Insomnia Complaint Versus Sleep Diary Parameters: Predictions of Suicidal Ideation.

The purpose of this study was to determine which aspects of insomnia best predict suicidal ideation (SI). Participants were grouped according to whether they complained of insomnia and whether their sleep would be characterized as poor or good by applying quantitative criteria for insomnia to their sleep diary data. Analyses revealed that insomnia complaint was more strongly associated with SI than was poor sleep. These findings suggest that patients who complain of insomnia, regardless of the presence or absence of poor sleep, may be at greater risk for suicide than those who are content with their sleep.

Hopelessness mediates the relation between insomnia and suicidal ideation.

INTRODUCTION: A growing body of literature indicates that insomnia is related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI). METHODS: The present study used archival data from community-dwelling adults. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the DSM-5 as well as quantitative criteria were used to identify participants with insomnia (n = 135). RESULTS: The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI. After adding depression as an additional mediator, hopelessness remained a significant predictor of SI. CONCLUSION: The present research suggests the need for clinicians to routinely screen clients who have insomnia for hopelessness and SI, and to treat hopelessness when it is present. Further research should address the limitations in this sample and should also consider other potential mediators of the insomnia-SI link.

Insomnia and hypnotic medications are associated with suicidal ideation in a community population.

Suicidal ideation (SI), a significant predictor of suicide, is associated with sleep disturbance, which is seldom assessed using stringent diagnostic criteria and validated sleep instruments in community samples. Cross-sectional data, including sleep diaries and validated instruments, from 767 community adults were used to identify variables associated with SI and subsequently entered into a regression model to predict SI. Suicidal ideation was endorsed by 9.3% of the sample. This group differed from non-ideators on several variables, but only insomnia diagnosis, depression severity, and hypnotic medication use predicted SI. Findings confirm an association of insomnia with SI using stringent criteria and controlling for depression. If treating insomnia is a conceivable pathway to reduce SI, the apparent risk posed by hypnotics may limit treatment options.

Dysmenorrhea, the menstrual cycle, and sleep.

This study examined the relationship between dysmenorrhea and insomnia, as well as variability in sleep across the menstrual cycle. Participants were 89 women, ages 18 to 24 (M = 18.63, SD = 0.93), who completed daily surveys for five weeks. On the second day of menses, they completed a questionnaire regarding dysmenorrhea. Participants having insomnia rated their dysmenorrhea as being more severe and causing more interference with daily activities than did participants without insomnia. Insomnia severity was directly associated with dysmenorrhea severity and interference. Sleep onset latency was longer and sleep efficiency was lower in participants with severe dysmenorrhea than in those with mild dysmenorrhea. Further, participants with mild dysmenorrhea reported significantly better sleep quality than did those having moderate or severe dysmenorrhea. Additionally, wake time after sleep onset was shortest and number of awakenings was lowest around the time of ovulation. Future research should examine whether treating dysmenorrhea or insomnia alone results in improvements in the other condition.

Co-occurring insomnia and obstructive sleep apnea.

STUDY OBJECTIVES: Prior research investigating co-occurring insomnia/obstructive sleep apnea (CIO) has mainly focused on comparing comorbid patients, obstructive sleep apnea (OSA), and insomnia (INS) to those with OSA alone. This approach is informative but omits the potentially interesting comparison of comorbid patients to those with INS alone. Our study used an incomplete factorial design, crossing OSA (present or absent) with INS (present or absent) to more clearly focus on the question, is comorbid INS an epiphenomenon of OSA or an independent disorder? METHODS: Our study was an archival analysis from the database of a sleep center comparing consecutively diagnosed patients characterized as OSA or INS. A third group, CIO, was derived from the OSA group. Our study was conducted at an American Academy of Sleep Medicine-accredited sleep disorders center. We studied 299 patients, including 94 OSA, 97 INS, and 108 CIO. Patients ranged from ages 15 to 86years. RESULTS: Groups were compared on polysomnography (PSG), sleep pattern, sleep stages, sleep pathology, self-reported sleep concerns, and self-reported daytime functioning. From a consecutive group of OSA patients, we estimate the prevalence of CIO at 67.4%. Based mainly on multivariate analysis of covariance (MANCOVA) controlling for demographic differences between groups, we found few if any significant differences between CIO and INS alone or between CIO and OSA alone. CONCLUSIONS: The clinical presentation of CIO is indistinguishable from INS alone, both with respect to PSG findings and to self-reported sleep onset and sleep maintenance disturbance. We observed a weak relation between OSA severity and co-occurring INS. These data are consistent with the view that INS with co-occurring OSA is an independent, self-sustaining disorder. We hypothesized that in some unknown proportion of cases, OSA initially instigated the INS, but the INS was then perpetuated and reshaped by sleep concerns and self-defeating compensatory behaviors.

Predictors of perceived sleep quality among men and women with insomnia.

The present study determined which self-reported sleep variables and daytime impairment measures are most closely associated with sleep quality ratings (SQR) in men and women with insomnia. The participants were 137 people with insomnia, 56 men and 81 women. Multiple regression found that for men, sleep efficiency best predicted SQR, explaining 26.9% of variance. A similar analysis was conducted for women. After race was entered as a covariate, number of awakenings and total sleep time were significant predictors of SQR. Collectively, race, number of awakenings, and total sleep time explained 35.7% of variance. This suggests that the middle-of-the-night experience predicts sleep quality rating in women with insomnia, whereas the full night experience predicts sleep quality ratings in men with insomnia.