Cognitive and psychological factors associated with severe insomnia in Brazilian women: a cross-sectional study

Abstract

Insomnia is the most prevalent sleep disorder in women. Sociodemographic, cognitive, and psychological factors may contribute to its severity. This study evaluated factors associated with severe insomnia in women with insomnia complaints. We evaluated 530 women aged 18–59 (mean = 40.5, SD = 10.2), who experienced insomnia complaints, using self-report instruments. Severe insomnia was defined as a score above 21 on the Insomnia Severity Index. Age, marital status, educational level, depression and anxiety, psychological inflexibility, and beliefs about sleep were assessed as potential factors associated with severe insomnia. Simple and multivariate analyses were conducted using binary logistic regression. Low education level (odds ratio; OR = 1.85 [1.27–2.69]), depression (OR = 2.17 [1.27–3.81]), psychological inflexibility (OR = 1.05 [1.02–1.08]), and dysfunctional beliefs about sleep (OR = 1.04 [1.02–1.06]) were factors associated with severe insomnia scores in the multiple logistic regression model. These findings are important from a public health perspective, because behavioral strategies designed to treat insomnia with a focus on cognitive and psychological factors are low-cost treatments and may help improve sleep quality in women, which also influences mental health.

Association Between Sleep-related Cognitions, Sleep-related Behaviors, and Insomnia in Patients with Anxiety and Depression: A Cross-sectional Study

“…Previous studies support that comorbid psychiatric disorders are associated with more behavioral symptoms and psychological inflexibility, leading to increased concerns about sleep and mal-adaptive behaviors, culminating in poor sleep quality. 17,46 Our findings concur with studies that revealed that pre-sleep arousal and sleep-related safety behaviors were linked with poor subjective sleep quality. 15,47,48…”

Sleep health challenges among women: insomnia across the lifespan

“…Women may experience greater levels of pre-sleep arousal, with resultant difficulties in falling asleep. This may be attributed in part to higher reports of worrying around bedtime in women as compared to men (El Rafihi-Ferreira et al, 2022). Working middle-aged women report ruminating and worrying about daily tasks at night, and may be under increased stress induced by the competing demands of paid work and unpaid domestic labor which may also restrict time that can be allocated toward adequate sleep (Sidani et al, 2019).…”