Assessing cognitive processes related to insomnia: A review and measurement guide for Harvey's cognitive model for the maintenance of insomnia

A multicountry study on the psychometric properties of the Arabic version of the Sleep Preoccupation Scale (SPS) using both classical testing theory and item response theory

BACKGROUND

Sleep distrurbances involves daytime preoccupation about sleep, which plays a critical role in perpetuating sleep disturbances. Recent cognitive models highlight the importance of daytime processes, like processing sleep-related information and interpretations during waking hours, in influencing sleep quality and quantity. The Sleep Preoccupation Scale (SPS) quantifies this daytime cognitive activity related to sleep. This study aimed to translate and validate an Arabic version of the SPS for assessing sleep preoccupation among Arabic speakers.

METHODS

523 Arabic speakers (mean age 23.6 years, 75% female) from four countries completed the Arabic SPS alongside the Athens Insomnia Scale, Generalized Anxiety Disorder-7 Scale, and the Anxiety and Preoccupation about Sleep Questionnaire (APSQ). The sample repeated the SPS after two weeks for test-retest reliability. Confirmatory factor analysis evaluated the SPS's two-factor structure. Internal consistency, item response theory, and convergent validity with the other scales were examined.

RESULTS

Confirmatory factor analysis supported the two-factor model's fit. Measurement invariance results suggest that the SPS exhibits a similar basic factor structure across both insomnia and non-insomnia groups. The Arabic SPS demonstrated good internal consistency (Cronbach's α = 0.92, McDonald's ω = 0.92) and two-way mixed effects, consistency, single rater/measurement intraclass correlation coefficient (ICC) test-retest reliability (ICC = 0.95). Most items exhibited satisfactory item response theory fit statistics and discrimination. The SPS total score showed strong positive correlations with insomnia severity (r = 0.48, p < 0.001), generalized anxiety (r = 0.57, p < 0.001), and sleep-related anxiety/preoccupation (r = 0.79, p < 0.001), demonstrating convergent validity.

CONCLUSION

The Arabic version of the SPS demonstrated good psychometric properties and validity, supporting its use for assessing sleep preoccupation among Arabic speakers. This culturally-adapted version enhances sleep assessment capabilities for improving insomnia understanding and treatment within Arabic-speaking populations.

Conceptual overlap of negative thought processes in insomnia: A focus on catastrophizing, worry, and rumination in a student sample

OBJECTIVES

The association and overlap between different forms of negative thought processes in insomnia is largely unknown. The purpose of the current investigation was to examine conceptual overlap between three insomnia-specific negative thought processes; catastrophizing, worry, and rumination, identify the underlying factors, and explore their associations with insomnia symptoms.

METHODS

A total of 360 students completed three insomnia-related negative thought process scales (Catastrophic Thoughts about Insomnia Scale, Anxiety and Preoccupation about Sleep Questionnaire, Daytime Insomnia Symptom Response Scale) and two insomnia symptoms measures (the Insomnia Severity Index and Sleep Condition Indicator).

RESULTS

The three scales and their subscales displayed acceptable reliabilities. Further, confirmatory factor analysis was supportive of the notion of catastrophizing, worry, and rumination measures as distinct. The catastrophizing and worry constructs were significantly associated with insomnia symptoms, but the rumination factor was not.

CONCLUSIONS

The findings indicate that catastrophizing, worry, and rumination might be viewed as distinct constructs. Although more research is warranted on the topic of conceptual overlap, the current results might have implications for the development of models of insomnia, clinical research, and practice.

Do changes in beliefs and behaviours moderate improvement in insomnia after acquired brain injury?

Key mechanisms of change in cognitive behavioural therapy for insomnia in the general population encompass changing sleep-related beliefs and behaviours. In a population with acquired brain injury, cognitive behavioural therapy for insomnia is effective as well, but little is known about the mechanisms of change. The aim of this study was to evaluate how changing sleep-related beliefs and behaviours were associated with improvement in insomnia following blended cognitive behavioural therapy for insomnia in a population with acquired brain injury. A secondary analysis was performed on data of a randomized-controlled trial, including 24 participants that received blended cognitive behavioural therapy for insomnia, and 24 participants that received treatment as usual. Results showed that following blended cognitive behavioural therapy for insomnia, significantly more participants improved on dysfunctional beliefs and sleep-related behaviours and this was associated to improvement in insomnia severity. For sleep-related behaviours, the association between improvement on behaviour and improvement on insomnia was significantly moderated by blended cognitive behavioural therapy for insomnia. However, the relation between dysfunctional beliefs and insomnia was not moderated by type of treatment. Similar results were found for acquired brain injury-adapted versions of the questionnaires in which up to half of the items were excluded as they could be regarded as not dysfunctional for people with acquired brain injury. These results show that improvement on insomnia severity is related to improvement in dysfunctional beliefs and behaviours, and cognitive behavioural therapy for insomnia efficacy may be moderated by the improvement in behaviours in particular. A focus on these behaviours can enhance treatment efficacy, but caution is needed regarding the behaviours that may reflect adequate coping with the consequences of the acquired brain injury.

Are sleep-related beliefs and behaviours dysfunctional in people with insomnia after acquired brain injury? A cross-sectional study

Inappropriate sleep-related beliefs and behaviours are considered key maladaptive mechanisms in the development and maintenance of insomnia in the otherwise healthy population. The aim of this study was to evaluate critically the role of sleep-related beliefs and behaviours in insomnia after acquired brain injury. Cross-sectional data of 51 outpatients with insomnia disorder and acquired brain injury were used to evaluate associations of the insomnia severity index with the dysfunctional beliefs and attitudes about sleep scale and sleep-related behaviours questionnaire. Seven (44%) of the dysfunctional beliefs and attitudes about sleep scale items and 10 (31%) of the sleep-related behaviours questionnaire items correlated significantly with insomnia severity. Ten experts were consulted on whether they considered the questionnaire items maladaptive or accurately reflecting coping with conditions experienced by people with acquired brain injury. Although multiple linear regression showed that the total scores of the questionnaires explained a significant part of interindividual differences in insomnia severity (R2 = 0.27, F(2,48) = 8.72, p < 0.01), the experts unanimously rated only four (25%) of the dysfunctional beliefs and attitudes about sleep scale items as dysfunctional beliefs and three (9%) of the sleep-related behaviours questionnaire items as safety behaviours. In people with brain injury, sleep related beliefs and behaviours may also play a role in insomnia, especially a diminished perception of control and worry about sleep. However, more than half of the questionnaire items on sleep-related beliefs and behaviours may not be considered inappropriate and maladaptive for the acquired brain injury population, and may reflect adequate observations and efforts in coping with consequences of the brain damage.

Sleep effort and its measurement: A scoping review

Insomnia disorder is characterized by disruption in sleep continuity and an overall dissatisfaction with sleep. A relevant feature of insomnia is sleep effort, which refers to both cognitive and behavioural conscious attempts to initiate sleep. The Glasgow Sleep Effort Scale is a self-report tool developed to assess this construct. The objective of the current scoping review was to map how sleep effort has been discussed in the literature and operationalized through its respective measure. Medline/PubMed, Scopus, Web of Science and PsycInfo databases were used to search for potential studies. The search query used in databases was the specific name of the self-reported tool itself (Glasgow Sleep Effort Scale) and "sleep effort" term. This scoping review followed JBI guidelines. To be included, records pertaining to any type of study that mentioned the Glasgow Sleep Effort Scale were considered. No language constraint was used. At the end, 166 initial records were retrieved. From those, 46 records met eligibility criteria and were analysed. Among the main findings, it was observed that the Glasgow Sleep Effort Scale has been increasingly used in recent years, with a notable observed upward trend, especially in the last 2 years. In addition to the original measure, only three published adapted versions of the instrument were identified. This suggests that there is limited research on adapting the scale for different populations or contexts. Sleep effort has been increasingly studied in the last few years. Nonetheless, more research on the Glasgow Sleep Effort Scale tool is recommended, including cross-cultural adaptations.

Deficits in brain default mode network connectivity mediate the relationship between poor sleep quality and anxiety severity

STUDY OBJECTIVES

Chronic insomnia disorder (CID) is a prevalent sleep disorder that frequently cooccurs with anxiety. The association between insomnia and anxiety has been established; however, the neurobiological basis of this relationship remains unclear. This study aimed to investigate the neural markers of CID patients with and without anxiety and to determine whether specific neural connectivity mediates the relationship between insomnia and anxiety.

METHODS

This study included 180 participants, comprising CID patients with anxiety (CID-A), CID patients without anxiety (CID-NA), and good sleep controls. All participants completed self-reported measures of sleep quality and anxiety severity and underwent functional magnetic resonance imaging. Brain functional integration was measured using functional connectivity density (FCD) and resting-state functional connectivity (rsFC). Correlation and mediation analyses were used to examine the relationships among brain connectivity, sleep quality, and anxiety severity.

RESULTS

The CID-NA and CID-A groups showed decreased local FCD in the medial prefrontal cortex (mPFC) and disrupted rsFC between the precuneus and other brain regions. Only the CID-A group exhibited altered long-range FCD in the precuneus and the rsFC between the anterior default mode network (DMN, e.g. mPFC) and posterior DMN (e.g. precuneus). Mediation analysis revealed DMN dysconnectivity underlying the association between poor sleep quality and anxiety symptoms.

CONCLUSIONS

This study identified shared and distinct brain circuit disruptions in the CID-NA and CID-A groups, with deficits in DMN connectivity as a potential neural mechanism through which disrupted sleep augments anxiety. These findings may facilitate the development of personalized therapies for insomnia and associated anxiety problems.

How patients with insomnia interpret and respond to the consensus sleep diary: a cognitive interview study

OBJECTIVE/BACKGROUND

The Consensus Sleep Diary (CSD) is widely used to assess subjective sleep. Psychometric evaluations and focus-groups support its validity and clinical usefulness, but further research into its validity is needed. The aim of the study was to evaluate a Swedish translation of the CSD regarding test content and response processes in patients with insomnia.

PATIENTS/METHODS

In connection with translating the CSD into Swedish, we used cognitive interviewing to evaluate test content and the response process, that is, how people make decisions when responding to survey items. Cognitive interviews were conducted with 13 primary health care patients with insomnia disorder (mean age, 49 years; SD 15.5). Iterative, reparative analysis was used to investigate test content. Descriptive deductive analysis was used to investigate interview transcripts for the themes of the cognitive model: comprehension, retrieval, decision process, and judgement. Together, the themes explain the response process when responding to a patient-reported outcome measure.

RESULTS

The overall comprehension of the CSD could be affected by poor adherence to the instructions (comprehension). Patients had difficulty with recall if they did not complete the diary immediately in the morning and just before bedtime (retrieval). They could have problems deciding how to respond to certain items because they imbued sleep-related concepts with extra meaning (decision process), and had trouble finding response alternatives nuanced enough to describe their experience of sleep and tiredness (judgement).

CONCLUSIONS

This study contributes knowledge on how the instrument is perceived and used by care-seeking patients with insomnia. In this context, the CSD exhibits known flaws such as memory lapses if the diary is not filled in directly in the morning. To increase the accuracy of patients' responses, therapists should support patients in reading the instructions.

Analysis of the Risk Factors for Negative Emotions in Patients with Esophageal Cancer During the Peri-Radiotherapy Period and Their Effects on Malnutrition

Background

Esophageal cancer has a high incidence in China. Many patients also have a heavy psychological burden due to clinical features such as wasting and choking on food. This study analyzed the risk factors of negative emotions in esophageal cancer patients during the peri-radiotherapy period and its effects on malnutrition.

Methods

We retrospectively analyzed 339 patients with esophageal cancer during the peri-radiotherapy who received treatment at our hospital from April 2017 to April 2020, and followed up for 3 years. t test and Chi-square test were used to analyze the relationship between patients' negative emotions and clinical data. Binary logistics regression was performed to analyze the independent risk factors for the occurrence of negative mood and malnutrition in the patients. Kaplan-Meier survival curves were used to analyze survival rates.

Results

Our results showed that 18.3% of patients undergoing radiotherapy for esophageal cancer had negative emotions, and 41.9% suffered from malnutrition. The results of the binary logistic regression analysis showed that monthly household income (OR = 0.470, P = 0.022), the TNM stage (OR = 2.030, P = 0.044), concomitant gastrointestinal symptoms (OR = 2.071, P = 0.024), sleep status (OR = 2.540, P = 0.003), swallowing disorders (OR = 1.919, P = 0.048), and post-radiotherapy complications were independent risk factors for the development of negative emotions in patients. Negative emotions (OR = 2.547, P = 0.038) were also a risk factor for malnutrition in patients with esophageal cancer.

Conclusion

Many patients with esophageal cancer suffer from anxiety and depression in the peri-radiotherapy period, which might lead to complications such as malnutrition or aggravate and affect the prognosis of patients. Therefore, psychological care should be provided based on conventional care to effectively relieve their psychological pressure, and improve their prognosis and quality of life.

Hyperarousal in insomnia disorder: Current evidence and potential mechanisms

Insomnia disorder is among the most frequent mental disorders, making research on its aetiology and pathophysiology particularly important. A unifying element of many aetiological and pathophysiological models is that they support or even centre on the role of some form of hyperarousal. In this theoretical review, we aim to summarise the current evidence on hyperarousal in insomnia. Hyperarousal is discussed as a state of relatively increased arousal in physiological, cortical and cognitive-emotional domains. Regarding physiological hyperarousal, there is no conclusive evidence for the involvement of autonomous variables such as heart rate and heart rate variability, whereas recent evidence points to a pathophysiological role of neuroendocrine variables. In addition, current literature supports a central involvement of cortical arousal, that is, high-frequency electroencephalographic activity. An increasingly important focus in the literature is on the role of other microstructural sleep parameters, especially the existence of microarousals during sleep. Beyond that, a broad range of evidence exists supporting the role of cognitive-emotional hyperarousal in the form of insomnia-related thought and worries, and their concomitant emotional symptoms. Besides being a state marker of insomnia, hyperarousal is considered crucial for the predisposition to insomnia and for the development of comorbid mental disorders. Thus, beyond presenting evidence from cross-sectional studies on markers of hyperarousal in insomnia, hypotheses about the mechanisms of hyperarousal are presented. Nevertheless, longitudinal studies are needed to further elucidate the mechanism of hyperarousal throughout the course of the disorder, and future studies should also focus on similarities and differences in hyperarousal across different diagnostic entities.

Cognitive factors and processes in models of insomnia: A systematic review

Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2458 records were identified for title and abstract screening. Of these, 34 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.

How relative deprivation affects the sleep quality of Chinese college students: testing an integrated model of social anxiety and trait mindfulness

Although previous studies have confirmed the association between relative deprivation and individual health, the relationship between and underlying mechanisms of relative deprivation and sleep quality have rarely been explored. Therefore, the present study investigated how relative deprivation affected sleep quality by testing an integrated model and examining the roles of social anxiety and trait mindfulness. We surveyed 568 college students using the Relative Deprivation Scale, Interaction Anxiousness Scale, Mindful Attention Awareness Scale, and Pittsburg Sleep Quality Index. Data were analyzed using SPSS 24.0 and PROCESS macro for SPSS. We found that a high relative deprivation score predicted poor sleep quality, and social anxiety partially mediated this relationship. Our model also indicated that the relationship between relative deprivation and sleep quality via social anxiety was moderated by mindfulness. Specifically, increasing trait mindfulness may decrease the indirect effect of relative deprivation on sleep quality through social anxiety. The current study expands our understanding of the underlying mechanisms, paths, and conditions of the effects of relative deprivation on sleep quality. Furthermore, we provide additional evidence that trait mindfulness can mitigate the adverse effects of negative events. College students should consciously use trait mindfulness techniques to consider problems, reduce anxiety, and improve their sleep quality.

Sleep-related attentional bias: Development and validation of a Chinese version of the brief sleep-associated monitoring index in pregnant women

OBJECTIVES

This study aimed to develop a Chinese version of the brief Sleep-Associated Monitoring Index (SAMI-B), and examine its psychometric properties among pregnant women.

METHODS

This cross-sectional study conveniently recruited 665 pregnant women from two tertiary hospitals in Shandong, China; 110 completed a retest survey within two or three weeks after completing the baseline questionnaires. The scale was developed following established guidelines. Participants completed the SAMI-B, SAMI, Insomnia Severity Index, Pittsburgh Sleep Quality Index, Pre-Sleep Arousal Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7 Scale. Psychometric evaluation included reliability (internal consistency, test-retest reliability) and validity (construct, item and concurrent validity; and diagnostic accuracy).

RESULTS

The Chinese SAMI-B demonstrated uni-dimensionality construct, appropriate item fit and functioning; acceptable internal consistency (McDonald's ω = 0.917) and test-retest reliability (intraclass correlation = 0.736). It was significantly correlated with the SAMI (correlation coefficient = 0.765，P < 0.001) and other sleep-related measurements (correlation coefficients = 0.412-0.638, P_s < 0.001). The SAMI-B displayed a comparable area under the curve (0.739, 95% CI: 0.703-0.772) with the SAMI in detecting insomnia symptoms. The optimal cutoff point (18) presented a sensitivity of 0.765 and a specificity of 0.615 in distinguishing individuals with and without insomnia symptoms. After controlling for general information, the differences in the SAMI-B scores between those with or without insomnia symptoms remained significant (OR = 1.16, 95% CI: 1.12-1.20).

CONCLUSION

The SAMI-B may be an effective alternative for clinicians and researchers to screen or track vulnerable individuals for prenatal insomnia symptoms.

Fear of progression and its associated factors in parents of children undergoing cancer treatment: A CROSS-SECTIONAL STUDY

OBJECTIVE

Fear of progression (FoP) is a common psychosocial problem among adult cancer patients, but data on parents of children undergoing cancer treatment are scarce. This study aimed to determine the prevalence of FoP in parents of children undergoing cancer treatment and explore the associated factors.

METHODS

Overall, 285 parents of children undergoing cancer treatment were recruited from three general hospitals in China. FoP in the parents was assessed using the Chinese version of the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR). Other questionnaires included the Self-Compassion Scale, Pittsburgh Sleep Quality Index, Posttraumatic Stress Disorder Checklist-Civilian Version, and items on socio-demographic and medical characteristics. Pearson correlation and multiple linear regression analysis were used to identify factors associated with FoP.

RESULTS

A total of 75.1% of the participants showed dysfunctional levels of FoP. The mean FoP-Q-SF/PR score was 39.98 (standard deviation=9.18). Parental FoP was significantly associated with a shorter time since diagnosis, lower levels of self-compassion, poor sleep quality, and severe posttraumatic stress symptoms (Adjusted R Squared=0.369, F=12.838, p<0.01).

CONCLUSIONS

FoP is a frequently reported problem among parents of children undergoing cancer treatment. In this cohort, parents of children with a shorter time since cancer diagnosis were at higher risk of suffering from FoP. Interventions to enhance self-compassion, improve sleep quality, and mitigate posttraumatic stress symptoms may help with the psychological adjustment and well-being of parents whose children are undergoing cancer treatment. This article is protected by copyright. All rights reserved.

Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain

OBJECTIVES

Sleep impairments are a strong predictor of pain, making sleep a potential interest when treating patients with spine pain. Typical beliefs about the importance of sleep in patients seeking care for spinal pain are unknown. The purpose of this study was to describe the beliefs and attitudes about sleep in patients seeking care for spinal pain and to examine the relationships between dysfunctional beliefs and attitudes about sleep (DBAS), disordered sleep, and pain interference.

MATERIALS AND METHODS

This cross-sectional study included patients presenting to physical therapy with spine pain. Participants completed questionnaires including demographics, medical history, pain interference (pain, enjoyment, and general activity), DBAS-16, and sleep-related impairment (Patient-Reported Outcome Measurement Information System). Correlations were calculated between DBAS-16 scores and measures of sleep quality/quantity, and a generalized linear model was used to investigate the predictive ability of DBAS-16 scores on pain interference.

RESULTS

The mean DBAS-16 score was 4.22 (SD=2.03), with 52.5% of participants having DBAS. There was a strong relationship between DBAS-16 and Patient-Reported Outcome Measurement Information System ( rs =0.7; P <0.001). For every point higher score on the DBAS-16, pain interference scores increased by approximately half a point (B=0.46; 95% CI 0.33, 0.59, 1.80; P <0.001).

DISCUSSION

These results highlight a strong relationship between beliefs and attitudes about sleep and measures of sleep quality/quantity and a linear association with pain interference scores. These findings provide a rationale for targeting beliefs and attitudes about sleep when managing pain-related symptoms in patients seeking care for spine pain.

Self-tracking via smartphone app: Potential tool for athletes’ recovery self-management?

Self-tracking technologies are possible approaches to support recovery self-management activities for athletes. These may have become even more appealing due to stay-at-home restrictions as part of the 2020 pandemic regulations. This study examined user behaviour of smartphone and wearable technologies among 217 athletes (29% women, M age = 26.9 ± 7 years). The online survey comprised demographic questions and standardised questionnaires to assess usage of technologies, sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), attitudes about sleep (Dysfunctional Beliefs and Attitudes about Sleep Scale), bedtime procrastination (Bedtime Procrastination Scale), and self-control (Brief Self-Control Scale). Fitness apps (46.5%) were more popular than sleep apps (15.7%) followed by nutrition apps (12%). The correlation between sleep apps and the other two apps indicate that non-users of sleep apps are probably also non-users of fitness or nutrition apps. Wearables were more frequently used to track fitness activities (36.9%) than sleep (17.5%). Considering sex, type of sport, competition participation, and training volume, no remarkable characteristics among users versus non-users of sleep apps were identified. There were also no significant differences among sleep indices between sleep app users and non-users. However, self-control was highest among sleep app users compared to non-users (d = 0.58). Despite 34.1% being identified as poor sleepers, behavioural sleeping patterns were within normal range. The results imply that athletes are not as attracted to self-tracking technologies as expected, which makes them less vulnerable to unsubstantiated feedback and inappropriate interventions by those tools. This serves as a starting point to explore the potential of self-tracking ambulatory assessment for physical activity and sleep behaviour of athletes in the post-pandemic era.

A virtual reality-based mind-body approach to downregulate psychophysiological arousal in adolescent insomnia

Objective

In this study, we describe the rationale, supported by preliminary data, for a novel, digital, immersive virtual reality (VR)-based mind-body approach, designed to reduce bedtime arousal in adolescents with insomnia.

Methods

Fifty-two high-school students (16-20 years; 32 female) with (N = 18) and without (N = 34) DSM-5 insomnia symptoms engaged with 20 min of immersive VR-guided meditation and paced breathing (0.1 Hz) (intervention condition) and 20 min of quiet activity (control condition), right before bedtime, on two separate evenings.

Results

The intervention resulted in acute autonomic and cortical modulation (p < 0.05), leading to reduced physiological arousal (↓heart rate, ↓cortisol) compared with the control condition, with similar effects in adolescents with and without insomnia. No significant changes were detected for cognitive arousal levels. During the intervention, all participants were able to achieve the targeted 0.1 Hz breathing rate, and the majority experienced no discomfort associated with the VR exposure. However, 30-40% of the participants experienced some trouble slowing down their breathing.

Conclusions

The study provides supporting preliminary evidence for the mechanism behind a novel VR-based digital approach, designed to regulate psychophysiological arousal levels by acting on neurocognitive and autonomic pathways. Further studies (e.g. randomized clinical trials) are needed to evaluate the isolated and synergistic effects of its components (e.g. VR vs. VR + paced breathing), and its efficacy, acceptance, and feasibility in alleviating insomnia symptoms in adolescents.

Identifying Insomnia From Social Media Posts: Psycholinguistic Analyses of User Tweets

Background

Many people suffer from insomnia, a sleep disorder characterized by difficulty falling and staying asleep during the night. As social media have become a ubiquitous platform to share users’ thoughts, opinions, activities, and preferences with their friends and acquaintances, the shared content across these platforms can be used to diagnose different health problems, including insomnia. Only a few recent studies have examined the prediction of insomnia from Twitter data, and we found research gaps in predicting insomnia from word usage patterns and correlations between users’ insomnia and their Big 5 personality traits as derived from social media interactions.

Objective

The purpose of this study is to build an insomnia prediction model from users’ psycholinguistic patterns, including the elements of word usage, semantics, and their Big 5 personality traits as derived from tweets.

Methods

In this paper, we exploited both psycholinguistic and personality traits derived from tweets to identify insomnia patients. First, we built psycholinguistic profiles of the users from their word choices and the semantic relationships between the words of their tweets. We then determined the relationship between a users’ personality traits and insomnia. Finally, we built a double-weighted ensemble classification model to predict insomnia from both psycholinguistic and personality traits as derived from user tweets.

Results

Our classification model showed strong prediction potential (78.8%) to predict insomnia from tweets. As insomniacs are generally ill-tempered and feel more stress and mental exhaustion, we observed significant correlations of certain word usage patterns among them. They tend to use negative words (eg, “no,” “not,” “never”). Some people frequently use swear words (eg, “damn,” “piss,” “fuck”) with strong temperament. They also use anxious (eg, “worried,” “fearful,” “nervous”) and sad (eg, “crying,” “grief,” “sad”) words in their tweets. We also found that the users with high neuroticism and conscientiousness scores for the Big 5 personality traits likely have strong correlations with insomnia. Additionally, we observed that users with high conscientiousness scores have strong correlations with insomnia patterns, while negative correlation between extraversion and insomnia was also found.

Conclusions

Our model can help predict insomnia from users’ social media interactions. Thus, incorporating our model into a software system can help family members detect insomnia problems in individuals before they become worse. The software system can also help doctors to diagnose possible insomnia in patients.

Sleep Patterns Related to Emotion Dysregulation Among Adolescents and Young Adults

OBJECTIVE

Adolescents and young adults in the college setting often report poor sleep hygiene and quality. These sleep difficulties may be related to emotion dysregulation, which is highly relevant to broader adjustment. The current study aimed to empirically identify latent groups of healthy college students with distinct subjective sleep patterns and examine differences in emotion dysregulation between subgroups.

METHODS

College students (N = 476; Mage=19.38) completed the Adolescent Sleep-Wake Scale-Revised, Adolescent Sleep Hygiene Scale-Revised, and Difficulties in Emotion Dysregulation Scale. Most participants were White (78%), non-Hispanic/Latinx (85%), and female (77%). Latent profile analysis identified patterns of sleep with maximum likelihood estimation. Bolck-Croon-Hagenaars procedure evaluated differences in emotion dysregulation by class.

RESULTS

A three-class model had optimal fit, Bayesian information criterion = 11,577.001, Bootstrapped Parametric Likelihood Ratio Test = -5,763.042, p < .001, entropy = .815. The three profiles identified were good sleep (overall high sleep quality and hygiene; n = 219), moderate sleep (low sleep quality with mix of low and high sleep hygiene; n = 221), and poor sleep (very low sleep quality and hygiene; n = 36). Those in the good sleep group (M = 68.06, SE = 1.5) reported significantly less emotion dysregulation than the moderate sleep group (M = 92.12, SE = 1.67; X2(2) = 98.34, p = .001) and the poor sleep group (M = 99.51, SE = 4.10; p < .001). The moderate and poor sleep groups did not significantly differ, X2(2) = 2.60, p = .11.

CONCLUSIONS

Emotion dysregulation differed across three sleep profiles, with participants classified in the good sleep group reporting, on average, the lowest emotion dysregulation, compared to the moderate and poor sleep groups. These findings highlight contextual factors of sleep that may be clinically targeted to promote emotion regulation.

Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship?

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.

A Time to Sleep Well and Be Contented: Time Perspective, Sleep Quality, and Life Satisfaction

A major aim of the present study was to examine the relationship between time perspective, i.e., habitual ways of relating to the past, present, and future, and sleep quality. A second aim was to test a model by which the expected negative relationship between deviation from a balanced time perspective (DBTP), a measure taking temporal biases across all three time frames into account, and life satisfaction was mediated by poor sleep quality. To these ends, a sample of young adults (N = 386) completed a version of the Zimbardo Time Perspective Inventory (S-ZTPI), Pittsburg Sleep Quality Index (PSQI), and the Satisfaction with Life Scale (SWLS). A measure of chronotype was in addition included for control purposes. Bivariate analyses revealed that the S-ZTPI subscales Past Negative, Future Negative and Present Fatalistic were associated with poorer sleep quality (higher PSQI scores), with significant associations in the opposite direction for Past Positive and Future Positive. However, DBTP was the strongest predictor of (poorer) sleep quality, suggesting that time perspective biases have an additive effect on sleep quality. Regression analyses with PSQI as the dependent variable and all six ZTPI subscales as the predictors indicated that time perspective accounted for about 20% of the variance in sleep quality (17% beyond chronotype), with Past Negative, Past Positive, and Future Negative as the unique predictors. The results additionally confirmed a strong relationship between DBTP and life satisfaction. Finally, data were consistent with the hypothesis that the association of DBTP and life satisfaction is mediated, in part, by sleep quality. Taken together, the results confirmed a substantial link between time perspective sleep-related problems, factors that may have a negative impact on life satisfaction.

Worry and Rumination Have Distinct Associations with Nighttime versus Daytime Sleep Symptomology

Objective: To assess whether worry and rumination differ in predicting nighttime sleep disturbance versus daytime sleep-related impairment, as assessed using short forms from the Patient Reported Outcomes Measurement Information System (PROMIS). Participants: Adults recruited from the United States population (N = 459) via an online crowdsourcing service. Methods: Factor analysis explored whether items comprising validated measures of worry and rumination loaded onto separate factors. Hierarchical multiple regression models entered worry and rumination in a stepwise fashion to assess their relative strength in predicting PROMIS sleep disturbance and sleep-related impairment, after controlling for 17 covariates. All analyses were run twice using sleep-specific and general measures of worry and rumination. Results: Worry and rumination items loaded onto separate factors. In the regression analysis of sleep-specific cognition, only worry entered the model predicting sleep disturbance, whereas rumination entered after worry in the model predicting sleep-related impairment. In the analysis of general cognition, both cognitive process variables significantly predicted the PROMIS outcomes. Worry was the stronger predictor of sleep disturbance, whereas rumination was the stronger predictor of sleep-related impairment. Conclusions: Worry and rumination were observed to be distinct constructs that separately contributed to predicting daytime sleep-related impairment. Future studies should more closely examine how cognitive processes relate to insomnia symptomology during the day.

Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis

Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitive behavioural therapy for insomnia (CBT-I) in reducing depression and anxiety symptoms, the literature on the effects of CBT-I on RNT has never been systematically appraised. Importantly, preliminary evidence suggests that reduction of RNT following CBT-I may be associated with reduction of depression and anxiety. Therefore, we aimed to conduct a systematic review and meta-analysis on the effects of CBT-I on RNT. Seven databases were searched, and 15 randomised controlled trials were included. Results showed moderate-to-large effects of CBT-I on worry (Hedge's g range: -0.41 to g = -0.71) but small and non-reliable effects on rumination (g = -0.13). No clear evidence was found for an association between post-treatment reduction in RNT and post-treatment reduction in depression and anxiety. Although the literature is small and still developing, CBT-I seems to have a stronger impact on sleep-related versus general measures of RNT. We discuss a research agenda aimed at advancing the study of RNT in CBT-I trials.

The impact of social constraints on insomnia among African-American breast cancer survivors: The mediating role of fear of recurrence

OBJECTIVE

Insomnia is a significant concern among African-American breast cancer survivors (BCS). Social constraints (SC)-receiving unsupportive or critical responses when expressing trauma-related emotions-and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African-American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR.

METHODS

Sixty-four African-American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS.

RESULTS

The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Moreover, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41).

CONCLUSIONS

Experiencing SC from family and friends could produce cognitions that impact sleep for BCS, and FOR could be one of those cognitions. Family-based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impacts sleep.

Temporal Associations between Sleep and Daytime Functioning in Parkinson's Disease: A Smartphone-Based Ecological Momentary Assessment

OBJECTIVES/BACKGROUND

Disruptions to mood, cognition, and other daytime functioning are common and debilitating symptoms of Parkinson's disease (PD), and there is evidence that sleep problems contribute to these symptoms. However, previous studies are limited by reliance on self-reported sleep and cross-sectional designs. With the aim of assessing sleep as a possible treatment target for improving daytime functioning in PD, we used smartphone-based ecological momentary assessment (EMA) and actigraphy to investigate temporal associations between sleep (objective and subjective) and daytime functioning.

PARTICIPANTS/METHODS

Twenty participants with mild-moderate PD wore actigraphs and completed sleep diaries for 14-15 days. They reported daytime functioning (anxiety, positive affect, cognitive function, fatigue, and social function) twice daily via smartphone-administered questionnaires. Multilevel modeling examined whether sleep quantity/quality predicted next-day functioning, and whether current mood (anxiety, positive affect) predicted later sleep.

RESULTS

Average completion rates for sleep diaries and daytime questionnaires were 94% and 91%, respectively. Subjective sleep quality predicted next-day anxiety (B = -.75, SE = .25, p= .003), but objective sleep did not predict any daytime functioning variables (p's>.112). Positive affect predicted later subjective sleep quality (B = 0.03, SE = .01, p = .003) but not objective sleep quantity/quality (p's>.107).

CONCLUSIONS

We demonstrated the feasibility of using EMA in PD. On a daily timescale, subjective sleep quality was bidirectionally associated with mood, whereas objective sleep was not associated with any daytime functioning. This discrepancy suggests that perception of sleep is important for mood in PD, which could provide targets for non-pharmacological interventions.

Are cognitive variables that maintain insomnia also involved in shift work disorder?

OBJECTIVE

Shift Work Disorder (SWD) is explained mainly by a misalignment between the sleep schedule and the circadian rhythm. However, the possible role of cognitive variables in maintaining SWD remains unknown. Therefore, the objective of this study is to evaluate whether cognitive variables known to maintain insomnia in day workers might also be involved in perpetuating SWD.

DESIGN

Cross-sectional.

SETTING

Sleep laboratory.

PARTICIPANTS

Twenty-five shift workers diagnosed with SWD (84% females; mean age = 35.9) and 22 shift workers who are good sleepers (91% females; mean age = 34.1).

MEASUREMENTS

The participants completed a sleep diary for two weeks, answered questionnaires, and underwent the Harvey's semistructured interview and the catastrophizing procedure. Data from the catastrophizing procedure underwent a content analysis.

RESULTS

Compared with good sleepers, shift workers with SWD reported experiencing more thoughts that keep them awake, more presleep cognitive arousal, more dysfunctional beliefs related to worries and helplessness, and more selective attention toward worries and noises. However, the two groups did not differ on the tendency to catastrophize about difficulties falling asleep. Furthermore, 12 catastrophizing themes were identified in the entire sample, the most frequently endorsed being "sleepiness and energy" and "performance at work."

CONCLUSIONS

The results suggest that cognitive variables may play a role in maintaining SWD. Finally, worries that interfere with sleep in shift workers are related to their work context.

Responses to academic stress mediate the association between sleep difficulties and depressive/anxiety symptoms in Chinese adolescents

OBJECTIVE

Sleep difficulties are pervasive in Chinese adolescents, which exert aversive influence on their emotional health. However, the underlying mechanisms of this effect remain unclear. This study addressed whether stress responses mediate the concurrent and prospective relationship between sleep difficulties and depressive/anxiety symptoms in Chinese adolescents.

METHOD

17,946 adolescents (14-18 years-old) were administrated the Pittsburgh Sleep Quality Index, the Center for Epidemiologic Studies Depression Scale, Revised Children's Manifest Anxiety Scale and the Responses to Stress Questionnaire. Further, 710 of them finished the one-year follow-up assessments. Structural equation models were conducted to determine the concurrent and prospective mediation effects of stress responses and the moderated effect of gender and age.

RESULTS

Involuntary engagement and disengagement responses, as well as engagement coping, significantly mediated the cross-sectional relationship between sleep difficulties and depressive/anxiety symptoms. Moreover, sleep difficulties at baseline predicted enhanced involuntary engagement responses but reduced the use of engagement coping strategies one year later, resulting in an elevated level of depressive/anxiety symptoms. Finally, females and younger adolescents with greater sleep difficulties were more likely to generate maladaptive stress responses.

LIMITATIONS

First, sleep difficulties were only measured using self-reported approaches. Second, potential confounding variables (e.g., socioeconomic status) were not adjusted for. Third, our study only focused on typically-developing youth samples rather than clinical samples.

CONCLUSIONS

Our findings highlight the important role of stress responses in the relationship between sleep difficulties and depressive/anxiety symptoms. The findings might also shed some light on the psychological intervention of sleep difficulties and mood disorder in adolescent populations.

Do sleep disturbances in depressed adolescents improve following psychological treatment for depression?

BACKGROUND

Persistent sleep disturbances are one of the most common symptoms of Major Depressive Disorder (MDD) in adolescence. These are not typically targeted in psychological treatments and it is not known if psychological treatment for depression improves sleep.

METHODS

Secondary analyses were conducted using data from a large, multi-centre, randomised controlled trial (Goodyer et al., 2017b). Young people aged 12-18 years (N = 465; 75% female) met diagnostic criteria for Major Depressive Disorder, based on the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). They were randomised to one of three psychological treatments. Sleep difficulties were assessed at baseline, post-treatment (36 weeks) and one year follow up (86 weeks) with the K-SADS, and the Mood and Feelings Questionnaire (MFQ).

RESULTS

At baseline, 92% of young people exhibited clinically significant sleep difficulties. Exploratory analyses suggest that sleep difficulties significantly decreased from baseline to end of treatment on self-report and interview-based measures, and this decrease was maintained at follow up. Reduction in sleep difficulties did not differ between the psychological treatments. Approximately, half of young people reported residual sleep difficulties at the end of treatment and at follow-up.

LIMITATIONS

This paper reports secondary data analyses and findings are exploratory.

CONCLUSIONS

Tentative results suggest that psychological treatments for depression reduced sleep problems for some participants. However, young people with treatment-resistant sleep problems may benefit from adjunctive sleep interventions. Future work with a range of sleep measures is needed to determine those who have residual sleep problems at the end of treatment and post-treatment follow-up.

A Systematic Review of Instruments for the Assessment of Insomnia in Adults

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.

Bidirectional associations between adolescents' sleep problems and impulsive behavior over time

Objective/Background

Adolescents who experience sleep problems are less able to resist impulses. Furthermore, youths who show more impulsive behaviors are, in turn, assumed to have more sleep problems, which sets the stage for a negative cycle over time. Empirical research has shown some evidence that sleep problems affect impulse control, but the bidirectional link has previously not been tested. Therefore, the aim of this study was to test this assumption.

Methods

In this study, we used cross-lagged models to investigate the bidirectional association between sleep problems (ie, insomnia and sleep duration) and impulsive behaviors over two years in a cohort of young adolescents (n = 2767, mean age ∼13.7, 47.6% girls). We also investigated the moderating role of age and gender.

Results

The results showed that the links between sleep duration/insomnia and impulsive behavior are bidirectional. Youths who experienced sleep problems also experienced increased difficulties with impulse control, and problems regulating impulses were also linked with increases in sleep problems, and these effects were systematic over two years. Moreover, age did not moderate these associations but impulsive behaviors had a larger impact on girls’ insomnia as compared to boys.

Conclusions

By confirming the bi-directionality of this association, this study supports the importance of developing interventions to promote sleep health in adolescents but also the need to tailor such programs to adolescents’ development because adolescents might not be able to prioritize sleep if they cannot control their impulses.

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Poor sleep and impulsive behavior were bidirectionally linked over three years.

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Girls might be at higher risk of insomnia when displaying impulsive behavior.

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Sleep interventions should take into account adolescents' lack of impulse control.

Anxiety and depression mediate the relationship between insomnia symptoms and the personality traits of conscientiousness and emotional stability

This study examined the relationship between the Big Five personality traits and insomnia symptoms in the general population. Additionally, the mediating role of anxiety and depression was examined. Participants (N = 625) completed online measures of the big five personality traits and insomnia severity. Insomnia symptoms were independently related to extroversion, agreeableness, conscientiousness, emotional stability, anxiety and depression in univariate analysis. Linear regression determined conscientiousness and emotional stability to be the only traits predicting insomnia symptoms. However, these relationships were at least partially mediated by anxiety and depression. Whilst reduced levels of conscientiousness and emotional stability has previously associated with poor sleep and insomnia, the current outcomes shed light on the mechanisms which serve to mediate this relationship.

Psychometric Properties of Two Brief Versions of Cognitive, Insomnia-Specific Measures: The Anxiety and Preoccupation About Sleep Questionnaire and the Sleep-Associated Monitoring Index

AIM

The purpose of this study was to examine the psychometric properties of two brief versions of previously validated cognitive process measures in insomnia: the Anxiety and Preoccupation about Sleep Questionnaire and the Sleep-Associated Monitoring Index.

METHODS

Two samples (168 students and 219 patients with insomnia disorder) completed original and brief versions of the two measures (Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version). Also, they filled out sociodemographic questions, sleep items, and the Insomnia Severity Index.

RESULTS

In both samples, the internal consistencies of the two brief versions were acceptable at α = .70 to.72. The correlations between the original and brief versions were significant at .79 to .82. The two brief versions were also significantly associated with insomnia severity and nighttime symptomatology. In the student sample, those with likely insomnia disorder (14.9% of the sample) scored significantly higher on the two brief versions, relative to those without insomnia.

CONCLUSION

The two brief versions, Anxiety and Preoccupation about Sleep Questionnaire-Brief version and Sleep-Associated Monitoring Index-Brief version, displayed acceptable psychometric properties. This implies that the two brief versions might be viable alternatives for use in clinical and research settings.

EEG Microstates Indicate Heightened Somatic Awareness in Insomnia: Toward Objective Assessment of Subjective Mental Content

People with Insomnia Disorder (ID) not only experience abundant nocturnal mentation, but also report altered spontaneous mental content during daytime wakefulness, such as an increase in bodily experiences (heightened somatic awareness). Previous studies have shown that resting-state EEG can be temporally partitioned into quasi-stable microstates, and that these microstates form a small number of canonical classes that are consistent across people. Furthermore, the microstate classes have been associated with individual differences in resting mental content including somatic awareness. To address the hypothesis that altered resting mental content in ID would be reflected in an altered representation of the corresponding EEG microstates, we analyzed resting-state high-density EEG of 32 people with ID and 32 age- and sex-matched controls assessed during 5-min eyes-closed wakefulness. Using data-driven topographical k-means clustering, we found that 5 microstate classes optimally explained the EEG scalp voltage map sequences across participants. For each microstate class, 3 dynamic features were obtained: mean duration, frequency of occurrence, and proportional coverage time. People with ID had a shorter mean duration of class C microstates, and more frequent occurrence of class D microstates. The finding is consistent with previously established associations of these microstate properties with somatic awareness, and increased somatic awareness in ID. EEG microstate assessment could provide objective markers of subjective experience dimensions in studies on consciousness during the transition between wake and sleep, when self-report is not possible because it would interfere with the very process under study. Addressing somatic awareness may benefit psychotherapeutic treatment of insomnia.

Effective Insomnia Treatments: Investigation of Processes in Mindfulness and Cognitive Therapy

Understanding the underlying mechanisms of recovery from insomnia is an important goal for improving existing treatments. In a randomised controlled trial, 57 participants with insomnia disorder were given either cognitive therapy (CT) or mindfulness-based therapy (MBT) following 4 sessions of CBT. Each participant was assessed on process measures related to CT and MBT. MBT resulted in improvement on mindfulness process measures and the size of the improvement was significantly greater than achieved in the CT condition. Interestingly, CT and MBT both resulted in significant improvement on the cognitive process measures. Treatment outcome on the primary outcome measure (Insomnia Severity Index) was not predicted by type of treatment but was predicted by posttreatment scores on the cognitive process measures. The results suggest that changes in cognitive processes are especially important in treating insomnia, and that there are different therapeutic modalities through which this can be achieved.

The relationship between Type D personality and insomnia

OBJECTIVES

Type D personality is characterized by the combination of social inhibition and negative affectivity. This study examined the relationship between Type D personality and insomnia symptoms amongst a sample of the general-population.

METHODS

Adults from the general-population (n = 392) completed online measures of Type D personality (DS14) and insomnia severity.

RESULTS

Individuals with the Type D personality trait reported significantly greater symptoms of insomnia relative to Non-Type Ds. Moreover, insomnia-symptoms were independently related to negative affectivity (NA) and social inhibition (SI) and the Type D interaction (i.e. synergistic product of SI and NA). Linear regression analysis determined that NA but not SI significantly predicted insomnia symptoms after controlling for age and sex. However, after accounting for the Type D interaction, negative affectivity remained the only significant predictor of insomnia-symptoms.

CONCLUSIONS

The Type D personality type appears to be related to insomnia-symptoms, both as a categorical and dimensional construct. These outcomes support prior research evidencing that whilst Type D personality is related to poor sleep in adolescents, NA appears to be the main contributor.

Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions

There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.

European Portuguese Adaptation of Glasgow Content of Thoughts Inventory (GCTI): Psychometric Characterization in Higher Education Students

Persistent cognitive activity is an important factor in disturbing sleep-onset both during bedtime and when attempting to get back to sleep after nocturnal awakenings. One of the most specific self-report measures designed to assess this feature is the Glasgow Content of Thoughts Inventory (GCTI). In this study, we investigated the preliminary psychometric properties of GCTI in a large sample of higher education European Portuguese students (N = 2995). Our results suggest that there is evidence of good internal consistency (α = 0.93) and validity indicators. Moreover, we found an interpretable factorial structure comprising 5 correlated factors that needs to be confirmed in future studies. The European Portuguese version of the GCTI appears to be a reliable and valid instrument for measurement of sleep-onset disturbing cognitions.

Automatic affective responses towards the bed in patients with primary insomnia: evidence for a negativity bias

Ruminating about sleep problems and negatively valenced thinking play a key role in the maintenance of sleep complaints in patients with insomnia. Based on associative learning principles, we hypothesized that repeated co-occurrence of negative thoughts (unconditioned stimulus) and the bedroom environment (conditioned stimulus) results in automatic negative affective responses towards the bed (conditioned response). Twenty-two insomniacs and 22 good sleepers performed a Single-Target Implicit Association Test measuring the strength of automatically triggered affective responses towards the bed. Results revealed a significant group difference, indicating a stronger negative affective response towards the bed in patients with insomnia. No correlations were found between the strength of negative affective responses towards the bed and subjective measures of sleep quality. As it might increase the stress experience further during bedtime, automatic negative responses towards the bed are likely to represent an additional factor accounting for the development and maintenance of sleep disorders and represent a potential target for therapeutic interventions.

Insomnia in women approaching menopause: Beyond perception

The menopausal transition is marked by increased prevalence in disturbed sleep and insomnia, present in 40-60% of women, but evidence for a physiological basis for their sleep complaints is lacking. We aimed to quantify sleep disturbance and the underlying contribution of objective hot flashes in 72 women (age range: 43-57 years) who had (38 women), compared to those who had not (34 women), developed clinical insomnia in association with the menopausal transition. Sleep quality was assessed with two weeks of sleep diaries and one laboratory polysomnographic (PSG) recording. In multiple regression models controlling for menopausal transition stage, menstrual cycle phase, depression symptoms, and presence of objective hot flashes, a diagnosis of insomnia predicted PSG-measured total sleep time (p < 0.01), sleep efficiency (p = 0.01) and wakefulness after sleep onset (WASO) (p = 0.01). Women with insomnia had, on average, 43.5 min less PSG-measured sleep time (p < 0.001). There was little evidence of cortical EEG hyperarousal in insomniacs apart from elevated beta EEG power during REM sleep. Estradiol and follicle stimulating hormone levels were unrelated to beta EEG power but were associated with the frequency of hot flashes. Insomniacs were more likely to have physiological hot flashes, and the presence of hot flashes predicted the number of PSG-awakenings per hour of sleep (p = 0.03). From diaries, women with insomnia reported more WASO (p = 0.002), more night-to-night variability in WASO (p < 0.002) and more hot flashes (p = 0.012) compared with controls. Women who develop insomnia in the approach to menopause have a measurable sleep deficit, with almost 50% of the sample having less than 6h of sleep. Compromised sleep that develops in the context of the menopausal transition should be addressed, taking into account unique aspects of menopause like hot flashes, to avoid the known negative health consequences associated with insufficient sleep and insomnia in midlife women.

Insomnia disorder

Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.