ObjectiveDescribe the development and psychometric validation of a brief scale (the Sleep Condition Indicator (SCI)) to evaluate insomnia disorder in everyday clinical practice.DesignThe SCI was evaluated across five study samples. Content validity, internal consistency and concurrent validity were investigated.Participants30 941 individuals (71% female) completed the SCI along with other descriptive demographic and clinical information.SettingData acquired on dedicated websites.ResultsThe eight-item SCI (concerns about getting to sleep, remaining asleep, sleep quality, daytime personal functioning, daytime performance, duration of sleep problem, nights per week having a sleep problem and extent troubled by poor sleep) had robust internal consistency (α≥0.86) and showed convergent validity with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. A two-item short-form (SCI-02: nights per week having a sleep problem, extent troubled by poor sleep), derived using linear regression modelling, correlated strongly with the SCI total score (r=0.90).ConclusionsThe SCI has potential as a clinical screening tool for appraising insomnia symptoms against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.

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The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the "sleep architecture stigmata" of depression may actually develop over the course transitioning from acute to chronic insomnia.

While there is an extensive literature on predisposing, precipitating, coping and perpetuating factors in those with chronic insomnia, very little work has been undertaken to evaluate these factors over the early developmental course of insomnia. The present aim was to determine whether several hypothesized factors in each domain (predisposing, precipitating, coping and perpetuating), assessed during an episode of acute insomnia, are related to its persistence or remission to normal sleep. Participants comprised n = 140 people with acute insomnia and n = 737 normal sleepers recruited from the general public. Participants completed measures assessing predisposing characteristics (personality traits, arousal predisposition and insomnia vulnerability), precipitating events and outcomes (life events, perceived stress, anxiety and depression), coping styles (thought control strategies and coping styles) and perpetuating factors (sleep preoccupation, pre-sleep arousal, dysfunctional beliefs and fatigue). Additionally, insomnia status (from acute insomnia at baseline to its persistence or natural remission) was assessed one month later (n = 129). Baseline differences between normal sleepers and individuals with acute insomnia were observed in each domain with increasing age, lower openness to experience and conscientiousness, higher insomnia severity, levels of anxiety and affective sleep preoccupation significantly predicting acute insomnia status. Further, a previous episode of insomnia, higher depression scores and affective sleep preoccupation scores significantly predicted its persistence, as opposed to its natural remission. Results are discussed with reference to the conceptualization of insomnia and how the findings may influence the design of preventative interventions to circumvent the transition from acute to chronic insomnia.

Data will be made available on reasonable request. Declaration of Competing Interests: No conflicts of interest declared in relation to this paper. Contributors: All authors contributed to developing the design of this study and data collection. Data was analysed by UA. Interpretation of results was conducted by UA. An initial version of the manuscript was written by UA. Following, input was sought from all other authors who approved the final version of the manuscript.

Perfectionism is one of several personality traits associated with insomnia. Whilst research has examined the relationships between perfectionism and insomnia, the mediating role of dysfunctional sleep-related cognition (i.e. sleep-related worry and dysfunctional beliefs about the biological attribution of and consequences of poor sleep) has yet to be examined. This study aimed to determine whether aspects of multidimensional perfectionism were related to increased reporting of insomnia symptoms. In addition, the potential mediating role of dysfunctional sleep-related cognition and anxiety symptoms was examined. Members of the general population (N = 624) completed the Dysfunctional Beliefs and Attitudes About Sleep Scale, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Multidimensional Perfectionism Scale. The results showed that perfectionism dimensions, anxiety symptoms, and dysfunctional sleep-related cognition were significantly associated with insomnia symptoms. Regression-based mediation analyses further showed that both dysfunctional sleep-related cognition and anxiety significantly mediated the associations between insomnia symptoms and three perfectionism dimensions (i.e. doubts about action, parental expectations, and parental criticism). The experience of perfectionistic tendencies, anxiety, and dysfunctional sleep-related cognition may initiate behavioural strategies (e.g. daytime napping) when faced with an acute sleep problem. However, these strategies may serve to transition insomnia from an acute to a chronic condition.

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