Insomnia severity and its correlates among English as a second language (ESL) college students.

OBJECTIVE: Little is known about insomnia characteristics among the English as a second language (ESL) student population. This study compared insomnia severity between ESL students and English native-speaking students and identified correlates of insomnia in the ESL population. PARTICIPANTS: College students (N = 352) from a private university in the Northeastern United States, including 22.4% (N = 79) ESL students. METHODS: For this cross-sectional study, participants completed the Insomnia Severity Index and indices of common risk factors of insomnia along with acculturation and language anxiety. RESULTS: ESL students reported higher insomnia severity than their US counterparts after controlling for depression, anxiety, and demographics. General anxiety, language anxiety, and cognitive pre-sleep arousal were selected as the strongest predictors of insomnia among the ESL population. CONCLUSIONS: Findings suggest that ESL college group is vulnerable to greater insomnia, and language anxiety is unique and important correlate of insomnia in this population.

Randomized controlled trial of cognitive refocusing versus stimulus control treatment for college insomnia: feasibility of a brief, electronic-based, and peer-led approach.

OBJECTIVE: Performance of Cognitive Refocusing Treatment for Insomnia (CRT-I) relative to stimulus control treatment (SCT) remains unknown among college students. This pilot trial compared single-session, electronic-based, peer-led CRT-I to SCT, and as well as awareness-based (AC) and no-treatment (NTC) controls. PARTICIPANTS: College students (N = 82; Mage=18.59 [SD = 0.78]; 58% female; 61% White; 16% Hispanic) with insomnia symptoms were randomly assigned to CRT-I (n = 12), SCT (n = 14), and AC (n = 14) conditions, or non-randomly recruited to NTC (n = 42). METHODS: All participants completed baseline and one-month follow-up surveys, and reported daily task enactment (except NTC). RESULTS: Feasibility ratings were comparable across conditions. Within-group treatment effects revealed greater improvements in (a) insomnia symptom severity among CRT-I (d = 1.13) and SCT (d = 1.66) groups relative to AC (d = 0.90) and (b) pre-sleep cognitive arousal among CRT-I (d = 0.94) and SCT (d = 1.42) groups relative to AC (d = 0.75). CONCLUSIONS: Brief, electronic-based, peer-led CRT-I and SCT interventions appear feasible and potentially efficacious for college insomnia.

Cannabis use for sleep aid among high school students: Concurrent and prospective associations with substance use and sleep problems.

INTRODUCTION: Adolescents are at risk for both sleep problems and cannabis use. Despite emerging evidence for college students' self-medication with cannabis to help sleep, generalizability to earlier developmental stages remains unknown. This study remedied this literature gap by characterizing high school students' cannabis sleep aid use in terms of psychosocial correlates and prospective associations with substance use and sleep. METHODS: Data were drawn froma longitudinal urban adolescent health behavior study, Project Teen, including 4079th-11thgraders(Year 1 Mage = 16.00 [SD = 1.08, range = 13-19]; 58% female; 41% Black, 22% White, 18% Asian, 17% multiracial,2% Native Hawaiian or other Pacific Islander, 1% American Indian or Alaska Native; 12% Hispanic/Latinx). Students completed two web-based surveys (Minterval = 388.89 days [SD = 27.34]) assessingsubstance use and sleep at Year 1 (Y1) and Year 2 (Y2). RESULTS: Students reporting lifetime cannabis sleep aid use (8%) endorsed greater depression and anxiety symptoms at Y1, as well as greater cannabis, alcohol, and cigarette use (but not insomnia symptoms or sleep durations) at Y1 and Y2, compared to non-using peers. Over one year, cannabis sleep aid use was associated with increased cannabis dependence symptoms among students using cannabis, past-2-week binge drinking among students using alcohol, and lifetime cigarette use. However, cannabis sleep aid use was not prospectively associated with changes in insomnia symptoms or sleep durations. CONCLUSIONS: Although replication is needed, cannabis sleep aid use among high school students may be associated with exacerbated cannabis dependence symptoms and increased binge drinking and cigarette use over time, without the intended sleep benefit.

Tobacco cigarette smokers who endorse greater intolerance for nicotine withdrawal also report more severe insomnia symptoms.

It has been suggested that nighttime nicotine withdrawal may help to explain why tobacco cigarette smokers are more likely than nonsmokers to experience clinically significant insomnia. There is also reason to believe that intolerance for withdrawal symptoms could play a role in withdrawal-related sleep disturbance. However, we are not aware of any previous research that examined whether smokers who endorse greater intolerance for smoking abstinence also report greater difficulty initiating and/or maintaining sleep. To address this question, 224 adult cigarette smokers (42.9% female, Mcigarettes per day = 21.3) completed the baseline portion of an experimental study that included assessment of current/historical smoking behavior, perceived intolerance for smoking abstinence, and insomnia severity and impact on functioning. The results indicated that, after accounting for general distress intolerance and sociodemographic factors, smokers who endorsed greater intolerance for nicotine withdrawal also reported greater insomnia severity and impact. Logistic regression further revealed that, for every 1-point increase in nicotine withdrawal intolerance scores, smokers were nearly twice as likely to score above threshold for clinically significant insomnia (p = .001). Collectively, these initial findings suggest that intolerance for nicotine withdrawal may warrant consideration as a potentially modifiable mechanistic factor in comorbid insomnia and nicotine/tobacco dependence. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sleep Problems and Drinking Frequency among Urban Multiracial and Monoracial Adolescents: Role of Discrimination Experiences and Negative Mood.

Mounting evidence suggests that multiracial adolescents may be at greater risk than their monoracial peers for both sleep problems and alcohol use. However, mechanisms underlying these uniquely-heightened risky health behaviors among multiracial adolescents remain a gap in the literature. This cross-sectional study examined a risk pathway involving discrimination experiences and negative mood underlying racial disparities in concurrent sleep problems and drinking frequency. Students at an urban, socioeconomically-disadvantaged high school (N = 414; grades 9-11, Mage = 16.00 [SD = 1.08]; 57% female; 17% multiracial, 41% Black, 22% White, 18% Asian, 2% Other; 12% Hispanic/Latinx) completed a survey. Path analysis demonstrated that associations of multiracial status with sleep problems (insomnia symptom severity and insufficient weekday sleep duration), but not drinking frequencies (past-year drinking or past-2-week binge-drinking frequencies), were explained by discrimination experiences and, in turn, negative mood. In ancillary analysis excluding White students, the serial indirect risk pathway was significant for both insomnia symptom severity and past-year drinking frequency outcomes. Discrimination experiences and negative mood may function as intermediate factors contributing to racial disparities in adolescent sleep problems, although longitudinal replication is needed.

Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ): Initial Development among College Students.

A growing body of literature demonstrates that cannabis is commonly used to aid sleep. Consistent with social cognitive theory, there is a vast literature documenting the role of outcome expectancies in the initiation, progression, and maintenance of cannabis use. Despite the readily endorsed belief that cannabis will help improve sleep, sleep-related expectancies have not been included in widely used cannabis expectancy measures. This study aimed to develop and provide preliminary psychometric evaluation of the Sleep-Related Cannabis Expectancy Questionnaire (SR-CEQ). Cross-sectional data were drawn from N= 166 college students (Mage = 18.83 [SD = 1.06; range: 18-24], 34% male, 71% White). Students completed an online survey including demographics and the 12-item SR-CEQ. Exploratory Factor Analysis identified two factors representing Negative Sleep-Related Cannabis Expectancies and Positive Sleep-Related Cannabis Expectancies. Confirmatory Factor Analysis demonstrated adequate fit of the two-factor measurement model to observed data (SRMR = 0.08). Students endorsed greater positive (versus negative) sleep-related cannabis expectancies on average, and male students reported significantly greater negative expectancies (but not positive expectancies) compared to female students. The SR-CEQ is the first cannabis expectancy assessment tool specific to sleep-related cannabis outcomes. Ongoing psychometric validation of the SR-CEQ is needed to assess convergent/predictive validity and replicate findings among relevant clinical samples.

Cannabis and alcohol use for sleep aid: A daily diary investigation.

OBJECTIVE: One in 5 college students use substances such as cannabis and/or alcohol to help sleep. Despite this high prevalence of sleep aid use, there remains a lack of research on the potential day-to-day sleep- and substance-related consequences. The current study examined associations of cannabis and alcohol sleep aid use with subsequent sleep and substance use consequences among college students. METHOD: Of a baseline sample of 217 college students endorsing past-month cannabis and/or alcohol use (1% cannabis only, 42% alcohol only, 58% both), 83 students endorsing past-month cannabis and/or alcohol use for sleep aid (Mage = 19.33 [SD = 1.11], 30% male, 72% White) completed online questionnaires for 14 consecutive days to report daily sleep, substance use, and negative substance consequences. RESULTS: Multilevel models demonstrated that nights of cannabis sleep aid use predicted longer same-night sleep duration, shorter same-night wake time after sleep onset, and greater next-day daytime fatigue within person, after controlling for daily cannabis frequency. Alcohol sleep aid use was not associated with sleep-related outcomes or negative drinking consequences after controlling for daily alcohol quantity; these null results may be due to a low frequency of alcohol sleep aid use (1% of observations) over 14 days of assessment. CONCLUSIONS: Results highlight daytime fatigue as a potential adverse short-term outcome of cannabis sleep aid use, despite its proximal sleep-related benefits. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sleep-related functional impairment as a moderator of risky drinking and subsequent negative drinking consequences in college students.

OBJECTIVE: Poor sleep quality and insufficient total sleep time have been shown to modify the relationship between college drinking and negative drinking consequences. This study aimed to examine whether prospective associations between risky drinking and negative drinking consequences similarly differ by sleep-related functional impairment, which is novel to the literature. METHOD: Data were obtained from a 2-month prospective study of 157 college drinkers (mean age = 19 years [SD = 1.11], 30% male, 76% White). Online questionnaires were administered at both Time 1 (T1) and Time 2 (T2) to measure sleep-related functional impairment (assessed by Insomnia Diurnal Impact Scale; Ruiz, Guilera, & Gomez-Benito, 2011) and drinking behaviors and negative drinking consequences (assessed retrospectively over the past 2 months). RESULTS: Prospective negative binomial regression analyses demonstrated that associations of both maximum drinks and binge drinking frequency at T1 with negative drinking consequences at T2 differed by T1 sleep-related functional impairment after controlling for covariates (sex, negative mood, total sleep time, insomnia symptoms, morning preference, and negative drinking consequences at T1). Students reporting lower sleep-related functional impairment experienced high levels of negative drinking consequences only at high levels of risky drinking, whereas students reporting higher sleep-related functional impairment experienced consistently high levels of negative drinking consequences regardless of their risky drinking levels. CONCLUSION: Findings indicate that sleep-related functional impairment may exacerbate negative drinking consequences of risky drinking. Thus, sleep-related functional impairment helps to explain individual differences in the association between risky drinking and negative drinking consequences in college students.

Self-Medication for Sleep in College Students: Concurrent and Prospective Associations With Sleep and Alcohol Behavior.

OBJECTIVE/BACKGROUND: College students are at an increased risk for poor sleep and associated sleep problems. Emerging evidence suggests that a substantial subset of college students self-medicate with alcohol, marijuana, or over-the-counter medications to help sleep. The current study identified demographic, psychosocial, and sleep- and alcohol-related correlates of self-medication for sleep, and assessed its concurrent and prospective associations with insomnia symptoms, alcohol drinking, and negative drinking consequences. PARTICIPANTS: Undergraduate students (N = 171; mean age = 19 years [SD = 1.35], 32% male, 74% White) enrolled in a four-year university in the northeastern United States. METHODS: Data were drawn from a short-term two-wave longitudinal study. Participants completed two online surveys, separated by an average interval of 68 days (SD = 10.22). RESULTS: At Time 1, 25% of students reported using at least one substance (alcohol, marijuana, or over-the-counter medications) for sleep aid in the past two weeks. Male and older students were more likely to report using substances for sleep. Sleep aid use at Time 1 was concurrently associated with greater levels of alcohol frequency, negative drinking consequences, and insomnia symptoms. Further, sleep aid use at Time 1 was associated with an increase in negative drinking consequences from Time 1 to Time 2, but not with changes in alcohol frequency or insomnia symptoms. CONCLUSIONS: These findings indicate that substances are widely used among college students for sleep aid. Sleep aid use is associated with greater concurrent drinking and insomnia symptoms, and increases in negative drinking consequences over a short time period.

The associations among prior drinking consequences, subjective evaluations, and subsequent alcohol outcomes.

Although the many positive and negative psychosocial consequences of alcohol use are well documented, evidence of the association between prior drinking consequences and subsequent alcohol-related outcomes is mixed. Social learning theory highlights that cognitive appraisals of prior drinking consequences play a crucial intermediate role in the relation of prior drinking consequences with subsequent alcohol-related outcomes. This prospective study was designed to test the mediating effects of subjective evaluations (i.e., perceived valence and controllability) in the association of prior drinking consequences with change in binge drinking and drinking consequences over time. Participants were 171 college students (69% female, 74% White, M age = 18.95 years, SD = 1.35) who completed 2 online surveys, with an average interval of 68 days (SD = 10.22) between assessments. Path analyses of the data did not support mediational effects of perceived valence or controllability of prior drinking consequences on subsequent alcohol-related outcomes. Specifically, greater frequency of negative consequences was associated with lower perceived valence and controllability, and greater frequency of positive consequences was associated with lower perceived controllability of the experienced consequences. However, perceptions of valence and controllability were not in turn associated with subsequent binge drinking and drinking consequences. Instead, greater frequency of positive consequences was directly associated with greater subsequent frequency of binge drinking. Findings highlight the importance of prior positive consequences in the escalation of binge drinking over a short period of time, although this relation may not be accounted for by perceptions of valence and controllability of the prior drinking consequences. (PsycINFO Database Record

Associations between sleep hygiene and insomnia severity in college students: cross-sectional and prospective analyses.

Although a small number of studies characterized cross-sectional associations between sleep hygiene and insomnia severity, no prior study has examined their relationships prospectively. Further, the relationship between sleep hygiene and insomnia severity among college students has rarely been examined. This study examined the prevalence of diverse sleep hygiene behaviors and their associations with insomnia severity in two independent samples of college students from a cross-sectional (N=548; mean age=19; 59% female; 71% White) and a two-wave short-term prospective (N=157; mean age=19; 71% female; 76% White) study. A total of 12% to 13% of students reported clinically significant insomnia. On average, students reported frequent engagement in inconsistent sleep-wake schedules and lounging and worrying/thinking about important matters in the bed. Improper sleep scheduling, behaviors that promote arousal near bedtime, and uncomfortable sleeping environments were positively associated with cross-sectional insomnia severity. After controlling for other well-established risk factors, only improper sleep scheduling remained significant. Prospectively, baseline improper sleep scheduling predicted insomnia severity at a 2-month follow-up after controlling for baseline insomnia severity and other well-established risk factors. Together, findings suggest a potential unique role of improper sleep scheduling in insomnia among college students.

Short-term prospective effects of impulsivity on binge drinking: mediation by positive and negative drinking consequences.

OBJECTIVE: Although the association of impulsivity with diverse alcohol outcomes has been documented, the mechanisms by which impulsivity predicts drinking over time remain to be fully characterized. The authors examined whether positive drinking consequences, but not negative drinking consequences, mediated the association between impulsivity and subsequent binge drinking, over and above prior binge drinking. PARTICIPANTS: Participants were 171 college students. METHODS: Participants completed 2 online surveys with an average interval of 68 days between assessments at Time 1 (September to October 2012) and Time 2 (November to December 2012). RESULTS: Path analysis showed that, among 5 facets of impulsivity, the effect of sensation seeking on subsequent binge drinking was completely mediated by prior positive consequences. No mediating effects of negative consequences were found. CONCLUSIONS: Prior experience of positive drinking consequences may serve as one of the risk pathways by which sensation seeking shapes binge drinking over time. Personalized intervention strategies may utilize information about students' impulsivity facets to address their binge drinking and alcohol-related consequences.

Cognitive refocusing treatment for insomnia: a randomized controlled trial in university students.

This investigation assessed the efficacy of a technique specifically designed to change the style and content of presleep thoughts in order to reduce nighttime cognitive arousal and decrease insomnia severity. This investigation, termed "cognitive refocusing treatment for insomnia" (CRT-I), previously improved sleep in a small sample of veterans with primary insomnia. In this investigation, university students with poor sleep were randomly assigned to attend either one session of CRT-I and sleep hygiene education (SH: n=27) or one session of only SH (n=24). Insomnia severity (assessed by the Insomnia Severity Index) and nighttime arousal (assessed by the Pre-Sleep Arousal Scale) were measured at baseline and 1month posttreatment. A significant Group×Time interaction for insomnia severity suggested more improved sleep over time for those receiving CRT-I+SH. A trend for a Group×Time interaction showed decreased cognitive arousal over time among those receiving CRT-I. These findings provide preliminary support for the efficacy of CRT-I for insomnia treatment among college students. Continued study of CRT-I in a community-based sample appears warranted.

An investigation of a cognitive refocusing technique to improve sleep.

Developing techniques designed to minimize arousing cognitions during the evening may be important to help improve the treatment of insomnia. This investigation assessed an intervention that focused exclusively on enhancing cognitive refocusing at sleep onset to change the content and style of presleep cognitions in order to improve sleep. Individuals with primary insomnia (N=10; 90% male, mean age=49.2, SD=12.6) attended four weekly individual meetings. Sleep quality (the Pittsburgh Sleep Quality Index), insomnia severity (the Insomnia Severity Index), sleep parameters based on one week of sleep diaries, and arousing thought content, were compared at baseline, posttreatment, and at a 1-month follow-up. Adherence was high, and participants showed good ability to engage in the procedure. Significant improvements in sleep quality, insomnia severity, sleep onset latency, total sleep time, and arousing thought content were revealed. Large effect sizes were observed on the majority of sleep variables at follow-up. Preliminary results were encouraging regarding a technique that targets the refocusing of thoughts during the evening in order to improve sleep. Further study regarding the efficacy of this procedure is warranted.

Functional quality of life in full versus partial posttraumatic stress disorder among veterans returning from Iraq and Afghanistan.

OBJECTIVE: This study assessed mental and health functioning in full versus partial posttraumatic stress disorder (PTSD) among newly returning veterans from Iraq (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) who were referred by primary care providers for a behavioral health assessment and reported an emotional trauma. METHOD: Participants included OEF/OIF veterans receiving care in 2 veterans' affairs medical centers and affiliated community-based outpatient clinics who reported behavioral health issues to their primary care providers. All veterans underwent a clinical behavioral health assessment of Axis I disorders and functioning via telephone between June 2007 and April 2008. Functioning was measured using the 12-item Short-Form Health Survey (SF-12). Those reporting a previous emotional trauma were subsequently assessed for PTSD using the PTSD Patient Checklist (PCL). RESULTS: The final sample (N=201) was 88.1% male with a mean age of 34.2 years (SD=10.1). Individuals with full PTSD (n=120, 59.7%) reported worse mental health functioning compared to those with partial PTSD (n=37, 18.4%). Individuals with partial PTSD reported worse mental health functioning scores than the trauma exposed-only group (n=44, 21.9%). Compared to national norms, patients with partial PTSD reported mental health functioning scores that were worse than 75% of individuals within a similar age range. After controlling for other psychiatric factors, there was no difference between partial PTSD and the trauma-only group. CONCLUSION: OEF/OIF veterans with partial PTSD referred for a behavioral health assessment may incur significant problems with functioning. These complaints may be better attributed to psychiatric comorbidity as opposed to symptoms specifically related to trauma.

Predictors of sleep disturbances in Operation Iraqi Freedom/Operation Enduring Freedom veterans reporting a trauma.

This investigation assessed the extent to which various health factors are associated with difficulties initiating and maintaining sleep (DIMS) and nightmares among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans reporting a trauma (combat, noncombat, or a trauma before service). Veterans (N = 201, 88.1% male, mean age = 34.2, SD = 10.1) were referred by primary care for a behavioral health assessment upon evidence of psychiatric symptoms. Sleep problems were assessed using items from the PTSD checklist. After controlling for demographics and nonsleep PTSD symptoms, head injury with a loss of consciousness increased the likelihood of severe nightmares (OR = 3.77, p = 0.019), alcohol abuse or dependence increased the likelihood of moderate nightmares (OR = 4.80, p = 0.007), and greater nonsleep depression increased the likelihood of severe DIMS (OR = 1.20, p = 0.008). Thus, factors aside from PTSD severity are related to sleep disturbance in OIF/OEF veterans reporting a trauma.

Sleep hygiene practices of good and poor sleepers in the United States: an internet-based study.

This Internet-based investigation assessed the frequency of multiple sleep hygiene practices in 128 good sleepers and 92 poor sleepers (mean age = 41.6, SD = 12.8, 61.8% women). The Pittsburgh Sleep Quality Index was used to measure sleep quality (< 5 = good sleep, > 7 = poor sleep). Although sleep hygiene practices were generally good, poor sleepers showed increased cognitive activity in the bed, even after controlling for global indices of depression and anxiety. Poor sleepers also reported statistically significant increases in excessive noise in the bedroom, uncomfortable nighttime temperature, and activities that were exciting, emotional, or demanded high concentration near bedtime. Future studies should further investigate the prevalence of these variables and their potential impact on sleep quality.

Socioeconomic status and insomnia.

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.