Insomnia and Anxiety

Abstract

INTRODUCTION: Previous research within the field of sleep psychology has shown that there is a relationship between the specific symptoms of depression and insomnia. Through this study, we will try to gain a deeper understanding of the relationship between anxiety and insomnia, particularly the main 7 specific symptoms of anxiety present on the GAD-7, and the daytime, nighttime, and perception symptoms of insomnia. The findings of this research will be able to further guide health professionals in being able to effectively treat patients with this comorbidity. METHODS: Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 community-dwelling adults age 22-60 from southeastern Pennsylvania. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty falling asleep or staying asleep or early morning awakening), DAYTIME symptoms (difficulty functioning, noticeable effects), and PERCEPTION symptoms (dissatisfaction and worry about sleep). The items of the GAD7 were assessed separately, including anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and feelings of fear; these were coded as yes/no indicating presence often. Binary logistic regression analyses examined each symptom, with each component of the ISI as predictor (adjusting for the others), as well as age, sex, race/ethnicity and education level. Post-hoc analyses included forward stepwise analyses to determine which components of the ISI contribute to each symptom. RESULTS: SLEEP symptoms were uniquely, independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were uniquely, independently associated with anxiety level (OR=1.3, p<0.0005), control (OR=1.2, p<0.0005), many worries (OR=1.3, p<0.0005), difficulty relaxing (OR=1.2, p=0.004), restlessness (OR=1.3, p=0.001), and irritability (OR=1.2, p<0.0005). PERCEPTION symptoms were uniquely, independently associated with anxiety level (OR=1.1, p=0.03), control (OR=1.2, p=0.001), many worries (OR=1.2, p=0.001) , difficulty relaxing (OR=1.4, p<0.0005), irritability (OR=1.2, p=0.018), and feelings of fear (OR=1.2, p=0.002). In stepwise analyses, fear was predicted only by PERCEPTION symptoms; anxiety level and difficulty relaxing were predicted by DAYTIME and PERCEPTION symptoms; restlessness was predicted by SLEEP and DAYTIME symptoms; and control, many worries and irritability were predicted by all three symptoms. CONCLUSIONS: The results of this study suggest that daytime and perception symptoms of insomnia played a more significant role in the symptoms of anxiety than nighttime symptoms of insomnia. This information offers new insight into this topic and can be used by health professionals to approach this issue differently by focusing on daytime symptoms in the experience of insomnia and overall perception symptoms when treating insomnia and anxiety as a comorbidity.