Strategies for controlling sleep-related intrusive thoughts, and subjective and objective sleep quality: how self-reported poor and good sleepers differ

The relationships among metacognitive functions, sleep-related thought-control strategies and sleep quality: A mediation analysis

In the context of sleep disturbances, increasing evidence suggests a critical role of sleep-related dysfunctional metacognitive activity, including metacognitive control of intrusive thoughts in the pre-sleep period. Although the relationship between sleep-related thought-control strategies and poor sleep quality is well recognized, the possible contribution of general metacognitive functioning within this relation is still unclear. In this study, we performed a mediation analysis to examine the role of thought-control strategies on the relationship between metacognitive abilities and sleep quality in individuals with different self-reported sleep characteristics. Two-hundred and forty-five individuals participated in the study. Participants completed the Pittsburgh Sleep Quality Index, the Thought Control Questionnaire Insomnia-Revised, and the Metacognition Self-Assessment Scale to evaluate sleep quality, thought-control strategies and metacognitive functions, respectively. The results showed that worry strategy in the pre-sleep period mediates the relationship between metacognitive functions and sleep quality. Particularly, the ability to understand one's mental states and mastery functions could be the two metacognitive domains primarily involved in the dysfunctional metacognitive thought-control activity responsible for reduced sleep quality. The observed effect suggests that inadequate metacognitive functioning is associated with poor sleep quality in healthy subjects via the mediation of dysfunctional worry strategy. These findings suggest the potential relevance of clinical interventions to enhance specific metacognitive abilities, with the aim to promote more functional strategies for managing cognitive and emotional processes during the pre-sleep period.

Investigating sleep quality and sleep hygiene awareness among Chinese adults: an association and network analysis study

PURPOSE

The relationships between sleep quality and sleep hygiene awareness in the Chinese population were unclear. We aimed to investigate the associations and related factors between sleep quality and sleep hygiene awareness in adults and to identify the most central domain for sleep quality using network analysis.

METHODS

A cross-sectional survey was conducted from April 22 to May 5, 2020. Adults (18 years old or above) who had access to smartphones were invited to participate in this survey. The Pittsburg Sleep Quality Index (PSQI) and the Sleep Hygiene Awareness and Practice Scale (SHAPS) were used to evaluate the sleep quality and sleep hygiene awareness of the participants. Propensity score matching (PSM) was used as sensitivity analysis to reduce the confounding effects. Multiple logistic regression was performed to evaluate the associations. The R packages "bootnet" and "qgraph" were used to estimate the connection and calculate the network centrality indices between good and poor sleepers.

RESULTS

In total, 939 respondents were included in the analysis. Of them, 48.8% (95% CI: 45.6-52.0%) were identified as poor sleepers. Participants with nervous system diseases, psychiatric diseases, and psychological problems were more likely to have poor sleep quality. The notion that using sleep medication regularly was beneficial to sleep was associated with poor sleep quality. Similarly, the notion that waking up at the same time each day disrupted sleep was also associated with poor sleep quality. The findings were consistent before and after PSM. Subjective sleep quality was the most central domain for sleep quality in good and poor sleepers.

CONCLUSION

Poor sleep quality was positively associated with certain sleep hygiene notions in Chinese adults. Effective measures such as self-relief, sleep hygiene education, and cognitive behavioral treatment may have been needed to improve sleep quality, especially during the COVID-19 outbreak.

How emotions induced by reading influence sleep quality in young and older adults

OBJECTIVES

This study examined whether emotions induced by reading before sleep influence sleep quality in young and older adults.

METHOD

Sixty older adults (64-75 years) and 60 young adults (18-35 years) were randomly assigned to three conditions: positive reading, neutral reading, and control. The reading groups read a short story at bedtime, whereas the control group kept its routine. Participants completed measures of affective states, subjective sleep parameters, and self-reported sleep quality related to emotions over 7 consecutive days.

RESULTS

Older adults reported much longer sleep latency and lower sleep efficiency than young adults. In both reading conditions, older adults reported reduced sleep latencies compared to the control group. In the positive reading condition, older adults reported an increased sleep duration compared to younger adults and the other conditions. Young and older adults in the positive condition showed better self-reported sleep quality than those in the neutral conditions, regardless of age.

CONCLUSIONS

Reading at bedtime appears to reduce older adults' time to fall asleep and increase their sleep duration. Positive emotions induced by reading short stories at bedtime seem to be a sleep-promoting factor that improves bedtime and wake time in young and older adults.

Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction

OBJECTIVES

Transitions from middle adolescence into merging adulthood, a life stage between age 15-25, has a high prevalence of sleep problems. Mindfulness is a trait defined as being attentive to the present moment which positively relates to sleep quality. In this study, we aimed to investigate how resilience and emotional dysfunction may influence the relationship between trait mindfulness and sleep quality.

METHODS

The Five Facet Mindfulness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scales were used to measure the key variables through an online survey of 497 participants between middle adolescence and emerging adults (317 females, mean age 18.27 ± 0.76 years). A process model was built to investigate the mediating roles of resilience and emotional dysfunction in the impact of trait mindfulness on sleep quality, together with the relationships between their specific components.

RESULTS

We found a positive association between mindfulness and sleep quality through resilience and through emotional dysfunction, and through the sequential pathway from resilience to emotional dysfunction. Of note, acting with awareness (mindfulness facet) showed significant indirect effects on sleep quality, mediated by resilience and emotional dysfunction.

CONCLUSIONS

Our findings may unveil the underlying mechanisms of how low mindfulness induces poor sleep quality. The findings indicate that conceiving mindfulness as a multifaceted construct facilitates comprehension of its components, relationships with other variables, and underscores its potential clinical significance given its critical implications for mental health.

Strategies for Controlling Unwanted Intrusive Thoughts and Insomnia Severity in Urban-Residing Young Adult African Americans

INTRODUCTION

Poor sleep is common in our society, particularly for African Americans, and is associated with adverse mental and physical health outcomes. Unwanted, intrusive thoughts contribute to sleep disturbances and can be engendered by living in stressful urban environments, which are disproportionately inhabited by African Americans. Studies of other populations have shown that cognitive coping strategies to manage intrusive thoughts vary in their adaptiveness.

OBJECTIVE

To examine the relationship between thought control strategies and insomnia severity in urban residing young-adult African Americans.

METHOD

Sixty-four young adult African Americans completed a demographic questionnaire, the Thought Control Questionnaire for Insomnia-revised, and the Insomnia Severity Index.

RESULTS

There were moderate to strong positive correlations of aggressive suppression, worry, behavioral distraction, and social avoidance with ISI scores. Poor sleepers endorsed greater use of worry and aggressive suppression than good sleepers. Results from a multiple linear regression analysis revealed that aggressive suppression, social avoidance, and behavioral distraction significantly predicted insomnia severity, and aggressive suppression was the strongest predictor in the model.

CONCLUSIONS

These results extend findings of aggressive suppression as a correlate of insomnia severity to an urban-residing young adult African American sample. Future research should identify adaptive approaches and the utility of modifying maladaptive strategies.

Do Sleep-Related Metacognitive Strategies Shape My Sleep? The Relationships between Strategies for Controlling Sleep-Related Intrusive Thoughts and Subjective and Objective Sleep Quality in Young Adulthood and Older Age

This study examined the associations between thought control strategies and subjective and objective sleep quality, across the adult lifespan. One hundred forty-nine individuals without insomnia (age range 18-86 years; M = 45.35, SD = 20.53) completed the Thought Control Questionnaire Insomnia-Revised for assessing sleep-related thought control strategies. Self-reported sleep quality was measured with the Pittsburgh Sleep Quality Index. Then, subjective and objective sleep parameters (i.e., total sleep time, sleep onset latency, sleep efficiency) were recorded through a sleep diary and an actigraph across 7 days. Results from linear mixed-effects models showed that a worry strategy was associated with longer subjective sleep latency and shorter subjective total sleeping time. An aggressive suppression strategy was associated with longer subjective total sleeping time. No such involvement of thought control strategies was detected for subjective sleep efficiency and all of the objective sleep parameters. Other individual differences (i.e., age, sex, circadian preference, self-reported sleep quality) also explained both subjective and objective sleep parameters, though to a different extent depending on the sleep parameter considered. The assessment of sleep-related thought control strategies, along with other individual characteristics, should be considered to account for individual differences in sleep quality and implement practices/interventions to support it in adulthood and older age.

Non-pharmacological interventions targeting sleep quality in older adults: a systematic review and meta-analysis

Objectives: This review aimed to examine the available evidence about non-pharmacological interventions (NPIs) aimed at improving sleep quality in older adults without insomnia or dementia.Methods: Studies on NPIs targeting older adults' sleep were searched in the PsycInfo, PubMed and Scopus databases, with no restriction on publication year up to September 2021. Studies on NPIs for older adults with no diagnosed sleep disorders were included, while those on pharmacological therapies and/or concerning pathological samples were excluded. The risk of bias was assessed using tools based on Joanna Briggs' criteria. The data extracted were meta-analyzed using random effects models for subgroups of NPIs.Results: Of the 1,893 records identified, 31 studies on NPIs (N = 2,224; range of mean ages: 60-78 years) were analyzed. All NPIs improved self-reported sleep quality, albeit to a different extent (physical activity: d=.97 - 95% CI=.62, 1.32-; psychological/psychoeducational, or NPIs that combined more than one sleep-targeting activity: d range: .21 to .97). Only the NPIs based on physical activity improved objectively-measured sleep, d=.31 (.04, .57). The methodological quality of most studies was limited.Conclusion: The most often used NPIs targeting sleep rely on physical activity and sensory stimulation with promising results on sleep quality for the former. More data are needed on psychological/psychoeducational NPIs and combined interventions in order to test their effectiveness. The methodological weaknesses of the available studies suggest they their findings should be interpreted with caution.

Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up

STUDY OBJECTIVES

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease.

METHODS

A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale).

RESULTS

Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant.

CONCLUSIONS

Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia.

CITATION

Frøjd LA, Papageorgiou C, Munkhaugen J, et al. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

The relationship between sleep hygiene, mood, and insomnia symptoms in men with prostate cancer

PURPOSE

Insomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients.

METHODS

An online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene, and psychological symptoms using validated questionnaires.

RESULTS

Data from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, number of comorbidities, and BMI) accounted for 11.9% of the variance in insomnia symptoms. Including treatment history contributed to an additional 1.6% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, and depressive symptoms to the model explained an additional 44.6% of the variance in insomnia symptoms. Furthermore, including the sleep hygiene item 'I think, plan, or worry when I am in bed' and 'I sleep in an uncomfortable bedroom' explained an additional 3.6% of the variance in insomnia symptoms.

CONCLUSIONS

Poor sleep hygiene, fatigue, sleepiness, anxiety, and depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.

Positive rumination can (also) interfere with sleep: A study in a non-clinical sample

It is postulated that negative ruminations perpetuate insomnia symptoms by increasing arousal. Less is known about the role of positive rumination. In this study, we set out to test the association between positive and negative ruminations and insomnia symptoms in a non-clinical sample, asking whether reappraisal and suppression moderate the relationship between rumination types and symptoms of insomnia.

METHODS

A convenience sample of 354 participants (59% women), ages 18-50, responded to online questionnaires regarding symptoms of insomnia (Insomnia Severity Index [ISI]), Emotion Regulation Questionnaire that provides separate scales for Reappraisal and Suppression, Negative Rumination (Ruminative Response Scale), Positive Rumination and Dampening (Responses to Positive Affect questionnaire), and general health and demographics.

RESULTS

About 30% of respondents had moderate to severe symptoms of insomnia according to the ISI. The primary hypothesis was tested using three moderation models, where rumination type, emotion regulation styles, and interaction terms were predictors, and ISI scores were the outcome variable. Negative rumination positively predicted ISI (β = 0.56, p < 0.001), while the interaction terms with Reappraisal (β = 0.02, p = 0.575) and Suppression (β = 0.07, p = 0.092) were not significant. Dampening also positively predicted ISI (β = 0.56, p < 0.001), with the interaction term with Reappraisal nearly significant (β = -0.09, p = 0.060), but not with Suppression (β = 0.08, p =0.098). Positive rumination negatively predicted ISI (β = -0.12, p = 0.021), this relationship was reversed with emotion regulation factors in the model (β = 0.11, p = 0.094), where the interaction with Reappraisal (β = 0.13, p = 0.020) and Suppression (β = -0.13, p = 0.024) were both significant.

DISCUSSION

Positive Rumination weakly and negatively correlated with ISI, but the combination with Reappraisal was associated with more insomnia symptoms. By contrast, Dampening was associated with more insomnia symptoms, with minimal to no moderating effects. These observations are interpreted in the context of the role of emotion regulation strategies and sleep, and their potential clinical implications.