Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns

Abstract

Study objectives: While anxiety rates are alarmingly high in short sleeping insomniacs, the relationship between insomnia and anxiety symptoms has not been extensively studied, especially in comparison to the relationship between insomnia and depressive symptoms. Using residency training as a naturalistic stress exposure, we prospectively assessed the role of sleep disturbance and duration on anxiety-risk in response to stress. Methods: Web-based survey data from 1336 first-year training physicians (interns) prior to and then quarterly across medical internship. Using mixed effects modeling, we examined how preinternship sleep disturbance and internship sleep duration predicted symptoms of anxiety, using an established tool for quantifying symptom severity in generalized anxiety disorder (GAD). Results: Pre-internship poor sleepers are at more than twice the odds of having short sleep (≤6 h) during internship as good sleepers (OR = 2.38, 95% CI = 1.61, 3.57). Poor sleepers were also at twice the odds for screening positive for probable GAD diagnosis (OR = 2.08, 95% CI = 1.26, 3.45). Notably, sleep onset insomnia strongly predicted anxiety development under stress (OR = 3.55, 95% CI = 1.49, 8.45). During internship, short sleep associated with concurrent anxiety symptoms (b = −0.26, 95% CI = −0.38, −0.14) and predicted future anxiety symptoms even more strongly (b = −0.39, 95% CI = −0.76, −0.03). Conclusions: Poor sleepers, particularly those with sleep onset insomnia symptoms, are vulnerable to short sleep and GAD anxiety and worry during chronic stress.

Sleep quality and mental health in the context of COVID-19 pandemic and lockdown in Morocco

“…A close relationship between the occurrence of sleep disorders and anxiety disorders in the general population has been demonstrated [ [25] , [26] , [27] , [28] ]. Furthermore, sleep deficiency during stress states increases exposure to anxiety [ 29 ]. In humans, acute and chronic stress has been shown to have harmful effects on sleep that are released through activation of the sympathetic system [ 30 ].…”

Study of the Effects of Recognition of Stress on Symptoms and Regular Hospital Visits: An Analysis from Japanese National Statistics

“…In addition, it has been pointed out that there are many limits to evaluating stress by means of a questionnaire [ 25 ]. Because of limits to the number of options, insomnia, which has been identified as having a relationship to stress [ 26 ], was not included among the options for symptoms. A more objective method for the evaluation of stress is to obtain samples of saliva and blood, and to examine these for stress markers [ 27 , 28 , 29 ].…”

Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID‐19 outbreak

“…Inadequate or disturbed sleep is experienced by up to 76% of interns (Almojali, Almalki, Alothman, Masuadi, & Alaqeel, 2017), a percentage that rises to 90% when considering interns carrying out shift work (Jaradat, Lahlouh, & Mustafa, 2020). Sleep problems in medical interns mostly include poor sleep quality (Surani et al., 2015), daytime sleepiness (Alami, Ghanim, & Zyoud, 2018) and insomnia (Kalmbach et al., 2019). A recent study by Morales et al.…”