Sleep‐related monitoring on awakening mediates the relationship between insomnia‐related interpretive bias and insomnia symptoms using the insomnia ambiguity paradigm

Abstract

Cognitive models highlight the role of attentional and interpretive biases for sleep-specific cues in the development and maintenance of insomnia (Espie et al., 2006;Harvey, 2002). Particularly, the experiences of arousal, distress and negative sleep-related thoughts and beliefs are considered to facilitate the onset of sleepspecific anxiety. This anxiety directs attentional resources towards sleep-related cues related to the internal (e.g., rapid heart rate) and external (e.g., passing car noise) environment (Espie et al., 2006;

Sleep-related Attentional and Interpretive Bias In Insomnia: A Systematic Review and Meta-analysis.

“…Furthermore, seven of eight studies examined group differences in sleeprelated interpretive bias between controls and poor sleepers/insomnia patients demonstrating small to moderate effect sizes. The majority evidenced an interpretive bias to be present in those with disturbed sleep (Akram et al, 2016(Akram et al, , 2021Ellis et al, 2010;Gerlach et al, 2020;. Based on a random effects model, meta-analytic data based on the standardized mean differences of interpretive bias studies determined the weighted pooled effect size (to be moderate., with most estimates being positive.…”

“…These findings suggest that poor sleepers exhibit a bias towards interpreting ambiguous situations in a threat-related manner, whether insomnia or anxiety related. These outcomes have since been replicated in several studies sampling poor sleepers (Akram et al, 2021;Ellis et al, 2010;Gerlach et al, 2020). In poor and normal sleeping students, Ellis and colleagues (2010) examined whether sleep-related questionnaire assessments elicit a priming effect which accentuate interpretive bias outcomes.…”

“…Hence, even though there may be some heterogeneity, the true outcomes of the studies are generally in the same direction as the estimated average outcome. An examination of the studentized residuals revealed that one study (Akram et al, 2021; IAT) had a value larger than ± 2.69 and may be a potential outlier in the context of this model. According to the Cook's distances, one study (Akram et al, 2021; IAT) could be overly influential.…”

“…An examination of the studentized residuals revealed that one study (Akram et al, 2021; IAT) had a value larger than ± 2.69 and may be a potential outlier in the context of this model. According to the Cook's distances, one study (Akram et al, 2021; IAT) could be overly influential. Neither the rank correlation nor the regression test indicated any funnel plot asymmetry (p = .773 and p = .416, respectively).…”

“…Possible mediational factors underlying the relationship between disorder-consistent processing of sleeprelated information and insomnia have only recently been examined from an experimental approach (Akram et al, 2021;Gerlach et al, 2020;Zheng et al, 2018). Gerlach and colleagues (2020) evidenced a positive relationship between pre-sleep worry and poor sleep quality with an increased tendency to choose sleeprelated interpretations of ambiguous sentences when using the IAT.…”