Perceived pre-sleep arousal in patients with persistent psychophysiologic and psychiatric insomnia

Two groups of clinical patients with persistent insomnia (22 with psychophysiologic insomnia and 18 with insomnia associated with affective disorders) were evaluated in a sleep disorders unit. Cognitive and somatic aspects of pre-sleep arousal were evaluated by use of the pre-sleep arousal scale (PSAS). Further, general anxiety and depression during the day was evaluated by self-rating scales, and sleep was evaluated objectively with polysomnography and subjectively by use of a morning questionnaire. Results showed that in psychophysiologic insomnia cognitive and somatic aspects of pre-sleep arousal were significantly associated with both objectively recorded and subjectively estimated sleep latency and total sleep time. This suggests that in psychophysiologic insomnia pre-sleep arousal is linked to the pre-sleep period in agreement with the notion that excessive pre-sleep arousal contributes to the persistence of sleeping difficulties in these patients. Conversely, in psychiatric insomnia, pre-sleep arousal was significantly associated with general anxiety and depression but not with sleep, which suggests that pre-sleep arousal is linked to the underlying disorder in these patients.