title: Contribution of cancer symptoms, dysfunctional sleep related thoughts, and sleep inhibitory behaviors to the insomnia process in breast cancer survivors: a daily process analysis.
abstract: OBJECTIVE
  using a comprehensive cognitive-behavioral model of insomnia and a daily process approach, this study was conducted to examine the contribution of cancer symptoms and dysfunctional sleep related thoughts and behaviors to the process of insomnia in breast cancer survivors.
  
  
  METHODS
  within-group longitudinal research design.
  
  
  METHODS
  an academic medical center.
  
  
  METHODS
  41 women with breast cancer who had completed their primary cancer treatment and met Research Diagnostic Criteria for primary insomnia or insomnia comorbid with breast cancer.
  
  
  METHODS
  NA.
  
  
  RESULTS
  for 28 days, participants completed morning diaries assessing sleep, nighttime pain and hot flashes, and dysfunctional sleep related thoughts and behaviors during the day and night, and evening diaries assessing daytime pain, fatigue, hot flashes, and mood. All diaries were collected using an automated telephone-based system. Results revealed that poorer sleep was related to nighttime pain and hot flashes in breast cancer patients. Time-lagged effects were also found. The current study identified higher levels of dysfunctional sleep related thoughts and sleep inhibitory behaviors during the day and night as antecedents of insomnia, and higher levels of pain, fatigue, and hot flashes and lower levels of positive mood and dysfunctional sleep related thoughts as consequences of insomnia in this population.
  
  
  CONCLUSIONS
  the current study found support for a comprehensive cognitive-behavioral model of insomnia, which has several theoretical, practice, and research implications.
authors.affiliation: Department of Psychiatry, University of Wisconsin, Madison, WI 53719, USA. rimble@wisc.edu
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Rumble
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Jack D
authors.initials: JD
authors.lastname: Edinger
authors.forename: Glenn
authors.initials: G
authors.lastname: Affleck
authors.forename: P Kelly
authors.initials: PK
authors.lastname: Marcom
authors.forename: Heather S
authors.initials: HS
authors.lastname: Shaw
mesh_terms: D000339:Affect; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology*; D003071:Cognition; D015897:Comorbidity; D005221:Fatigue / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D019584:Hot Flashes / Q000523:psychology; D006801:Humans; D055809:Illness Behavior; D008137:Longitudinal Studies; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data