The role of pre-sleep cognitions in adolescent sleep-onset problems

A scoping review of sleep discrepancy methodology: What are we measuring and what does it mean?

STUDY OBJECTIVES

To examine how past studies have conceptualised sleep discrepancy and identify and evaluate the methods used for its measurement and analysis.

METHOD

We searched MEDLINE, Embase, PsycINFO, CINAHL Plus, PubMed, Scopus, and Web of Science in April 2022 for studies comparing self-report and objective measures of sleep. Methodological information was extracted from relevant studies and included measures of self-report and objective sleep, sleep variables (e.g., total sleep time), derived discrepancy indices (e.g., difference scores), handling of repeated measurements, and methods of measure comparison (e.g., Bland-Altman analyses).

RESULTS

Two hundred and forty-four relevant records were identified. Studies varied according to objective sleep measure; actigraphy algorithm, software, and rest interval; polysomnography setting and scoring criteria; sleep variables; self-report sleep measure; number of nights of objective recording; time frame of self-report measure; self-report sleep variable definition; sleep discrepancy derived index; presence and handling of repeated measurements; and statistical method for measure comparison.

CONCLUSIONS

Sleep discrepancy was predominantly conceived as discordance in sleep states or sleep time variables, and various forms of this discordance differed in their conceptual distance to sleep misperception. Furthermore, studies varied considerably in methodology with critical conceptual and practical implications that have received little attention to date. Substantive methodological issues were also identified relating to the use of derived indices for operationalising sleep discrepancy, defining objective sleep onset latency, calculating actigraphy rest intervals, measuring correlation and concordance, averaging sleep variables across nights, and defining sleep quality discrepancy. Solutions and recommendations for these issues are discussed.

Sleep-Related Problems and Pediatric Anxiety Disorders

Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.

Pre-sleep arousal induced by suspenseful series and cliffhangers have only minor effects on sleep: A sleep laboratory study

Pre-sleep arousal impairs sleep. Therefore, watching suspenseful TV series before sleep is not recommended as they increase arousal. In particular, the consumption of multiple episodes of the same suspenseful TV series in one sitting - termed binge-watching - could lead to large increases in physiological arousal delaying sleep onset. Furthermore, abrupt endings during critical scenes - termed cliffhangers - result in unfinished story lines, which further increase cognitive arousal and could negatively impact sleep architecture and the number of awakenings. However, the effects of binge-watching and cliffhangers on objective sleep parameters are still unknown. Here we tested in a controlled sleep-laboratory setting whether pre-sleep arousal induced by watching 3-4 episodes of a suspenseful TV series has negative effects on sleep in 50 healthy young participants (39 females, mean age = 22.62 ± 2.60 (SD)). Watching a neutral TV series served as a control condition, according to a within-subject design. In one group of participants, the suspenseful TV series ended with a cliffhanger. In the other group, the same TV series ended where no ongoing action was interrupted. Pre-sleep arousal was measured both subjectively with the self-reported level of stress and objectively with the mean heart rate and cortisol level. As expected, suspenseful TV series induced higher cognitive and physiological pre-sleep arousal than neutral control TV series, with highest values for TV series with cliffhangers. In spite of the high pre-sleep arousal, participants fell asleep faster after watching the suspenseful compared with the neutral TV series (F_(1,48) = 4.89, p = 0.032, η² = 0.09). Sleep architecture and the number of awakenings remained unaffected. However, in the first two sleep cycles, heart rate was still higher after watching suspenseful TV series (F_(1,48) = 6.76, p = 0.012, η² = 0.12). And only after cliffhangers, objective sleep quality - measured as the ratio between slow-wave and beta activity during sleep - was lower than in the other conditions (interaction effect, F_(1,48) = 5.05, p = 0.029, η² = 0.10). Our results speak against large impairments of pre-sleep watching of multiple episodes of suspenseful TV series and cliffhangers on sleep quality and architecture. However, unfinished narratives might induce more subtle changes in oscillatory power during sleep, possibly reflecting ongoing cognitive processing during sleep.

Linear and nonlinear associations between the sleep environment, presleep conditions, and sleep in adolescence: moderation by race and socioeconomic status

OBJECTIVE/BACKGROUND

The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear and nonlinear associations between the sleep environment and presleep conditions and adolescents' daytime sleepiness and sleep/wake problems.

METHOD

Participants included 313 adolescents (M_age = 17.39 years, SD = 10.38 months; 51.4% girls, 48.6% boys; 59.1% White/European American, 40.3% Black/African American) from a wide range of socioeconomic backgrounds living in the southeastern United States. Adolescents completed surveys assessing the sleep environment (eg, light, bedding), four presleep conditions (ie, general worries, family concerns, arousal, somatic complaints), and sleep (daytime sleepiness, sleep/wake problems).

RESULTS

Sleep environment disruptions and worse presleep conditions were positively associated with sleepiness and sleep/wake problems in a linear fashion. Nonlinear associations emerged such that levels of sleepiness increased rapidly between low and average levels of the sleep environment and two presleep conditions (worries, arousal); the slope leveled off between average and high levels. Moreover, linear effects of environmental disruptions, family concerns, somatic complaints, and presleep arousal on sleep/wake problems were moderated by race and/or SES, indicating that positive associations between some presleep conditions and sleep/wake problems were more pronounced for Black and lower SES youth.

CONCLUSIONS

Results support the importance of the sleep environment and multiple presleep conditions and assessments of both linear and nonlinear effects for a better understanding of factors that may contribute to sleep. Additionally, results indicate the sleep environment and some presleep conditions may be more consequential for disadvantaged youth.

The falling asleep process in adolescents

STUDY OBJECTIVES

To investigate the pre-sleep psychophysiological state and the arousal deactivation process across the sleep onset (SO) transition in adolescents.

METHODS

Data were collected from a laboratory overnight recording in 102 healthy adolescents (48 girls, 12-20 years old). Measures included pre-sleep self-reported cognitive/somatic arousal, and cortical electroencephalographic (EEG) and electrocardiographic activity across the SO transition.

RESULTS

Adolescent girls, compared with boys, reported higher pre-sleep cognitive activation (p = 0.025) and took longer to fall asleep (p < 0.05), as defined with polysomnography. Girls also showed a less smooth progression from wake-to-sleep compared with boys (p = 0.022). In both sexes, heart rate (HR) dropped at a rate of ~0.52 beats per minute in the 5 minutes preceding SO, and continued to drop, at a slower rate, during the 5 minutes following SO (p < 0.05). Older girls had a higher HR overall in the pre-sleep period and across SO, compared to younger girls and boys (p < 0.05). The EEG showed a progressive cortical synchronization, with increases in Delta relative power and reductions in Alpha, Sigma, Beta1, and Beta2 relative powers (p < 0.05) in the approach to sleep, in both sexes. Delta relative power was lower and Theta, Alpha, and Sigma relative powers were higher in older compared to younger adolescents at bedtime and across SO (p < 0.05).

CONCLUSIONS

Our findings show the dynamics of the cortical-cardiac de-arousing process across the SO transition in a non-clinical sample of healthy adolescents. Findings suggest a female-specific vulnerability to inefficient sleep initiation, which may contribute to their greater risk for developing insomnia.

Sleep-related monitoring on awakening mediates the relationship between insomnia-related interpretive bias and insomnia symptoms using the insomnia ambiguity paradigm

A number of studies have examined and confirmed the presence of a sleep-related interpretive bias amongst poor sleepers and individuals with insomnia using an insomnia ambiguity task. This study explored possible mechanisms underlying the relationship between interpretive bias and insomnia using the insomnia ambiguity task. More importantly, the possible mediating role of sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety was also examined. A total of N = 176 participants were stratified into normal sleepers and those displaying insomnia symptoms. Participants completed an online version of the insomnia ambiguity task and questionnaire measures pertaining to sleep and anxiety. Data concerning task response time and time of testing were also collected. Individuals in the insomnia symptom group presented significantly higher sleep-related interpretive bias scores compared to normal sleepers. When sleepiness, sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety were controlled for, only monitoring on awakening predicted sleep-related interpretive bias. Multiple mediation modelling demonstrated that sleep-associated monitoring on awakening mediated the relationship between interpretive bias and insomnia symptoms. The current outcomes are consistent with previous research, supporting the notion that insomnia is characterized by a disorder-consistent interpretive bias. Furthermore, monitoring for insomnia-consistent cues on awakening appears to mediate group differences in interpretive bias.

Sleep-Related Problems and Pediatric Anxiety Disorders

Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.

Effects of Presleep Cognitive Intrusions on Subjective Sleep and Next-Day Cognitive Performance in Insomnia

Presleep cognitive intrusions about next-day activities, or proprioceptive and environmental stimuli, are thought to trigger insomnia in neurocognitive models. Recent research showed that intrusive cognitions at bedtime may interact with sleep in influencing next-day emotional functioning; their effects on cognitive functioning, however, is largely unknown. We tested the effects of presleep cognitive intrusions on subjective sleep and next-day cognitive performance in 80 participants, either with chronic insomnia or good sleepers. Presleep intrusions were inspected using a validated questionnaire and sleep was assessed with a sleep diary. Cognitive functioning the following morning was measured using a task-switching paradigm assessing executive functions. Structural equation modeling with manifest variables (i.e., path analysis) shows that presleep cognitive intrusions predicted increased sleep onset latency and wake after sleep onset, and lowered sleep efficiency. Moreover, task-switching accuracy was independently predicted by presleep cognitive intrusions in the previous night in those with insomnia but not in controls, beyond the effects of trait anxiety, task-switching components, and previous night's sleep. Findings confirm detrimental effects of presleep intrusions on sleep continuity and suggest the presence of links between presleep conscious activity and next-day executive performance in patients with insomnia, with the need to better elucidate potential mediators.

Association between insufficient sleep and suicidal ideation among adolescents

The objective of this study was to examine the association between insufficient sleep and suicidal ideation among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,659 adolescents aged 14-18 years (51.8% female) were analyzed using logistic regression with suicidal ideation as the outcome variable and insufficient sleep as the main explanatory variable. Of the 13,659 adolescents, 2,409 representing 17.6% experienced suicidal ideation during the past 12 months and three out of four adolescents (75.2%) had insufficient sleep on an average school night. Controlling for all other predictors, the odds of experiencing suicidal ideation were 1.35 times higher for adolescents who had insufficient sleep relative to those who had sufficient sleep on an average school night (AOR = 1.35, 95% CI = 1.16-1.58). Other factors associated with suicidal ideation include female gender, sexual minority, history of traditional bullying and cyberbullying victimization, feeling sad or hopeless, being slightly or very overweight, and substance use. Physical activity was inversely associated with suicidal ideation. School counselors, clinicians, and practitioners should consider adequate sleep as an important intervention in suicide prevention.

The relationship between body shape perception and health behaviors among Korean normal-weight adolescents using Korea Youth Risk Behavior Web-Based Survey

Inappropriate adolescent health behavior can be influenced by the negative impact of physical and mental health promotion. Obesity influences subjective improper weight perception. This study aimed to verify Korean normal-weight adolescents' subjective experience of weight control, mental health, physical activity, and subjective status based on their body mass index (BMI). As a result, efforts to control weight appeared less in normal-weight boys. Thin girls were less likely to carry out 60 min of physical activity 7 or 5 days per a week. Obese boys were less likely to carry out vigorous physical activity 3 days per a week. Normal-weight girls were less likely to practice muscular strength training 3 days per a week. Thin boys and thing girls were less likely to practice regular physical activity, and less likely to practice at the rate stipulated in the sedentary behavior guideline. In conclusion, boys and girls with inappropriate weight perception reported feeling stressed and depressed, and reported subjective sleep fulfillment, perceived subjective happiness, and perceived subjective health.