| Summary: | 碩士 === 國立政治大學 === 心理學研究所 === 101 === OBJECTIVE: Various etiological models of insomnia suggest that stress might interfere with sleep by increasing level of arousal. Sleep vulnerability to stress might precipitate an individual to this effect, and maladaptive belief and coping skills could perpetuate the transient sleep disturbance into more long term insomnia symptoms. Previous studies have supported the associations between these factors and insomnia. However, past studies were mostly cross-sectional in nature, how these factors interact to contribute to the development of insomnia is still limited. Thus, the goals of present study are to examine (1) whether normal sleepers who are vulnerable to stress-related sleep disturbance are at higher risk for subsequent development of insomnia symptoms at a long-term follow-up, and (2) whether pre-sleep arousal serves as a mediator, and coping and maladaptive sleep belief serve as moderators of the association between stress and insomnia severity.
METHOD: The sample was from the participants of a sleep survey at National Chengchi University in 2006. There were 330 participants agreed to be contacted for follow-up sleep surveys. They were invited to participate in the study through telephone in 2012. Participants who agreed to take part in the study were asked to complete a battery of questionnaires online, including the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Ford Insomnia Response to Stress Test (FIRST), the Dysfunctional beliefs and attitudes about sleep questionnaire (DBAS), the Pre-sleep arousal scale (PSAS), the Perceived Stress Scale (PSS), the Life Experiences Survey (LES) and the COPE. Logistic regression analysis was used to examine whether sleep vulnerability to stress predicts insomnia symptoms, and linear regression analysis was used to explore whether pre-sleep arousal serves as a mediator and coping and maladaptive sleep belief as moderators for the association between stress and the development of insomnia.
RESULTS: Sleep vulnerability to stress showed a near significant trend in predicting insomnia symptoms. Pre-sleep arousal plays a mediating role between negative life experiences and insomnia severity. On the other hand, sleep vulnerability to stress moderates the association between negative life experiences and pre-sleep somatic arousal; emotional coping strategies serve as a moderator for the association between negative life experiences and pre-sleep cognitive arousal affecting insomnia severity. Although maladaptive sleep belief does not play a moderating role, it predicts pre-sleep arousal directly.
CONCLUSIONS: The findings basically support the prediction of insomnia etiological models that stress interferes with sleep by increased arousal; however, different psychological factors play different roles in the process. It showed a tendency that participants have more sleep vulnerability to stress are at high risk to develop insomnia symptoms. However, the predictability of sleep vulnerability does not reach significant level. Individuals with high vulnerability might have increased somatic arousal when facing stressful situations and those who use more emotional coping strategies might increase cognitive arousal. Maladaptive sleep belief predicts pre-sleep arousal directly instead of interacting with negative events. It is possible that the maladaptive sleep belief can increase sleep-related stress directly. The results imply that sleep vulnerability to stress can serve as an indicator to identify individuals with higher risk for insomnia. A preventive program with sleep education and relaxation training to reduce pre-sleep arousal can be provided to prevent occurrence of insomnia.
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