Cognitive “insomnia” processes in delayed sleep–wake phase disorder: do they exist and are they responsive to chronobiological treatment?

Cele Richardson, Gorica Micic, Neralie Cain, Kate Bartel, Ben Maddock, Michael Gradisar

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To systematically investigate whether cognitive "insomnia" processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. Method: Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75% f) completed baseline measures of sleep, daytime functioning and cognitive "insomnia" processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63% f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. Results: Adolescents with DSWPD had significantly later sleep timing (d = 0.99 -1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive "insomnia" symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70 -1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54 -0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46 -1.00). Repetitive negative thinking (d = 0.64 -0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. Conclusions: Cognitive "insomnia" processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse.

LanguageEnglish
Pages16-32
Number of pages17
JournalJournal of consulting and clinical psychology
Volume87
Issue number1
Early online date29 Nov 2018
DOIs
Publication statusPublished - Jan 2019
Externally publishedYes

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Sleep Initiation and Maintenance Disorders
Sleep
Therapeutics
Polysomnography
Sleep Wake Disorders
Neurobehavioral Manifestations
Phototherapy
Arousal
Maintenance
Recurrence

Cite this

@article{ae1dd8f4788c40fc97ac160ff6b5b5e5,
title = "Cognitive “insomnia” processes in delayed sleep–wake phase disorder: do they exist and are they responsive to chronobiological treatment?",
abstract = "Objective: To systematically investigate whether cognitive {"}insomnia{"} processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. Method: Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5{\%} f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75{\%} f) completed baseline measures of sleep, daytime functioning and cognitive {"}insomnia{"} processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63{\%} f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. Results: Adolescents with DSWPD had significantly later sleep timing (d = 0.99 -1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive {"}insomnia{"} symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70 -1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54 -0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46 -1.00). Repetitive negative thinking (d = 0.64 -0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. Conclusions: Cognitive {"}insomnia{"} processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse.",
keywords = "adolescents, delayed sleep phase disorder, etiology, insomnia, light therapy",
author = "Cele Richardson and Gorica Micic and Neralie Cain and Kate Bartel and Ben Maddock and Michael Gradisar",
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doi = "10.1037/ccp0000357",
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Cognitive “insomnia” processes in delayed sleep–wake phase disorder : do they exist and are they responsive to chronobiological treatment? / Richardson, Cele; Micic, Gorica; Cain, Neralie; Bartel, Kate; Maddock, Ben; Gradisar, Michael.

In: Journal of consulting and clinical psychology, Vol. 87, No. 1, 01.2019, p. 16-32.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cognitive “insomnia” processes in delayed sleep–wake phase disorder

T2 - Journal of consulting and clinical psychology

AU - Richardson,Cele

AU - Micic,Gorica

AU - Cain,Neralie

AU - Bartel,Kate

AU - Maddock,Ben

AU - Gradisar,Michael

PY - 2019/1

Y1 - 2019/1

N2 - Objective: To systematically investigate whether cognitive "insomnia" processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. Method: Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75% f) completed baseline measures of sleep, daytime functioning and cognitive "insomnia" processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63% f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. Results: Adolescents with DSWPD had significantly later sleep timing (d = 0.99 -1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive "insomnia" symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70 -1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54 -0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46 -1.00). Repetitive negative thinking (d = 0.64 -0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. Conclusions: Cognitive "insomnia" processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse.

AB - Objective: To systematically investigate whether cognitive "insomnia" processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. Method: Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75% f) completed baseline measures of sleep, daytime functioning and cognitive "insomnia" processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63% f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. Results: Adolescents with DSWPD had significantly later sleep timing (d = 0.99 -1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive "insomnia" symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70 -1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54 -0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46 -1.00). Repetitive negative thinking (d = 0.64 -0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. Conclusions: Cognitive "insomnia" processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment; however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse.

KW - adolescents

KW - delayed sleep phase disorder

KW - etiology

KW - insomnia

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