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

Annika Norell-Clarke,Markus Jansson-Fröjmark,Mikael Hagström

doi:10.3389/fpsyg.2021.677538

Abstract

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.

Highlights

Insomnia is a common disorder that is characterized by sleep initiation and maintenance difficulties
The current evidence indicates that factors associated with developing insomnia include sociodemographic parameters, such as gender (Jansson and Linton, 2006; Gureje et al, 2011), a previous episode or family history of insomnia (LeBlanc et al, 2009; Morin et al, 2009), stressful life events or stress reactivity (Healey et al, 1981; Bastien et al, 2004; Jarrin et al, 2014), psychosocial work stressors (Jansson and Linton, 2006), and health-related issues such as pain, anxiety, depression, and disability (Foley et al, 1999; Jansson-Fröjmark and Lindblom, 2008; Kim et al, 2009; LeBlanc et al, 2009; Gureje et al, 2011; Jansson-Fröjmark and Boersma, 2012)
Most insomnia models focus on this category of factors as they explain how insomnia can be treated but a question that is insufficiently answered is whether the perpetuating factors may be risk factors for incident insomnia

Summary

Introduction

Insomnia is a common disorder that is characterized by sleep initiation and maintenance difficulties. The so-called “3P model” has been widely used as a conceptual framework to understand the development of insomnia (Spielman, 1986; Spielman and Glovinsky, 1991; Morin, 1993) This model suggests that the susceptibility to developing insomnia is increased by a combination of predisposing (e.g., stress reactivity) and precipitating factors (e.g., a stressful live event). Most insomnia models focus on this category of factors as they explain how insomnia can be treated but a question that is insufficiently answered is whether the perpetuating factors may be risk factors for incident insomnia

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