Pre-sleep Arousal Research Articles

Association Between Sleep-related Cognitions, Sleep-related Behaviors, and Insomnia in Patients with Anxiety and Depression: A Cross-sectional Study.

The cognitive model of insomnia states that worry about sleep contributes to poor sleep quality. Besides worry, beliefs about sleep and maladaptive safety behaviors also affect sleep quality. We aimed to find the association among the presence of insomnia, sleep-related cognitions, and behaviors among patients diagnosed with anxiety or depression. The present cross-sectional comparison study included patients with anxiety spectrum or depressive disorders as per the Diagnostic and Statistical Manual for Mental Disorders-fifth edition and healthy controls. Mood status, insomnia severity, sleep quality, dysfunctional beliefs about sleep, maladaptive safety behaviors, and pre-sleep arousal were evaluated using Hamilton Anxiety Scale (HAM-A), Montgomery Åsberg Depression Rating Scale (MADRS), Insomnia Severity Index, Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes Sleep Scale (DBAS), Sleep-related Behavior Questionnaire (SRBQ), and Pre-sleep Arousal Scale (PSAS), respectively. A p value ≤.05 was considered statistically significant. Both patients (n = 80) and controls (n = 80) were similar in sociodemographic profile, though the sample was predominantly female. Comparison between patients with insomnia (n = 60), patients without insomnia (n = 20), and healthy controls (n = 80) showed that HAM-A and MADRS, DBAS, SRBQ, and PSAS scores were higher in patients with insomnia compared to their counterparts. DBAS and SRBQ scores positively correlated with increasing severity of insomnia. Dysfunctional beliefs regarding sleep (OR: 1.05; 95% CI = 1.00-1.09) and maladaptive behaviors related to sleep (OR: 1.02; 95% CI = 1.00-1.05) predicted insomnia in patients with depression or anxiety. Insomnia in anxiety or depression is associated with illness severity, dysfunctional beliefs regarding sleep, and sleep-related maladaptive behaviors. Maladaptive cognitions and behaviors can independently influence sleep quality.

Psychological and physiological health outcomes of virtual reality-based mindfulness interventions: A systematic review and evidence mapping of empirical studies

Objective In the past two decades, mindfulness, rooted in Buddhist traditions, has gained considerable scientific interest. Virtual reality (VR) technology, in particular head-mounted displays, offers immersive experiences and is examined in this systematic review in terms of VR-based mindfulness interventions and their effects on psychological and physiological health outcomes. Methods Using the Preferred Reporting Items for Systematic Review and Meta Analyses guidelines, a systematic search was conducted with the following search terms: [(mindful* OR “meditat*”) AND (“virtual reality” OR “VR”) AND (health OR physio* OR psycho* OR mental OR physical)]. Considering critiques of methodological quality in existing systematic reviews, this study adopts Boell and Cecez-Kecmanovic’s hermeneutic approach, critically evaluating research outcomes. Results Psychological benefits include improved anxiety, mindfulness, emotions, disease patterns, affect, stress, (presleep) arousal, meditation and others. Physiological effects focus on neurobiological markers, heart rate/heart rate variability, pain, blood pressure, cortisol and galvanic skin resistance. Evidence mapping shows that more research has been conducted in the last 6 years, particularly by North American and South Korean authors, and points to gaps in study methodology. In addition, attention regulation is identified as a primary mindfulness mechanism in VR scenarios, often in nature-based virtual environments, with mainly single-session studies lasting 5 or 10 minutes. Discussion Critical mapping reveals the need for additional studies to support and extend initial findings in this emerging research field. Methodologically, there is a call for more true-experimental studies to enhance rigor. From a content perspective, VR protocols are currently still strongly characterized by single-session interventions, which makes it especially difficult to make a dose–response statement regarding long-term effects. Conclusion In summary, the studies provide important initial findings on psychological and physiological effects of VR-based mindfulness interventions on health. In addition, the need for more methodologically rigorous studies was emphasized, along with other methodological adjustments that must be carefully considered in the planning of future studies.

Predicting the Persistence of Insomnia Symptoms during the COVID-19 Pandemic

ABSTRACT Objective The goal of this study is to evaluate the factors associated with vulnerability and course of insomnia longitudinally in the COVID-19 pandemic and examine differences between: (a) those who never demonstrated clinical insomnia symptoms, (b) those who demonstrated clinically elevated insomnia symptoms at 1 or 2 time points, and (c) those who demonstrated clinically elevated insomnia symptoms at all 3 time points. Methods Participants (≥18 years old) completed measures of insomnia (ISI), depression (PHQ-8), anxiety (GAD-7), and pre-sleep arousal (PSAS) at 3 time points (baseline, 1 month, and 3 months). Data were analyzed using univariable odds ratios and multivariable multicategory logistic regression to determine demographic, psychological, and behavioral predictors of insomnia persistence. Results A total of 129 participants completed all 3 assessments (70 female, age M = 44 years, SD = 16). We found that 40% (N = 51) never had insomnia symptoms, 33% (N = 42) reported transient insomnia symptoms (1 or 2 time points), and 28% (N = 36) reported persistent insomnia symptoms (all 3 time points). From the multivariable multicategory logistic analyses, pre-sleep arousal, gender, and income were significant predictors of insomnia persistence. Conclusions Findings indicate elevated insomnia symptoms were persistent in a substantial number of individuals throughout the pandemic. Results suggest additional insomnia and psychological interventions are needed to improve sleep and mental health.

Exploring Variables Associated with the Effects of a Self-Administered Hypnosis Intervention for Improving Sleep Quality

ABSTRACTAbout two-thirds of college students rate their sleep as suboptimal which is associated with a variety of additional issues. Poor sleep is shown to follow certain pre-sleep cognitive activity that inhibits sleep onset and reduces sleep quality. Preliminary evidence suggests that a self-administered hypnosis intervention is feasible in improving sleep within a college student population, and the current study explores potential correlating variables to inform future mechanistic research. Twenty-two college students who self-reported poor sleep quality utilized a three-week self-administered hypnosis intervention while completing baseline and endpoint measures of sleep quality, insomnia symptoms, and psychological factors. Results indicated that participants experienced significant improvement with large effects in sleep quality (d = -1.21) and significant decreases in insomnia symptoms (d = 1.05) from pre- to post-intervention. Significant improvements were also observed on measures of pre-sleep arousal and worry. The results suggest that a self-administered hypnosis intervention may modulate pre-sleep cognitive activity associated with poor sleep quality.

Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study.

Perfectionism is considered a predisposing and maintaining factor for insomnia disorder. However, previous studies were predominantly based on retrospective self-reports of sleep and have yielded mixed results. Here, we investigated associations between perfectionism, daily stress levels, pre-sleep arousal, and actigraphic and sleep diary-derived sleep in insomnia using an experience sampling design. Individuals with insomnia (n = 63) reported their trait perfectionism levels and completed assessments on seven consecutive days. Momentary stress levels were reported on mobile phones at three semirandom time points each day. Presleep arousal levels were rated each morning for the previous night. Sleep onset latency, total sleep time, wake after sleep onset, and sleep efficiency were assessed prospectively using actigraphic watches and sleep diaries. Perfectionism dimensions and daily stress levels did not predict self-reported or actigraphic sleep parameters. Higher levels of somatic and cognitive presleep arousal were robustly associated with indicators of poorer same-night sleep. The concern over mistakes and doubts dimension of perfectionism interacted with cognitive presleep arousal in predicting self-reported sleep parameters. In the presence of higher presleep arousal, participants with high concern over mistakes and doubts experienced shorter self-reported total sleep time and lower sleep efficiency (both Ps < .01) than on days with lower cognitive arousal. Taken together, our results did not indicate an impact of heightened perfectionism levels on sleep in individuals with insomnia, based on prospective sleep assessments. However, our findings provide further evidence for the role of somatic and cognitive presleep arousal, potentially interacting with perfectionism, in the perpetuation of insomnia symptoms. Küskens A, Stricker J, Hertrampf LS, Pietrowsky R, Gieselmann A. Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study. J Clin Sleep Med. 2024;20(3):433-443.

Screening for Comorbidity of Sleep Disorders in Career Firefighters.

The purpose of this study was to assess the prevalence and sequelae of insomnia, obstructive sleep apnea (OSA), and comorbid OSA and insomnia (COMISA). In the morning, after a shift end, Midwest career firefighters ( N = 89) in a midsized city completed an electronic battery of questionnaire to screen for OSA, daytime sleepiness, insomnia, presleep arousal, nightmares, mental and physical health symptoms, and a one-night sleep diary. Prevalence of firefighters exceeding screening thresholds: OSA: 54%; insomnia: 30%; COMISA: 17%; four or more nightmares per month: 15%. Firefighters who met criteria for COMISA had shorter total sleep time, less restful and worse sleep quality, higher depression and anxiety symptoms, and presleep arousal symptoms than firefighters without self-reported sleep problems. Many firefighters are at elevated risk of individual behavioral sleep disorders, COMISA, and daytime dysfunction.

The Roles of Intrusive Visual Imagery and Verbal Thoughts in Pre-Sleep Arousal of Patients with Insomnia Disorder: A Path Model

The Roles of Intrusive Visual Imagery and Verbal Thoughts in Pre-Sleep Arousal of Patients with Insomnia Disorder: A Path Model

Sleep characteristics and pain in middle-aged and older adults: Sex-specific impact of physical and sitting activity

ObjectivesThe relationship between poor sleep health and worse pain is established. Physical activity has been successful in reducing chronic pain and improving sleep in aging adults. Despite known sex differences (more women than men experiencing chronic pain and insomnia), sex-specific patterns of interactive associations between physical activity, sleep, and pain remain unexplored. This study tested whether physical and sitting activity moderated associations between sleep characteristics and pain intensity, and whether sex further moderated these relationships. MethodsParticipants aged 50+ (N = 170, Mage = 64.34, 72 women) completed an online survey measuring pre-sleep arousal (Pre-sleep Arousal Scale), sleep (Pittsburgh Sleep Quality Index), past month average pain intensity, and physical activity (International Physical Activity Questionnaire). Multiple regressions evaluated whether minutes of physical activity (total, vigorous, moderate, walking) or sitting activity, pre-sleep arousal, sleep, sex, or their interaction was associated with pain. Analyses controlled for education, difficulty walking, body mass index, total medical conditions, pain medication, and depressive/anxiety symptoms. ResultsIn women, vigorous activity interacted with total pre-sleep arousal and somatic pre-sleep arousal in its association with pain. Higher total arousal and somatic arousal were associated with worse pain intensity only for women who reported highest levels of vigorous activity. No such associations were observed for men or for other physical or sitting activity levels. ConclusionsVigorous physical activity may exacerbate the association between more pre-sleep arousal and worse pain in middle-aged and older women. Research should explore potential sex-specific mechanisms (e.g., inflammatory cytokines, arousal neural networks) underlying these results.

The interaction between stress and sleep disorders among foreign medical students in Georgia

ObjectivesThis study aimed to: a. Investigate daytime sleepiness, stress, and pre-sleep arousal prevalence among foreign medical students in Georgia. b. Explore gender-based associations between sleep and stress parameters. MethodsMental health was assessed in 207 foreign medical students in Georgia using the Epworth Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI). ResultsMost participants reported elevated stress levels and excessive daytime sleepiness (EDS). EDS affected 25.1% of students, with slightly higher prevalence in males. PSAS was prevalent in 97.1% of students. Stress was widely reported, with 78% experiencing it, with a higher prevalence in females.Significant correlations were observed between sleepiness and arousal, including somatic (r = 0.41) and total scores (r = 0.28). Sleepiness was also linked to stressors like pressure, changes, self-imposed stress, and overall self-evaluation stress (r = 0.45). Strong correlations existed between ESS, Total PSAS, and overall self-evaluation SLSI scores for both genders.Gender differences were observed in the associations with Cohen's d within the small to moderate size. Men showed significant associations between ESS and stressors: conflict, pressure, chances, all stress reaction categories, and total SLSI scores (p < 0.001). In women, ESS correlated significantly only with overall self-evaluation (p < 0.001). Excessive daytime sleepiness, especially with somatic and total PSAS, predicted total SLSI scores for the entire sample and both genders, with stronger predictive values for total PSAS. ConclusionThe study reveals a high prevalence of clinical sleepiness and its significant correlation with pre-sleep arousal and stress among foreign medical students, with females experiencing more difficulties than males.

The psychometric properties of the Turkish version of the Pre-sleep Arousal Scale.

The aim of the present study was to examine the psychometric properties of the Turkish version of the Pre-sleep Arousal Scale (PSAS), which measures pre-sleep arousal, a significant predictor of insomnia symptoms. 651 participants were recruited via social media and the Internet. Confirmatory factor analysis was conducted in the total sample (65.28% females; Mage1 = 28.09 ± 14.00). Convergent, divergent, incremental, and known-groups validity and internal consistency coefficients were assessed in a subsample of 556 participants (62.77% females; Mage2 = 29.25 ± 14.81). A second separate sample of 88 participants (80.68% females; Mage3 = 22.19 ± 4.98) was used to evaluate three-week test-retest reliability. The results of factor analysis confirmed the two-factor structure of the Turkish PSAS with cognitive (PSAS-C) and somatic (PSAS-S), similar to the original scale. The correlations of the PSAS with convergent and divergent measures showed that the Turkish form had good convergent and acceptable divergent validity. PSAS-C and PSAS-S were able to explain an 18% additional variance in insomnia severity beyond depression and anxiety, an 18% additional variance in depression beyond insomnia severity, and a 35% additional variance in anxiety beyond insomnia severity. Moreover, insomnia patients had significantly higher PSAS-C and PSAS-S scores than good sleepers. Finally, the PSAS, PSAS-C, and PSAS-S had satisfactory internal consistency coefficients (α = 0.92, 0.91, and 0.86, respectively) and three-week test-retest correlations (ICC = 0.82, 0.82, and 0.71, respectively). The Turkish form of thePSAS was a valid and reliable measure of pre-sleep arousal and can be utilized in sleep studies. The online version contains supplementary material available at 10.1007/s41105-023-00483-z.

Testing the nightmare cognitive arousal processing model.

Posttrauma nightmares are recurring nightmares that begin after a traumatic experience. Research has only recently begun to identify variables that predict posttrauma nightmare occurrences. Research has identified presleep arousal-cognitive (PSA-C) and presleep arousal physiological (PSA-PHYS), sleep onset latency (SOL), and sleep-disordered breathing (SDB) as potential predictors of posttrauma nightmares. However, previous research includes methodological limitations, such as a lack of physiological measures and a homogeneous sample. To replicate previous findings and increase generalizability, the current study investigated predictors of nightmare occurrences in a sample of male inpatient veterans with mixed-trauma history. Participants (n = 15) completed an initial assessment battery and seven consecutive days of pre and postsleep diaries, including measures of posttrauma nightmare triggers and posttrauma nightmare occurrences. Portable objective measurements of sleep and presleep states were used to examine sleep quality and physical arousal. Analyses revealed that PSA-C and SOL both predicted posttrauma nightmare occurrences and that PSA-PHYS was significantly higher on nights when nightmares occurred. Results replicate earlier research which posits that PSA and SOL play a role in triggering the occurrence of posttrauma nightmares. It should be noted that the sample was relatively small, warranting cautious interpretation of results. However, when taken together with the findings of the replicated study, results could suggest the plausibility of therapies targeting presleep cognitions, SOL, and presleep arousal in the treatment of posttrauma nightmares. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Can restricting while-in-bed smartphone use improve sleep quality via decreasing pre-sleep cognitive arousal among Chinese undergraduates with problematic smartphone use? Longitudinal mediation analysis using parallel process latent growth curve modeling

Background and aimProblematic smartphone use (PSU) has become a global public health problem. Excessive while-in-bed smartphone use may result in poor sleep quality. The present study aimed to examine whether restricting while-in-bed smartphone use can improve sleep quality and the mediating role of pre-sleep cognitive arousal in this process. MethodsA total 152 Chinese undergraduates with symptoms of PSU (Smartphone Addiction Scale-Short Version [SAS-SV] > 31) were recruited and randomly assigned to the intervention group (N = 76) and the control group (N = 76) for a 4-week follow-up experiment. Sleep quality (assessed by the Pittsburgh Sleep Quality Index) and pre-sleep cognitive arousal (assessed by the Pre-sleep Arousal Scale-Cognitive Arousal) were measured at baselime, Week1, Week2, Week3, and Week4. The longitudinal mediation model was analyzed using parallel process latent growth curve modeling. The significance of indirect effect was tested by 95% biascorrected accelerated confidence intervals on the basis of 5000 bootstrap samples. ResultsThe initial level of sleep quality was positively associated with the initial level of pre-sleep cognitive arousal. The intervention decreased pre-sleep cognitive arousal and increased sleep quality. The slope of pre-sleep cognitive arousal was positively associated with the slope of sleep quality. The mediating effect of pre-sleep cognitive arousal was significant. DiscussionRestricting while-in-bed smartphone use can improve sleep quality via decreasing pre-sleep cognitive arousal among Chinese undergraduates with symptoms of PSU. These results suggests that restricting while-in-bed smartphone use is a potential remedy for sleep disturbance induced by PSU.

Healthcare worker burnout during the first COVID-19 lockdown in Italy: experiences from an intensive neurological rehabilitation unit.

The study aim was to investigate the prevalence of behavioral symptoms and burnout in healthcare workers in an intensive neurological rehabilitation unit in Messina, Italy, during the first COVID-19 lockdown in Italy. Forty-seven healthcare workers (including neurologists, physiatrists, nurses and rehabilitation therapists) were enrolled in this cross-sectional study from February 2020 to June 2020. Participants were administered the following psychometric tests to investigate burnout and related symptoms: the Maslach Burnout Inventory, which measures emotional exhaustion, depersonalization and reduced personal accomplishment; the Zung Self-Rating Depression Scale (SDS); the Pre-Sleep Arousal Scale (PSAS); the Dyadic Adjustment Scale; and the Buss-Perry Aggression Questionnaire (BPAQ). We found several correlations between test scores and burnout subdimensions. Emotional exhaustion was correlated with SDS (r = 0.67), PSAS-Cognitive (r = 0.67) and PSAS-Somatic (r = 0.70) scores, and moderately correlated with all BPAQ dimensions (r = 0.42). Depersonalization was moderately correlated with SDS (r = 0.54), PSAS-Cognitive (r = 0.53) and PSAS-Somatic (r = 0.50) scores. During the first COVID-19 lockdown in Italy, healthcare workers were more exposed to physical and mental exhaustion and burnout. Research evaluating organizational and system-level interventions to promote psychological well-being at work for healthcare workers are needed.

The effects of greater occipital nerve blockage with lidocaine on sleep characteristics in chronic migraine patients

PurposeThe aim of our study was to determine the effects of greater occipital nerve block (GONB) with lidocaine on sleep characteristics in patients with chronic migraine. Materials and methodsTwenty female patients who underwent GONB with lidocaine were included in the study. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Pre-Sleep Arousal Scale (PSAS), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Restless Legs Syndrome Severity Scale (RLSSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and headache diary results before and after the treatment of the patients were compared. ResultsWe included 20 patients (all females) in our study. The mean age was 35.80 ± 8.82 years (range 24–50). After GON blockade, the number of days with pain (p < 0.001), duration of pain (p < 0.001), and Visual Analog Scale (VAS) score (p < 0.001) were significantly lower than before. After GONB, BDI (p = 0.007), BAI (p = 0.022), ISI (p = 0.009), and PSQI (p = 0.026) scores were significantly lower than before. After GONB, sleep quality was better than before (p = 0.035). ConclusionThis study showed that GONB with lidocaine can improve sleep quality, insomnia, and symptoms of depression and anxiety while reducing migraine headache.

0197 To delay perchance to sleep: The daily association between pre-sleep arousal and bedtime procrastination

Abstract Introduction Bedtime procrastination, a behavior associated with poor sleep health and wellbeing, refers to voluntary delays of bedtime. Although bedtime procrastination is often defined as a needless or mindless delay, bedtime procrastinators often report delaying their bedtime strategically to regulate sleep-interfering processes. One such process is pre-sleep arousal, an important vulnerability for and perpetuating factor in insomnia. Preliminary evidence supports this association, as some bedtime procrastinators report delaying bedtime to avoid anxiety-producing bedtime routines. However, this association has not been directly examined. To further investigate strategic delay in bedtime procrastination, the current study examined the association between pre-sleep arousal and bedtime procrastination using a daily diary design. Methods 390 young adult participants (Mage = 24.4, SD = 6.5) completed 14-days of experience sampling procedures, including completing self-report measures of nightly pre-sleep arousal and morning ratings of prior-night bedtime procrastination. Associations between pre-sleep arousal and bedtime procrastination were estimated with multilevel models using centering procedures which disaggregated between- and within-person covariance. Gender and age were entered into each model as covariates. Results Pre-sleep arousal was associated with increased bedtime procrastination both within- (B = 0.01, p &amp;lt; 0.001) and between-persons (B = 0.02, p &amp;lt; 0.001). Additionally, cognitive pre-sleep arousal was more strongly associated with bedtime procrastination (Bwithin = 0.014, p &amp;lt; 0.001; Bbetween = 0.032, p &amp;lt; 0.001) than somatic arousal (Bwithin = 0.007, p = 0.165; Bbetween = 0.038, p &amp;lt; 0.001). Conclusion The results suggest that pre-sleep arousal is a putative mechanism for bedtime procrastination. Cognitive arousal, including worry and rumination, may be particularly relevant for the development of this behavior. This finding supports the notion that bedtime procrastination may occur as a (maladaptive) strategy to regulate pre-sleep arousal. Alternatively, findings may suggest that bedtime procrastinators engage in arousing pre-sleep activities. Regardless, the association between bedtime procrastination and pre-sleep arousal suggests that bedtime procrastination is relevant in the development and/or maintenance of sleep-related disorders. Treatment of bedtime procrastination may be enhanced by considering the role this behavior has in regulating pre-sleep arousal. Support (if any)

0422 The relationship between EEG spectral analysis and pre-sleep cognitive arousal in insomnia disorder

Abstract Introduction The hyperarousal model suggests that insomnia is characterized by increased cortical, cognitive, and physiological arousal. However, the relationship between these domains of arousal remains insufficiently studied. The aim of the current observational study was to investigate pre-sleep cognitive arousal, cortical arousal during the night, and the relationship between these domains. Methods 109 patients with insomnia disorder (ID) and 109 age-and gender matched healthy controls (GSC) were investigated on two sleep laboratory nights. As a measure of cortical arousal, EEG spectral power was analyzed during NREM and REM sleep. In addition, participants completed the Pre-Sleep Arousal Scale (PSAS), which consists of a subscale for cognitive arousal (PSAS-CA) and another subscale for self-reported somatic arousal (PSAS-SA). The relationship between the subscale scores and EEG spectral power was calculated by multivariate and univariate analyses of variance. Results The total sample consisted of 218 participants. ID patients had a mean age of 44.7 years (± 10.6 years) and GSC had a mean age of 44.4 years (± 12.6 years). Both groups consisted of 78 women and 31 men.During NREM and REM sleep, patients with ID showed significantly increased spectral power in the EEG gamma band (NREM: p &amp;lt; .001; REM: p = .002). In addition, patients with ID showed significantly increased scores on the PSAS-SA (ID: M = 12.4, SD = 4.4; GSC: M = 10.7, SD = 3.3; t(216) = 3.34, p = .001, d = 0.45) and the PSAS-CA (ID: M = 18.3, SD = 7.2; GSC: M = 10.6, SD = 2.9; t(216) = 10.33, p &amp;lt; .001, d = 1.40). The PSAS-CA score was significantly associated with increased NREM (p = .001) and REM gamma power (p = .004), whereas PSAS-SA was associated with significant decreases in NREM (p &amp;lt; .001) and REM gamma power (p = .001). Conclusion In line with our hypothesis, patients with ID showed increased cortical and cognitive arousal. Moreover, there was a relationship between pre-sleep cognitive arousal and high-frequency EEG activity during the night. This might suggest that the latter is caused (at least in part) by pre-sleep worry and rumination. Support (if any)

0420 Sleep onset misperception in youths with insomnia: Correlates and implications for treatment

Abstract Introduction Individuals with insomnia often show subjective-objective sleep discrepancy, especially an overestimation of their sleep onset latency (SOL) while the factors associated with such discrepancy remained unclear. Whilst cognitive behavioral therapy for insomnia (CBT-I) has been recommend as the first-line treatment for insomnia, there has been limited research to investigate the effects of CBT-I on sleep onset perception in youths with insomnia. The present study aimed to identify potential variables related to sleep onset misperception and explore the effects of CBT-I on sleep onset misperception among youths with insomnia. Methods Sixty treatment-seeking youths with insomnia (mean: 19.74 ±2.42, female: 55%) were recruited to assess for their sleep and clinical characteristics using self-report questionnaires and 7-days sleep diary and actigraphy (T1). A subset of the sample (N=19) further completed an 8-week CBT-I programme and assessed at one-week post-treatment (T2) and 6-month follow-up (T3). Sleep misperception index was computed by subtracting actigraphy-measured SOL from sleep diary reported SOL, where a higher value indicates a higher degree of SOL overestimation. Demographic, clinical and sleep-related variables were compared between high versus low sleep onset misperception groups as divided by the mean of the sample. Changes in sleep onset misperception after CBT-I were analyzed using repeated measures ANOVA. Results High sleep onset misperception group demonstrated a significantly higher degree of anxiety symptoms (t(28)=-3.92, p&amp;lt;.01) and pre-sleep cognitive arousal (t(28)=-0.49, p&amp;lt;.05) as compared to low sleep onset misperception group. Participants who completed CBT-I showed a significant decrease in subjective-objective SOL discrepancy (T1=19.52, T2=6.96, T3=-1.37). A post-hoc pairwise comparison using the Bonferroni correction suggested a significant decrease in subjective-objective SOL discrepancy from T1 to T3 (p&amp;lt;.05). Significant improvement in pre-sleep cognitive arousal was found from T1 to T3 (&amp;lt;.001) and such an improvement was found to be significantly correlated with the reduction in sleep onset misperception (r=0.16, p&amp;lt;.05). Conclusion Sleep onset misperception is associated with anxiety symptoms and pre-sleep cognitive arousal in youths with insomnia. Preliminary evidence supports that CBT-I is effective in improving sleep onset misperception in youths with insomnia. Future research should explore the neurophysiological mechanism underlying sleep onset misperception and the changes of such a discrepancy upon intervention. Support (if any)

0176 Predictors of sleep duration among university students in Japan: Cross-cultural insights for developing sleep health interventions

Abstract Introduction Inadequate sleep among university students, especially in Japan, contributes to low academic performance and mental health challenges. Sleep health, including adequate sleep duration and quality, may serve a protective role in promoting performance and full participation in daily life. We sought to identify factors explaining sleep duration in Japanese college students as potential targets for culturally sensitive sleep health promoting intervention. Methods Cross-sectional descriptive study of university students in Japan in 2021; N = 362 completed validated Japanese versions of the Pittsburg Sleep Quality Index (PSQI), Morningness and Eveningness Questionnaire, Sleep Hygiene Practice Scale, and Dysfunctional Beliefs and Attitudes about Sleep. Indicators of sleep and PSQI subscales (except sleep duration), personality, depression, anxiety, time use, and participation quality were included in multivariate logistic regression modeling to explain less healthy (6 hours or less) versus healthier (more than 6 hours) sleep duration. Results Students were 20.0 (SD = 1.3) years, 86.4% female with a mean sleep duration of 400 (SD = 67) minutes. The mean PSQI score was 4.8 (SD = 2.5) indicating good sleep quality, though 41.4% of the sample reported sleeping 6 hours or less and these persons had lower sleep quality (PSQI; d = 1.20) compared to longer sleepers. Logistic regression explained category assignment (Chi-square = 68.978, df = 8, p &amp;lt;.001; Nagelkerke R-squared = .234). Longer sleepers were more likely to report greater sleep efficiency, less frequent sleep disturbances, lesser daytime dysfunction, shorter commuting times, a morning-like chronotype, greater participation quality, and a less agreeable personality type. Interestingly, longer sleepers reported less effective sleep hygiene practices. Conclusion Short sleep was common and associated with poor sleep quality. Longer sleepers were more likely to report optimal sleep health indicators and greater participation quality (i.e. engagement in meaningful activities). Counter-intuitive sleep hygiene findings indicate potential cultural variation in sleep timing, pre-sleep arousal, and environment regulation as targets for intervention. Sleep health promotion intervention should consider personality, chronotype preference and time use (e.g. meaningful activities, commuting) as factors promoting or inhibiting sufficient sleep duration and quality in university students. Support (if any) Fulbright U.S. Scholar Award to Japan

0093 Chronotypic characteristics of sleep, mental health, and daily life of Japanese university of health sciences students

Abstract Introduction Students’ lifestyles change after entering the university negatively impacting effective sleep regulation, daytime alertness, motivation to learn, and mental health. An evening chronotype has been increasingly associated with negative impacts upon performance and well-being. Greater understanding of chronotype differences in sleep-related, mental health, and daily life characteristics is needed to develop a sleep health promoting intervention. Methods Cross-sectional descriptive design among health sciences students (nursing, occupational therapy and physical therapy) in a Japanese university. The Japanese version of the Morningness-Eveningness Questionnaire (MEQ-J) was used to create morning (M), intermediate (I), and evening (E) chronotype groups. One-way analysis of variance was used to investigate differences among chronotype groups by sleep, mental health, and daily life characteristics. We assessed insomnia severity (ISI-J), sleep quality (PSQI-J), sleep hygiene (SHPS-J), daytime sleepiness and dysfunctional sleep beliefs; depression (JCES-D) and anxiety; and time use in club, commuting, sleep, and work, as well as engagement in meaningful day-to-day activities (EMAS-J), significant group differences were explored post-hoc. Results Of 369 students there were 21% classified as M chronotype, 63% as I, and 16 % as E; an approximate 1:3:1 ratio. Sleep quality was progressively better as chronotype advanced from E, to I, to M (PSQI-J: d range 0.41-1.07); along with sleep problems being less likely (ISI-J: d range 0.45-1.16). Sleep hygiene practices were most effective for the M chronotype, followed by I then E (SHPS-J: d range 0.49-1.14). No group differences were found in daytime sleepiness or dysfunctional sleep beliefs. Depression symptoms were greater in the E chronotype compared to I and M (JCES-D: d range 0.52-0.84). M chronotypes reported the longest commuting times (d range 0.45-0.55). No differences were found in sleep duration or time spent in other activity types. Lastly, M chronotypes reported engaging in more meaningful activities compared to E (EMAS-J: d = 0.47). Conclusion Sleep health lifestyle intervention should target chronotype preference to be less evening-like, thereby promoting sleep quality and mental health. Intervention could tailor sleep hygiene beliefs and skills to address sleep timing, pre-sleep arousal and environment regulation according to individuals’ daily life characteristics and chronotype differences. Support (if any)

0749 Adolescents’ Self-Reported Insomnia, Subjective Experiences And Objective Sleep Measures During The COVID-19 Pandemic

Abstract Introduction Studies examining adolescents’ sleep during the COVID-19 pandemic yielded inconsistent results, with some studies finding a significant increase in insomnia symptoms but others finding no change. A majority of these studies used retrospective or concurrent reports of insomnia symptoms and did not include objective sleep measures, making it impossible to know the extent to which the reported symptoms were associated with actual sleep patterns. In addition, these studies did not account for factors that might have biased adolescents’ subjective reporting of insomnia such as negative emotions or high levels of pre-bedtime cognitive arousal. The goal of the present study was to examine the associations of self-reported symptoms of insomnia among typically developing adolescents with their emotional experiences, cognitive arousal at bedtime, and objective sleep measures during the COVID-19 pandemic. Methods Participants. Seventy-six adolescents (33 female, M(SD) age = 13.74(0.87) years). Procedure. Each participant’s sleep pattern was assessed in the home environment using actigraphy and a sleep log for seven consecutive nights in 2021. Adolescents provided information regarding their experiences during the COVID-19 pandemic using the COVID-19 Adolescent Symptom &amp; Psychological Experience (CASPE) questionnaire; information regarding their arousal at bedtime using the Pre-Sleep Arousal Scale and information regarding the insomnia symptoms using the Insomnia Severity Index. Results Principal-component analysis produced a three-factor solution for the CASPE labeled as Negative-Anxious, Negative-Angry and Positive Emotions. Hierarchical regression analysis was conducted to examine the cross-sectional associations among adolescents’ emotional responses and subjective and objective sleep measures during the COVID-19 pandemic. Being a girl, reporting high level of pre-bedtime cognitive arousal and high Negative-Anxious emotions accounted the explained variance in adolescents’ self-reported insomnia symptoms. Actigraphy measured sleep efficiency, latency or duration did not increase significantly the explained variance. Conclusion These findings suggest that documentation of adolescents’ insomnia during the COVID-19 pandemic might have captured adolescents’ negative emotions rather than their objective sleep patterns. Limitations The cross-sectional design of this study limits the ability to determine causality. Support (if any) CIHR, SSHRC