Acceptance of insomnia

Abstract

Introduction In behavioural medicine the concept of acceptance, that is willingness to accept things that can not be altered, has gained popularity and scientific support. How acceptance influences the experience of poor sleep in insomnia has not yet been investigated. To study acceptance in insomnia, we developed a questionnaire with 10 items, the Insomnia Acceptance Questionnaire (IAQ), following the model of the Chronic Pain Acceptance Questionnaire, CPAQ. The IAQ consists of two subscales, labelled Activity Engagement (AE) and Willingness (W). Materials and methods Acceptance data was collected in a randomised controlled insomnia treatment study in primary care (n = 66). Correlations with other sleep related measures at baseline and follow-up assessments were analysed: the Insomnia severity index (ISI), sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), sleep quality (SQ), the Epworth sleepiness scale (ESS), the Fatigue severity scale (FSS), the Hospital anxiety and depression scale (HADS), and the Short-form health survey (SF-36). Results Acceptance correlated negatively with subjective insomnia severity at baseline, measured with ISI, with less acceptance associated with more insomnia. On the other hand, more objective measures derived from sleep diaries (SOL, WASO, TST) did not correlate with acceptance. There were negative correlations with fatigue and anxiety, but positive correlations with perceived sleep quality and mental health. Daytime sleepiness did not correlate with acceptance. Increased acceptance during treatment correlated with lower ISI-score, less anxiety and better mental health, but not with changes in objective sleep time assessed with SOL, WASO, or TST. Conclusion Low acceptance characterized by a lack of willingness to accept insomnia symptoms, seemed to be more closely correlated with the subjective experience of insomnia than with sleep diary parameters at baseline. During the course of treatment, increased acceptance correlated with decreased perceived insomnia and reduced anxiety, and was associated with better mental health. Thus, enhanced acceptance of symptoms could be an important target in insomnia treatment. Acknowledgements The study was supported by the Uppsala-Orebro Regional Research Council and the Disciplinary Domain of Medicine and Pharmacy, Uppsala University. The factor analysis behind the items of the IAQ was made by Viktor Kaldo, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.