Insomnia behaviours independently influence sleep in mood disorders

Behaviours associated with controlling sleep and managing the negative effects of insomnia are independently associated with disturbed sleep in patients with anxiety or depressive disorders, US research shows.

“The fact that these psychological factors contribute to poor sleep above and beyond trait vulnerabilities for emotional disorders and state negative affect may explain why poor sleep is a common residual symptom following treatment of anxiety and depression,” say the researchers Christopher Fairholme (Boston University, Massachusetts) and Rachel Manber (Stanford University, California).

“Given the evidence supporting sleep disturbance as a significant risk factor for relapse and symptom recurrence, our findings suggest that it may be important to directly target sleep-specific cognitive behavioral factors when sleep disturbance is present.”

The sleep-specific factors were sleep-related safety behaviours, which are maladaptive strategies used by individuals to prevent the consequences of a poor night’s sleep, such as cancelling obligations and reducing daytime activity levels, and increased sleep effort, whereby patients attempt to control sleep.

In a group of 63 outpatients with a current anxiety or depressive disorder, high scores on the Sleep-Related Safety Behaviors Questionnaire and the Glasgow Sleep Effort Scale were significantly associated with more disturbed sleep, as measured on the Pittsburgh Sleep Quality Index.

The associations were independent of the effects of current symptoms of anxiety and depression as well as trait neuroticism and extraversion, the researchers note in the Journal of Psychosomatic Research.

Dysfunctional beliefs about sleep were not significantly associated with disturbed sleep, however, which “raises the possibility that safety behaviors and sleep effort may be more proximally related to sleep disturbance than beliefs that may be underlying them”, report the researchers.

Safety behaviours were also associated with fatigue, particularly in patients with dysfunctional beliefs about sleep, but the relationship was not significant after taking into account sleep disturbance and other variables.

Fairholme and Manber conclude that their findings are “consistent with a burgeoning literature supporting the notion that insomnia is distinct from anxiety and depression and that sleep-related processes might represent unique treatment targets.”

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