Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.

Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.

Social support as a moderator of life stress

Background Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. Methods In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. Results Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. Conclusions Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/206050/YOA20380.pdf

Mortality Associated With Sleep Duration and Insomnia

Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory.

Stress inoculation training originally referred to a relatively specific set of operations (Meichenbaum & Cameron, 1972) In order to evaluate the efficacy of a skills training approach to anxiety management, a study was conducted using phobia as a target problem Treatment involved three phases It began with an educational phase that clarified the cognitive, affective, and physiological concomitants of the client’s avoidant behavior The Schachter (1966) model of emotion was presented to the client, who was encouraged to view anxiety as a reaction involving negative self-statements and images and physiological arousal It was suggested that acquisition of two skills, namely, coping self-statements and self-directed relaxation, would help ameliorate the problem This initial phase was followed by a skills training phase: specific types of coping self-statements and relaxation skills were learned and rehearsed Finally, during an application phase, the client actually tested out the skills in a stressful laboratory situation (unpredictable electric shock was administered) This treatment was found to be more effective than imaginal systematic desensitization, then the standard treatment for phobia

Stress inoculation training

https://psycnet.apa.org/doi/10.1037/h0077132

Dropping out of treatment: a critical review.

DELTA (slow wave, stages 3 and 4) sleep has been widely thought of as deep sleep according to criteria involving cerebral responsiveness or ease of arousal. 1-5 On the other hand, it is commonly felt that exercise promotes sound or deep sleep, a notion supported by recent experimental studies which indicate the delta sleep-promoting effects of exercise both in animals 6,7 and man. 8 Although it was shown in this laboratory 8 that subjects (Ss) who exercise regularly have more delta sleep on days with exercise than on days without it, it was not possible to determine the duration of the effects of exercise on sleep since the Ss never went without exercise for more than two consecutive days. Hence, we decided to study the sleep of a group of Ss used to regular exercise both while they were exercising and over a relatively prolonged

Exercise deprivation. Sleep and psychological reactions.

Visual stage-of-sleep analysis of the sleep EEGs of 10 college athletes under three different conditions of exercise suggests a general positive relationship between exercise and the amount of slow-wave (delta) sleep in a night's sleep as well as a stress effect of exercise obtained in the evening.

Exercise and Sleep Patterns in College Athletes

Twenty-one carefully screened normal Ss used to the sleep laboratory filled out sleep and dream logs both at home and after one or more nights in the laboratory. Subjective descriptions of sleep ordinarily associated with reports of "poor" sleep were related to transient episodes of wakefulness. In general, subjective sleep parameters appeared related to episodes of wakefulness rather than to other sleep stages. Abrupt as opposed to gradual awakenings from sleep favored REM period dream recall. Terminal as opposed to earlier REM periods tended to be associated with detailed rather than vague or no-content dream recall. Presleep tension favored longer sleep latencies, while unusual fatigue promoted transient intercurrent wakefulness. By a number of criteria, Ss appeared to sleep better at home than in the lab.

Reported vs recorded sleep characteristics.

This is an investigation of the psychological characteristics of males who normally obtain over nine or under six hours of sleep per 24 hours, and who function well with these unusual amounts of sleep. The study includes results from detailed sleep histories, sleep logs, psychiatric interviews, and a number of psychological tests. Short sleepers were found generally to be smooth, efficient persons with a tendency towards handling stress by keeping busy and by denial. Long sleepers were "worriers" and were chronically somewhat depressed or anxious; they scored higher than the short sleepers on most tests of pathology. This group also included some creative persons. It is suggested that the differences in sleep need may be aresponseto the above differences in life-style and personality and that sleep, and especially D-sleep, may have a function in restoring the brain and psyche after stress or psychic pain.

Frederick Baekeland

Papers

Dropping out of treatment: a critical review.

Exercise deprivation. Sleep and psychological reactions.

Exercise and Sleep Patterns in College Athletes

Reported vs recorded sleep characteristics.

Psychological differences between long and short sleepers.