title: Psychological mechanisms in the maintenance of insomnia: arousal, distress, and sleep-related beliefs.
abstract: The purpose of this study was to examine whether arousal, distress, and sleep-related beliefs are related to the maintenance of insomnia. From a randomly selected sample from the general population (n=3600), 1936 participants filled out a baseline and 1-year follow-up survey. Logistic regressions were used to investigate whether arousal, distress, and beliefs were related to sleep status (insomnia: n=116; poor sleep: n=222; normal sleep: n=529; good sleep: n=234) over 1 year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. The results showed that beliefs in the long-term negative consequences of insomnia, anxiety, depression, and arousal were significantly related to the maintenance of insomnia (18-72% of the variance). Of the individuals with persistent insomnia, 91% belonged to a cluster characterized by high scores on sleep-related beliefs, anxiety, depression, and arousal, and 9% to a cluster defined by low scores on the mechanisms. This study shows that sleep-related beliefs, anxiety, depression, and arousal are related to the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with insomnia.
authors.affiliation: Department of Occupational and Environmental Medicine, Orebro University Hospital, SE 701 85 Orebro, Sweden. markus.janson@orebroll.se
authors.forename: Markus
authors.initials: M
authors.lastname: Jansson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Linton
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D001007:Anxiety / Q000150:complications / Q000523:psychology; D001143:Arousal / Q000502:physiology*; D002908:Chronic Disease; D016000:Cluster Analysis; D003863:Depression / Q000150:complications / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D013997:Time Factors