Association Between Shift Work And Affective Disorders: A Systematic Review

Atypical working time patterns are known to be associated with adverse physical health consequences. The impact of chronic exposure to shift work on psychological wellbeing and mental health is also reported, but not fully appreciated. We conducted a systematic review of the literature on the association between shift work and affective disorders using the electronic databases Medline, PsycINFO, Embase, Web of Science and Google Scholar. Data extracted included detailed characteristics of shift work, the affective disorders under study, and the population targeted. Some 25 extracted articles satisfied all inclusion and exclusion criteria. Findings of these articles reveal shift work is associated with increases in depressive symptoms (12 studies), anxiety (2 studies), and depression and anxiety (7 studies). Only three studies found no association between shift work and depression. The findings of this review suggest that shift work increases the symptoms of depression and anxiety.

Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study

Background

Over 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep.

Objective

We conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep.

Methods

Participants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as “good sleepers,” “poor sleepers,” or “those with insomnia diagnosis.” Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance.

Results

There was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ²₂=1548.8, P<.001), reduce depression or anxiety (χ²₂=15.5, P<.001), or improve overall health (χ²₂=57.6, P<.001). Respondents with insomnia used Calm most often (mean 5.417 days/week, SD 1.936), followed by poor sleepers (mean 5.043 days/week, SD 2.027; F₂=21.544, P<.001). The most common time to use Calm was while lying down to sleep (7607/9686, 78.54%), and bedtime use was more common among poor sleepers and those with insomnia (χ²₂=382.7, P<.001). Compared to good and poor sleepers, those with insomnia were more likely to use Calm after waking up at night (χ²₂=410.3, P<.001). Most participants tried to use Calm on a regular basis (5031/8597, 58.52%), but regular nighttime use was most common among those with insomnia (646/977, 66.1%), followed by poor sleepers (4040/6930, 58.30%; χ²₂=109.3, P<.001).

Conclusions

Of the paying subscribers to Calm who have used one of the sleep components, approximately 90% have sleep difficulties, and 77% started using Calm primarily for sleep. These descriptive data point to areas of focus for continued refinement of app features and content, followed by prospective trials testing efficacy of consumer-based meditation mobile apps for improving sleep.

Insight into the relationship between sleep characteristics and anxiety: A cross-sectional study in indigenous and minority populations in northeastern Greece

A cross-sectional population-based study was conducted in order to evaluate the association of sleep characteristics with anxiety disorders using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants between 19 and 86 years old were enrolled in our study. Anxiety symptoms were assessed using the Zung Self-rating Anxiety Scale. Participants self-reported their daily sleep habits and filled in the following scales: Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of anxiety was 33.6%. Anxiety symptoms were more prominent among minority groups. Subjects with anxiety reported shorter sleep duration and reduced sleep efficiency. After adjusting for all possible confounders, they were five times more likely to exhibit short sleep duration (≤6h) and 0.60 times less likely long sleep duration (>8h). These relations remained significant in both genders, but were more pronounced among men. Moreover, anxiety was associated with excessive daytime sleepiness, insomnia, poor sleep quality and higher risk of obstructive sleep apnea (OSA). Results highlight the association of sleep disturbances with anxiety disorders and call for conduction of larger scale prospective studies in order to assess causality on the clinically important relationship between sleep characteristics and anxiety disorders.

Workplace violence and health in human service industries: a systematic review of prospective and longitudinal studies

OBJECTIVES

To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.

METHODS

The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type: prospective or longitudinal in articles published 1990-August 2019. Quality assessment was performed based on a modified version of the Cochrane's 'Tool to Assess Risk of Bias in Cohort Studies'.

RESULTS

After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.

CONCLUSION

There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.

Efficacy and Safety of Jiawei Suanzaoren Decoction Combined with Lorazepam for Chronic Insomnia: A Parallel-Group Randomized Controlled Trial

Background

Chronic insomnia is a major public health problem, but there are limited effective therapies. Jiawei Suanzaoren Decoction (JW-SZRD) has been used as an alternative option for treating insomnia. This study aimed to investigate the long-term efficacy and safety of JW-SZRD in combination with lorazepam for chronic insomnia.

Methods

A total of 207 participants were analyzed in this study. The treatment group (TG) received JW-SZRD and lorazepam orally, and the control group (CG) received lorazepam alone. The Insomnia Severity Index (ISI), the Self-Rating Depression Scale (SDS), the Self-Rating Anxiety Scale (SAS), and the Somatic Self-rating Scale (SSS) were evaluated at baseline, weeks 4, 8, and 12. The MOS 36-item Short Form Health Survey (SF-36) was assessed at baseline and week 12. Adverse effects (AEs) were evaluated by the Treatment Emergent Symptom Scale (TESS).

Results

Both TG and CG showed obvious improvements in the sleep onset latency (SOL) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (d = 1.28). The ISI reduction rate in TG was higher than that in CG at weeks 4, 8, and 12 (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (P=0.001 and 0.005) and total sleep time (TST) (

Conclusion

The combination of JW-SZRD with lorazepam can significantly improve sleep quality with fewer AEs. It is an effective treatment and superior to lorazepam alone for chronic insomnia.

The Associations between Problematic Social Networking Site Use and Sleep Quality, Attention-Deficit Hyperactivity Disorder, Depression, Anxiety and Stress

Social networking sites (SNSs) are now used by billions of users worldwide and can help facilitate communication and the sharing of information. However, there is evidence that problematic SNS use (PSNSU) can have negative effects on health. The present study examined the associations between PSNSU, sleep quality, attention-deficit/hyperactivity disorder (ADHD), depression, anxiety and stress among SNS users. A total of 638 SNS users (mean age = 32.03 years, SD = 10.08) completed an online survey comprising instruments assessing SNS addiction, sleep quality, ADHD, depression, anxiety and stress. Regression analysis indicated that the factors of age (β = − .24, p < .01), relationship status (i.e., being in a relationship) (β = − .09, p < .05), ADHD (β = .43, p < .01) and anxiety (β = .12, p < .01) explained 23.9% of the variance in problematic SNS use. Bivariate correlations identified moderate positive correlations between PSNSU, poor sleep quality (r = .24, p < .01, R2 = .06), ADHD (r = .47, p < .01, R2 = .22), depression (r = .32, p < .01, R2 = .10), anxiety (r = .38, p < .01, R2 = .14) and stress (r = .34, p < .01, R2 = .12). The study demonstrated that PSNSU was associated with psychopathological and psychiatric disorders symptoms, the findings will help inform future interventions for reducing and tackling PSNSU.

Sleep Problems and Workplace Violence: A Systematic Review and Meta-Analysis

Background: This systematic review with meta-analysis was carried out to study the relationship between workplace violence and sleep problems.

Methods: The PRISMA statement was used to conduct a systematic search of the literature on PubMed/MEDLINE, Scopus, Sociological abstract, DOAJ, Web of Science, and Google Scholar databases. Of the original number of 749 studies, 34 were included in the systematic review, and 7 in the meta-analysis.

Results: A total of 119,361 participants from 15 different countries took part in these studies which were published between 1999 and 2019. Significant heterogeneity was observed among the studies (I² = 96%). In a random-effects meta-analysis model, pooled odds ratio (OR) analysis revealed that there was a direct relationship between occupational exposure to violence and sleep problems (OR = 2.55; 95% CI = 1.77–3.66). According to the GRADE guidelines, the quality of evidence of the association was low.

Conclusions: The findings of this study demonstrate that occupational exposure to physical, verbal, or sexual violence is associated with sleep problems. Further research on the relationship between violence and sleep is needed so that appropriate measures can be taken to prevent violence and improve sleep hygiene in the workplace.

Trial Registration Number: PROSPERO International prospective register of systematic reviews (CRD42019124903) February 9, 2019.

Effects of individual characteristics on insomnia severity trajectory among nurses: A prospective longitudinal study

AIMS

To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses.

BACKGROUND

The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited.

METHODS

This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modelling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously.

RESULTS

Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < .001).

CONCLUSIONS

Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies have an opportunity to investigate the reason for the effects of the educational level on the pattern of insomnia.

IMPLICATIONS FOR NURSING MANAGEMENT

Considering nurses' occupational stress and educational level would lead more effective management of stress and insomnia in newly graduated nurses.

Wellness and sleep quality in Korean nursing students: A cross-sectional study

BACKGROUND

Nursing students often experience stress and related sleep disturbances in striving to meet their academic needs. Wellness is the optimal state of health required to perform their roles successfully.

AIM

This study aimed to examine the relationship between wellness and sleep quality among nursing students in South Korea.

METHODS

We conducted a descriptive and correlational study, using standardized tools assessing sleep quality and wellness. Participants were recruited through convenience sampling. We surveyed 237 nursing students from two Korean universities, who agreed to participate in this study and completed a self-reported questionnaire between June 2017 and March 2018. The online questionnaire collected data on general information about the participants, their wellness, and their sleep quality. Data were analyzed using descriptive statistics, Mann-Whitney U test, chi-square test and correlation analyses.

RESULTS

We found a significant difference in wellness between the good-quality and poor-quality sleep groups and a positive correlation between nursing students' wellness and sleep quality.

CONCLUSIONS

The findings suggest that improving sleep quality is important for enhancing wellness among nursing students. Therefore, academic efforts are needed to improve nursing students' sleep quality and maximize their overall wellness and positively impact patient care.

Locus of Control Moderates the Relationship Between Exposure to Bullying Behaviors and Psychological Strain

Workplace bullying is regarded as one of the most devastating stressors at work for those targeted, and the bullying-mental health relationship is well-documented in the literature, even under lower levels of exposure. However, less is known about when and for whom these negative behaviors have more effect. Perceived control over outcomes in life (i.e., internal locus of control) has normally been related to good health and well-being, while relying on chance and/or powerful others (i.e., external locus of control) have been related to stress and poor health. In situations with reduced individual control like bullying, however, these mechanisms may act differently. Hence, the aim of the present study was to investigate whether internal and external locus of control, respectively, moderates the bullying-mental health relationship. Data were gathered in 2014-2015 from 1474 Russian employees (44% response rate), and analyzed using Mplus and SEM modeling. Included measurement scales were the Negative Acts Questionnaire-Revised, the General Health Questionnaire-12, and Levenson's Locus of Control scale. Although the prevalence of high intensity bullying was low, the results showed the expected positive relationship between exposure to bullying behaviors and psychological strain. Furthermore, this relationship was moderated by locus of control. In line with our expectations, internal locus of control did not have the generally assumed positive effect on strain when exposed to bullying behaviors. On the other hand, external locus of control seems relatively beneficial when facing bullying behaviors. The results of this study thus support that exposure to bullying and its associated behaviors are unique stressors where personal characteristics seem to play a different role than normally expected when facing other kinds of stressors.

Insomnia as a Partial Mediator of the Relationship Between Personality and Future Symptoms of Anxiety and Depression Among Nurses

Background: This study investigates insomnia as a partial mediator in the relationship between personality and symptoms of anxiety and depression.

Methods: The study is based on partly longitudinal data from the ongoing cohort study “Survey of Shift work, Sleep, and Health” (SUSSH) among Norwegian nurses, a survey examining the work situation and health status of Norwegian nurses measured with annual questionnaires. The present study uses data collected in 2012 (Wave 4), 2013 (Wave 5), and 2014 (Wave 6). The final sample at Wave 6 consisted of 2002 participants, of which 91% were females. The questionnaires included items measuring, among others, demographic variables, work time schedule, insomnia (Bergen Insomnia Scale), personality (Mini-IPIP) and anxiety and depression (Hospital Anxiety and Depression Scale).

Results: Extraversion and conscientiousness had no significant direct or indirect association with insomnia, anxiety or depression. Neuroticism and insomnia had direct associations to future symptoms of anxiety and depression. Insomnia was also a significant partial mediator of the relationship between both neuroticism and anxiety, and neuroticism and depression, meaning that neuroticism had an indirect relation to symptoms of anxiety and depression through insomnia. When adjusting for previous symptoms of anxiety and depression at Wave 5, insomnia was no longer a significant mediator between neuroticism and anxiety, and only marginally mediated the relationship between neuroticism and depression.

Conclusion: The results showed that insomnia may act as a mediator between neuroticism and symptoms of anxiety and depression, but the indirect relationship between neuroticism and anxiety and depression through insomnia is considerably weaker than the direct association. Hence, the mediating effect of insomnia should be interpreted with caution. The sample mainly consisted of female nurses, and the generalizability of the findings to male dominated occupations is limited. Findings from the present study highlight the importance of an integrated approach and strengthen the understanding of how personality and psychopathology are connected.

Divergent concurrent and lagged effects of the reciprocal relation between work-nonwork interactions and sleep disturbance

STUDY OBJECTIVES

Work-nonwork interactions and sleep disturbances are found to be important predictors of well-being and job performance outcomes. However, little is known about the mutual interrelations of the interactions between life domains and disturbed sleep over short and long periods of time.

METHODS

In total, 4079 representative individuals of the Swedish working population completed three subsequent waves of surveys with a time interval of 2 years (i.e. longitudinal design).

RESULTS

Concurrent, cross-lagged, and reverse directionality effects were simultaneously examined using autoregressive longitudinal path analysis. Contemporarily, interference between work and nonwork increased sleep disturbances, whereas work-nonwork enhancement decreased sleep disturbances. From one time point to the other, work-nonwork interference negatively related to sleep disturbances, and work-nonwork enhancement was mostly no longer (or positively) related to sleep disturbances. Over time sleep disturbances, in turn, predicted more interference and less enhancement between both life domains.

CONCLUSIONS

The results highlight that problematic work-nonwork interactions (i.e. high work-nonwork interference and low work-nonwork enhancement) disturb an individual's sleep in the short term (i.e. cross-sectional). Furthermore, the results suggest that individuals adapt to negative work-nonwork interactions over time, but that sleep disturbances impair an individual's work-nonwork interactions 2 years later.

Omega-3 polyunsaturated fatty acids and psychological intervention for workers with mild to moderate depression: A double-blind randomized controlled trial

BACKGROUND

This study assessed whether a combined intervention of omega-3 polyunsaturated fatty acids (PUFAs) and psychoeducation better improved mild to moderate depression in workers compared to psychoeducation alone.

METHODS

This study was a double-blinded, parallel group, randomized controlled trial that compared the intervention group, receiving omega-3 fatty acids, with a control group, receiving a placebo supplement. Participants receiving omega-3 fatty acids took 15 × 300 mg capsules per day for 12 weeks. The total daily dose of omega-3 PUFAs was 500 mg docosahexaenoic acid and 1000 mg eicosapentaenoic acid (EPA). The Beck Depression Inventory®-II (BDI-II) was used to assess the severity of depression after treatment.

RESULTS

After 12 weeks of treatment, BDI-II scores were significantly lower in the placebo and omega-3 group, when compared to their respective baseline scores (Placebo: t = - 4.6, p < 0.01; Omega-3: t = - 7.3, p < 0.01). However, after 12 weeks of treatment, we found no significant difference between both groups with respect to changes in the BDI-II scores (0.7; 95% CI, - 0.7 to 2.1; p = 0.30).

LIMITATIONS

This study did not measure blood omega-3 fatty acid concentration and presented a high-dropout rate. Moreover, our results may not be generalizable to other regions.

CONCLUSIONS

The results show that a combination of omega-3 fatty acids and psychoeducation and psychoeducation alone can contribute to an improvement in symptoms in people with mild to moderate depression. However, there is no difference between the interventions in ameliorating symptoms of depression.

Chronotype, nursing activity, and gender: A systematic review

AIM

To synthesize evidence about the effect of individual circadian preference (chronotype) and gender in the development of sleep and mood problems in nursing professionals.

BACKGROUND

Shift workers are more prone to having unhealthy habits and unfavourable clinical conditions than nonshift workers. These associations are mediated by chronotype and gender differences have also been detected.

DESIGN

A quantitative systematic review.

DATA SOURCES

Electronic searches were performed in MEDLINE, Scopus, ScienceDirect, and Web of Science from 1 July 2012 - 1 July 2017.

REVIEW METHODS

A systematic review was conducted using the Cochrane Collaboration guidelines and two quality assessment tools: the National Heart, Lung and Blood Institute and GRADE. Inclusion criteria were quantitative studies where the sample consists entirely of nurses, analysing circadian rhythms or individual chronotype or gender and sleep/mood disturbances in nursing activity. The review was reported using the PRISMA statement.

RESULTS

A total of 23 studies were included in the review (five cohort studies and 18 cross-sectional studies). Data on gender-specific attention were scarce (two studies) and showed a higher incidence of sleep problems. Female nurses with eveningness-oriented personality seem to be more prone to having sleep disorders, insomnia, fatigue, and anxiety than male and morningness ones.

CONCLUSIONS

Evidence seems to show that female nurses with an evening-oriented preference suffer more problems of insomnia, sleepiness, fatigue, and anxiety. The impact of our results may affect nurses, patient safety and the quality of clinical practice.

Acceptance of Workplace Bullying Behaviors and Job Satisfaction: Moderated Mediation Analysis With Coping Self-Efficacy and Exposure to Bullying

Previous research explored workplace climate as a factor of workplace bullying and coping with workplace bullying, but these concepts were not closely related to workplace bullying behaviors (WBBs). To examine whether the perceived exposure to bullying mediates the relationship between the climate of accepting WBBs and job satisfaction under the condition of different levels of WBBs coping self-efficacy beliefs, we performed moderated mediation analysis. The Negative Acts Questionnaire - Revised was given to 329 employees from Serbia for assessing perceived exposure to bullying. Leaving the original scale items, the instruction of the original Negative Acts Questionnaire - Revised was modified for assessing (1) the climate of accepting WBBs and (2) WBBs coping self-efficacy beliefs. There was a significant negative relationship between exposure to bullying and job satisfaction. WBB acceptance climate was positively related to exposure to workplace bullying and negatively related to job satisfaction. WBB acceptance climate had an indirect relationship with job satisfaction through bullying exposure, and the relationship between WBB acceptance and exposure to bullying was weaker among those who believed that they were more efficient in coping with workplace bullying. Workplace bullying could be sustained by WBB acceptance climate which threatens the job-related outcomes. WBBs coping self-efficacy beliefs have some buffering effects.

Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift. Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.

Working Conditions and Individual Differences Are Weakly Associated with Workaholism: A 2-3-Year Prospective Study of Shift-Working Nurses

This study focuses on individual differences and the demand-support-control model in relation to workaholism. We hypothesized that unfavorable working conditions (high job demands, low job control/decision latitude, and low social support at work) and individual differences concerning sleep/wake-related variables (high flexibility, high morningness, and low languidity) would be related to workaholism measured 2–3 years later. Survey data stemmed from a prospective cohort of shift-working nurses (N = 1,308). The results showed that social support at work was negatively related to workaholism, whereas job demands were positively related to workaholism. Flexibility in terms of time for working/sleeping was also positively related to workaholism. The analyses further revealed that workaholism was inversely associated with age as well as having a child or having a child move in. Conjointly, the independent variables explained 6.4% of the variance in workaholism, while their relative importance was small overall. After controlling for all other independent variables, high job demands had the strongest relationship (small-to-medium) with workaholism. This implies that less pressure from the external environment to work excessively hard may prevent an increase in workaholic behaviors. Overall, the study adds to our understanding of the relationships between working conditions, individual differences, and workaholism.

Insomnia as a Precipitating Factor in New Onset Mental Illness: a Systematic Review of Recent Findings

PURPOSE

We aimed to systematically review recent publications (01/2014-03/2017) with longitudinal designs allowing for the assessment of the prospective risk of insomnia on new onset mental illness in key conditions: anxiety, depression, bipolar disorder, posttraumatic stress disorder, substance use disorders, and suicide.

RECENT FINDINGS

A literature yielded 1859 unique articles meeting search criteria were identified; 16 articles met all selection criteria and reviewed with some studies reporting on more than one mental health outcome. Overall, the review supports the hypothesis that insomnia is a predictor of subsequent mental illness. The evidence is strongest for an insomnia-depression relationship. The new studies identified and reviewed add to a modest number of publications supporting a prospective role of insomnia in new onset mental illness in three areas: anxiety disorders, bipolar disorder, and suicide. The few selected new studies focused on SUD were mixed, and no studies focused on PTSD were identified that met the selection criteria. Treatment of insomnia may also be a preventive mental health strategy.

Shortened sleep fuels inflammatory responses to marital conflict: Emotion regulation matters

Sleep problems can boost inflammation and may jeopardize interpersonal functioning, risks that may be magnified in couples. This observational study examined the effects of self-reported recent sleep duration on couples' inflammation, inflammatory responses to a problem discussion, interpersonal behavior, and use of emotion regulation strategies (emotion expression, cognitive reappraisal) during conflict. People who slept less had higher stimulated interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) production after the marital problem discussion than those who slept more. However, using emotion expression and cognitive reappraisal strategies during conflict protected couples who slept less from inflammatory reactivity. Specifically, people's short sleep did not relate to inflammatory increases when they expressed their own feelings more or when their partner reappraised or expressed their emotions more. When both partners slept less, couples interacted in a more hostile way than when at least one partner slept more. These data point to the combination of short sleep and marital conflict as a novel path to heightened inflammation, a risk that partners' emotion regulation strategies may counteract. The study also highlights the role of short sleep in more negative or punishing marital behavior.

Insomnia and Personality-A Network Approach

Studies on personality traits and insomnia have remained inconclusive about which traits show the most direct associations with insomnia severity. It has moreover hardly been explored how traits relate to specific characteristics of insomnia. We here used network analysis in a large sample (N = 2089) to obtain an integrated view on the associations of personality traits with both overall insomnia severity and different insomnia characteristics, while distinguishing direct from indirect associations. We first estimated a network describing the associations among the five factor model personality traits and overall insomnia severity. Overall insomnia severity was associated with neuroticism, agreeableness, and openness. Subsequently, we estimated a separate network describing the associations among the personality traits and each of the seven individual items of the Insomnia Severity Index. This revealed relatively separate clusters of daytime and nocturnal insomnia complaints, that both contributed to dissatisfaction with sleep, and were both most directly associated with neuroticism and conscientiousness. The approach revealed the strongest direct associations between personality traits and the severity of different insomnia characteristics and overall insomnia severity. Differentiating them from indirect associations identified the targets for improving Cognitive Behavioral Therapy for insomnia with the highest probability of effectively changing the network of associated complaints.