Presleep Cognitions Research Articles

Executive dysfunction, negative pre-sleep cognitions, and sleep problems: examining a cyclical model

Executive dysfunction, negative pre-sleep cognitions, and sleep problems: examining a cyclical model

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).

Mechanisms of Cognitive Behavioral Therapy and Light Therapy for Cancer-Related Insomnia: A Randomized Clinical Trial during Chemotherapy for Breast Cancer

ABSTRACT Study Objectives This study aimed to investigate the mechanisms of a combined brief cognitive behavioral plus bright light therapy (CBT-I+Light) in women receiving chemotherapy. Methods Women (N = 101) were randomly assigned to CBT-I+Light or treatment as usual plus relaxation audios (TAU+). Participants completed sleep diaries and wore an actigraph during the 6-week intervention period. Patient-reported outcomes were assessed at baseline, mid-point (week 3), and later (week 6). Cognitive (i.e., dysfunctional sleep beliefs, pre-sleep cognitions, and arousal) and behavioral (i.e., time in bed awake and day-to-day out-of-bedtime variability) mechanisms were examined. Results Cognitively, both groups declined significantly in overall dysfunctional sleep beliefs from pre- to post-intervention (both p< .04); however, they did not differ on sleep-related beliefs nor pre-sleep cognitions and arousal at post-intervention (both p> .50). Dysfunctional beliefs sleep expectations subscale was lower in CBT-I+Light versus TAU+ (p= .01). Behaviorally, CBT-I+Light reported less overall time in bed awake after the start of the intervention (p< .05) and significantly less time in bed during the morning until the final week of the intervention period. Out-of-bedtime day-to-day variability was lower in the CBT-+Light vs TAU+ at the final intervention day. Conclusion Mechanisms of CBT-I+Light during chemotherapy remain to be shown. Our results suggest that changes in behavioral mechanisms may be associated with sleep improvements within this cohort. Future studies should assess the role of additional mechanisms (e.g., sleep effort) within larger samples. Whilst intervention brevity is important, more potent interventions may be required to achieve robust changes in target mechanisms.

Stress dynamically reduces sleep depth: temporal proximity to the stressor is crucial.

The anticipation of a future stressor can increase worry and cognitive arousal and has a detrimental effect on sleep. Similarly, experiencing a stressful event directly before sleep increases physiological and cognitive arousal and impairs subsequent sleep. However, the effects of post- vs. pre-sleep stress on sleep and their temporal dynamics have never been directly compared. Here, we examined the effect of an anticipated psychosocial stressor on sleep and arousal in a 90-min daytime nap, in 33 healthy female participants compared to an anticipated within-subject relaxation task. We compared the results to an additional group (n = 34) performing the same tasks directly before sleep. Anticipating stress after sleep reduced slow-wave activity/beta power ratio, slow-wave sleep, sleep spindles, and slow-wave parameters, in particular during late sleep, without a concomitant increase in physiological arousal. In contrast, pre-sleep psychosocial stress deteriorated the same parameters during early sleep with a concomitant increase in physiological arousal. Our results show that presleep cognitions directly affect sleep in temporal proximity to the stressor. While physiological arousal mediates the effects of presleep stress on early sleep, we suggest that effects during late sleep originate from a repeated reactivation of mental concepts associated with the stressful event during sleep.

Assistive Relaxation Therapy for Older Adults With Insomnia and Mild Cognitive Impairment: A Pilot Study

Insomnia symptoms are prevalent in older adults with mild cognitive impairment (MCI) and can pose treatment challenges. Our objective was to test the preliminary efficacy of tablet-based assistive relaxation therapy (ART) to improve insomnia symptoms in community-dwelling older adults with MCI. ART involves breath-based relaxation techniques coupled with a physical anchoring task to redirect thoughts and disengage from pre-sleep anxiety-provoking cognitions. Using a pilot randomized controlled non-crossover design, 20 participants recruited from one urban adult day center were allocated in a 1:1 ratio to intervention or education only control group for a treatment period of two weeks. Our final sample (n=20) was balanced on all demographic and clinical variables and consisted of Black (100%), female (75%), older adults (mean age 68.85 ± 7.29) with mean Montreal Cognitive Assessment scores of 21.2 ± 2.48. All participants at baseline had insomnia symptoms (mean Insomnia Severity Index (ISI) score 15.8 ± 3.78) and poor sleep quality (mean Pittsburgh Sleep Quality Index (PSQI) score 12.95 ± 0.70); half had daytime sleepiness (Epworth Sleepiness Scale (ESS) score 10.15 ± 1.07). Compared to baseline, participants improved on ISI (9.83 ± 1.32; p=0.0002), PSQI (9.11 ± 1.02; p=0.0016) and ESS (8.17 ± 0.86; p=0.08). The intervention group had statistically significant mean change scores on ISI compared to the control (-7.5 ± 1.37 vs. -3.88 ± 1.48; p=.0461). There were no statistically significant between group differences on PSQI or ESS. Our preliminary results suggest ART therapy is an effective treatment for insomnia symptoms in older adults with MCI.

Rumination and dissociation: The mediating role of poor sleep quality and presleep cognitions.

Rumination and dissociation: The mediating role of poor sleep quality and presleep cognitions.

0928 Pre-Sleep Cognitions Partially Mediate the Relationship Between Depression and Daytime Energy

0928 Pre-Sleep Cognitions Partially Mediate the Relationship Between Depression and Daytime Energy

The role of pre-sleep cognitions in adolescent sleep-onset problems

Study objectivesTo examine the relationship between pre-sleep cognitions and sleep-onset difficulties in an adolescent sample. MethodsParticipants comprised 385 students (59% male) from grades 9 to 11, aged between 13 and 18 years (M = 15.6, SD = 1.0), from eight co-educational high schools of varied socio-economic status in metropolitan Adelaide, South Australia. The cross-sectional study used a questionnaire battery including the Sleep Anticipatory Anxiety Questionnaire -Adolescent Version (SAAQ-A), completed during school time, followed by eight days of sleep diary completion and wearing wrist actigraphy to obtain subjective and objective sleep onset latency (SOL). ResultsSignificant relationships were found between somatic arousal (SAAQ-A subscale) and objective SOL and also between sleep-related cognitions (SAAQ-A subscale) and subjective SOL and SOL overestimation (sleep misperception). No relationships were found between subjective SOL and somatic or rehearsal and planning cognitions. Objective SOL was not related to rehearsal and planning and to sleep-related cognition scores, and sleep misperception had no relationship with somatic as well as rehearsal and planning cognition scores. ConclusionsThese findings are not only similar to those in clinical adult populations but also notably different, for example, the lack of association between negative sleep-related pre-sleep cognitions and objective sleep difficulty. The results of this study provide a basis for a more detailed causal study on the existing relationships between negative pre-sleep cognitions and subjective and objective sleep difficulties in this population.

The Association Between Trait Gratitude and Self-Reported Sleep Quality Is Mediated by Depressive Mood State

ABSTRACTBackground: It has been shown that higher levels of trait gratitude are associated with better self-reported sleep quality, possibly due to differences in presleep cognitions. However previous studies have not taken into account the role of depressive symptoms in this relationship. Participants and Methods: In this study, 88 nonclinical 18–29-year-olds completed the Gratitude Resentment and Appreciation Test (GRAT) as a measure of trait gratitude. The Glasgow Content of Thought Inventory (GCTI) was used to measure the intrusiveness of cognitions prior to sleep onset, the Motivation and Energy Inventory (MEI) assessed daytime fatigue, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess self-reported sleep quality. The BDI-II assessed self-reported depressive symptoms. Results: Consistent with previous work, GRAT scores were positively associated with higher daytime energy and greater number of hours of sleep per night. Importantly, however, we further observed that depressive symptoms mediated the relationships between gratitude scores and sleep metrics. Conclusions: Depressive mood state appears to mediate the association between gratitude and self-reported sleep quality metrics. We suggest, as one plausible model of these phenomena, that highly grateful individuals have lower symptoms of depression, which in turn leads to fewer presleep worries, resulting in better perceived sleep quality. Future work should aim to disentangle the causal nature of these relationships in order to better understand how these important variables interact.

Психологические факторы хронификации инсомнии: подход психологии телесности

Contemporary cognitive approach considers both dysfunctional beliefs about sleep, pre-sleep thoughts and behavior as key factors in the insomnia prepetuation, along with emotional factors such as anxiety and depression. The question remains whether the contribution of each of these factors is independent or whether any of these factors dominate or complement each other. The aim of the study was to compare the contribution of cognitive and behavioral factors to the subjective and objective quality of sleep in patients with chronic insomnia. 37 patients with primary chronic insomnia participated in 1-night polysomnographic recording of sleep and psychological observation. According to the results of hierarchical regression analysis and moderation analysis, the negative effects of dysfunctional beliefs, disturbances in sleep hygiene and pre-sleep thoughts are irreducible to each other, and only the effect of thoughts can be explained by the emotional state of patients. Self-restrictive behavior is associated with difficulties in transition to deep sleep and longer wakefulness at night. The results of moderation analysis suggest that the disturbance of sleep hygiene is so important that it is prominent, the effect of dysfunctional beliefs is not so obvious. Self-restrictive behavior can amplify the negative effect of pre-sleep cognitions on subjective sleep.

Nighttime Thought Control Strategies and Insomnia Severity

Strategies used to control unwanted thoughts during the evening have been shown to be significantly associated with insomnia, a common problem associated with numerous negative consequences. This study examined whether nighttime thought control strategies would predict insomnia severity among 460 college students (mean age = 18.8, 61 % female, and 72 % Caucasian) after accounting for well-established risk factors for the disorder such as anxiety, depression, sleep hygiene, and nighttime pain. The Insomnia Severity Index was used to measure insomnia severity and the Thought Control Questionnaire Insomnia-Revised was used to measure nighttime thought management strategies. Results from a hierarchical multiple linear regression showed that the strategy of cognitive distraction (attempts to withdraw from unwanted thoughts or think about more pleasant content) was negatively associated with insomnia severity and the strategy of aggressive suppression (the use of critical and punishing self thought) was positively associated with insomnia severity after accounting for other risk factors. These findings add to the growing literature highlighting arousing pre-sleep cognitions as a correlate of insomnia. These findings also add to emerging literature showing the ability to cognitively distract from the arousing thought as a correlate of good sleep.

An investigation of a cognitive refocusing technique to improve sleep.

Developing techniques designed to minimize arousing cognitions during the evening may be important to help improve the treatment of insomnia. This investigation assessed an intervention that focused exclusively on enhancing cognitive refocusing at sleep onset to change the content and style of presleep cognitions in order to improve sleep. Individuals with primary insomnia (N=10; 90% male, mean age=49.2, SD=12.6) attended four weekly individual meetings. Sleep quality (the Pittsburgh Sleep Quality Index), insomnia severity (the Insomnia Severity Index), sleep parameters based on one week of sleep diaries, and arousing thought content, were compared at baseline, posttreatment, and at a 1-month follow-up. Adherence was high, and participants showed good ability to engage in the procedure. Significant improvements in sleep quality, insomnia severity, sleep onset latency, total sleep time, and arousing thought content were revealed. Large effect sizes were observed on the majority of sleep variables at follow-up. Preliminary results were encouraging regarding a technique that targets the refocusing of thoughts during the evening in order to improve sleep. Further study regarding the efficacy of this procedure is warranted.

Gratitude influences sleep through the mechanism of pre-sleep cognitions

Objectives To test whether individual differences in gratitude are related to sleep after controlling for neuroticism and other traits. To test whether pre-sleep cognitions are the mechanism underlying this relationship. Method A cross-sectional questionnaire study was conducted with a large (186 males, 215 females) community sample (ages=18–68 years, mean=24.89, S.D.=9.02), including 161 people (40%) scoring above 5 on the Pittsburgh Sleep Quality Index, indicating clinically impaired sleep. Measures included gratitude, the Pittsburgh Sleep Quality Index (PSQI), self-statement test of pre-sleep cognitions, the Mini-IPIP scales of Big Five personality traits, and the Social Desirability Scale. Results Gratitude predicted greater subjective sleep quality and sleep duration, and less sleep latency and daytime dysfunction. The relationship between gratitude and each of the sleep variables was mediated by more positive pre-sleep cognitions and less negative pre-sleep cognitions. All of the results were independent of the effect of the Big Five personality traits (including neuroticism) and social desirability. Conclusion This is the first study to show that a positive trait is related to good sleep quality above the effect of other personality traits, and to test whether pre-sleep cognitions are the mechanism underlying the relationship between any personality trait and sleep. The study is also the first to show that trait gratitude is related to sleep and to explain why this occurs, suggesting future directions for research, and novel clinical implications.

Presleep Cognitive Activity and Thought Control Strategies in Insomnia

The aim of this study was to examine presleep cognitive activity and thought control strategies used by individuals with insomnia, with and without comorbid generalized anxiety disorder (GAD), and by good sleepers. Fifty participants were divided into the following comparison groups: (a) individuals with insomnia alone (n = 14), (b) individuals with insomnia and comorbid GAD (n = 16), and (c) good sleepers (n = 20). Participants completed a standardized evaluation including interviews and questionnaires on insomnia, anxiety, presleep cognitive activity, and thought control strategies. Results showed that individuals with insomnia and comorbid GAD reported greater presleep cognitive arousal than individuals with insomnia alone, who in turn reported greater cognitive arousal than good sleepers. Results also showed that individuals with insomnia and comorbid GAD used avoidance as a mean of controlling disturbing presleep cognitions more frequently than the other two groups. Both groups of individuals with insomnia evaluated their presleep thought control strategies as being less effective than good sleepers did. These results support the assertion that higher presleep cognitive arousal plays a role in insomnia and, by distinguishing individuals with insomnia alone (i.e., without comorbid anxiety disorders) from individuals with comorbid GAD, this study further suggests that higher cognitive arousal in individuals with insomnia is not necessarily accounted for by high rates of comorbidity between insomnia and GAD. The main clinical implication of these findings is that the evaluation and treatment of insomnia should consider these cognitive features in order to optimize outcome.

Presleep Cognitive Activity and Thought Control Strategies in Insomnia

The aim of this study was to examine presleep cognitive activity and thought control strategies used by individuals with insomnia, with and without comorbid generalized anxiety disorder (GAD), and by good sleepers. Fifty participants were divided into the following comparison groups: (a) individuals with insomnia alone (n = 14), (b) individuals with insomnia and comorbid GAD (n = 16), and (c) good sleepers (n = 20). Participants completed a standardized evaluation including interviews and questionnaires on insomnia, anxiety, presleep cognitive activity, and thought control strategies. Results showed that individuals with insomnia and comorbid GAD reported greater presleep cognitive arousal than individuals with insomnia alone, who in turn reported greater cognitive arousal than good sleepers. Results also showed that individuals with insomnia and comorbid GAD used avoidance as a mean of controlling disturbing presleep cognitions more frequently than the other two groups. Both groups of individuals with insomnia evaluated their presleep thought control strategies as being less effective than good sleepers did. These results support the assertion that higher presleep cognitive arousal plays a role in insomnia and, by distinguishing individuals with insomnia alone (i.e., without comorbid anxiety disorders) from individuals with comorbid GAD, this study further suggests that higher cognitive arousal in individuals with insomnia is not necessarily accounted for by high rates of comorbidity between insomnia and GAD. The main clinical implication of these findings is that the evaluation and treatment of insomnia should consider these cognitive features in order to optimize outcome. Keywords: insomnia; cognitive arousal; thought control strategies; avoidance Cognitive activity has been hypothesized to play an important role in the development and maintenance of insomnia (Borkovec, 1982; Harvey, 2002; Morin, 1993). Experimental manipulations of presleep cognitive activity have shown that higher levels of cognitive activity increase sleep-onset latency in otherwise good sleepers (Ansfield, Wegner, & Bowser, 1996; Gross & Borkovec, 1982; Haynes, Adams, & Franzen, 1981; Tang & Harvey, 2004). Furthermore, individuals with insomnia are more likely to attribute their sleep difficulties to presleep activities involving greater cognitive arousal, such as planning and reappraisal, than to somatic factors such as sweating and palpitations (Lichstein & Rosenthal, 1980). Individuals with insomnia also tend to evaluate their cognitions as more intrusive, unpleasant, negative, worrisome and hard to dismiss, than good sleepers do (Borkovec, Lane, & VanOot, 1981; Harvey, 2000, 2001; Kuisk, Bertelson, & Walsh, 1989). Studies on thought control strategies conducted with nonclinical samples have suggested that avoidance was one of the most frequently used coping strategies to eliminate intrusive thoughts (Freeston, Ladouceur, Provencher, & Biais, 1995; Freeston, Ladouceur, Thibodeau, & Gagnon, 1991). Although it produces an immediate relief, avoidance remains an ineffective and maladaptive long-term strategy compared to problem-solving strategies (Suis & Fletcher, 1985). A number of studies have shown that trying to eliminate thoughts from consciousness may paradoxically increase the frequency of these thoughts during the suppression period (enhancement effect; Trinder & Salkovskis, 1994), or after the attempts to suppress (rebound effect; Clark, Ball, & Pape, 1991; Wegner, 1989), and tend to make them even more intrusive. In many instances, worry and anxiety have been shown to increase intrusive thoughts (Freeston, Dugas, & Ladouceur, 1996; York, Borkovec, Vasey, & Stern, 1987). Individuals with anxiety disorders are known to have more intrusive thoughts (not necessarily at bedtime) and more difficulty coping with them than nonanxious individuals (Borkovec, Shadic, & Hopkins, 1991; York et al. …

Presleep cognitions in patients with insomnia secondary to chronic pain.

This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The three most frequently reported presleep cognitions were general pain-related thoughts (36%), thoughts about the experimental procedure (27%), and negative sleep-related thoughts (26%). Stepwise multiple regression analyses found the presleep thoughts pertaining to pain and environmental stimuli were significantly associated with sleep continuity, independent from the effects of depression and nightly pain severity. Pain severity was found to be positively associated with Wake After Sleep Onset Time. These results are consistent with cognitive-behavioral models of primary insomnia and suggest the content of presleep cognitive arousal may contribute to sleep disturbance secondary to pain.

Presleep cognitions and attributions in sleep-onset insomnia.

This research examined the role of cognitive factors (attributions about the causes of sleep difficulties and presleep cognitive activity) in sleep-onset insomnia. Thirty-four subjects, including 13 mild to extreme insomniacs, were interviewed and then spent 5 consecutive nights in a sleep laboratory. In a multiple regression paradigm predictor measures included attribution ratings of sleep difficulty, perceived control of presleep cognitive content, and affect associated with presleep cognitions. Criterion measures included laboratory measured objectives and subjective sleep-onset latency, a score presenting the difference between objective and subjective laboratory measures of sleep-onset latency, interview-measured subjective sleep-onset latency, and degree of overall concern and presleep concern about initiating sleep. The results of multiple regression analyses suggested that the content of presleep cognitions and the attributions of sleep difficulties were significantly associated with several subjective measures of sleep-onset latency or concern with initiating sleep. None of the predictor measures was significantly associated with objectively measured sleep-onset latency. Implications for cognitive theories of sleep-onset insomnia and for the psychophysiologic-subjective dimension of insomnia are discussed.