Predictors Of Insomnia Symptoms Research Articles

Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms.

The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms. This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020-May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only. Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes. Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.

Understanding the impacts of childhood adversity on sleep problems in children with fetal alcohol spectrum disorder: A comparison of cumulative and dimensional approaches.

The developmental impacts of prenatal alcohol exposure (PAE) and postnatal exposure to adversity are typically considered in isolation. However, both contribute independently to sleep problems. Children with fetal alcohol spectrum disorder (FASD) have PAE and significant sleep disturbances. What is not clear is the relative contribution to these disturbances of exposure to early life adversity. This study examined how exposure to such adversity impacts frequent insomnia symptoms and nightmares in children with FASD and "At Risk" designations. We compared two approaches to modeling adversity in children who had undergone a diagnostic assessment for FASD: a cumulative risk approach that sums adversities to create a total score and an approach that treats exposure to threat and deprivation as independent dimensions. Data on caregiver-reported exposure to adversity and sleep problems for 63 children (aged 3 years 4 months to 7 years 8 months) were extracted from clinical archives. Cumulative risk, threat exposure, and deprivation exposure scores were computed and were tested as predictors of insomnia symptoms and nightmares. All analyses controlled for age and gender. There were high rates of caregiver-reported sleep problems with 60.3% (n = 38) of children having nightmares and 44.4% (n = 28) having a frequent insomnia symptom. The cumulative risk analysis showed that for every additional exposure to adversity, the odds of having a caregiver-reported insomnia symptom increased by 38%. The dimensional analysis showed no relationship between deprivation and sleep problems. However, every additional exposure to threat increased the odds of nightmares by 93%. Exposure to postnatal adversity contributes to sleep disturbances in children with FASD, with unique roles for cumulative risk and the threat dimension of adversity. The implications of these findings for the etiology and treatment of sleep disturbances in children with FASD are discussed.

Predictors of insomnia symptoms in police employees: a longitudinal investigation and comparison of personality and psychosocial work factors

Insomnia is a growing public health concern and a risk factor for reduced health, safety, and performance among workers. This study investigated and compared the predictive value of personality traits and psychosocial factors associated with symptoms of insomnia. The study followed a longitudinal design and included 206 Norwegian police employees (52% men). The predictors of insomnia symptoms were divided into the following groups in the multiple regression analyses: 1) demands, control, and support at work, 2) stress and overcommitment, and 3) the personality traits of the five-factor model. A fourth final model included significant predictors from the initial analyses. The results showed high stability in insomnia symptoms at baseline and follow-up six months later. Neuroticism was the strongest and most stable predictor of insomnia, and associated with an increase in insomnia symptoms after six months. Overcommitment and stress had positive associations with insomnia symptoms but could not predict changes after six months. Social support had a negative association with insomnia, whereas job demands and control at work had no significant association with insomnia symptoms measured at follow-up six months later. The findings demonstrate that the personality trait neuroticism can play an important role in the development and maintenance of insomnia symptoms. Job demands and resources only explained a marginal proportion of variance in insomnia symptoms measured six months later in police employees, indicating that they may be less crucial in the development of insomnia. However, more research on the potential interaction effects between personality and organizational factors is needed. The study highlights the importance of taking personality characteristics into consideration when investigating predictors of insomnia.

Pain-related beliefs about sleep as a predictor of insomnia symptoms and treatment acceptability

ObjectiveDysfunctional beliefs about sleep and pain are common among individuals experiencing recurrent pain and may inadvertently maintain insomnia symptoms. Thus, the present study sought to determine the level at which pain-related beliefs about sleep may predict insomnia and assess whether pain-related beliefs about sleep predict attitudes towards insomnia treatment above other known factors. Patients/methodsData consisted of 999 individuals (M age = 44.18, 45.75% male) who participated in an online study about sleep and health across the lifespan. Beliefs about sleep and pain were measured via the pain-related beliefs and attitudes scale (PBAS) while insomnia and pain were assessed using the insomnia severity index (ISI) and a visual analogy scale, respectively. Attitudes towards insomnia treatment was measured using the insomnia treatment acceptability scale (ITAS). Results and conclusionA score of 6.10 out of 10 on PBAS optimized sensitivity (66.40%) and specificity (66.90%) for insomnia classification. Pain-related beliefs about sleep predicted treatment acceptability of both behavioral (β = .46, p <. 001) and pharmacological treatments (β = 0.50, p < .001) over and above insomnia symptoms, pain severity, or sleep-self efficacy. Results underscore the importance of cognitive-behavioral factors as it relates to insomnia among individuals with comorbid pain and are relevant to the developments of models which seek to understand attitudes towards insomnia treatment.

Associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors in persons with HF: Health and retirement study.

Insomnia symptoms are very common in persons with heart failure (HF). However, many of the correlates and predictors of insomnia symptoms in this population remain unclear. The purpose of this study isto investigate the associations of sociodemographic, clinical, and lifestyle factors with insomnia symptoms in persons with HF. A theoretical framework was adapted from the neurocognitive model of chronic insomnia to guide the study. Data from the health and retirement study were used for the analysis. Parametric and nonparametric bivariate and multivariate analyses were conducted to investigate these associations. Age, depressive symptoms, comorbidity, dyspnea, pain, and smoking had significant bivariate associations with all insomnia symptoms. Race, Hispanic ethnicity, marital status, household income, poverty, and physical activity were associated with difficulty initiating sleep (DIS) and early morning awakening (EMA). Female sex, education, and alcohol consumption had a significant bivariate association with DIS. Sleep-disordered breathing and body mass index were significantly associated with EMA. Multivariate analysis suggested that depressive symptoms, comorbidity, dyspnea, and pain had independent associations with each insomnia symptom. Age explained DIS and difficulty maintaining sleep, and significant interaction effects between age and physical activity on DIS and EMA were revealed. Results suggest that insomnia symptoms are associated with several sociodemographic, clinical, and lifestyle factors. Age below 70 years, depressive symptoms, comorbidity, dyspnea, and pain might be considered as a phenotype to identify persons with HF who are at increased risk for insomnia symptoms.

Abstract 12801: Heart Failure as an Independent Predictor of Insomnia Symptoms

Background: Heart failure (HF) is accompanied with several untoward outcomes including insomnia symptoms. Many factors including comorbidities, experienced symptoms, and psychosocial characteristics associated with HF were attributed to the high prevalence of insomnia symptoms in persons with HF. However, it is not yet clear if HF itself contributes to insomnia symptoms regardless of these associated factors. Purpose: The purpose of this analysis was to investigate the association of HF with insomnia symptoms in adjusted models for sociodemographic, clinical, and lifestyle factors. Methods: A secondary data analysis guided by the neurocognitive model of insomnia was conducted on data from the health and retirement study using multiple logistic regression. The total sample size included 17,910 subjects of which 1,189 were identified to have HF. Results: The results showed that those with HF were approximately two times more likely to have insomnia symptoms (OR:1.95, p &lt;0.001) in the unadjusted model. After adjusting for age, sex, race, ethnicity, education, marital status, income, poverty level, sleep-disordered breathing, obesity, depression symptoms, comorbid diseases, smoking, alcohol consumption, and physical activity using block-wise selection, HF maintained a significant association with insomnia symptoms (OR:1.15, p&lt;0.05). When looking at each insomnia symptom separately, HF significantly predicted difficulty initiating sleep (OR: 1.23, p &lt; 0.01) in the fully adjusted model, but maintained a trend with difficulty maintaining sleep and early morning awakening. Conclusion: These results are suggestive of an alerting effect in HF which could be attributed to its pathophysiology. Specifically, the neurohormonal compensatory mechanism and the increased sympathetic stimulation in heart failure may exert an alerting effect during the day and contribute to a hyper-arousal state and difficulty initiating sleep before it partially wears off after sleep. Further studies are needed to investigate this hypothesis.

Prevalence of insomnia symptoms and associated risk factors in UK Biobank participants with hazardous alcohol use and major depression

IntroductionWe aimed to examine the prevalence of insomnia symptoms (IS), sleep duration, and associated risk factors in participants with hazardous/harmful alcohol use (HAU), major depressive disorders (MDD), and HAU+MDD. MethodsData from the UK Biobank (UKB) (n = 55,000) were utilized to categorize participants into those with MDD (n = 5612), HAU (n = 15,893), MDD+HAU (n = 3738), and controls (n = 29,511). We examined whether rates of IS and sleep duration differed among the groups and determined the clinical predictors of IS. Rates of IS and sleep duration were compared using regression analyses accounting for demographic (age, sex, ethnicity, Townsend deprivation index) and clinical (body mass index, neuroticism score, alcohol consumption) factors. ResultsThe unadjusted prevalence of IS was 26.5%, 27%, 39.5%, and 43% in control, HAU, MDD, and MDD+HAU categories respectively. Rates of IS in controls versus HAU and MDD versus MDD+HAU did not differ in unadjusted models (p = 0.45 and 0.075, respectively). Prevalence of IS differed in the four groups (p < 0.0001 for all pairwise comparisons) after adjusting for demographic confounders. After further adjustment for clinical factors, effect sizes were reduced, but pairwise comparisons remained significant. After adjusting for demographic and clinical factors, sleep duration did not differ among the groups.After accounting for diagnostic category and demographic/clinical factors, older age (OR=1.33 per 10 year increase; p < 0.0001), female sex (OR=1.39; p < 0.0001), obesity (OR=1.17 compared to normal; p < 0.0001), higher neuroticism score (OR=1.13; p < 0.0001), and alcohol consumption (OR=1.01 per serving increase; p < 0.0001) were associated with IS. ConclusionSleep-related morbidity is the greatest in the MDD+HAU group, followed by the MDD group. Demographic and clinical characteristics explain some, but not all of the differences in the prevalence of IS in MDD±HAU. Genetic and other factors capable of influencing IS in those with MDD, HAU, and MDD+HAU merit future investigation.

Bidirectional relationship between perceived stress and insomnia symptoms: the role of coping and quality of life

Perceived stress is strongly associated with sleep problems. Despite the evidence linking these variables, research examining the reciprocal relationships between them using non-recursive models, which include feedback loop between endogenous variables, is lacking. The main objective was to analyse if there is a bidirectional relation between perceived stress and insomnia symptoms with a model using coping and quality of life as predictors of both variables. This is a cross-sectional study with a sample of 987 adults with insomnia symptoms (M = 40.90 years old; SD = 17.17). An exploratory Canonical Correlation Analysis assessed the interrelationships between a set of perceived stress and insomnia symptoms and a set of coping and quality of life variables. Structural Equation Modelling was used to explore the bidirectional relationships between perceived stress and insomnia symptoms, using coping strategies and quality of life as covariates. The first correlation (0.562), dominated by perceived stress, suggested a direct association with insomnia symptoms. The second correlation (0.146), dominated by insomnia symptoms, suggested a reverse association with perceived stress. The model showed good model fit indices (χ2(6) = 4.505, GFI = 0.999; RMSEA = 0.000 [CI 90% 0.000–0.035]). Self-blame, positive reframing, denial, self-distraction, social relationships, and environment were significant predictors of perceived stress; Denial and environment significantly predicted insomnia symptoms. Regarding the bidirectional relationship only perceived stress was a predictor of insomnia symptoms (β = 0.42, p ≤ 0.001). Insomnia symptoms depend on perceived stress, but no evidence of the direct effect of insomnia symptoms on perceived stress was observed. Although the bidirectional relationship has not been confirmed, this study supports the role of perceived stress in the management of insomnia symptoms.

Sleepless in Beirut: Sleep Difficulties in an Urban Environment With Chronic Psychosocial Stress.

The prevalence of sleep disorders in the Lebanese population is unknown. We assessed the prevalence of insomnia and sleep apnea risk and examined their relationship with sociodemographic, lifestyle, and health characteristics in a sample from Greater Beirut. This cross-sectional pilot survey included 501 adults from the community (age 45.2 ± 15.2 years, 64% females). Insomnia symptoms, insomnia disorder, and sleep apnea risk were assessed using the Sleep Heart Health Study and Berlin Questionnaire. Characteristics were compared between individuals with and without insomnia symptoms, insomnia disorder, and sleep apnea. Correlates were assessed using multivariate regression. A total of 44.5% of participants reported insomnia symptoms > 15 nights/mo and 34.5% reported insomnia. Predictors of insomnia symptoms and disorder included female sex (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.01-2.27 and OR 1.76, 95% CI 1.13-2.75, respectively), education level below high school (OR 1.96, 95% CI 1.31-2.95 and OR 2.40, 95% CI 1.52-3.77, respectively) and medical comorbidities (OR 2.27, 95% CI 1.30-3.95 and OR 3.02, 95% CI 1.3-5.27, respectively). Although 31% of participants were at high risk for sleep apnea, only 5% received the diagnosis from a physician. Increased sleep apnea risk was associated with unemployment (OR 1.96, 95% CI 1.11-3.49), high body mass index (OR 1.17, 95% CI 1.11-1.24), snoring (OR 16.7, 95% CI 9.0-31.0), hypertension (OR 4.33, 95% CI 2.28-8.22), arthritis (OR 2.00, 95% CI 1.01-4.01), and other medical comorbidities (OR 2.65, 95% CI 1.24-5.68). Insomnia and sleep apnea are highly prevalent and likely underdiagnosed in this cohort from Lebanon and are associated with disadvantaged socioeconomic status and medical comorbidities. This alarming prevalence of sleep difficulties and disorders calls for future research exploring the causes including the potential effect of social, economic, and political instability, mental and psychological stress, local customs, and environmental factors.

Affective Temperaments, Mood, and Insomnia Symptoms in a Nonclinical Sample

ABSTRACTObjective: The aim of the study was to understand the relationship between affective temperaments and insomnia symptoms and to examine mood state as a mediator in this relationship. Participants: The sample consisted of 659 adults (428 women and 231 men), aged 18–77 years old, derived from a nonclinical population. Methods: Affective temperaments were assessed using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). Mood was measured using the UWIST Mood Adjective Checklist (UMACL). Insomnia was evaluated by the Athens Insomnia Scale. Results: We found positive correlations among anxious, cyclothymic, depressive, and irritable affective temperaments and insomnia symptoms. Negative correlation with insomnia symptoms was found for hyperthymic temperament. Energetic arousal and tense arousal, as mood dimensions, positively correlated with insomnia symptoms. Hierarchical regression analysis indicated that anxious, cyclothymic, and hyperthymic temperaments were significant predictors of insomnia symptoms. Mediation analyses indicated that anxious, cyclothymic, and hyperthymic temperaments affected insomnia symptoms, both directly and indirectly, through energetic arousal as a mediator. Conclusions: The results showed a relationship between affective temperaments and insomnia symptoms and included the role of energetic arousal, a mood state dimension, as a mediator.

Predictors of insomnia symptoms and nightmares among individuals with post-traumatic stress disorder: an ecological momentary assessment study.

Despite the high levels of comorbidity between post-traumatic stress disorder (PTSD) and sleep disturbance, little research has examined the predictors of insomnia and nightmares in this population. The current study tested both PTSD-specific (i.e. PTSD symptoms, comorbid anxiety and depression, nightmares and fear of sleep) and insomnia-specific (i.e. dysfunctional beliefs about sleep, insomnia-related safety behaviours and daily stressors) predictors of sleep quality, efficiency and nightmares in a sample of 30 individuals with PTSD. Participants participated in ecological momentary assessment to determine how daily changes in PTSD- and insomnia-related factors lead to changes in sleep. Multi-level modelling analyses indicated that, after accounting for baseline PTSD symptom severity, PTSD-specific factors were associated with insomnia symptoms, but insomnia-specific factors were not. Only daytime PTSD symptoms and fear of sleep predicted nightmares. Both sleep- and PTSD-related factors play a role in maintaining insomnia among those with PTSD, while nightmares seem to be linked more closely with only PTSD-related factors.

Change in organizational justice as a predictor of insomnia symptoms: longitudinal study analysing observational data as a non-randomized pseudo-trial.

BackgroundDespite injustice at the workplace being a potential source of sleep problems, longitudinal evidence remains scarce. We examined whether changes in perceived organizational justice predicted changes in insomnia symptoms.MethodsData on 24 287 Finnish public sector employees (82% women), from three consecutive survey waves between 2000 and 2012, were treated as ‘pseudo-trials’. Thus, the analysis of unfavourable changes in organizational justice included participants without insomnia symptoms in Waves 1 and 2, with high organizational justice in Wave 1 and high or low justice in Wave 2 (N = 6307). In the analyses of favourable changes in justice, participants had insomnia symptoms in Waves 1 and 2, low justice in Wave 1 and high or low justice in Wave 2 (N = 2903). In both analyses, the outcome was insomnia symptoms in Wave 3. We used generalized estimating equation models to analyse the data.ResultsAfter adjusting for social and health-related covariates in Wave 1, unfavourable changes in relational organizational justice (i.e. fairness of managerial behaviours) were associated with increased odds of developing insomnia symptoms [odds ratio = 1.15; 95% confidence interval (CI) 1.02-1.30]. A favourable change in relational organizational justice was associated with lower odds of persistent insomnia symptoms (odds ratio = 0.83; 95% CI 0.71-0.96). Changes in procedural justice (i.e. the fairness of decision-making procedures) were not associated with insomnia symptoms.ConclusionsThese data suggest that changes in perceived relational justice may affect employees’ sleep quality. Decreases in the fairness of managerial behaviours were linked to increases in insomnia symptoms, whereas rises in fairness were associated with reduced insomnia symptoms.

The Effects of Transdiagnostic Group CBT for Anxiety on Insomnia Symptoms

Insomnia is a common feature among individuals with anxiety disorders. Studies of cognitive behavioral therapy (CBT) for anxiety report moderate effects on concomitant insomnia symptoms, but further research is still needed especially toward understanding how CBT for anxiety renders beneficial effects on insomnia. The current study examined changes in insomnia symptoms reported by 51 Veterans who participated in a group-based transdiagnostic CBT for anxiety intervention. In addition, insomnia symptoms were examined in relation to symptoms of general distress (GD), anhedonic depression (AD), and anxious arousal (AA) pre- to post-treatment. Results revealed a small, though statistically significant (p < .05) beneficial effect on insomnia symptoms. When changes in GD, AD, and AA were simultaneously examined in relation to changes in insomnia, change in AA was the only significant predictor of insomnia symptoms. The current study highlights the role of AA in the relationship between anxiety disorders and insomnia and demonstrates that reductions in insomnia during transdiagnostic CBT for anxiety can be largely attributed to changes in AA.