Abstract
Insomnia is a widespread neuropsychological sleep-related disorder known to result in various predicaments including cognitive impairments, emotional distress, negative thoughts, and perceived sleep insufficiency besides affecting the incidence and aggravation of other medical disorders. Despite the available insomnia-related theoretical cognitive models, clinical studies, and related guidelines, an evidence-based conceptual framework for a personalized approach to insomnia seems to be lacking. This study proposes a conceptual cognitive framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of insomnia and consequent cognitive deficits. The current CCF for insomnia relies on evaluative conditional learning and appraisal which generates negative valence (emotional value) and arousal (cognitive value). Even with the limitations of this study, the suggested methodology is well-defined, reproducible, and accessible can help foster future high-quality clinical databases. During clinical insomnia but not the neutral one, negative mood (trait-anxiety) causes cognitive impairments only if mediating with a distorted perception of insomnia (Ind-1 = 0.161, 95% CI 0.040–0.311). Further real-life testing of the CCF is intended to formulate a meticulous, decision-supporting platform for clinical interventions. Furthermore, the suggested methodology is expected to offer a reliable platform for CCF-development in other cognitive impairments and support the causal clinical data models. It may also improve our knowledge of psychological disturbances and complex comorbidities to help design rehabilitation interventions and comprehensive frameworks in line with the “preventive medicine” policies.
Highlights
Behavioral sleep disturbances are classified into various types of insomnia, excessive daytime somnolence (EDS), sleep phase disorders, and parasomnias
The present study aims to fill this void in the literature by proposing and validating a novel conceptual cognitive framework (CCF) for insomnia in light of the abovementioned models
Before the sessions in both studies, participants filled up a Portuguese version of a battery of questionnaires that included (a) a six-item state-trait anxiety inventory (STAI) (Gorenstein and Andrade, 1996) for measuring the presence and severity of anxiety symptoms in the current moment (State anxiety) and a generalized predisposition to be anxious (Trait anxiety), and (b) a mini-sleep questionnaire (MSQ) (Falavigna et al, 2011), i.e., a short screening for sleep disturbances in clinical populations for the assessment of insomnia and sleep difficulties (Table 1)
Summary
Behavioral sleep disturbances are classified into various types of insomnia, excessive daytime somnolence (EDS), sleep phase disorders, and parasomnias. Bootzin and Rider (1997) noted that “bedtime may often be the first quiet time during the day available to think about the day’s events and FIGURE 1 | Conceptual Cognitive Framework of Insomnia: During the pre-sleep situation, when attentional resources are captured by insomnia-related stimuli, either directly or through insomnia-related cognitive and emotional values, distress is triggered, resulting in a distorted perception of sleep quality, which, in turn, worsens the sleep-initiation process. Attention bias to sleep-preventing cues (as concern-relevant stimuli) can trigger a cognitively aroused state with subsequent appraisals about insomnia, “I am never going to get to sleep,” “I am not coping with the amount of sleep I get,” and “I am going to lose my job” (Harvey, 2002) Negative thoughts through this appraisal mechanism further fuel the negative sleep-related cognitive value, leading to annoyance or distress reaction. I get in a state of tension or turmoil as I think over my recent concerns and interests
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