Dysfunctional Beliefs and Attitudes about Sleep and Its Relation with Insomnia in Three Groups of Psychiatric Patients

Background and Objective: Reports have shown a link between dysfunctional beliefs about sleep and sleep disorders. We investigated the frequency of dysfunctional beliefs about sleep in three groups of patients suffering from psychiatric disorders (patients with major depression, bipolar disorder, and anxiety). Materials and Methods: In this cross-sectional study, 150 patients with psychiatric disorders referred to psychiatry clinic affiliated to Qazvin University of Medical Sciences, Qazvin, Iran. Fifty patients were selected in each group (anxiety, depression, and bipolar disorder). Two questionnaires of Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Insomnia Severity Index (ISI) were completed for all patients. Data were analyzed with Student’s t, chi-square, analysis of variance (ANOVA), and Pearson correlation tests. Results: A significant difference was observed between the three groups in the latency to fall asleep at night (P = 0.002) and Pittsburgh Sleep Quality Index (PSQI) ≤ 5 (P = 0.002). Patients with anxiety and bipolar disorder more than other groups believed that insomnia caused loss of life joy (P = 0.010) and the only solution for sleeplessness was medication (P = 0.003), respectively. There was a significant relationship between sleep quality and anxiety (P = 0.030), total sleep time (P = 0.040), sleep latency (P = 0.020), and ISI (P < 0.010) with depression, awakening time during night, and bipolar disorder (P = 0.030). Conclusion: Patients with psychiatric disorders have high frequency of dysfunctional beliefs about sleep. Regarding the relationship between dysfunctional beliefs about sleep and insomnia, future work is needed for better treatment.

Practice Does Not Make Perfect: The Tireless Pursuit of Achieving Perfect Sleep

Objective: Perfectionism is consistently identified as a predisposing and perpetuating factor for a wide range of mental health conditions and disorders. Given the unique cognitive, emotional, and physiological characteristics associated with perfectionism, perfection could have serious implications for a critical health behavior—our sleep. The current study examines the links between perfectionism and sleep health with the goal of identifying potential sleep-related beliefs as underlying mechanisms. Methods: Participants were 417 undergraduate students at a large, public university in the mid-Atlantic United States. Participants completed a one-time online survey with the Almost Perfect Scale-Revised, the Dysfunctional Beliefs about Sleep Scale, Perceived Competence Scale about their sleep, and the RU SATED sleep health scale. Results: A two-step structural equation modeling strategy was used. Greater perfectionism discrepancies predicted greater dysfunctional beliefs about sleep (β = 0.45) and worse perceived sleep competence (β = −0.33). Moreover, greater dysfunctional beliefs and worse perceived sleep competence predicted worse sleep health (β = −0.23 and 0.59, respectively). Dysfunctional beliefs and perceived sleep competence significantly mediated the effect of maladaptive perfectionism on sleep health (β = −0.302). Discussion: Dysfunctional beliefs and sleep competence emerged as mechanisms through which maladaptive perfectionism may function as a barrier to healthy sleep. Although prior research positions perfectionism as a primary correlate of poor sleep, the current study identifies the role of beliefs about sleep as the pathway from perfectionism to poorer sleep health. The results highlight the importance of addressing both maladaptive beliefs about sleep as well as beliefs about one’s own sleep competency with undergraduate students with higher maladaptive perfectionism.

089 Impact of A Single Sleep Education Session on Beliefs and Attitudes Among People with Excessive Daytime Sleepiness: A Pilot Study

Introduction Excessive daytime sleepiness is associated with adverse health outcomes and substantial functional deficits. However, little is known about experiences among these individuals and whether some education about sleep health would be helpful. Methods N=28 participants with excessive daytime sleepiness (ESS&gt;=10) but no other major medical problems were recruited from the community. The intervention was a single 2-hour sleep education workshop. Participants were randomized to either the education session or a wait-list control. Change from baseline on Epworth Sleepiness Scale (ESS), Dysfunctional Beliefs About Sleep (DBAS) scale, Fatigue Severity Scale (FSS), Insomnia Severity Index (ISI),pHQ9 depression scale, and GAD7 anxiety scale were evaluated versus controls, adjusted for age, sex, and race/ethnicity. Also,participants were asked whether they agree to a range of beliefs/attitudes about sleep before and after the session (as part of intervention or following wait list). Posttest-Pretest difference scores were compared to determine if any were changed by the session (nominal significance p&lt;0.05). Results Compared to the wait-list control, those who received the education session did not show differences in sleepiness (4.2% reduction,p=0.73) or dysfunctional beliefs about sleep (52.1% reduction,p=0.07), but they did demonstrate a 26.5% reduction in fatigue (p=0.01), a 55.2% reduction in insomnia severity (p=0.004), a 59.1% reduction in depression score (p=0.02), and a 54.5% reduction in anxiety score (p=0.04). The single session resulted in increased agreement with the statements, “People with daytime sleepiness should discuss their problems with their doctor or health care provider” (t=-2.3,p=0.03), “I understand the basics of how sleep works” (t=-2.2,p=0.04), “I understand the basics of how sleepiness works” (t=-2.7,p=0.01), “Excessive daytime sleepiness is something that can be improved with psychological treatment” (t=-2.3,p=0.03), and “I know what to do if…” “I have trouble falling asleep” (t=-4.3,p=0.0003), “I have trouble with poor quality sleep” (t=-5.1,p=0.0001), and “I experience daytime sleepiness” (t=-3.0,p=0.007). Conclusion A brief sleep health education session improved sleep and mental health in individuals with daytime sleepiness, even if it did not improve sleepiness. Further, the session did likely provide useful educational information. Support (if any) This work was supported by Jazz Pharmaceuticals

Insomnia in the Italian Population During Covid-19 Outbreak: A Snapshot on One Major Risk Factor for Depression and Anxiety

Objectives: One of the largest clusters of Covid-19 infections was observed in Italy. The population was forced to home confinement, exposing individuals to increased risk for insomnia, which is, in turn, associated with depression and anxiety. Through a cross-sectional online survey targeting all Italian adult population (≥18 yrs), insomnia prevalence and its interactions with relevant factors were investigated.Methods: The survey was distributed from 1st April to 4th May 2020. We collected information on insomnia severity, depression, anxiety, sleep hygiene behaviors, dysfunctional beliefs about sleep, circadian preference, emotion regulation, cognitive flexibility, perceived stress, health habits, self-report of mental disorders, and variables related to individual difference in life changes due to the pandemic's outbreak.Results: The final sample comprised 1,989 persons (38.4 ± 12.8 yrs). Prevalence of clinical insomnia was 18.6%. Results from multivariable linear regression showed that insomnia severity was associated with poor sleep hygiene behaviors [β = 0.11, 95% CI (0.07–0.14)]; dysfunctional beliefs about sleep [β = 0.09, 95% CI (0.08–0.11)]; self-reported mental disorder [β = 2.51, 95% CI (1.8–3.1)]; anxiety [β = 0.33, 95% CI (0.25–0.42)]; and depression [β = 0.24, 95% CI (0.16–0.32)] symptoms.Conclusion: An alarming high prevalence of clinical insomnia was observed. Results suggest that clinical attention should be devoted to problems of insomnia in the Italian population with respect to both prevention and treatment.

0454 Sleep Disruptive Cognitions in Deployment-Related Insomnia

Introduction Sleep disturbance is common following military deployment, and insomnia is associated with many adverse psychiatric and medical outcomes. Deployment to a threatening environment can engender nocturnal vigilance, which may be a salient feature of sleep disturbance in formerly deployed Veterans. Cognitive behavioral therapy for insomnia (CBTI) is an effective treatment; however, CBTI emphasizes targeting dysfunctional beliefs about sleep (DBAS) and generalized worries rather than vigilance. The goal of the present study was to investigate the role of vigilance, in relation to other potential types of sleep-interfering cognitions in formerly deployed Veterans with sleep disturbance. Methods Thirty-nine formerly deployed Veterans with disturbed sleep completed measures prior to an intervention. Insomnia was measured with the Insomnia Severity Index (ISI) and measures derived from actigraphy and morning sleep diaries administered for one week. Measures for sleep interfering cognitions included Dysfunctional Beliefs about Sleep (DBAS), the Penn State Worry Questionnaire (PSWQ), a measure of generalized worry, and the Fear of Loss of Vigilance (FLV) subscale of the Fear of Sleep Inventory (FOSI). Results All of the measures of sleep-interfering cognitions were significantly associated with ISI score. Generalized worries (PSWQ scores) were strongly and significantly correlated with both FLV and DBAS, which were not significantly correlated with each other. FOSI FLV explained 7.1% more variance in ISI score than DBAS alone (p = .04) while DBAS explained 23.1% additional variance in ISI score over FOSI FLV alone (p &lt; .001). Conclusion It may be important to target both nocturnal vigilance and dysfunctional beliefs about sleep in the treatment of insomnia in formerly deployed Veterans. Support Supported by W81XWH-14-1-0066 from the Congressionally Directed Peer-Reviewed Medical Research Program of the Department of Defense.

0157 The Relationship Between Reaction Time, Insomnia Severity, Sleepiness, and Dysfunctional Beliefs About Sleep

Introduction Poor sleep quality has adverse effects ranging from decreased focus to increased work-related injuries. The Perceptual Vigilance Task (PVT), a measure of reaction time (RT) used to assess alertness is commonly used in sleep research. This study focuses on the relationship between dysfunctional sleep-related cognitions (Dysfunctional Beliefs and Attitudes About Sleep Scale [DBAS]), insomnia severity (Insomnia Severity Index [ISI]), and sleepiness (Epworth Sleepiness Scale [ESS]) and their association to PVT RT. Methods 162 participants were recruited from East Carolina University. Inclusion criteria: right-handed adults; exclusion criteria: history of brain injury, seizure disorder, or vision impairment. Age range 18–39 (M = 20.15; SD = 3.01); 81 (49.1%) females. Results ISI was correlated with PVT RT for inter-stimulus interval delay times of 1000ms r(162) = .155, p =.05, 2000ms r(162) = .204, p = .009, 5000ms r(162) =.164, p = .04, and 6000ms r(162) = .181, p = .02. DBAS was correlated with PVT RT for delay times of 2000ms r(162) = .204, p =.021, 3000ms r(162) = .160, p = .04, 4000ms r(162) = .170, p = .03, 6000ms r(162) = .171, p = .030, 7000ms r(162) = .219, p =.005, and 8000ms r(162) = .158 p = .045. ESS was not correlated with PVT. A regression was calculated to predict reaction time at 7000ms delay based on the DBAS (F(1,151) = 2.51, p = .01), with an R2 of .12. Conclusion There is a diminishing association found between insomnia severity and RT during inter-stimulus delay times (&gt;6000ms). Dysfunctional beliefs about sleep correlate with RT through 8000ms delay, eventually predicting RT. Regardless of severity of sleep disturbance, sleep-related bias may affect subjective feelings of wakefulness and objective levels of alertness (e.g., one who believes they are not obtaining sufficient sleep may act accordingly). Support N/A