Belief in an Unjust World: When Beliefs in a Just World Fail

Past research has attempted to delineate personality differences between insomniacs and good sleepers but has failed to control for type of insomnia or severity of the disorder. The purpose of this study was to compare MMPI scores of mild and severe sleep onset insomniacs with a control group of noninsomniacs. Results demonstrated that sleep onset insomniacs, regardless of degree of severity, differed significantly from noninsomniacs; and that mild and severe insomniacs differed from each other on only one MMPI scale.     

The effectiveness of various treatment techniques on different degrees and durations of sleep-onset insomnia

Mild and moderate insomniacs were randomly assigned to one of five group therapy conditions: relaxation without muscle-tension, stimulus control plus relaxation without muscletension, placebo, self-monitoring, and waiting list. Mild insomniacs were differentiated according to the duration of their sleep disturbance. Insomniacs were told that improvement would not be noticeable until after the final therapy session. During this counterdemand period, the two relaxation groups showed significantly greater decreases in sleep onset latency than the control conditions. In addition, it appeared that duration affected treated outcome. The effectiveness of treatment packages and self-monitoring in alleviating insomnia is briefly discussed.     

Association Between Insomnia and Quality of Life: An Exploratory Study Among Software Engineers

Insomnia is a major public health challenge. Due to its high prevalence and impact on health in recent years it has attracted attention of health care providers. The concept of quality of life (QOL) has gained importance as an outcome measure in sleep disturbed people. This study aims to determine the prevalence of insomnia among software engineers as the job related stress is considered very high. Ninety-one software engineers aged between 21 and 45 from a software developing company in Mysore formed the study population. Insomnia Screening Questionnaire and SF 36 Health Survey Questionnaire were used to elicit information about sleep quality and quality of life respectively. Sleep status among the subjects was as follows: 20.9% severe insomnia, 35.2% mild insomnia and 43.9% normal sleeper. Mean scores for SF 36 and those for physical and mental health were considerably lower among severe insomniacs. Software engineers run at the risk of developing insomnia, those with severe insomnia had poor QOL in comparison with the others. Quality of sleep among software engineers needs special attention since they are prone to develop sleep disturbances.     

RELAXATION TREATMENT OF PSEUDOINSOMNIA AND IDIOPATHIC INSOMNIA: AN ELECTROENCEPHALOGRAPHIC EVALUATION

Twenty-nine insomniacs underwent four consecutive sleep laboratory evaluations before and after receiving tension-release relaxation training, no-tension-release relaxation training, or no-treatment. On the basis of the discrepancy between subjective and EEG-defined measures of latency to sleep onset, subjects were classified as pseudoinsomniacs or idiopathic insomniacs. As predicted, tension-release relaxation was significantly more effective than the other two conditions on subjective sleep measures, regardless of insomnia subtype and on objective sleep measures only for idiopathic insomniacs. Subjective improvement was maintained at 12-month followup. Numerous differences between the two subtypes emerged on pretherapy and during-therapy measures distinct from the latency measures, but changes on those variables were unrelated to outcome improvement.     

Insomniacs' perceived lack of control over sleep

Abstract

It is widely assumed that insomniacs have poor self-efficacy for sleep and it is known that successful treatment is usually accompanied by improved self-efficacy. However, there has been little detailed investigation of insomniacs perceived lack of control over sleep. Insomniacs' perceived control over sleep itself is affected more than their perceived control over pre-sleep mental activity or physical tension. It was hypothesised that insomniacs would diverge from controls more in their sense that sleep was out of their control than that sleep was under their control, though this was not supported by the data. Also, there was no clear support for the idea that insomniacs' dissatisfaction with their control over sleep was the product of excessive aspirations for control. One factor that seems likely to contribute to insomniacs' lack of perceived control over sleep is that they do not have as lawful a pattern of expectations of sleep, based on their recent pattern of sleep, as normal sleepers do. Insomniacs, like non-insomniacs, were most likely to attribute poor sleep to external stresses and an over-active mind. Insomniacs showed a wide range of heightened emotional reactions to poor sleep. The implications of the results for self-regulation approaches to the treatment of insomnia are discussed.     

Melatonin rhythm abnormalities and sleep disorders in the elderly

Biological aging is often associated with sleep problems and daytime napping. Complaints of difficulty in initiating and maintaining sleep, as well as daytime drowsiness, are more common in the elderly than in any other age group. This report reviews evidence that impaired melatonin secretion is associated with sleep disorders in old age. Circulating melatonin levels have been found to be significantly lower and onset and peak times have been delayed in elderly insomniacs as compared to age-matched control subjects. In view of these findings, we investigated the effects of melatonin treatment on melatonin-deficient insomnia in the elderly. From the results of our study, it seems likely that melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep in this population.     

Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment

Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment—however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.     

The measurement of sleep onset latency in insomnia

Research into insomnia has relied almost exclusively upon subjects self-reports of sleep onset latency. The unreliability of self-reports have been repeatedly criticized yet despite the implementation of suggested changes substantial weaknesses remain. This study of 17 insomniacs outlines the development of a simple electrochemical device designed to yield objective estimates of sleep onset latency and compares this with independent estimates made by patients and their partners. The application of this device and the implications for the continued use of self-report measures are discussed.     

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.     

Treatment of sleep-maintenance insomnia in older adults: sleep period reduction, sleep education, and modified stimulus control

We evaluated a behavioral treatment package consisting of sleep period restriction, sleep education, and modified stimulus control in the treatment of sleep-maintenance insomnia in older adults. A multiple baseline design was used with 4 chronic insomniac subjects, ages 59, 65, 65, and 72. Sleep diaries and an objective behavioral measure of sleep were used to monitor improvement. Results revealed clinically significant reductions in time awake after sleep onset in 3 subjects, coincident with the initiation of treatment. These improvements were maintained at 2- and 6-month follow-ups. The 4th subject showed little improvement; however, a polysomnogram conducted on this subject at the end of the study revealed a fragmented sleep pattern secondary to periodic movements of sleep (nocturnal myoclonus). These encouraging but preliminary results call for further controlled evaluations of the efficacy of this behavioral treatment package for sleep-maintenance insomnia. The importance of conducting polysomnographic studies on elderly insomniacs is discussed.     

Paradoxical intention in the treatment of chronic insomnia: six case studies illustrating variability in therapeutic response

The relatively small behavioural literature available contains a number of encouraging reports evidencing the effectiveness of paradoxical intention therapy as a treatment for sleep onset insomnia. This present paper contributes a further six case studies of chronic insomniacs, referred for treatment within the context of a major treatment comparison study, who were randomly allocated to receive paradoxical intention. Therapy typically lasted for 8 weeks, consisting of two 4-week phases, the first of which involved a counterdemand manipulation designed to control for demand and expectancy factors. Considerable variability in response to therapy was observed, with 3 patients obtaining a rapid reduction in sleep onset latency while the sleep pattern of the 3 other Ss was significantly exacerbated. Although 1 S from this latter group did improve after several weeks treatment, the other 2 Ss were ultimately successfully treated with progressive relaxation training having been unable to persevere with paradoxical intention. These results are discussed with reference to previous research and the consideration of individual patient characteristics.     

Psychopathology subtypes and symptom correlates among former prisoners of war

Psychopathology and symptom patterns were studied in 60 former prisoners-of-war (POWs) by administering standardized tests including the Minnesota Multiphasic Personality Inventory (MMPI), an adjustment problem checklist, and a structured clinical interview. Most POWs showed marked psychological impairment, but modal profile analysis identified two prototypic MMPI patterns, which differed in pervasiveness and type of psychopathology. Profile subtypes were defined by unique clusters of clinical symptoms and differed in confinement stress severity. The typology of symptoms argues against a homogeneous conceptualization of stress-induced disorders and suggests the need for definition of the severity and subtype of stress phenomena and individual difference factors in responding to trauma.     

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.     

Vicious Cycles of Sleeplessness,Sleep Phobia,and Sleep-Incompatible Behaviours in Patients with Persistent Insomnia

Abstract

In order to study the possible role of vicious cycles of sleeplessness, sleep-incompatible behaviours, and sleep phobia in patients with persistent insomnia, 70 insomniacs were compared with 70 controls on a Sleep Behaviour Questionnaire. Although the insomniacs reported much shorter sleep time than the controls, they did not differ on the amount of time spent in bed. They reported more thinking about problems and planning in bed, but did not report more overt sleep-incompatible behaviours than the controls. The notion of sleep phobia was weakly supported, but the results clearly supported the notion of vicious cycles of sleeplessness (worries, frustration, and negative expectations about sleeplessness). In a second study, SBQ items were factor analyzed, and correlations between SBQ items and personality variables, depression, and stress measures were studied. The item that correlated most strongly with degree of reported sleeping problems referred to negative expectations about sleeplessness. Factor analysis identified four factors: negative expectations, worrying, frustration over sleeplessness, and sleep phobia, with negative expectations accounting for most of the variance.     

Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Attribution theory, insomnia, and the reverse placebo effect: a reversal of Storms and Nisbett's findings.

Storms and Nisbett found that insomniacs got to sleep faster than usual on nights when they took placebos believed to be arousal pills. Our study attempted: (a) to replicate the reverse placebo effect using a method of measurement considered more accurate than the original technique, (b) to evaluate the effect of an arousal pill therapy after therapy is discontinued, and (c) to clarify which of two hypotheses better accounts for the effect. Using 42 insomniacs, the design varied whether pills were administered (pill) or withheld (no pill) and whether or not high justification was provided for taking the pills. The high-justification-pill and the high-justification-no-pill groups were given information intended to justify their participation, while the no-justification-pill and no-pill-no-justification groups were treated like the original arousal and control groups. Instead of a decrease in latency to sleep, the no-justification-pill group but not the high-justification-pill troup displayed a typical placebo reaction on nights they took the pills. Our results cast suspicion on the original finding. The lack of response by the high-justification-pill group is discussed in terms of Bem and Kelley's views of attribution theory.     

The treatment of sleep-maintenance insomnia with stimulus-control techniques

Sleep-maintenance insomniacs received either a stimulus-control (n = 7) or a credible placebo treatment (n = 8), administered in small groups for 4 weeks. Self-reports of time awake after sleep onset, total number of arousals and number of arousals exceeding 10 min were collected at baseline, at termination of treatment (post-treatment), and at a 3-month follow-up. Results showed a statistically- and clinically-significant reduction on all three dependent measures from baseline to post-treatment for both groups; these gains were maintained through the follow-up period. However, the results achieved with stimulus-control procedures were not significantly different from reductions found with a credible placebo condition. These findings compare favorably with other reports of behavioral treatments of both onset and maintenance insomnia.     

REM Sleep Bout Duration and Frequency in PTSD

The few pharmacological treatments shown to be effective in reducing sleep disturbance in posttraumatic stress disorder (PTSD) might work through normalization of rapid eye movement (REM). However, evidence of REM sleep disturbance in PTSD has been inconsistent and the definition of REM bout has varied as well. In this study, we compared polysomnographic findings in adults with PTSD to both normal sleepers and insomniacs. We found no differences between those with and without PTSD on REM bout frequency or duration. We did, however, find gender differences within our PTSD sample as consistent with a previous review suggesting that males with PTSD are more likely to demonstrate REM sleep disturbance. Consensus on REM bout definition is needed, in addition to studies powered to detect gender differences.     

Unpicking the semantic impairment in Alzheimer's disease: qualitative changes with disease severity

Despite a vast literature examining semantic impairment in Alzheimer's disease (AD), consensus regarding the nature of the deficit remains elusive. We re-considered this issue in the context of a framework that assumes semantic cognition can break down in two ways: (1) core semantic representations can degrade or (2) cognitive control mechanisms can become impaired. We hypothesised and confirmed that the nature of semantic impairment in AD changes with disease severity. Patients at mild or severe stages of the disorder exhibited impairment across various semantic tasks but the nature of those deficits differed qualitatively for the two groups. Commensurate with early dysfunction of the cognitive control, temporoparietal-frontal-cingulate network, characteristics of deregulated semantic cognition were exhibited by the mild AD cases. In contrast, the severe AD group reproduced features of additional degradation of core semantic representations. These results suggest that spread of pathology into lateral anterior temporal lobes in later stage AD produces degradation of semantic representations, exacerbating the already deregulated system. Moreover, the dual nature of severe patients' impairment was highlighted by disproportionately poor performance on tasks placing high demand on both conceptual knowledge and control processes--e.g., category fluency.