Sleep Reactivity Research Articles

Improved resilience following digital cognitive behavioral therapy for insomnia protects against insomnia and depression one year later.

While the negative consequences of insomnia are well-documented, a strengths-based understanding of how sleep can increase health promotion is still emerging and much-needed. Correlational evidence has connected sleep and insomnia to resilience; however, this relationship has not yet been experimentally tested. This study examined resilience as a mediator of treatment outcomes in a randomized clinical trial with insomnia patients. Participants were randomized to either digital cognitive behavioral therapy for insomnia (dCBT-I; n = 358) or sleep education control (n = 300), and assessed at pre-treatment, post-treatment, and 1-year follow-up. A structural equation modeling framework was utilized to test resilience as a mediator of insomnia and depression. Risk for insomnia and depression was also tested in the model, operationalized as a latent factor with sleep reactivity, stress, and rumination as indicators (aligned with the 3-P model). Sensitivity analyses tested the impact of change in resilience on the insomnia relapse and incident depression at 1-year follow-up. dCBT-I resulted in greater improvements in resilience compared to the sleep education control. Furthermore, improved resilience following dCBT-I lowered latent risk, which was further associated with reduced insomnia and depression at 1-year follow-up. Sensitivity analyses indicated that each point improvement in resilience following treatment reduced the odds of insomnia relapse and incident depression 1 year later by 76% and 65%, respectively. Improved resilience is likely a contributing mechanism to treatment gains following insomnia therapy, which may then reduce longer-term risk for insomnia relapse and depression.

Associations between burnout symptoms and sleep among workers during the COVID-19 pandemic

BackgroundThe aim of this study was to investigate the relations between underlying dimensions of burnout (ie exhaustion, mental distance, cognitive impairment and emotional impairment) and sleep reactivity in occupations that maintain critical societal functions during the COVID-19 pandemic. Sleep reactivity refers to the vulnerability of experiencing sleep disturbances during stressful and challenging situations, and manifests as difficulties with falling and staying asleep. Previous research has highlighted the importance investigating psychological factors that may influence or trigger vulnerability to stress induced sleep problems, including factors at work. MethodsLongitudinal self-report data was collected using an online survey administered to Norwegian workers employed in health care, education, social services, emergency services and other sectors with critical tasks during the COVID-19 pandemic at two different time points three months apart. The sample in the present study (N = 1331) consisted of 76% females and 24% males with a mean age of 44 years. ResultsThe results showed that work-related exhaustion measured at baseline was the strongest symptom of burnout associated with higher sleep reactivity three months later, followed by emotional impairment. Mental distance and cognitive impairment at work were not associated with sleep reactivity, indicating that these burnout dimensions have less of an impact on sleep than exhaustion and emotional impairment. ConclusionWork-related exhaustion and emotional impairment can lower the individual's tolerance to perceiving events as stressful as well as reinforce the stress response, and contribute to difficulties with initiating and/or maintaining sleep. Workers employed in occupations with critical tasks during the pandemic may be more susceptible to exhaustion, emotional strain and poorer sleep due to increased and prolonged work pressure. Organizational and individual measures that can decrease stress and increase coping should be offered to employees working in high-stress conditions.

Adjunctive therapy for sleep disorders

The article describes pathogenetic models for insomnia: «3P» model of insomnia, hyperarousal model, and sleep reactivity to stress model. Anxiety and stress are addressed as predisposing, precipitating and perpetuating factors of insomnia. The problem of high comorbidity of insomnia and mental disorders is highlighted. Modern non-pharmacological and pharmacological approaches to treatment of insomnia are described: psychotherapy, other non-pharmacological methods as well as the use of medications. These methods can be used both independently and in combination. In particular, combination of psychotherapy and nonprescription medicines aimed at normalizing emotional state is possible.

Can an E-Mail-Delivered CBT for Insomnia Validated in the West Be Effective in the East? A Randomized Controlled Trial.

This study examined the effects of an e-mail-delivered cognitive behavioral therapy for insomnia (CBT-I), validated in Western countries, on insomnia severity, anxiety, and depression in young adults with insomnia in Eastern countries, particularly Japan. This prospective parallel-group randomized clinical trial included college students with Insomnia Severity Index (ISI) scores of ten or higher. Participants were recruited via advertising on a university campus and randomized to an e-mail-delivered CBT-I (REFRESH) or self-monitoring (SM) with sleep diaries group. The primary outcomes were insomnia severity, anxiety, and depression; secondary outcomes were sleep hygiene practices, dysfunctional beliefs, sleep reactivity, and pre-sleep arousal. All measurements were assessed before and after the intervention. A total of 48 participants (mean (SD) age, 19.56 (1.86) years; 67% female) were randomized and included in the analysis. The results of the intent-to-treat analysis showed a significant interaction effect for insomnia severity, anxiety, depression, sleep hygiene practice, and pre-sleep arousal. Compared with the SM group, the REFRESH group was more effective in reducing insomnia severity (Hedges’ g = 1.50), anxiety (g = 0.97), and depression (g = 0.61) post-intervention. These findings suggest that an e-mail-delivered CBT-I may be an effective treatment for young adults with elevated insomnia symptoms living in Japan.

Negative life stress, sleep disturbance, and depressive symptoms: The moderating role of anterior insula activity in response to sleep-related stimuli

BackgroundThis study investigated the effects of anterior insula (AI) activation on the association between stress and sleep disturbance as a neurobiological basis of the trait-like degree of sleep reactivity to stress. Additionally, it examined the effects of AI activity on the association between sleep disturbance and depression. MethodsThe participants were 48 adults. To assess AI activation in response to sleep-related stimuli (SS) compared to neutral stimuli (NS), we extracted mean AI parameter estimates for the SS–NS contrast. We examined whether the interaction between life stress and AI activation would predict sleep disturbance and whether the interaction between sleep disturbance and AI activation would predict depression. ResultsAt higher levels of bilateral AI activation in response to SS, higher levels of stress were associated with greater sleep disturbance (left AI x stress: b = 1.07, SE = 0.44, p < 0.05; right AI x stress: b = 1.05, SE = 0.48, p < 0.05). In addition, at higher levels of right AI activation, higher levels of sleep disturbance were associated with more severe depressive symptoms (right AI x sleep disturbance: b = 2.55, SE = 1.10, p < 0.05). LimitationThis study assessed sleep quality and depressive symptoms based on self-reported questionnaires. ConclusionThis study revealed moderating effects of AI activation on the association between negative life stress and sleep disturbance. Additionally, AI activation strengthened the association between sleep disturbance and depression. AI activation may reflect a crucial etiological diathesis for insomnia and stress-related disorders.

Emotion coping strategies and dysfunctional sleep-related beliefs are associated with objective sleep problems in young adults with insomnia

BackgroundThough insomnia is associated with affected emotion regulation and dysfunctional ideas about sleep, little is known about the relation of these problems with objective sleep disruption. We aimed to explore this relationship in young adults with and without insomnia. MethodsTwenty young adults with diagnosed insomnia disorder (aged 27.7 ± 8.6 years) and twenty age-matched individuals without insomnia (26.7 ± 7.0 years) completed questionnaires, measuring sleep-related thoughts and emotions and emotion regulation. Objective sleep measurements were collected through 10-days actigraphy as a representative sample of nights, and analyzed for sleep onset latency, sleep efficiency total sleep time. T-tests and multivariate analyses of variance (MANOVA) were conducted for sample characterization and analysis of the association of sleep-related thoughts and emotions and emotion regulation with objective sleep data. ResultsAs expected, young people showed more dysfunctional sleep-related thoughts and emotions (all ps ≤ 0.025) and dysfunctional emotion regulation strategies (all ps ≤ 0.040). Surprisingly, MANOVA results showed that only emotion coping strategies after a stressful event (p = 0.017) and dysfunctional beliefs about sleep (p = 0.012), but not other factors of arousal or sleep reactivity, were associated with overall worse sleep, especially sleep onset latency (all ps ≤ 0.012) and sleep efficiency (all ps ≤ 0.010). ConclusionsMaladaptive emotion coping strategies after a stressful event and dysfunctional sleep-related beliefs and attitudes affect objective sleep onset latency and sleep efficiency in young adults, highlighting the importance of targeting these features in the prevention and treatment of chronic insomnia and improving actual sleep quality.

Sleep Reactivity and Depressive Symptoms Among Chinese Female Student Nurses: A Longitudinal Mediation Analysis.

Previous cross-sectional studies have documented that sleep reactivity was associated with depressive symptoms, but the potential mechanisms underlying this relationship were understudied. Therefore, the present study with a longitudinal prospective design was to reveal the mediating roles of sleep disturbance and emotion regulation difficulties (ERD) between sleep reactivity and depressive symptoms. This study included 725 student nurses who were followed up periodically for 9 months, with an interval of three months. All participants completed questionnaires regarding sleep reactivity, sleep disturbance, ERD, and depressive symptoms. Adjusted analyses suggested that the direct effect of sleep reactivity on depressive symptoms was non-significant. The bootstrap procedure revealed two significant indirect effects: from sleep reactivity to depressive symptoms with sleep disturbance as a mediator and from sleep reactivity to depressive symptoms with sleep disturbance and ERD as sequential mediators. Therefore, sleep reactivity might be considered as an indicator of shiftwork adaptability in the evaluation of recruitment. Psychological interventions aimed at developing healthy sleep habits and emotion regulation skills may be helpful in decreasing the risk of depression.

Night work as a stressor: The role of sleep reactivity to stress in the relationship between night work and insomnia.

Sleep reactivity to stress is a predisposition to experience sleep disturbances in response to stress. The present study aimed to examine the potential moderating role of sleep reactivity to stress in the relationship between the number of night shifts per month as a stressor and insomnia symptoms. A total of 188 shift-working physicians completed a short questionnaire about work schedule, the Ford Insomnia Response to Stress and the Insomnia Severity Index. Sleep reactivity to stress was a significant moderator of the effect of number of nights worked in the last month on insomnia symptoms. At low and medium sleep reactivity to stress the relationship between the number of night shifts per month and insomnia symptoms was positive and significant. At high sleep reactivity to stress the relationship was no longer significant. The results show that with low and medium sleep reactivity to stress, the more night shifts a person works per month, the more severe insomnia symptoms they will report. With high sleep reactivity to stress even a low number of night shifts per month will lead to a deterioration of sleep. This is important for identifying those who are more vulnerable to adverse consequences of working in the shift system, and the knowledge of workers' sleep reactivity to stress may help in providing targeted interventions.

Sleep Disturbances During the Menopausal Transition: The Role of Sleep Reactivity and Arousal Predisposition

ABSTRACT Background Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. Methods Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40–60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. Results Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. Conclusion More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause.

Sleep reactivity is associated with social anxiety and disordered-eating behaviors in college students

Objective: Investigate whether sleep reactivity was associated with social anxiety and disordered-eating behaviors in a college population. Participants: One hundred ninety-eight college-age men and women. Methods: Participants completed self-report measures of social anxiety, disordered-eating behaviors and sleep reactivity. Results: Sleep reactivity was associated with greater dietary restriction and purging, controlling for social anxiety but it was not associated with binge eating. Sleep reactivity was associated with elevated symptoms of social anxiety, controlling for disordered-eating behaviors. Conclusions: The results suggest that sleep reactivity represents a shared correlate of disordered-eating behaviors and social anxiety that may partially explain their co-occurrence. Interventions to help college students high in sleep reactivity effectively manage stress and regulate their sleep may aid in the prevention and treatment of social anxiety and disordered-eating behaviors.

Consequences of child maltreatment: A glimpse at stress and sleep

The present study goal was to provide further information on the association of maltreatment experiences in childhood (CM) and impaired sleep taking the hyperarousal theory of insomnia and stress reaction into account. In all, 62 participants took part in the study. CM history (Childhood Trauma Questionnaire) and subjective sleep quality (Pittsburgh Sleep Quality Index) were assessed before study commencement. In addition, participants wore an actigraph for 6-7 consecutive nights and completed a sleep log during this time. After 3-4days, the participants took part in a laboratory stress paradigm (Maastricht Acute Stress Test) with 29 participants in the experimental and 31 in the control condition. Saliva cortisol samples were taken before and after the experiment and heart rate variability was assessed. CM was positively correlated with impaired subjectively assessed sleep in adulthood. The stress manipulation led to heightened subjective and physiological stress. Although lower cortisol changes after and lower mean heart rate values during the stress induction were found in the CM group, the differences were not statistically significant. There was no observable sleep reactivity on the stress induction. Stress and CM appear to have long-term effects on subjective sleep. Acute social stress does not directly worsen sleep quality, neither in participants with nor without a history of CM. However, the association underlines the importance of prevention and intervention. When treating sleep impairments, potential CM experiences should be taken into account.

The relationship among sleep reactivity, job-related stress, and subjective cognitive dysfunction: a cross-sectional study using path analysis.

Insomnia, job-related stress, and cognitive dysfunction affect the mental health of workers. However, the relationships among sleep reactivity, job-related stress, and subjective cognitive dysfunction in workers remains not fully understood. Therefore, this study seeks to investigate the relationships among these variables in Japanese adult workers. In total, 536 adult workers in Japan were evaluated using the Japanese version of Ford Insomnia Response to Stress Test, Brief Job Stress Questionnaire, and Cognitive Complaints in Bipolar Disorder Rating Assessment to assess sleep reactivity, job-related stress, and subjective cognitive function, respectively. Path analysis was also carried out. The results of the path analysis showed that sleep reactivity significantly influenced on subjective cognitive dysfunction directly and indirectly via job stressors and stress reaction. Our results may not be generalizable to underage workers because only adult workers were included, which is a limitation of this study. The results of the present study suggest that job-related stress mediates the effect of sleep reactivity on subjective cognitive dysfunction in Japanese adult workers. This underscores the need to evaluate the mediating effect of job-related stress in addressing the subjective cognitive dysfunction associated with insomnia in workers.

Patterns of concomitant prescription, over-the-counter and natural sleep aid use over a 12-month period: a population based study.

Concomitant patterns of sleep aid use may provide insight for understanding the transition to chronic sleep medication use. Therefore, we sought to characterize the trajectories of concomitant natural product (NP), over-the-counter (OTC), and prescribed (Rx) sleep aid use in a population-based sample over 12-months. Self-reported data on the use of NP, OTC, and Rx sleep aids were extracted from a Canadian longitudinal study on the natural history of insomnia (N = 3416, M age = 49.7 ± 14.7 years old; 62% women) at baseline, 6-month, and 12-month. Latent class growth modeling was used to identify latent class trajectories using MPlus Version 7. Participants completed a battery of clinical measures: Ford Insomnia Response to Stress Test, abbreviated Dysfunctional Beliefs and Attitudes about Sleep Scale, Beck Depression Inventory, Insomnia Severity Index and, the Pittsburgh Sleep Quality Index. Associations between class membership and baseline covariates were evaluated. Concurrent sleep aid use fell into six distinct latent class trajectories over a 12-month period: Minimal Use (74.5%), Rx-Dominant (11.3%), NP-Dominant (6.3%), OTC-Dominant (4.3%), Rx-NP-Dominant (2.4%), and Rx-OTC-Dominant (1.1%). The three latent classes with prominent prescribed agent use predicted greater incidence of healthcare professional consultations for their sleep (p < 0.05), poorer sleep quality (p < 0.001), elevated dysfunctional sleep beliefs (p < 0.001), and sleep reactivity (p < 0.001). Compared to the other four latent classes, clinical profiles of Rx-NP-dominant and Rx-OTC-dominant groups endorsed greater severity across measures. Patterns of sleep aid use may provide insight for identifying individuals who may be vulnerable to inappropriate self-medicating practices.

582 Insomnia-related cognitive and behavioural factors in adolescents with delayed sleep-wake phase disorder

Abstract Introduction Although delayed sleep-wake phase disorder (DSWPD) shares phenomenological experiences with chronic insomnia disorder, previous research on the conceptual understanding of DSWPD has been limited, with a predominant focus on its chronobiological basis. The present study examined several insomnia-related cognitive and behavioural factors in adolescents with DSWPD. Methods Twenty-five adolescents with DSWPD (age = 19.9 ± 1.6; female = 28%), 28 with chronic insomnia disorder (age = 20.4 ± 2.0; female = 61%), diagnosed according to the ICSD-3 criteria, and 25 healthy control (age = 20.4 ± 1.5; female = 68%) were included in the present study. Participants completed 7-day prospective sleep diary and actigraphy monitoring, and a battery of questionnaires on sleep and chronotype measures. Participants were also measured on hyperarousal (Pre-Sleep Arousal Scale, PSAS), sleep reactivity (Ford Insomnia Response to Stress Test, FIRST), sleep-related beliefs (Dysfunctional Beliefs and Attitudes about Sleep, DBAS-16), and sleep hygiene practices (Sleep Hygiene Practices Scale, SHPS). Analysis of covariance (ANCOVA) with gender as the covariate was used for between-group comparisons. Results Relative to healthy control group, insomnia and DSWPD group showed significantly more insomnia symptoms as measured by Insomnia Severity Index (p&amp;lt;.001). As compared to healthy control group, DSWPD group showed significantly more delay in circadian phase based on sleep diary and actigraphy derived mid-point of sleep, as well as greater preference towards eveningness as measured by the Morningness-Eveningness Questionnaire. DSWPD group also showed significantly more cognitive and somatic hyperarousal (p&amp;lt;.001, d = 1.36–2.31), sleep reactivity (p&amp;lt;.001, d = 1.73), dysfunctional belief about sleep (p&amp;lt;.001, d = 1.59), as well as poorer sleep hygiene practices (p&amp;lt;.001, d = 2.62), compared to healthy control. There were no significant differences in the circadian parameters, PSAS, FIRST, DBAS-16, and SHPS between DSWPD and insomnia groups. Conclusion Several insomnia-related cognitive and behavioural factors, namely hyperarousal, sleep reactivity, maladaptive beliefs about sleep, and poor sleep hygiene, are also evident in youths with DSWPD. The findings had important implications for the conceptual understanding and clinical management of DSWPD. Support (if any) This work was supported by the Seed Fund for Basic Research (University Research Committee, The University of Hong Kong) awarded to Dr. Shirley Li.

381 Evening Chronotype Predicts Subjective Sleep Symptom Severity in Pregnant Women with Insomnia Disorder

Abstract Introduction Evening chronotype is associated with greater reports of insufficient sleep and sleep-related distress. Little research has examined this relationship within the context of pregnancy. This study investigated whether eveningness predicts insomnia severity, sleep effort, dysfunctional sleep beliefs, and sleep reactivity to stress in pregnant women with insomnia disorder. Methods Pregnant women with insomnia disorder who spoke English or Spanish enrolled in a clinical trial of cognitive behavioral therapy for insomnia (N = 178; M age = 32.6 years). Before beginning treatment, participants completed the Composite Scale of Morningness (CSM), Insomnia Severity Index (ISI), Glasgow Sleep Effort Scale (GSS), Dysfunctional Beliefs and Attitudes about Stress Scale (DBAS), and Ford Insomnia Response to Stress Test (FIRST). Participants were categorized into evening, intermediate, or morning chronotypes (bottom 25%, middle 50%, or top 25% of CSM scores, respectively). MANCOVA examined whether chronotype predicted higher baseline ISI, GSS, DBAS, and FIRST scores after adjusting for age, gestational week of pregnancy, and language. Results Sleep measures collectively differed by chronotype, F(8, 336) = 4.05, p &amp;lt; .001; Wilk’s Λ = .83, partial η-sqd = .09. Follow-up ANOVAs testing individual dependent variables were all significant (partial η-sqd = .04 – .10, p &amp;lt; .05). Pairwise comparisons (Bonferroni-adjusted; p &amp;lt; .05) found that evening types had higher ISI scores than intermediate (M difference = 2.21) and morning types (M difference = 2.30), and higher DBAS scores than morning types (M difference = .95). Morning types had lower FIRST scores than evening (M difference = 5.44) and intermediate types (M difference = 3.89). Conclusion Evening chronotype was associated with greater insomnia severity and maladaptive sleep-related cognition than other chronotypes among pregnant women with insomnia disorder. Future research may examine whether differences in chronotype have implications for insomnia treatment outcome during pregnancy, and whether greater morningness confers protection against sleep challenges during the early postpartum period. Support (if any) NIH R01 NR013662

374 Cognitive Behavioral Therapy with Exercise in Adults with Insomnia and Short Sleep: Daytime Function Outcomes from a Pilot Study

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is efficacious, but there is mixed evidence as to whether improvement is blunted in adults with insomnia and short sleep duration. Exercise training can reduce physiologic hyperarousal and may increase homeostatic sleep drive, which could potentiate CBT-I treatment effects. This pilot study explored changes in self-reported outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and objective short sleep duration. Methods Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (mean actigraphic TST &amp;lt;6.5 hr) completed a 12-week single-arm trial. Participants self-administered the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program with additional staff guidance while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 days/wk of strength training). Participants completed assessments of self-reported sleep and daytime function pre- and post-intervention, including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), Ford Insomnia Response to Stress Test (FIRST), Perceived Stress Scale (PSS), and Epworth Sleepiness Scale (ESS). Differences between timepoints were analyzed using paired t-tests and Cohen’s d effect size calculations. Results Insomnia severity significantly decreased after the intervention (ISI: p&amp;lt;0.001, d=2.99), with 75% reporting post-intervention ISI ≤ 7. Likewise, fatigue significantly decreased after the intervention (FFS: p=0.032, d=0.95). Symptoms of stress-related sleep reactivity and stress were also reduced (FIRST: p=0.012, d=1.19; PSS: p=0.014, d=1.14). Though nonsignificant, large reductions in sleepiness were additionally observed (ESS: p=0.058, d=0.80). Conclusion In this pilot trial among patients with insomnia and short sleep duration, online CBT-I plus a supervised exercise program resulted in a significant reduction in insomnia severity. The intervention also produced large and meaningful reductions in fatigue and stress, which are common daytime impairments in patients with insomnia. Future research should attempt to disentangle the independent contributions of CBT-I and exercise on outcomes in this population. Support (if any) NIH: K23HL118318

Arousability as a trait predisposition to insomnia: multidimensional structure and clinical utility of the Spanish and English versions of the Arousal Predisposition Scale

ObjectivesTraits related to a hyper-reactive arousal system (arousability) and weakened sleep system (sleep reactivity) are considered predisposing factors for insomnia of potential clinical utility. However, research examining the psychometric properties (ie, reliability and validity) of the Arousal Predisposition Scale (APS) and its clinical utility (ie, cut-off scores) among population-based and clinical samples is very limited. MethodsA total of 500 adults (41.8% female, 39.1 ± 15.9 years) from the general population in Spain and 217 adults (64.5% female, 46.0 ± 16.1 years) from a clinical sample in the United States completed the APS, as well as measures of sleep reactivity, insomnia severity, anxiety, depression, and stress. Structural equation modeling was used to conduct confirmatory factor analysis (CFA) of the APS. Correlation and receiver operating characteristic (ROC) analyses were used to determine convergent and predictive validity of the APS and its factors. ResultsThe CFAs supported two dimensions of emotional reactivity (APS-ER, 9 items) and trait anxiety (APS-TA, 3 items) in both independent samples. APS-ER was associated with sleep reactivity and performed better than APS-TA when predicting clinically significant sleep reactivity and similarly when predicting clinically significant insomnia severity. ConclusionsOur findings support the specificity of emotional reactivity and sleep reactivity as trait predispositions to insomnia, while trait anxiety is a predisposing factor for the comorbidity of insomnia with state anxiety rather than a specific diathesis for insomnia. These data provide further support for the diathesis-stress model of insomnia and, as a transdiagnostic process, its potential etiological link with psychopathology.

"When I Sleep Poorly, It Impacts Everything": An Exploratory Qualitative Investigation of Stress and Sleep in Junior Endurance Athletes.

On their journeys toward senior athletic status, junior endurance athletes are faced with a multitude of stressors. How athletes react to stressors plays a vital part in effective adaptation to the demanding, ever-changing athletic environment. Sleep, the most valued recovery strategy available to athletes, has the potential to influence and balance athletic stress, and enable optimal functioning. However, sleep is sensitive to disturbances by stress, which is described by the concept of sleep reactivity. Among athletes, poor sleep quality is frequently reported, but our understanding of the associations between stress and sleep in junior athletes is currently incomplete. The present study therefore investigated the themes of stress and sleep, and the associations between these variables with the use of in-depth semi-structured interviews in six junior endurance athletes (three men and three women, mean age 17.7 ± 0.5 years). Data was analyzed qualitatively based on the Grounded Theory. The qualitative material was supplemented with quantitative data on subjective sleep quality (Pittsburg Sleep Quality Index), sleep reactivity (Ford Insomnia Response to Stress Test), and mental strain (visual analog scale). The main results showed that stress could be differentiated into relevant stressors (encompassing poor performance, uncertainty in relation to training, school, daily hassles, and sleep) and reactions to stress (with sub-categories facilitative and maladaptive). Sleep could be differentiated into sleep benefits (encompassing energy levels and athletic functioning) and sleep quality (with sub-categories satisfactory and inadequate). All athletes identified relevant stressors, and all athletes were aware of the benefits of sleep for athletic functioning. However, athletes formed two distinctive categories based on the interactions between stress and sleep: three exhibited facilitative reactions to stress and good sleep quality, as well as low sleep reactivity, and low mental strain. The remaining participants exhibited maladaptive reactions to stress and poor sleep quality, as well as high sleep reactivity and high mental strain. Conceptualizing sleep quality based on the evaluation of stressors, reactions to stress, degree of mental strain, and the propensity to stress-related sleep disturbance may offer a plausible explanation for why the occurrence of stressors leads to poor sleep quality in some athletes, but not others.

Studies of insomnia psychophysiological aspects and etiopathogenesis: Russian and foreign approaches

The authors describe two approaches to the classification of insomnia - one was presented in earlier works, the other is currently accepted in the medical scientific community. The following three models of the etiopathogenesis of insomnia are considered: a 3-P model that identifies predisposing, precipitating, and perpetuating factors as the key ones in the development and chronicity of insomnia; a hyperarousal model that defines psychological and neurobiological hyperarousal as a factor contributing to the development of insomnia; and a sleep reactivity to stress model, according to which the pronounced premorbid sleep reactivity to stress increases the risk of developing insomnia. Hyperarousal and sleep reactivity to stress are supposed to be autonomous yet equally predisposing factors of insomnia which act reciprocally and can simultaneously contribute to the development of stress-induced insomnia. It is noteworthy that the clinical usefulness of the sleep reactivity to stress model can extend beyond the preliminary assessment of the risk of insomnia development and be used for screening patients in remission who may be at increased risk of recurrence in future and should receive supportive treatment to minimise this risk. At present, it remains unclear whether hyperarousal is the core of the disorder, its cause, risk factor, or epiphenomenon. Further investigations are required to clarify the psychological and biological basis of chronic insomnia and confirm its current theoretical and conceptual models.

Smartphone usage in adolescents – motives and link to sleep disturbances, stress and sleep reactivity

Using a smartphone in bed (SPiB) before going to sleep is associated with sleep problems; however, it remains unclear whether it is not the duration but rather the individual motives behind the usage that cause the problems. This was studied in late adolescents. A total of 201 participants aged 16–21 years were questioned about their sleep and stress as well as their smartphone usage habits in bed and the reasons for this use. The Motives of Smartphone Usage Scale (MSPUS) was developed to measure motives behind phone use such as “use for entertainment”, “avoidance of worries”, “sleep aid” and “fear of missing out (FoMO)”. Sleep was analysed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Questionnaire for Adults (IQA), and other parameters; stress was assessed with the Ford Insomnia Response to Stress Test (FIRST). Multiple regression analyses were used to examine the association between the motives of usage, duration of SPiB and sleep parameters. Correlations with stress and differences in sleep reactivity were examined. The usage motives “entertainment”, “FoMO” and “avoiding worries” predicted a longer smartphone usage duration (SPiB-d). Sleep problems were associated with longer use in general, particularly to avoid worries, but less with use for entertainment. Adolescents with high sleep reactivity did not use their phone longer, but more often because of FoMO and to avoid worrying. What becomes clear is that smartphone use duration is not the main sleep-disruptive factor. Adolescents with sleep difficulties and stress seem to suppress worries and rumination by using their smartphone in bed. This problem-avoidant use behaviour should be considered in intervention approaches and, correspondingly, active problem-solving behaviour should be trained.