Gender and cognitive-emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia.

OBJECTIVE Elevated pre-sleep arousal has been consistently associated with insomnia, yet the cognitive-emotional mechanisms involved in sleep-related arousal remain unclear. The purpose of this study was to identify predictors of pre-sleep arousal and trait hyperarousal from a set of variables that included self-reported affect, sleep-related cognitions, locus of control, and gender. METHODS Cross-sectional data were analyzed for 128 participants (89 females) who met criteria for psychophysiological insomnia and completed a set of questionnaires that included the beliefs and attitudes about sleep (BAS), positive and negative affect schedule (negative subscale (nPANAS) and positive subscale (pPANAS)), sleep locus of control (SLOC), Pre-Sleep Arousal Scale (PSAS), hyperarousal scale (HAS) and demographic information. Step-wise regression was conducted with a set of independent variables, with PSAS and HAS serving as separate dependent variables. RESULTS Trait hyperarousal was associated with higher levels of both negative and positive emotionality, as well as negative beliefs about sleep, in both genders. Pre-sleep arousal was associated with greater negative emotionality and internal sleep locus of control, varying by gender. Among women, high pre-sleep arousal was associated with negative emotionality, while in men greater pre-sleep arousal was associated with an internal sleep locus of control. CONCLUSION These findings have clinical implications, suggesting that men and women may require different cognitive targets when addressing pre-sleep arousal.