Abstract
This study had two primary objectives: (1) characterize the content of presleep cognitions of chronic pain patients and (2) evaluate the association between presleep cognitions and sleep disturbance. Thirty-one outpatients with benign chronic pain completed the Beck Depression Inventory, pain and sleep diaries and participated in an in vivo, presleep thought sampling procedure for 1 week in their homes. The three most frequently reported presleep cognitions were general pain-related thoughts (36%), thoughts about the experimental procedure (27%), and negative sleep-related thoughts (26%). Stepwise multiple regression analyses found that presleep thoughts pertaining to pain and environmental stimuli were significantly associated with sleep continuity, independent from the effects of depression and nightly pain severity. Pain severity was found to be positively associated with Wake After Sleep Onset Time. These results are consistent with cognitive-behavioral models of primary insomnia and suggest the content of presleep cognitive arousal may contribute to sleep disturbance secondary to pain.
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REFERENCES
Affleck, G., Urrows, S., Tennen, H., Higgins, P., and Abeles, M. (1996). Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain 68: 363–368.
Atkinson, J. H., Ancoli-Israel, S., Slater, M. A., Garfin, S. R., and Gillin, J. C. (1988). Subjective sleep disturbance in chronic back pain. Clin. J. Pain 65(2): 225–232.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., and Erbaugh, J. (1961). An inventory for measuring depression. Arch. Gen. Psychiatry 4: 561–571.
Beck, A. T., Steer, R. A., and Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory; Twenty-five years of evaluation. Clin. Psychology Review 8: 77–100.
Bonnet, M. H., and Arand, D. L. (1997). Hyperarousal and insomnia. Sleep Med. Rev. 1(2): 97–108.
Bootzin, R. R. (1972). Stimulus control treatment for Insomnia. Proceedings, 80th Annual Convention, APA, pp. 395–396.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 28(2): 193–213.
Cragg, K., Perlis, M., Aloia, M., Boehmler, J., Millikan, A., Greenblatt, D., and Giles, D. (1999). Questionnare vs. diary assessments of sleep complaints. Sleep 22(Suppl. 1): 244.
Coates, T., Killen, J., Silberman, S., Marchini, J., Hamilton, S., and Thoresen,C. (1983). Cognitive activity, sleep disturbance, and stage specific differences between recorded and reported sleep. Psychophysiology 20: 243–243.
Darlington, R. B. (1990). Regression and Linear Models, McGraw-Hill, New York.
Follick, M., Smith, T., and Ahern, D. (1985). The sickness impact profile: A global measure of disability in chronic low back pain. Pain 21: 67–76.
Gross, R., and Borkovec, T. (1982). Effects of cognitive intrusion manipulation on the sleep-onset latency of good sleepers. Behav. Ther. 13: 112–116.
Hall, M., Buysse, D. J., Reynolds, C. F., Kupfer, D. J., and Baum, A. (1996). Stress-related intrusive thoughts disrupt sleep onset and contiguity. Sleep Res. 25: 163.
Hall, M., Buysse, D. J., Dew, M. A., Prigerson, H. G., Kupfer, D. J., and Reynolds, C. F. (1997). Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement-related depression. Depress. Anx. 6(3): 106–112.
Haythornthwaite, J. A., Hegel, M. T., and Kerns, R. D. (1991). Development of a sleep diary for chronic pain patients. J. Pain Sympt. Manage. 6(2): 65–72.
Hurlburt, R. T. (1979). Random sampling of cognition and behavior. J. Res. Person. 13: 103–111.
Kerns, R. D., Finn, P., and Haythornthwaite, J. (1988). Self-monitored pain intensity: Psychometric properties and clinical utility. J. Behav. Med. 11(1): 71–82.
Kuisk, L. A., Bertelson, A. D., and Walsh, J. K. (1989). Presleep cognitive hyperarousal and affect as factors in objective and subjective insomnia. Percept. Motor Skills 69: 1219–1225.
Lacks, P., Bertelson, A. D., Sugerman, J., and Kunkel, J. (1983). The treatment of sleep-maintenance insomnia with stimulus-control techniques. Behav. Res. Ther. 21(3): 291–295.
Lamberg, L. (1999). Chronic pain linked with poor sleep; Exploration of causes and treatment. JAMA 281(8): 691–692.
Lavigne, G., Zucconi, M., Castrinovo, C., Manzini, C., Marcettini, P., and Smirne, S. (2000). Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems. Pain 84: 283–290.
Lichstein, K. L., and Riedel, B. (1994). Behavioral assessment and treatment of insomnia: A review with an emphasis onclinical application. Behav. Ther. 25: 659–688.
Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain 23: 345–356.
Melzack, R., and Torgerson, W. S. (1971). On the language of pain. Anesthesiology 34: 50–59.
Mitchell, K. R. (1979). Behavioral treatment of presleep tension and intrusive cognitions in patients with severe predormital insomnia. J. Behav. Med. 2: 57–69.
Moldofsky, H., and Scarisbrick, P. (1976). Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom. Med. 38(1): 35–44.
Moldofsky, H., Scarisbrick, P., England, R., and Smythe, H. A. (1975). Musculoskeletal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects. Psychosom. Med. 37: 341–351.
Monk, T. H., Reynolds, C. F., and Kupfer, D. J. (1994). The Pittsburgh Sleep Diary (PghSD). J. Sleep Res. 3: 111–120.
Morin, C., Gibson, D., and Wade, J. (1998). Self-reported sleep and mood disturbance in chronic pain patients. Clin. J. Pain 14(4): 311–314.
Morin, C. M., Kowatch, R. A., and Wade, J. B. (1989). Behavioral management of sleep disturbances secondary to chronic pain. J. Behav. Ther. Exp. Psychiatry 20(4): 295–302.
Morin, C. M., Culvert, J. P., and Schwartz, S. M. (1994). Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. Am. J. Psychiatry 151(8): 1172–1180.
Morin, C. M. (1993). Insomnia: Psychological Assessment and Management, Guilford Press, New York.
Murtagh, D. R., and Greenwood, K. M. (1995). Identifying effective psychological treatments for insomnia: A meta-analysis. J. Consult. Clin. Psychol. 63(1): 79–89.
Nielson, T., McGregor, D. L., Zadra, A., Ilnicki, D., and Ouellet, L. (1993). Pain in dreams. Sleep 16(15): 490–498.
Nielsen, K. D., Drewes, A. M., Svendsen, L., Bjerregard, K., and Taagholt, S. (1994). Ambulatory recording and power spectral analysis by autoregressive modeling of polygraphic sleep signals in patients suffering from chronic pain. Methods Inform. Med. 33: 76–78.
Perlis, M. L., Giles, D. E., Mendelson, W. B., Bootzin, R. R., and Wyatt, J. K. (1997a). Psychophysiological insomnia: The behavioural model and a neurocognitive perspective. J. Sleep Res. 6: 179–188.
Perlis, M. L., Giles, D. E., Bootzin, R. R., Dikman, Z. V., Fleming, G. M., Drummond, S. P. A., and Rose, M. W. (1997b). Alpha sleep and information processing, perception of sleep, pain, and arousability in fibromyalgia. Int. J. Neurosci. 89: 265–280.
Pilowsky, I., Crettenden, I., and Townley, M. (1985). Sleep disturbance in pain clinic patients. Pain 23(1): 27–33.
Schmidt, R. F. (1978). Somatovisceral sensibility. In Schmidt, R. F. (ed.), Fundamentals of Sensory Physiology, Springer-Verlag, New York, pp. 31–80.
Smith, M. T., Perlis, M. L., Smith, M. S., Giles, D. E., and Carmody, T. P. (2000). Sleep quality and pre-sleep arousal in chronic pain. J. Behav. Med. 23(1): 1–13.
Spielman, A., Caruso, L., and Glovinsky, P. (1987a). A behavioral perspective on insomnia treatment. Psychiatr. Clin. North Am. 10(4): 541–553.
Spielman, A. J., Saskin, P., and Thorpy, M. J. (1987b). Treatment of chronic insomnia by restriction of time in bed. Sleep 10: 45–56.
Van Egeren, L., Haynes, S. N., Franzen, M., and Hamilton, J. (1983). Presleep cognitions and attributions in sleep-onset insomnia. J. Behav. Med. 6: 217–232.
Watts, F. N., Coyle, K., and East, M. P. (1994). The contribution of worry to insomnia. Br. J. Clin. Psychol. 33(Pt. 2): 211–220.
Wilson, K. G., Watson, S. T., and Currie, S. R. (1998). Daily diary and ambulatory activity monitoring of sleep in patients with insomnia associated with chronic musculoskeletal pain. Pain 75(1): 75–84.
Wittig, R. M., Zorick, F. J., Blumer, D., Heilbronn, M., and Roth, T. (1982). Disturbed sleep in patients complaining of chronic pain. J. Nerv. Ment. Dis. 170(7): 429–431.
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Smith, M.T., Perlis, M.L., Carmody, T.P. et al. Presleep Cognitions in Patients with Insomnia Secondary to Chronic Pain. J Behav Med 24, 93–114 (2001). https://doi.org/10.1023/A:1005690505632
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DOI: https://doi.org/10.1023/A:1005690505632