The Natural History of Insomnia: Predisposing, precipitating, coping and perpetuating factors over the early developmental course of insomnia

Sleep. 2021 Apr 13;zsab095. doi: 10.1093/sleep/zsab095. Online ahead of print.

Abstract

While there is an extensive literature on predisposing, precipitating, coping and perpetuating factors in those with chronic insomnia, very little work has been undertaken to evaluate these factors over the early developmental course of insomnia. The present aim was to determine whether several hypothesized factors in each domain (predisposing, precipitating, coping and perpetuating), assessed during an episode of acute insomnia, are related to its persistence or remission to normal sleep. Participants comprised n = 140 people with acute insomnia and n = 737 normal sleepers recruited from the general public. Participants completed measures assessing predisposing characteristics (personality traits, arousal predisposition and insomnia vulnerability), precipitating events and outcomes (life events, perceived stress, anxiety and depression), coping styles (thought control strategies and coping styles) and perpetuating factors (sleep preoccupation, pre-sleep arousal, dysfunctional beliefs and fatigue). Additionally, insomnia status (from acute insomnia at baseline to its persistence or natural remission) was assessed one month later (n = 129). Baseline differences between normal sleepers and individuals with acute insomnia were observed in each domain with increasing age, lower openness to experience and conscientiousness, higher insomnia severity, levels of anxiety and affective sleep preoccupation significantly predicting acute insomnia status. Further, a previous episode of insomnia, higher depression scores and affective sleep preoccupation scores significantly predicted its persistence, as opposed to its natural remission. Results are discussed with reference to the conceptualization of insomnia and how the findings may influence the design of preventative interventions to circumvent the transition from acute to chronic insomnia.

Keywords: Acute Insomnia; Depression; Prevention; Sleep Preoccupation; Spielman.