Stress-related Sleep Disturbance Research Articles

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity.

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equationmodelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ 2 (15)=17.69, p=.279, CFI=.99, TLI=.97, SRMR=.04, RMSEA=.04 (90% CI <0.001-0.09). Emotional neglect (β=.22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β=.31) during a stressful transition.Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.

High-Frequency Heart Rate Variability Reactivity and Trait Worry Interact to Predict the Development of Sleep Disturbances in Response to a Naturalistic Stressor.

High-frequency heart rate variability (HF-HRV) reactivity was proposed as a vulnerability factor for stress-induced sleep disturbances. Its effect may be amplified among individuals with high trait worry or sleep reactivity. This study evaluated whether HF-HRV reactivity to a worry induction, sleep reactivity, and trait worry predict increases in sleep disturbances in response to academic stress, a naturalistic stressor. A longitudinal study following 102 undergraduate students during an academic semester with well-defined periods of lower and higher academic stress was conducted. HF-HRV reactivity to a worry induction, trait worry using the Penn State Worry Questionnaire, and sleep reactivity using the Ford Insomnia Stress Reactivity Test were measured during the low stress period. Sleep disturbances using the Pittsburgh Sleep Quality Index were assessed twice during the lower stress period and three times during the higher stress period. Greater reductions in HF-HRV in response to the worry induction predicted increases in sleep disturbances from the lower to the higher academic stress period. Trait worry moderated this association: individuals with both higher trait worry and greater HF-HRV reactivity to worry had larger increases in stress-related sleep disturbances over time, compared to participants with lower trait worry and HF-HRV reactivity. A similar, but marginally significant effect was found for sleep reactivity. This study supports the role of HF-HRV reactivity as a vulnerability factor for stress-induced sleep disturbances. The combination of high trait worry and high HF-HRV reactivity to worry might identify a subgroup of individuals most vulnerable to stress-related sleep disturbances.

Physical Fitness, Physiological and Sleep Responses to Stress in Women

PURPOSE: Stress-related psychiatric disorders (such as depression) are twice as common in women as in men and have been linked to aberrations in physiological and psychological stress responding. Being physically fit may be protective against the development of adverse symptoms related to stress, however, to date, there has been limited investigation of the relationship between physical fitness and behavioral and physiological responses to stress which considers the profound influence of the ovarian cycle on physiological and behavioral stress responding. This study aims to investigate the relationship between physical fitness and physiological and behavioral (sleep disturbances) responses to stress in women during the follicular phase of the menstrual cycle (when ovarian hormones are low and stable). METHODS: Following a two-tiered screening process, 10 healthy women (18-45y) who were medication-free and had regular menstrual cycles were enrolled. Participants completed: (1) enrollment visit, (including mood and sleep assessment and assessment of cardiorespiratory fitness via maximal oxygen consumption during exercise); (2) one-week sleep monitoring period (objective and subjective measures of sleep-wake behavior); and (3) psychosocial stressor protocol for the collection of hemodynamic [blood pressure (SBP, DBP) and heart rate (HR)] and hormonal stress responses. Psychosocial stress testing sessions occurred during the follicular phase of the menstrual cycle to control for hormone fluctuations which can influence the physiological response to stress. RESULTS: Though not significant at this time, preliminary results from this ongoing study show that higher levels of physical fitness may be associated with lower sleep reactivity to stress (r = -.43, p = 0.17) and reduced wake after sleep onset (WASO; r = -.58, p = .07). Consequently, increased WASO was significantly associated with increased SBP and DBP reactivity to an acute psychosocial stressor (r’s = .78, .65; p’s = .01, .05 respectively). CONCLUSIONS: If confirmed in our larger sample results suggest that, in women, physical fitness may be protective against the physiological response to stress, perhaps via reduction in stress-related sleep disturbances.

Intimate Partner Violence Is Associated with Stress-Related Sleep Disturbance and Poor Sleep Quality during Early Pregnancy.

ObjectivesTo examine the associations of Intimate partner violence (IPV) with stress-related sleep disturbance (measured using the Ford Insomnia Response to Stress Test [FIRST]) and poor sleep quality (measured using the Pittsburgh Sleep Quality Index [PSQI]) during early pregnancy.MethodsThis cross-sectional study included 634 pregnant Peruvian women. In-person interviews were conducted in early pregnancy to collect information regarding IPV history, and sleep traits. Adjusted odds ratios (aOR) and 95% confidence intervals (95%CIs) were calculated using logistic regression procedures.ResultsLifetime IPV was associated with a 1.54-fold increased odds of stress-related sleep disturbance (95% CI: 1.08–2.17) and a 1.93-fold increased odds of poor sleep quality (95% CI: 1.33–2.81). Compared with women experiencing no IPV during lifetime, the aOR (95% CI) for stress-related sleep disturbance associated with each type of IPV were: physical abuse only 1.24 (95% CI: 0.84–1.83), sexual abuse only 3.44 (95%CI: 1.07–11.05), and physical and sexual abuse 2.51 (95% CI: 1.27–4.96). The corresponding aORs (95% CI) for poor sleep quality were: 1.72 (95% CI: 1.13–2.61), 2.82 (95% CI: 0.99–8.03), and 2.50 (95% CI: 1.30–4.81), respectively. Women reporting any IPV in the year prior to pregnancy had increased odds of stress-related sleep disturbance (aOR = 2.07; 95% CI: 1.17–3.67) and poor sleep quality (aOR = 2.27; 95% CI: 1.30–3.97) during pregnancy.ConclusionLifetime and prevalent IPV exposures are associated with stress-related sleep disturbance and poor sleep quality during pregnancy. Our findings suggest that sleep disturbances may be important mechanisms that underlie the lasting adverse effects of IPV on maternal and perinatal health.

Intimate Partner Violence Is Associated with Stress-Related Sleep Disturbance and Poor Sleep Quality during Early Pregnancy.

Intimate Partner Violence Is Associated with Stress-Related Sleep Disturbance and Poor Sleep Quality during Early Pregnancy.

Childhood abuse is associated with stress-related sleep disturbance and poor sleep quality in pregnancy

ObjectivesChildhood abuse is associated with increased risks of adult psychiatric disorders and physical health conditions. Mounting evidence documents associations of childhood abuse with sleep disturbances in adulthood. However, to date, no study has evaluated associations of childhood abuse and sleep disturbances among pregnant women. MethodsThis cross-sectional study included 634 pregnant Peruvian women. To collect information regarding socio-demographic characteristics, history of childhood abuse, and complaints of sleep disturbances, face-to-face interviews were conducted with women in early pregnancy. Ford Insomnia Response to Stress Test (FIRST-S) and the Pittsburgh Sleep Quality Index (PSQI-S), translated from English to Spanish, were used to assess stress-related sleep disturbance and sleep quality, respectively. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CIs). ResultsWomen who experienced any childhood abuse had a 1.65-fold increased odds of stress-related sleep disturbance (aOR = 1.65; 95% CI: 1.15–2.38) and 2.11-fold increased odds of poor sleep quality during early pregnancy (aOR = 2.11; 95% CI: 1.35–3.30) as compared with women who reported no abuse. Women who reported both physical and sexual abuse during childhood were more than twice as likely to suffer from stress-related sleep disturbance (aOR = 2.26; 95% CI: 1.44–3.53) and poor sleep quality (aOR = 2.43; 95% CI: 1.45–4.09) in comparison to women who reported no childhood abuse. ConclusionsA history of childhood abuse is associated with increased odds of stress-related sleep disturbance and poor sleep quality during pregnancy. These findings, if replicated, should be used to inform the development of trauma-informed care for such sleep disturbances induced by childhood trauma.

Vulnerability to Stress-Related Sleep Disturbance and Insomnia: Investigating the Link with Comorbid Depressive Symptoms.

Greater sleep difficulty following a challenging event, or a vulnerability to stress-related sleep disturbance (i.e., sleep reactivity), is characteristic of insomnia. However, insomnia is rarely observed in isolation; rather it is frequently seen in combination with other problems, such as depression. Despite the link between depression and increased sensitivity to stress, relatively little is known about the role sleep reactivity has in explaining variability in depressive symptoms. Therefore, the current study examined whether sleep reactivity was associated with depressive symptoms, and whether this relationship was mediated by insomnia. We assessed sleep reactivity, insomnia, and depressive symptoms among 2250 young adults (1244 female; Mage = 23.1, SDage = 2.97) from the Colorado Longitudinal Twin Study and Community Twin Study. Results indicated that greater sleep reactivity was significantly associated with elevated depressive symptoms, and that this link was partially mediated by insomnia. This is one of the first studies to demonstrate an independent association between sleep reactivity and depressive symptomatology. These findings suggest that a greater sensitivity to stress-related sleep disturbance may also be a predisposing factor to depression, and highlight the need for a better understanding of sleep reactivity, as it may represent a more global vulnerability construct.

Correlation analysis of hyperarousal, personality characteristics, coping strategy with the vulnerability to stress-related sleep disturbance

Objective To explore the influence factors of hyperarousal, personality characteristics and coping strategies on the vulnerability to stress-related sleep disturbance. Methods A total of 345 sleep good healthy volunteers were recruited by purposive sampling technique. Every participant completed an extensive survey that included the general condition questionnaire, Ford Insomnia Response to Stress Test (FIRST), Pre-Sleep Arousal Scale (PSAS), NEO Personality Inventory-Revised (NEOPI-R), Coping Inventory for Stressful Situations (CISS) and Heart Rate Variability(HRV). All participants were classified as High risk and Low risk by using the FIRST criterion. Results The high risk group was younger than the low risk group (27.91±8.22 vs 24.82±7.73, P<0.01), and had a higher percentage of females (34.7% vs 53.4%, P<0.05) . The high risk group showed significantly higher scores in PSAS total (30.11±6.22), pesleep cognitive arousal (17.73±4.51), presleep somatic arousal (12.78±3.23), neuroticism (3.13±0.51), emotion oriented (48.98±10.54), but lower score in extraversion (2.96±0.54), then those indicators of the low risk group (28.52±5.82, 16.32±4.32, 11.41±2.75; 3.11±0.56, 2.87±0.47, 46.23±11.21, 3.11±0.56, P<0.01 or 0.05). There were significant difference between the two group in LF/HF (1.51±0.19 vs 1.17±0.11, P<0.01), HF((311.21±72.32)ms2/Hz vs (490.43±91.74)ms2/Hz, P<0.01), LF((469.49±85.67)ms2/Hz vs (573.21±98.75)ms2/Hz, P<0.01) in HRV. Results of linear regression analysis showed that gender, and scores of PSAS total, cognitive arousal, presleep cognitive arousal, presleep somatic arousal, neuroticism, emotion oriented and LF/HF were significant correlation with FIRST score (P<0.01 or 0.05). Conclusion Presleep cognitive and somatic arousal, neurotic character may be the premorbid characteristics of stress-related sleep disturbance, and bad stress coping strategies are easy to promote the development of insomnia. Key words: Stress-related sleep disturbance; Vulnerability; Hyperarousal; Stress coping strategy

Interaction between 5-HTTLPR genotype and cognitive stress vulnerability on sleep quality: effects of sub-chronic tryptophan administration.

Background:Abundant evidence suggests that allelic variation in the serotonin transporter-linked polymorphic region (5-HTTLPR) influences susceptibility to stress and its affective consequences due to brain serotonergic vulnerability. Based on recent assumptions, the present study examined whether the 5-HTTLPR genotype may also interact with a vulnerability to chronic stress experience (conceptualized by trait neuroticism) in order to influence sleep quality and, additionally, whether this is influenced by brain serotonergic manipulations.Methods:In a well-balanced experimental design, homozygous S-allele (n = 57) and L-allele (n = 54) genotypes with high and low chronic stress vulnerability (neuroticism) were first assessed for general past sleep quality during a month before onset of the experiment. Then subjects were assessed for sleep quality following 7 days of tryptophan (3.0g/day) or placebo intake.Results:Although high neuroticism was significantly related to a higher frequency of stressful life events and daily hassles, it did not interact with the 5-HTTLPR genotype on general past sleep quality. However, as expected, a 7 day period of tryptophan administration was exclusively associated with better sleep quality scores in the S’/S’ genotype with high trait neuroticism.Conclusions:Current findings suggest that 5-HTTLPR does not directly interact with stress vulnerability in order to influence sleep quality. Instead, based on current and previous findings, it is suggested that the S’/S’ 5-HTTLPR genotype promotes the risk for stress-related sleep disturbances because of an increased susceptibility to the depressogenic consequences of stress. Accordingly, by way of reducing depressive symptomatology, tryptophan augmentation may particularly improve sleep quality in stress-vulnerable individuals carrying the 5-HTTLPR S-allele.

Stress-related sleep vulnerability and maladaptive sleep beliefs predict insomnia at long-term follow-up.

Vulnerability to stress-related sleep disturbances and maladaptive sleep beliefs has been proposed to be predisposing factors for insomnia. Yet previous studies addressing these factors have been cross-sectional in nature and could not be used to infer the time sequences of the association. The current study used a six-year follow-up to examine the predisposing roles of these two factors and their interactions with major life stressors in the development of insomnia. One hundred seventeen college students recruited for a survey in 2006 participated in this follow-up survey in 2012. In 2006, they completed a packet of questionnaires including the Dysfunctional Beliefs and Attitudes about Sleep Questionnaire, 10-item version (DBAS-10), the Ford Insomnia Response to Stress Test (FIRST), and the Pittsburgh Sleep Quality Index (PSQI); in 2012 they completed the Insomnia Severity Index (ISI) and the modified Life Experiences Survey (LES). Fourteen of the participants were found to suffer from insomnia as measured by the ISI. Logistic regression showed that scores on both DBAS-10 and FIRST could predict insomnia at follow-up. When the interaction of DBAS-10 and LES and that of FIRST and LES were added, both DBAS-10 and FIRST remained significant predictors, while the interaction of FIRST and LES showed a near-significant trend in predicting insomnia. The results showed that both vulnerability to stress-related sleep disturbances and maladaptive sleep beliefs are predisposing factors for insomnia. The hypothesized interaction effect between sleep vulnerability and major life stressors was found to be marginal. The maladaptive sleep beliefs, on the other hand, showed a predisposing effect independent from the influences of negative life events.

Information processing during sleep and stress‐related sleep vulnerability

Previous studies showed enhanced attention and decreased inhibitory processes during early non-rapid eye movement sleep in primary insomnia patients, as measured by event-related potentials. The current study aims to examine information processing during sleep in non-insomniac individuals with high vulnerability (HV) to stress-related sleep disturbances. Twenty-seven non-insomniac individuals were recruited, 14 with low vulnerability and 13 with HV. After passing a screening interview and polysomnographic recording, subjects came to the sleep laboratory for 2 nights (a baseline night and a stress-inducing night) for event-related potentials recordings. The HV group demonstrated shorter P2 latency during the first 5 min of stage 2 sleep and higher P900 amplitudes under the stress condition during slow-wave sleep, which indicates an increased level of inhibitory processes. In addition, they had shorter N1 latencies during slow-wave sleep that could indicate an elevated level of attention processing during deep sleep. Unlike patients with chronic insomnia, individuals with high sleep vulnerability to stress show a compensatory process that may prevent external stimulation from interfering with their sleep. This may be one of the factors preventing their acute sleep disturbances from becoming chronic problems.

The Association of Dysfunctional Beliefs About Sleep With Vulnerability to Stress-Related Sleep Disturbance in Young Adults

This study aims to explore the association between dysfunctional sleep beliefs and vulnerability to stress-related transient sleep disturbance in people without sleep disturbance. One hundred thirty-two good sleepers and 307 poor sleepers were included in this study. As expected, poor sleepers showed more dysfunctional beliefs than good sleepers on the Dysfunctional Beliefs and Attitudes about Sleep scale–10 item version (DBAS–10). More important, even in good sleepers, DBAS–10 scores positively correlated with the vulnerability to stress-related sleep disturbance as measured by the Ford Insomnia Response to Stress Test. The results suggest that dysfunctional sleep belief is not only a perpetuating factor for chronic insomnia, it may also serve as a risk factor for stress-related transient insomnia.

Role of CRH in stress-related sleep disturbances: a study using site-specific CRH overexpressing mice

Role of CRH in stress-related sleep disturbances: a study using site-specific CRH overexpressing mice

Vulnerability to insomnia: The role of familial aggregation

Background The goal of this study was to determine the degree of familial aggregation in vulnerability to stress-related sleep disturbance among siblings. One approach to investigating a potential “familial” predisposition to sleep disturbance is to examine the relationship between siblings on a standard measure of vulnerability to stress-related sleep disturbance. Design Cross-sectional data on insomnia, vulnerability to stress-related sleep disturbance, sleepiness, habitual sleep, and additional demographic variables was collected separately from pairs of biological siblings. Data were collected during a 15–20 min phone assessment. Participants Interviews on a total of 62 individuals (31 sibling pairs) were completed. A total of 8 individuals and their respective siblings were excluded after meeting conservative criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV)-based insomnia. The mean age of the sample was 51.1 ± 12.1 years (range 18–70) and habitual nightly total sleep time averaged 6.91 ± 1.42 h/night. Results Individuals completed the Ford Insomnia Response to Stress Test (FIRST), a standardized measure of individual vulnerability to stress-induced sleep disturbance. The intraclass correlation coefficient (ICC) was r = 0.61, df = 23, p = 0.001 for the relationship between siblings in FIRST scores. This indicated that 37.2% of the variance in vulnerability to stress-related sleep disturbance can be accounted for by familial aggregation. This relationship remained after controlling for potential confounds including age, gender, shift schedule, and psychiatric history. Conclusions Our data support the notion that vulnerability to stress-related sleep disturbance has a strong familial aggregation. Additional studies are needed to determine the genetic or environmental origins of this relationship and its underlying biological substrates.

Sleep Disturbances in Caregivers of Patients With End‐Stage Congestive Heart Failure: Part I—The Problem

Up to 90% of caregivers report sleep disturbances, particularly congestive heart failure (CHF) caregivers. Sleep disturbances have numerous consequences that can negatively impact a wide domain of outcomes in both the caregiver and the patient for whom they care. Ultimately, these disturbances can lead to caregiver morbidity and CHF patient morbidity, readmission, and mortality. Nurses play a central role in patient education, especially with caregivers. Therefore, nurses can help to educate caregivers on the consequences of stress-related sleep disturbances, which are very prevalent in CHF caregivers.

Stress-related sleep disturbance and polysomnographic response to caffeine

Background and purpose To determine the sleep response to caffeine in individuals vulnerable to stress-related sleep disturbance as measured by polysomnography. Patients and methods Eleven healthy individuals without insomnia scoring low (4 women, mean age=32.64±15.46 years) and 10 healthy individuals also without insomnia scoring high (6 women, mean age=34.20±13.73 years) on a measure of vulnerability to stress-related sleep disturbance were studied in a laboratory protocol. A moderate-low dose of caffeine (3 mg/kg) was administered 1 h prior to lights-out and compared to a counterbalanced control night with each condition separated by 1 week. Standard polysomnographic measures were assessed (i.e. total sleep time, sleep efficiency, latency to persistent sleep, and sleep stage percentages) for both control and caffeine nights. Results There were no between-group differences in sleep on the control night. Importantly, individuals reporting vulnerability to stress-related sleep disturbance had significantly prolonged latency to persistent sleep in response to the caffeine challenge (interaction; P<0.05). Conclusion Normal sleepers with an identified vulnerability to stress-induced sleep disturbance exhibited greater objectively verifiable sleep-reactivity in response to a caffeine challenge compared to non-vulnerable individuals. These results suggest that the construct of individual differences in vulnerability to sleep disturbance applies to a pharmacological ‘stressor’ (i.e. caffeine) as well as to previously assessed stressors such as a first-night effect. This finding provides further support for generalized trait vulnerability by demonstrating a sleep disturbance to a wake-promoting pharmacological challenge in specific a priori identified individuals.

Vulnerability to stress-related sleep disturbance and hyperarousal.

To determine the presence of a hypothesized trait vulnerability to sleep disturbance and hyperarousal. Polysomnographic assessment of sleep in response to stress during a first night in the laboratory and subsequent physiologic arousal. One hundred and four individuals (46% men, mean age 40.4 +/- 12.9 years) drawn from a population-based sample. Individuals were exposed to a first night in the laboratory. Participants completed a Likert-scale questionnaire, consisting of 27 items, that assesses sleep disturbance in response to commonly experienced stressful situations. Factor analytic techniques identified a single 9-item factor that was representative of the construct of "stress-related" vulnerability to sleep disturbance. Reliability of the resulting 9-item scale was high (Cronbach's alpha = .83). Individuals with higher scores on this scale, the Ford Insomnia Response to Stress Test (FIRST; median split), had a lower sleep efficiency (P = .001), as well as an increased latency to stage 1 sleep (P = .001) and persistent sleep (P = .002) on the first night of nocturnal polysomnography. Moreover, these high-scoring individuals showed increased arousal as evidenced by an elevated sleep latency on the Multiple Sleep Latency Test compared to individuals with low FIRST scores. Importantly, after controlling for current and past insomnia, the differences between individuals scoring high and low on the FIRST in terms of nocturnal sleep and daytime arousal remained significant. Other stages of sleep (stage 2, slow-wave, and rapid eye movement sleep) were not different between the groups. These results showing a relationship between FIRST scores and nocturnal polysomnography and Multiple Sleep Latency Test scores have 3 potential implications: (1) the data demonstrate a characteristic that relates to vulnerability to stress-related sleep disturbance as manifested by a first night in the laboratory; (2) the elevated latencies on the Multiple Sleep Latency Test in these individuals, despite significantly disturbed sleep, support the notion of physiologic hyperarousal in these individuals and suggests they may be predisposed to developing chronic primary insomnia; and (3) the vulnerability identified may underlie vulnerability to transient sleep disturbance associated with other sleep-disruptive factors.

Attentional Bias in People With Acute Versus Persistent Insomnia Secondary to Cancer

This study investigated the role of attentional bias in the development of persistent insomnia. Two groups of people with cancer who developed sleep-onset problems 0-3 months and 12-18 months after diagnosis completed a computerized emotional Stroop task comprising cancer-related and sleep-related word cues and self-complete measures. Both groups demonstrated attentional bias for cancer-related words, but only the persistent insomnia group demonstrated attentional bias for sleep-related words. High levels of presleep cognitive arousal were evident in both groups despite lower levels of psychological distress in the persistent insomnia group. Results suggest that secondary, sleep-related mental preoccupation may inhibit recovery to normal sleep after stress-related acute sleep disturbance. Findings are discussed in relation to current models of insomnia.