Trait- and pre-sleep-state-dependent arousal in insomnia disorders: what role may sleep reactivity and sleep-related metacognitions play? A pilot study.
Research into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder.



Fifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS.



Participants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values <0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) CONCLUSIONS: This study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia.
Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy. Electronic address: lpalagini@tiscali.it.
Laura
L
Palagini
Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
Mauro
M
Mauri
Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy.
Liliana
L
Dell'Osso
Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany.
Dieter
D
Riemann
Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI, USA.
Christopher L
CL
Drake
D000328:Adult; D001143:Arousal / Q000502:physiology; D015984:Causality; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition / Q000502:physiology*; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D011795:Surveys and Questionnaires
Chronic insomnia; Pre-sleep arousal; Sleep reactivity; Sleep-related metacognitive processes; Trait predisposition to arousal