Pre-Sleep Arousal Scale Research Articles

A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis.

Research suggests that sleep disturbance is common in psoriasis. While several sleep investigations have been conducted in psoriasis populations, many have methodological shortcomings, and no study has examined multiple dimensions of sleep-wake functioning. Moreover, research has yet to be performed comprehensively examining the range of physical and psychological factors that may affect sleep in people with psoriasis. To characterize sleep disturbance using validated measures and to identify physical and psychological predictors of sleep quality in people with psoriasis. An online survey was conducted (186 respondents; mean age 39·2 years) comprising validated measures assessing sleep [Pittsburgh Sleep; Quality Index (PSQI), Berlin Questionnaire, Pre-Sleep Arousal Scale]; chronotype (Morningness-Eveningness Questionnaire); mood (Hospital Anxiety and Depression Scale); itch (5-D Itch Scale); and psoriasis severity (Simplified Psoriasis Index). Group comparisons and regression analyses were used to examine predictors of poor sleep. The mean PSQI score was 9·2 ± 4·3, with 76·3% scoring above the threshold for poor sleep (≥ 6 on the PSQI) and 32·5% scoring 'positive' for probable obstructive sleep apnoea (OSA). Poor sleep and high likelihood of OSA were associated with more severe psoriasis (P < 0·05; η = 0·07; η2 = 0·005). Cognitive arousal (β = 0·26, P = 0·001), itch (β = 0·26, P < 0·001) and depression (β = 0·24, P = 0·001) were the most robust predictors of poor sleep quality, which, together with somatic arousal (β = 0·17, P = 0·022), accounted for 43% of variance in PSQI scores. Poor sleep is common in psoriasis and associated with psychological and physical factors. Rates of probable OSA are also high. Given the importance of restorative sleep for health, sleep complaints should receive greater clinical attention in the management of psoriasis.

Confirmatory Factor Analysis of the Portuguese Version of the Arousal Predisposition Scale

The Arousal Predisposition Scale (APS) is an instrument aimed to assess individual differences in self-reported arousability, specifically physiologically arousal. Besides, it is a scale frequently used in stress and sleep-related researches. The principal purpose of this study is to determine the factor structure of the APS through confirmatory factor analysis (CFA) and to test the goodness-of-fit of one- and two-factor models. A sample of 341 undergraduate medical students of both genders aged 17 to 25 years was enrolled. Beyond the APS, the participants also filled out the Portuguese versions of the Pre-Sleep Arousal Scale (PSAS), Ford Insomnia Response to Stress Test (FIRST) and the Neuroticism scale of Eysenck Personality Inventory (EPI) for concurrent validity purposes. From the studied solutions, a modified two-factor model (F1 = emotional reactivity and F2 = trait anxiety) achieved the better fit to the data. The Portuguese version of the APS was also significantly correlated with measures of neuroticism, insomnia, sleep reactivity to stress, and cognitive and somatic arousal. The two-factor modified model appears to display a superior fit to the data, supporting a scoring model of the APS according to two different factors as suggested by a previous research on the Portuguese version. This study supports reliability and validity indicators of the APS and its use in research and applied settings.

The mediating role of sleep-related metacognitive processes in trait and pre-sleep state hyperarousal in insomnia disorder

ObjectiveTrait predisposition to hyperarousal and pre-sleep state hyperarousal are considered key factors in insomnia, but research also supports the role of cognitive and metacognitive processes. Therefore, the aim of this study was to evaluate the relationship between unhelpful sleep-related beliefs, sleep-related metacognition and trait/pre-sleep state arousal in insomnia disorder. MethodSixty-eight subjects with insomnia disorder (DSM-5) and 36 good sleepers were evaluated with a set of questionnaires that included Dysfunctional Beliefs about Sleep scale (DBAS), Metacognitions Questionnaire – Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). The statistical analyses included univariate, multivariate regression and mediation analyses. ResultsSubjects with insomnia reported higher scores on the DBAS, MCQI, APS, and PSAS (p's<0.001) compared to good sleepers. In the insomnia group, trait hyper-arousal was best determined by insomnia-related metacognition (p=0.02). Pre-sleep cognitive arousal was determined by insomnia-related metacognition (p=0.001) and trait hyperarousal (p<0.0001) after controlling for years of insomnia. Insomnia-metacognitive activity mediated the association between trait-hyperarousal and cognitive arousal (p=0.01, p=0.002) and the bidirectional association between pre-sleep cognitive and somatic arousal (p=0.002, p=0.04). ConclusionThis study suggests that a broad range of cognitive and metacognitive processes may be involved in the development of sleep-related arousal among people with insomnia. Insomnia metacognitive activity may influence trait factors and pre-sleep state factors depending on insomnia duration. Both insomnia evaluation and treatment may also be focused on insomnia metacognitive processes especially in subject with a long history of insomnia.

Sleep-related cognitive processes, arousal, and emotion dysregulation in insomnia disorder: the role of insomnia-specific rumination

ObjectiveInsomnia-specific rumination has presented in subjects with insomnia. Research has identified hyperarousal as a key factor, with both trait and state components. It has been shown that emotion dysregulation also plays a role in insomnia. Hence, the aim was to investigate how insomnia rumination is associated with both trait- and state-dependent arousal and emotion dysregulation in insomnia. MethodsSixty-eight subjects with insomnia disorder (DSM-5) and 36 good sleepers were evaluated using: Insomnia Severity Index (ISI), Daytime Insomnia Symptom Response Scale (DISRS), Arousal Predisposition Scale (APS), Pre-sleep Arousal Scale (PSAS), and Difficulties in Emotion Regulation Scale (DERS). Univariate and multivariate regression analyses and mediation analyses were performed. ResultsSubjects with insomnia (F 41, mean age 50.2 ± 10) presented higher scores than good sleepers (F 22, mean age 49.7 ± 14) in all the scales (ISI, DISRS, APS, PSAS, DERS; p < 0.0001). Insomnia rumination was directly correlated with trait (APS, B = 0.22, p < 0.0001) pre-sleep state arousal (PSAS cognitive B = 0.22, p < 0.0001, PSAS somatic B = 0.24, p < 0.0001) and emotion dysregulation (B = 0.5, p = 0.03). It mediated the association between trait and pre-sleep state hyperarousal (Z = 3.3, p = 0.0008), the bidirectional association between cognitive and somatic arousal (p = 0.02), and the association between trait hyperarousal and emotion dysregulation (Z = 2.3, p = 0.04). ConclusionsIn insomnia, specific rumination is related to both trait predisposition to arousal and to state-dependent arousal. It is also related to emotion dyregulation. Insomnia-specific ruminative response style may modulate the complex association between trait- and state-dependent arousal factors and arousal and emotion regulation in insomnia. In this framework, a broad range of cognitive processes may be considered when dealing with subjects with insomnia: the use of rumination-oriented psychological strategies could be important.

Trait- and pre-sleep-state-dependent arousal in insomnia disorders: what role may sleep reactivity and sleep-related metacognitions play? A pilot study

ObjectiveResearch into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder. MethodsFifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire – Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS. ResultsParticipants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values <0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) ConclusionsThis study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia.

Parent Report and Actigraphically Defined Sleep in Children with and without Developmental Coordination Disorder; Links with Fatigue and Sleepiness

Impaired sleep is associated with negative effects on quality of life and daytime functioning. Higher rates of sleep disturbance are reported in children with various developmental disorders. However, little is known about sleep in children with developmental coordination disorder (DCD), a condition characterized by everyday movement difficulties. Previously, in a preliminary study, we found higher rates of parent-reported sleep disturbance in children with DCD compared to controls. To examine sleep in DCD using objective measures and to examine links with daytime fatigue and sleepiness. Two groups (primary and secondary school-aged) of 15 children with DCD, plus matched controls, participated. Parent-reported child sleep was assessed using the Children's Sleep Habits Questionnaire and actigraphy provided an objective measure of sleep-wake patterns over 1 week (including weekdays and weekend). Pediatric restless legs syndrome (RLS) semi-structured diagnostic interview was conducted with each child and parent to capture symptoms of RLS. Aspects of self-rated child functioning were assessed with questionnaires (Pre-sleep Arousal Scale, Pediatric Daytime Sleepiness Scale, PedsQL Multidimensional Fatigue Scale) and mothers' reported thoughts about child sleep with the Maternal Cognitions about Infant Sleep Questionnaire. The DCD groups had greater parent-reported sleep disturbance. Actigraphy results suggested that for secondary aged children with DCD their sleep quality was impaired and there were differences in the timing of sleep compared to controls (including some differences in the variation between weekday and weekend sleep times). The actigraphy of the primary age group with DCD was unremarkable compared to controls. No child in the study met the criteria for RLS. Exploratory analyses suggested that daytime fatigue, aspects of pre-sleep arousal, and daytime sleepiness were reported as greater in the DCD groups and were particularly related to objective sleep parameters in the DCD groups. Maternal thoughts about sleep did not differ between the DCD and control groups. The nature and underlying cause of sleep disturbance and how it might be linked with aspects of daytime functioning in adolescents with DCD requires further research. Meanwhile, clinical awareness of the risk of atypical sleep patterns/sleep problems in DCD is important to ensure early identification and implementation of appropriate support.

What's Keeping Teenagers Up? Prebedtime Behaviors and Actigraphy-Assessed Sleep Over School and Vacation

PurposeTechnology-related behaviors (e.g., computer use) before bedtime (BT) have been associated with poorer and shorter sleep in adolescents; however, less is known about other behaviors in relation to sleep. This study characterized a range of behaviors in the hour before bed (i.e., pre-BT behaviors [PBBs]) and examined their relationship with sleep parameters during school and vacation periods (i.e., restricted and extended sleep opportunities, respectively). Mechanistic roles of chronotype and cognitive presleep arousal (PSAcog) were also examined. MethodsDuring the last week of a school term and throughout a 2-week vacation, 146 adolescents (47.26% male, age M ± standard deviation = 16.2 ± 1.0 years) from the general community completed daily sleep measure using actigraphy, self-report measures on PBBs and PSAcog (Presleep Arousal Scale) for both school and vacation periods, and chronotype (Morningness–Eveningness Questionnaire). ResultsAdolescents engaged in a variety of behaviors before bed. Notably, playing video games was associated with significantly later school and vacation BT and shorter school sleep duration (controlling for chronotype). During vacation, online social media was associated with significantly longer sleep onset latency, and this relationship was mediated by higher PSAcog. In contrast, on school nights, spending time with family was associated with significantly earlier BT and longer sleep duration. ConclusionsTechnology-related PBBs video games and online social media were risk factors for shorter and poorer sleep, whereas time with family was protective of sleep duration. In addressing sleep problems in adolescents, therapeutic procedures that target the potentially addictive nature of technology use and reduce PSAcog were implicated.

The exploratory power of sleep effort, dysfunctional beliefs, and arousal for insomnia severity and PSG determined sleep

Introduction Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent in patients with primary insomnia, indicating that the two measures are partially independent. Objectives To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG determined sleep. Aims The aim of this study was to investigate to which extent sleep effort, dysfunctional beliefs and attitudes about sleep, and pre-sleep arousal are associated with subjective insomnia severity and PSG- determined sleep. Methods 47 patients with primary insomnia and 52 good sleeper controls underwent two nights of PSG and filled in the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses adjusted for age, gender, depressive symptoms, and group status were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. Results Subjective insomnia severity was positively associated with sleep effort. PSG determined total sleep time was negatively associated with somatic pre-sleep arousal and dysfunctional beliefs and attitudes about sleep. Conclusions The pattern of results suggests that subjective insomnia severity and PSG determined total sleep time are driven by different mechanisms. Being associated with subjective sleep disturbance, which defines the diagnosis of insomnia, the reduction of sleep effort appears to be an important therapeutic target for all patients. Somatic pre-sleep arousal and dysfunctional beliefscould be a target for patients who suffer from markedly reduced PSG determined total sleep time.

Relationship of daytime fatigue and hyperarousal in patients with primary insomnia

To study the relationship between daytime fatigue and hyperarousal in patients with primary insomnia. One hundred and sixty eighty patients with primary insomnia as research group and 149 healthy people as control group were recruited during November 2013 to December 2014 in the psychiatry department of the Third Affiliated Hospital, Sun Yat-sen University. The Hyperarousal Scale (HAS), Pre-Sleep Arousal Scale (PSAS), Fatigue scale-14 (FS-14) and a visual analogue scale (VAS) were used to evaluate the symptom of hyperarousal trait, pre-sleep arousal, daytime fatigue and self reported sleep quality respectively. The participants in research group had more severe symptoms of hyperarousal trait [(41.9±9.7) vs (27.6±7.0)], pre-sleep arousal [(42.0±7.3) vs (22.1±4.7)], daytime fatigue [(9.2±3.1) vs (3.0±0.7)] than those in control group. According the multiple linear regressions, the daytime fatigue in research group was positively related not only to sleep quality, but also to hyperarousal trait and pre-sleep arousal. Hyperarousal is an important factor which could affect the daytime fatigue in patients with primary insomnia and should be given more attention to.

Effects of cognitive behavioral therapy in patients with depressive disorder and comorbid insomnia: A propensity score-matched outcome study

ObjectiveWe evaluated the effects of cognitive behavioral therapy for insomnia (CBT-I) in inpatients with a diagnosis of depression and comorbid insomnia. MethodThis study used a prospective, parallel-group design. The experimental group received CBT-I for no more than 90 min once weekly for 6 weeks and the control group only have health education manuals for insomnia. The following questionnaires were administered at baseline: the Hamilton Rating Scale for Depression (HAM-D), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Presleep Arousal Scale (PSAS), Sleep Hygiene Practice (SHP), and Pittsburgh Sleep Quality Index. The questionnaires were readministered after the completion of the 6-wk CBT-I intervention and 1 month following the completion of CBT-I, to determine the effects of the CBT-I intervention over time. The analysis of Generalized Estimation Equations was identified the difference between the experimental group and the control group by controlling for the variables in BZD dose and propensity score of gender, age, and the scores for the DBAS-16, PSAS, SHPS, and HAM-D. ResultsConsequently, the significant difference in the PSQI scores was observed at the 1-month follow-up assessment however, no significant intergroup difference in the PSQI scores was found at the completion of the CBT-I intervention between two groups. ConclusionsAs a conclusion, we found that overall sleep quality significantly improved in patients who received CBT-I after we controlled for the BZD dose and propensity score, which suggests that CBT-I may represent a useful clinical strategy for improving sleep quality in patients with depression and comorbid insomnia.

The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep.

Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent, particularly in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG-determined sleep. The aim of this study was to investigate to what extent three major components of insomnia models, i.e., sleep effort, dysfunctional beliefs and attitudes about sleep, and presleep arousal, are associated with subjective insomnia severity and PSG-determined sleep. A sample of 47 patients with primary insomnia according to DSM-IV criteria and 52 good sleeper controls underwent 2 nights of PSG and completed the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. All analyses were adjusted for age, gender, depressive symptoms and group status. The results showed that subjective insomnia severity was associated positively with sleep effort. PSG-determined total sleep time was associated negatively with somatic presleep arousal and dysfunctional beliefs and attitudes about sleep. This pattern of results provides testable hypotheses for prospective studies on the impact of distinct cognitive and somatic variables on subjective insomnia severity and PSG-determined total sleep time.

The Exploratory Power of Sleep Effort, Dysfunctional Beliefs, and Arousal for Insomnia Severity and Psg Determined Sleep

Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG determined sleep. The aim of this study was to investigate to which extent sleep effort, dysfunctional beliefs and attitudes about sleep, and pre-sleep arousal are associated with subjective insomnia severity and PSG- determined slee p . 47 patients with primary insomnia and 52 good sleeper controls underwent two nights of PSG and filled in the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses adjusted for age, gender, depressive symptoms, and group status were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. Subjective insomnia severity was positively associated with sleep effort. PSG determined total sleep time was negatively associated with somatic pre-sleep arousal and dysfunctional beliefs and attitudes about sleep. The pattern of results suggests that subjective insomnia severity and PSG determined total sleep time are driven by different mechanisms. Being associated with subjective sleep disturbance, which defines the diagnosis of insomnia, the reduction of sleep effort appears to be an important therapeutic target for all patients. Somatic pre-sleep arousal and dysfunctional beliefscould be a target for patients who suffer from markedly reduced PSG determined total sleep time.

Correlation analysis of hyperarousal, personality characteristics, coping strategy with the vulnerability to stress-related sleep disturbance

Objective To explore the influence factors of hyperarousal, personality characteristics and coping strategies on the vulnerability to stress-related sleep disturbance. Methods A total of 345 sleep good healthy volunteers were recruited by purposive sampling technique. Every participant completed an extensive survey that included the general condition questionnaire, Ford Insomnia Response to Stress Test (FIRST), Pre-Sleep Arousal Scale (PSAS), NEO Personality Inventory-Revised (NEOPI-R), Coping Inventory for Stressful Situations (CISS) and Heart Rate Variability(HRV). All participants were classified as High risk and Low risk by using the FIRST criterion. Results The high risk group was younger than the low risk group (27.91±8.22 vs 24.82±7.73, P<0.01), and had a higher percentage of females (34.7% vs 53.4%, P<0.05) . The high risk group showed significantly higher scores in PSAS total (30.11±6.22), pesleep cognitive arousal (17.73±4.51), presleep somatic arousal (12.78±3.23), neuroticism (3.13±0.51), emotion oriented (48.98±10.54), but lower score in extraversion (2.96±0.54), then those indicators of the low risk group (28.52±5.82, 16.32±4.32, 11.41±2.75; 3.11±0.56, 2.87±0.47, 46.23±11.21, 3.11±0.56, P<0.01 or 0.05). There were significant difference between the two group in LF/HF (1.51±0.19 vs 1.17±0.11, P<0.01), HF((311.21±72.32)ms2/Hz vs (490.43±91.74)ms2/Hz, P<0.01), LF((469.49±85.67)ms2/Hz vs (573.21±98.75)ms2/Hz, P<0.01) in HRV. Results of linear regression analysis showed that gender, and scores of PSAS total, cognitive arousal, presleep cognitive arousal, presleep somatic arousal, neuroticism, emotion oriented and LF/HF were significant correlation with FIRST score (P<0.01 or 0.05). Conclusion Presleep cognitive and somatic arousal, neurotic character may be the premorbid characteristics of stress-related sleep disturbance, and bad stress coping strategies are easy to promote the development of insomnia. Key words: Stress-related sleep disturbance; Vulnerability; Hyperarousal; Stress coping strategy

A randomized controlled trial of mindfulness meditation for chronic insomnia.

To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia. Three-arm, single-site, randomized controlled trial. Academic medical center. Fifty-four adults with chronic insomnia. Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or an eight-week self-monitoring (SM) condition. Patient-reported outcome measures were total wake time (TWT) from sleep diaries, the pre-sleep arousal scale (PSAS), measuring a prominent waking correlate of insomnia, and the Insomnia Severity Index (ISI) to determine remission and response as clinical endpoints. Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy. Linear mixed models showed that those receiving a meditation-based intervention (MBSR or MBTI) had significantly greater reductions on TWT minutes (43.75 vs 1.09), PSAS (7.13 vs 0.16), and ISI (4.56 vs 0.06) from baseline-to-post compared to SM. Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures, but no significant differences were found when comparing MBSR to MBTI from baseline-to-post. From baseline to 6-month follow-up, MBTI had greater reductions in ISI scores than MBSR (P < 0.05), with the largest difference occurring at the 3-month follow-up. Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up, with MBTI showing the highest rates of treatment remission (50%) and response (78.6%) at the 6-month follow-up. Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia. Mindfulness-Based Approaches to Insomnia: clinicaltrials.gov, identifier: NCT00768781.

Prediction of Insomnia Severity Based on Cognitive, Metacognitive, and Emotional Variables in College Students

Insomnia is the most common sleep disorder whose origin is attributed to various variables. The current study aims to predict the symptoms of insomnia by investigating some of its predictors. Numerous variables such as depression and anxiety symptoms, worry, pre-sleep arousal (cognitive arousal and somatic arousal), dysfunctional cognitions, and metacognitive beliefs about sleep were assessed as insomnia predictors. A total of 400 students of Tehran University of Medical Sciences completed the Depression Anxiety Stress Scale (DASS), the Penn State Worry Questionnaire (PSWQ), the Pre-Sleep Arousal Scale (PSAS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10), the Metacognitions Questionnaire-Insomnia (MCQ-I), and the Insomnia Severity Index (ISI). All variables were significantly correlated with insomnia symptoms (P < .001). Stepwise multiple regression analysis suggested a predictive model for insomnia including cognitive arousal, dysfunctional beliefs about sleep, metacognitive beliefs about sleep, and depressive symptoms. The findings underline the significant role of cognitive and metacognitive variables for predicting insomnia symptoms. Moreover, the results suggest that metacognitive beliefs about sleep may need to be considered as a significant component in the context of insomnia.

Sleep Problems, Posttraumatic Stress, and Mood Disorders Among Active-Duty Service Members

Sleep problems among active-duty service members are pervasive and complicate the recovery from comorbid posttraumatic stress and mood disorders. To better understand chronic sleep problems among active-duty service members. Medical records for active-duty service members who completed enhanced sleep assessments during an 18-month period beginning in October 2010 at the Walter Reed National Military Medical Centers' Psychiatry Continuity Service were retrospectively reviewed. Sleep assessment measures included the Pittsburgh Insomnia Rating Scale, the Alcohol Use Disorders Identification Test, the Zung Self-Rating Depression Scale, the Zung Self-Rating Anxiety Scale, the Posttraumatic Stress Disorder Checklist - Military Version, the Epworth Sleepiness Scale, the Pre-Sleep Arousal Scale, and a home sleep study. A total of 76 records met the study criteria. Twenty-two participants (29%) had an apnea/hypopnea index that suggested mild to moderate sleep apnea. Service members with higher self-reported posttraumatic stress scores also reported a higher degree of both somatic and cognitive factors interfering with sleep initiation. Compared with those who had low self-reported posttraumatic stress scores, service members with high posttraumatic stress scores also had less total sleep time (mean difference, 38 minutes) and higher scores on the apnea/hypopnea index, the respiratory disturbance index, and the oxygen saturation index. Enhanced sleep assessments that include traditional self-report tests and a home sleep study can help identify previously undiscovered behavioral and respiratory problems among service members, particularly those with higher posttraumatic stress scores.

Pre-sleep worry decrease by adding reading and guided imagery to insomnia treatment

Introduction Worry is considered an important insomnia maintenance factor. There is an urge in researching new treatments for insomnia that target diminishing pre-sleep cognitive arousal or worry. Although reading is a popular method of getting to sleep, it is recommended in stimulus control not to read in bed. Guided imagery is considered a way of dealing with cognitive pre sleep arousal. Our aim is to compare the effect on pre-sleep worry from reading and guided imagery added to insomnia treatment. Materials and methods Eighty volunteer participants were divided in reading ( n = 42; 30 females; mean age = 52.1 years) and imagery ( n = 38; 27 females; mean age = 53.3 years) groups after two baseline weeks. Treatment lasted 3 weeks and after 4 weeks follow-up was made during one week. Pre-sleep arousal scale (PSAS) was measured at baseline, post treatment and follow-up. PSAS is a 16-item scale that measures separately the somatic and cognitive arousal associated with pre-sleep time. Treatment included lectures on sleep hygiene, dysfunctional beliefs and attitudes about sleep, microanalitic and cognitive models of insomnia and the role of worries in maintaining insomnia. Reading group was asked to read during 15 min before sleep a boring, or difficult or calming book. Imagery group received a 14 min CD with imagery instructions related to get rid of worries that disturbed sleep to be listened before sleep. The Federal University of Sao Paulo Ethics Committee approved the protocol, and all candidates signed the study consent form (#01677/04). Results The comparison shows that there is no difference between reading ( p = 0,977) and somatic ( p = 0,877) groups at baseline (B), post treatment (PT) and follow-up (FU) for the cognitive and somatic components. Compared to baseline, cognitive component at post treatment and follow-up decreased significantly ( p p = 0,233) and decreased at follow-up ( p = 0,001).When compared to post treatment, somatic component showed significant decrease at follow-up ( p = 0,003). Conclusion Reading and guided imagery added to insomnia treatment are useful tools in reducing pre-sleep arousal. However, both had a quicker effect on cognitive components, while effects on somatic components appeared just at follow-up. As thoughts and worry are very important in maintaining insomnia, reading and guided imagery added to the treatment may help to cope with cognitive arousal. Acknowledgements I acknowledge Dr. Charles Morin for his generous help.

Age Differences in the Role of Cognitive Versus Somatic Arousal in Sleep Outcomes

The purpose of this study is twofold: (a) to determine whether daily or overall cognitive and somatic arousal better predict sleep and (b) to investigate age differences in the arousal–sleep relation. Fifty younger and 50 older adults completed the Pre-Sleep Arousal Scale and sleep diaries for 14 consecutive days. Analyses revealed mean arousal may better predict sleep regardless of age. However, daily arousal represents an important avenue of research as it may uncover lagged or coupling effects in the arousal–sleep relation. Significant age differences in the arousal–sleep relation suggest age-dependent associations between the type of arousal and sleep. Implications for assessment of sleep in older and younger adults are discussed.

Gender and cognitive–emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia

ObjectiveElevated pre-sleep arousal has been consistently associated with insomnia, yet the cognitive–emotional mechanisms involved in sleep-related arousal remain unclear. The purpose of this study was to identify predictors of pre-sleep arousal and trait hyperarousal from a set of variables that included self-reported affect, sleep-related cognitions, locus of control, and gender. MethodsCross-sectional data were analyzed for 128 participants (89 females) who met criteria for psychophysiological insomnia and completed a set of questionnaires that included the Beliefs and Attitudes about Sleep (BAS), Positive and Negative Affect Schedule (Negative Subscale (nPANAS) and Positive Subscale (pPANAS)), Sleep Locus of Control (SLOC), Pre-Sleep Arousal Scale (PSAS), Hyperarousal Scale (HAS) and demographic information. Step-wise regression was conducted with a set of independent variables, with PSAS and HAS serving as separate dependent variables. ResultsTrait hyperarousal was associated with higher levels of both negative and positive emotionality, as well as negative beliefs about sleep, in both genders. Pre-sleep arousal was associated with greater negative emotionality and internal sleep locus of control, varying by gender. Among women, high pre-sleep arousal was associated with negative emotionality, while in men greater pre-sleep arousal was associated with an internal sleep locus of control. ConclusionThese findings have clinical implications, suggesting that men and women may require different cognitive targets when addressing pre-sleep arousal.

Hyperarousal, sleep scheduling, and time awake in bed as mediators of outcome in computerized cognitive-behavioral therapy (cCBT) for insomnia

This study investigated the relationship between hyperarousal, sleep scheduling, and time awake in bed in a secondary data analysis. Participants were 89 adults with chronic insomnia previously involved in a randomized controlled trial of 5 weeks of computerized cognitive behavioral therapy (cCBT). At measurement periods, participants completed the Pre-Sleep Arousal Scale, 7 days of sleep diaries, and the Insomnia Severity Index. Measures were re-administered at a 4 week follow-up. Results showed that improvements in hyperarousal and time awake in bed partially mediated the impact of cCBT on sleep at follow-up but that improvements in sleep schedule consistency did not. Of these mediators, pre-sleep arousal is more significant in explaining change associated with cCBT for insomnia.