Pre-sleep Arousal Research Articles

0154 Pre-Sleep Arousal and Poor Sleep Quality Indirectly Predict the Relationship between Emotion Regulation Difficulties and Depression Symptoms

0154 Pre-Sleep Arousal and Poor Sleep Quality Indirectly Predict the Relationship between Emotion Regulation Difficulties and Depression Symptoms

Effect of Brief Mindfulness Induction on University Athletes' Sleep Quality Following Night Training.

Given the need to alleviate sleep problems confronting athletes, the present experiment, conducted as much as possible in a naturalistic fashion that mimics daily life, seeks to examine whether a brief mindfulness induction immediately prior to sleep following night training can improve athletes’ sleep. A sample of university athletes (n = 80) was recruited and 63 of them were eligible to participate in this experiment. They were then randomly assigned into experimental group (n = 32) and control group (n = 31). Following night training and just prior to sleep, those in the experimental group received a self-administered brief 6-min mindfulness induction via a video clip, whereas the control group participants viewed a similar 6-min video devoid of mindfulness induction passively. Questionnaire-based measures of training intensity, pre-sleep arousal, state mindfulness, and sleep diary (i.e., level of rest, sleep duration, and overall sleep quality) were administered. Results showed that brief mindfulness induction reduced pre-sleep arousal, and improved level of rest and overall sleep quality, but not sleep duration. Pre-sleep arousal was also found to be a partial mediator in the relationship between the brief mindfulness induction and reported level of rest during sleep. These findings suggest that the brief mindfulness induction may be an effective approach for decreasing pre-sleep arousal and improving sleep quality after night training among athletes.

Nonrestorative sleep in healthy, young adults without insomnia: associations with executive functioning, fatigue, and pre-sleep arousal

ObjectivesPrevious research suggests that nonrestorative sleep (NRS), even in the absence of insomnia symptoms or other sleep disorders, may be associated with daytime dysfunction. This study examined the association between NRS and daytime dysfunction in healthy adults screened for insomnia and sleep apnea. DesignMulti-day assessment approach. SettingCommunity-based adults and college students. ParticipantsHealthy young adults without insomnia and sleep apnea (n = 79; 68% female, mean age = 27.5, SD = 6.5). MeasurementsLaboratory protocol included a behavioral assessment of executive functioning (EF), self-report of prior month sleep-related daytime dysfunction, and depressive symptoms in the prior two weeks. Subsequently, participants completed an experience sampling assessment that included morning ratings of NRS, repeat affect ratings throughout the day via palm-pilot, nighttime ratings of pre-sleep arousal and EF disturbances, ambulatory cardiac impedence monitoring, and wrist actigraphy. ResultsNRS was significantly associated with poorer performance on behaviorally-assessed EF, perceived EF difficulties, daily ratings of fatigue, and past-month reported daytime dysfunction. These associations remained significant after controlling for age and sleep duration (measured by actigraphy). NRS was also associated with increased sympathetic nervous system activation prior to bedtime. Further, reported pre-sleep arousal was associated with NRS, and this association was mediated by perceived EF difficulties. ConclusionsFindings indicate that, even among healthy, young adults without insomnia or sleep apnea, NRS is associated with poorer cognitive functioning and may be a precursor to insomnia.

Pre-sleep arousal can be associated with efficient processing of sleep-related information

Background and objectivesCognitive bias to sleep-related information is thought to be a core feature of sleep disturbances. The bias may enhance pre-sleep arousal, such as excessive worry about sleeplessness, which prevents people from initiating normal sleep onset. The present study focused on (a) attention bias toward sleep-related stimuli and (b) difficulty in updating working memory for sleep-related stimuli as two possible mechanisms underlying pre-sleep cognitive arousal. MethodParticipants (n = 61, a community sample) completed a dot-probe task (with sleep-related and matched control word stimuli) and a 1-back and 2-back task (with sleep-related and non-sleep-related pictorial stimuli). ResultsFor the dot-probe task, the results showed no significant association between pre-sleep cognitive arousal and sleep-related attention bias. However, the results of the 2-back task suggest that pre-sleep arousal is associated with decreased interference by sleep-related stimuli in maintaining non-sleep-related information. That is, individuals with higher levels of pre-sleep arousal are more efficient at processing sleep-related materials. LimitationsThe non-clinical nature of the sample may limit the clinical implications of the findings. ConclusionsAlthough the current results cannot be explained by the extant cognitive theories of insomnia, we offer an alternative explanation based on the idea of worry as mental habit: mental processes that occur frequently (e.g., repetitive thoughts about sleep) require less cognitive resource. Therefore, sleep-related information may be processed easily without consuming much cognitive effort.

Validity and Reliability of the Dysfunctional Beliefs and Attitudes about Sleep Scale-10 in Iranian Clinical Population

Background: Dysfunctional cognitions and attitudes about sleep are considered as one of the most important factors underlying insomnia. Objectives: The current study aimed at investigating the validity and reliability of the dysfunctional beliefs and attitudes about sleep scale-10 (DBAS-10) in an Iranian clinical population. Methods: The clinical sample consisted of 120 patients with insomnia disorder referred to the sleep disorders clinic at Baharloo hospital in Tehran in 2015. The control group (n = 120) included a community sample volunteered to participate in the study. Sleep Diary, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Pre-Sleep Arousal Scale, and Depression, Anxiety, Stress Sacle-21, were used to assess concurrent validity. Test-retest and Cronbach' alpha were conducted to examine the reliability of the scale. Construct validity of the scale was investigated via confirmatory factor analysis. Results: The current study findings indicated that DBAS-10 had appropriate test-retest reliability (r = 0.83) and internal consistency (Cronbach' alpha = 0.82). Total score of DBAS-10 was significantly associated with PSQI (r = 0.34), ISI (r = 0.45), the cognitive subscale of PSAS (r = 0.36), and depression (0.34), anxiety (r = 0.34) and stress (r = 0.39) subscales of DASS-21. Factor analysis indicated that the Espie et al. (2000) model had significantly better fitness in comparison with the Edinger andWohlgemuth (2001) model. The cutoff point, sensitivity, and specificity of the scale were 6.7, 74.17 and 87.50, respectively. Conclusions: The Persian version of DBAS-10 had proper psychometric properties for Iranian clinical population. ©2018, Iranian Journal of Psychiatry and Behavioral Sciences.

Adult insecure attachment plays a role in hyperarousal and emotion dysregulation in Insomnia Disorder

Studies show that unhelpful cognitive processes play a role in insomnia, whereas interpersonal factors have been less studied in insomnia. Attachment theory can be used as a cognitive-interpersonal framework for understanding insomnia. Because attachment insecurity (vs security) is related to psychiatric disorders the objective was to study the attachment style in insomnia. To this aim sixty-four subjects with Insomnia Disorder (DSM-5) and 38 good sleepers were evaluate in a cross-sectional study with: Attachment Style Questionnaire (ASQ), Arousal Predisposition Scale (APS), Pre-Sleep Arousal Scale (PSAS) and Difficulties in Emotion Regulation Scale (DERS). Differences in means between groups were assessed using t-test or Mann-Whitney U/Wilcoxon test. Linear/multiple regression analyses were performed. Subjects with insomnia (mean age 47.1 + 13 yrs) presented an insecure attachment style and higher scores in all the scales (ASQ, APS, PSAS, DERS p < 0.0001) than good sleepers (mean age 48.2 + 14 yrs). After taking into account anxiety/depressive symptoms, insecure attachment was related to hyperarousal trait (p = 0.02), pre-sleep hyperarousal (p = 0.04) and emotion dysregulation (p = 0.002). In conclusion subjects with insomnia showed an insecure attachment which was related to hyperarousal trait, pre-sleep hyperarousal and emotion dysregulation. It may intervene in the trajectory of insomnia starting from predisposition to perpetuation. Clinical implications are discussed.

Altering Adolescents’ Pre-Bedtime Phone Use to Achieve Better Sleep Health

ABSTRACTMobile phone use is often blamed for adolescent sleeping difficulties in the popular and scientific literature, with correlations observed between adolescents’ mobile phone use and their bedtime. We aimed to obtain experimental evidence to support these causal claims. A within-subjects experiment (baseline, intervention) was conducted in adolescents’ homes, to determine the effect of restricting adolescents’ pre-bed mobile phone use on school night sleep habits. Following a baseline week, adolescents were given individualized phone stop times, 1 hour before bed for one school week. An online sleep diary was used to monitor bedtime, lights out time, sleep latency and total sleep. Sixty three adolescents (age range 14–18, M = 16.3, SD = 0.93yrs; 17%male) provided data. During one week of phone restriction, adolescents stopped using their phones earlier (80 min, p < .001), turned their lights off earlier (17 min, p = .01), and slept longer (21 min, p = .01). Participant recruitment was low (26%), indicating many adolescents lack motivation to negotiate changes to their evening phone use. Overall, there are potential benefits of restricted mobile phone use during the pre-sleep period, yet, future research is needed to identify non-technological interventions to increase adherence to phone restriction (e.g., motivational interviewing) or otherwise decrease pre-sleep arousal (e.g., cognitive strategies).

Psychological processes associated with insomnia in patients with multiple sclerosis.

Despite the high comorbidity of insomnia disorder (ID) with multiple sclerosis (MS), the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in this neurological disorder. This study aimed to ascertain to what extent the suggested emotional, cognitive, and behavioral processes maintaining insomnia are relevant in people with insomnia and MS. A between-subjects design was used to compare 26 patients with insomnia and MS, with 31 patients with MS only, and with 26 matched neurological disease-free individuals with insomnia. All patients participated in a standardized clinical interview and completed a battery of self-reported measures of cognitive and somatic presleep arousal experienced at bedtime, sleep- or insomnia-related unhelpful beliefs, and sleep-related safety behaviors. All patients with MS underwent a neurological examination. ID comorbid to MS was strongly associated with increased levels of cognitive and somatic arousal, higher endorsement of dysfunctional beliefs about the consequences of insomnia on daytime functioning, and worry about insomnia and more frequent engagement in sleep-related safety behaviors. Patients with MS with ID did not differ from neurological disease-free individuals with insomnia on these measures. No link was found between MS clinical peculiarities and ID diagnosis. ID comorbid to MS is associated with the classical psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Primary care providers and neurologists should consider target-oriented therapies like cognitive behavioral therapy for chronic insomnia as a treatment approach for ID comorbid to MS.

The impact of pre-sleep arousal state and strategy to control unwanted thoughts on sleep quality

ABSTRACTObjective: It has been questioned whether elevated pre-sleep cognitive arousal contributes to poor sleep or whether it is the use of maladaptive thought control strategies, used to manage this cognitive arousal, that are responsible. The study aimed to examine how these factors – cognitive arousal (with and without anxiety) and maladaptive thought control strategies contribute to perceived sleep quality (SQ). Design: 129 “healthy adults” (46 males, 83 females) were exposed to picture-stimuli eliciting either anxious cognitive arousal or non-anxious cognitive arousal at bedtime. The groups were then randomly split and briefed to use either a cognitive distraction or cognitive suppression thought control strategy or no instructions were given (controls). Subjective SQ was measured immediately on waking. Results: Induced anxious cognitive arousal was associated with lower SQ compared to non-anxious cognitive arousal. Analyses revealed a significant interaction between arousal and the strategies used to control unwanted thoughts on SQ. When experiencing anxious cognitive arousal, the strategy of distraction was associated with poorer sleep outcomes. Conclusion: The findings suggest that the efficacy of differing thought control strategies vary depending upon whether cognitive arousal elicits anxiety or not. With that in mind, clinical implications in terms of augmenting the treatment of insomnia are discussed.

Prevalence and Associated Factors of Insomnia in College Students with Irritable Bowel Syndrome

Purpose: The purpose of this study was to identify factors associated with insomnia in college students with Irritable Bowel Syndrome (IBS). Methods: College students with IBS (n=259) were recruited in 4 universities in Daegu city and Ulsan city, South Korea. Participants completed questionnaires measuring the following variables: insomnia (Insomnia Severity Index [ISI]), dysfunctional beliefs and attitudes about sleep (Dysfunctional Beliefs and Attitudes about Sleep Scale-16 [DBAS-16]), pre-sleep arousal (Pre-Sleep Arousal Scale [PSAS]), gastrointestinal symptoms during sleep (Gastrointestinal Symptoms during Sleep), sleep hygiene (Sleep Hygiene Practices Scale [SHPS]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), and IBS symptom severity(IBS Severity Scoring System [IBS-SSS]). Results: In our participants, 53.3%(n=138) reported having insomnia (ISI score ≥10). Compared to the non-insomnia group (n=121), the insomnia group reported significantly higher scores in DBAS-16, PSAS, gastrointestinal symptoms during sleep, IBS-SSS, SHPS, and BSI-18 (p＜.001 for all). Multiple logistic regression analysis revealed that gastrointestinal symptoms during sleep (Odds Ratio [OR]=2.77, 95% Confidence Interval [CI]: 1.29~5.96), dysfunctional beliefs and attitudes about sleep (OR=1.04, 95% CI: 1.03~1.06), cognitive arousal before sleep (OR=1.10, 95% CI: 1.05~1.17), and somatization (OR=1.12, 95% CI: 1.02~1.23) were associated with insomnia in this sample. Conclusion: Our findings indicate that insomnia is a serious problem for college students with IBS and that gastrointestinal symptoms during sleep and sleep related dysfunctional cognitions should be managed to improve insomnia of them.

Subjective sleep-related variables in those who have and have not experienced sleep paralysis.

Research suggests that poor sleep quality is related to the occurrence of sleep paralysis, although the precise relationship between these two variables is unknown. This association has generated interest due to the related possibility that improving sleep quality could help to combat episodes of sleep paralysis. To date, studies examining the association between sleep quality and sleep paralysis have typically measured sleep quality using general measures such as the global score of the Pittsburgh Sleep Quality Index (PSQI). The aim of this study was to increase the precision of our understanding of the relationship between sleep paralysis and other aspects of sleep by investigating associations between different sleep-related variables and sleep paralysis. Using data from the G1219 twin/sibling study, analyses were performed on 860 individuals aged 22-32years (66% female). Results showed that two components of the PSQI, sleep latency and daytime dysfunction, were predictors of sleep paralysis. In addition, a number of other sleep-related variables were related significantly to sleep paralysis. These were: insomnia symptoms, sleep problems commonly related to traumatic experiences, presleep arousal, cognitions about sleep and excessive daytime sleepiness. There was no relationship with sleep-disordered breathing, diurnal preference or sleeping arrangements. Potential mechanisms underlying these results and suggestions for future research are discussed.

Who is sleepier on the night shift? The influence of bio-psycho-social factors on subjective sleepiness of female nurses during the night shift

Sleepiness is a common complaint during the night shift and may impair performance. The current study aims to identify bio-psycho-social factors associated with subjective sleepiness during the night shift. Ninety-two female nurses working rotating shifts completed a sociodemographic questionnaire, the Munich ChronoType Questionaire for shift workers, the Pittsburg Sleep Quality Index, and the Pre-sleep Arousal Scale. Subjective sleepiness was measured hourly during two night shifts using the Karolinska Sleepiness Scale, and activity monitors assessed sleep duration 24-h before each shift. Findings showed that increased sleepiness was associated with increased age in nurses with early chronotypes and with more children. High cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes. The impact of bio-psycho-social factors on night shift sleepiness is complex, and depends on mutual interactions between these factors. Nurses most prone to increased sleepiness must develop personal strategies for maintaining vigilance on the night shift.Practitioner Summary: This study aims to identify bio-psycho-social factors associated with subjective sleepiness of female nurses during the night shift. Increasing sleepiness was associated with increased age in nurses with early chronotypes and with more children. Increased cognitive pre-sleep arousal, but not sleep, was associated with increased sleepiness, especially in late chronotypes.

Pre-Sleep Arousal Scale (PSAS): psychometric study of a European Portuguese version

Objective/BackgroundPre-sleep arousal constitutes one of the major features of insomnia. As such, it is imperative to have adequate instruments to measure this construct in both clinical and research settings. The Pre-Sleep Arousal Scale (PSAS) is the most well-known measure to evaluate pre-sleep arousal. The current study aimed to examine some of the psychometric properties of a European Portuguese version of the scale. Participants/MethodsFor this purpose, data from 691 undergraduate students from a medical school were analyzed. Internal consistency indices and factor analysis were performed. In addition, the association between the PSAS and its subscales with other measures was also examined. Finally, PSAS scores of self-reported insomniacs were compared with those of self-reported non-insomniacs. ResultsThe results indicated that the PSAS comprises a cognitive scale and a somatic scale, both with adequate internal consistency indices (α = 0.82 and 0.79, respectively). However, a three-factor solution also seemed plausible, suggesting that the original somatic arousal subscale might be divided into two subscales. Significant associations between the PSAS total score and its subscales were found with other concurrent measures such as sleep reactivity to stress, arousability and neuroticism. Self-defined insomniacs presented higher levels of cognitive and somatic arousal than healthy individuals. ConclusionsFurther investigations of the PSAS are needed to refine its psychometric properties and explore its research and clinical utility in other populations.

The relationship between pre-sleep monitoring behavior and arousal in people with different stress reactivity and chronic insomnia

The relationship between pre-sleep monitoring behavior and arousal in people with different stress reactivity and chronic insomnia

Investigating psychological and physiological responses to the Trier Social Stress Test in young adults with insomnia

ObjectiveStress and hyperarousal both contribute to insomnia. Elevated stress-related sleep reactivity is associated with hyperarousal, and might constitute a vulnerability to future insomnia. The present study examined acute stress-induced arousal and its association with nocturnal sleep. MethodsParticipants were 30 healthy adults (66.7% female, Mage = 26.7 years): 10 with insomnia (INS) and 20 good sleepers with high vulnerability (HV) or low vulnerability (LV) to insomnia. They underwent two consecutive nights of polysomnography. During the evening preceding the second night, the Trier Social Stress Test (TSST) was administered, and psychological and physiological arousal indices were assessed. ResultsThe TSST elicited an increase in psychological and physiological arousal in all three groups. The INS group showed greater acute cortisol response (p < 0.05) and secretion at bedtime (p < 0.05), and higher pre-sleep cognitive arousal (p < 0.01) than the LV group; HV participants did not significantly differ from those in the INS or the LV group. Increased cortisol response and elevated sympathovagal imbalance (ie, low frequency/high frequency ratio) were each significantly associated with longer nocturnal awakenings (p = 0.048, p = 0.037, respectively). Heightened blood pressure was significantly associated with prolonged sleep onset latency, and reduced total sleep time and sleep efficiency (all ps < 0.05). ConclusionsThese findings support the hyperarousal conceptualization of insomnia and indirectly suggest that increased stress reactivity and bedtime hyperarousal might represent a trait-like vulnerability in certain good sleepers. More research is warranted to validate and expand these preliminary findings.

Binge Viewing, Sleep, and the Role of Pre-Sleep Arousal

To investigate the prevalence of binge viewing, its association with sleep and examine arousal as an underlying mechanism of this association. Four hundred twenty-three adults (aged 18-25 years old, 61.9% female) completed an online survey assessing regular television viewing, binge viewing, sleep quality (Pittsburgh Sleep Quality Index), fatigue (Fatigue Assessment Scale), insomnia (Bergen Insomnia Scale), and pre-sleep arousal (Pre-Sleep Arousal Scale). Regression analyses were conducted. Mediation analysis was performed using PROCESS Macro. There were 80.6% who identified themselves as a binge viewer. Among those who binge viewed (n = 341), 20.2% had binge viewed at least a few times a week during the past month. Among poor sleepers (Pittsburgh Sleep Quality Index > 5), 32.6% had a poor sleep quality associated with being a binge viewer. Higher binge viewing frequency was associated with a poorer sleep quality, increased fatigue and more symptoms of insomnia, whereas regular television viewing was not. Cognitive pre-sleep arousal fully mediated these relationships. New viewing styles such as binge viewing are increasingly prevalent and may pose a threat to sleep. Increased cognitive arousal functions as the mechanism explaining these effects. Measures of media exposure should take into account the user's level of engagement with media. Interventions aimed at (1) alerting viewers about excessive viewing duration and (2) reducing arousal before sleep may be useful ways to tackle sleep problems in binge viewers.

PERFORMANCE ANXIETY AND SLEEP PROBLEMS AS PREDICTORS OF ACADEMIC ACHIEVEMENT

The present study investigated performance anxiety and sleep problems as predictors of academic achievement among a convenience sample of 100 university students (Male = 43, Female = 57).&#x0D; Method: The participants, aged 18 to 25 years, were selected from three different departments of University of Gujrat. Hamilton Anxiety Scale (Hamilton, 1959) and Pre Sleep Arousal Scale (Nicassio, Mendlowitz, Fussell, &amp; Petras, 1989) were individually administered to the participants in their respective departments. Academic achievement was measured in terms of GPA of previous semester of each respondent.&#x0D; Results: The Cronbach Alphas for both the scales for the present sample fell in acceptable range (α = 0 .84 - 0.87). Linear regression analyses indicated that performance anxiety significantly predicted (p &lt;.01, p&lt;.001) of low academic achievement among university students. It was also identified that the higher level of performance anxiety was also a strong predictor (p &lt; .0.001) of sleep problems among students.&#x0D; Conclusions: Discussion includes implications for future research and practices with reference to Pakistani culture.

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.

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.

1030 BELIEFS ABOUT SLEEP IN PEOPLE WITH PSORIASIS: AN IN-DEPTH QUALITATIVE STUDY USING THE COMMON-SENSE MODEL OF SELF-REGULATION FRAMEWORK

Psoriasis a common, complex, long-term inflammatory condition primarily affecting the skin, is associated with significant physical and psychological comorbidity. Sleep disturbance is frequently reported by people with psoriasis and is associated with pre-sleep arousal, itch and low mood. This is the first study to our knowledge that explores in-depth the beliefs people with psoriasis hold about sleep. We used the established Common-Sense Self-Regulation Model (CS-SRM) as a theoretical framework. Semi-structured interviews were conducted in a purposive sample of 9 people with psoriasis. The interviewer explored participants’ beliefs about their sleep (characteristics of sleep patterns; timeline; causes of good/poor sleep; consequences of poor sleep and beliefs about the curability/controllability of poor sleep) and coping strategies used. Data were analysed using principles of framework and thematic analysis. Five key themes emerged within the dimensions of the CS-SRM: 1) ‘Dissatisfaction with sleep’: reduced sleep quality and duration and difficulty initiating sleep; 2) ‘Sleep varies by perceptions of psoriasis’; sleep disturbance triggered by psoriasis symptoms, and sleep changes as a function of time since treatment; 3) ‘Heightened awareness of psoriasis at night’; symptom management and thoughts/worries about psoriasis contributing to sleep disturbance 4) ‘Sleep affecting multiple domains of life’; consequences of sleep disturbance on work, social and family life 5) ‘Perceived lack of control of sleep’: a constant battle for control over sleep, increased effort to sleep and resigned acceptance of poor sleep. Patients report strong links between sleep disturbance and psoriasis symptoms and management in a bi-directional manner that require further testing. The CS-SRM appears to be a valid theoretical model for assessing the beliefs about sleep in people with psoriasis. This work was supported by a grant from The Psoriasis Association of Great Britain and Northern Ireland (R117541)