Perfectionism and insomnia in adolescents: The role of vulnerability to stress and gender

Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

OBJECTIVES

Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism.

METHODS

Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected.

RESULTS

High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions.

CONCLUSIONS

Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

The Prevalence and Correlates of Depression, Anxiety, and Insomnia among Camp Residing Palestinian Women Migrants during the Outbreak of the War on Gaza: A Cross-Sectional Study from Jordan

Background and Objectives: The current war on the Gaza strip and the circulating violent content is believed to negatively impact the mental health of the Palestinians living in refugee camps outside their homeland. This study explores the prevalence and correlates of depression, anxiety, and insomnia in a cohort of female Palestinian refugees in Jordan who have family members entangled in the persistent conflict in the Gaza strip. Materials and Methods: This cross-sectional study employed validated tools to assess depression, anxiety, and insomnia in women residing in a Gaza camp located in Jerash, Jordan. The correlates were determined by regression analysis. Results: The study unearths disconcerting statistics from 177 recruited women, revealing alarmingly high rates of severe depression (73%), anxiety (60%), and insomnia (65%). Multivariable analysis revealed that severe depression was significantly associated with prior diagnosis with chronic diseases (OR = 3.0, CI = 1.36-6.58), and having a first-degree relative in Gaza (OR = 0.42, CI = 0.20-0.85). Additionally, severe insomnia was associated with "losing relatives or friends in the war" (OR = 3.01, CI = 1.41-6.44), and "losing connection with families and friends" (OR = 3.89, CI = 1.58-9.53). Conclusions: The implications of these results are profound, underscoring the immediate and imperative need for both medical and psychiatric interventions aimed at addressing the substantial psychological burden borne by this population because of the ongoing conflict.

Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study

STUDY OBJECTIVES

Perfectionism is considered a predisposing and maintaining factor for insomnia disorder. However, previous studies were predominantly based on retrospective self-reports of sleep and have yielded mixed results. Here, we investigated associations between perfectionism, daily stress levels, pre-sleep arousal, and actigraphic and sleep diary-derived sleep in insomnia using an experience sampling design.

METHODS

Individuals with insomnia (n = 63) reported their trait perfectionism levels and completed assessments on seven consecutive days. Momentary stress levels were reported on mobile phones at three semirandom time points each day. Presleep arousal levels were rated each morning for the previous night. Sleep onset latency, total sleep time, wake after sleep onset, and sleep efficiency were assessed prospectively using actigraphic watches and sleep diaries.

RESULTS

Perfectionism dimensions and daily stress levels did not predict self-reported or actigraphic sleep parameters. Higher levels of somatic and cognitive presleep arousal were robustly associated with indicators of poorer same-night sleep. The concern over mistakes and doubts dimension of perfectionism interacted with cognitive presleep arousal in predicting self-reported sleep parameters. In the presence of higher presleep arousal, participants with high concern over mistakes and doubts experienced shorter self-reported total sleep time and lower sleep efficiency (both Ps < .01) than on days with lower cognitive arousal.

CONCLUSIONS

Taken together, our results did not indicate an impact of heightened perfectionism levels on sleep in individuals with insomnia, based on prospective sleep assessments. However, our findings provide further evidence for the role of somatic and cognitive presleep arousal, potentially interacting with perfectionism, in the perpetuation of insomnia symptoms.

CITATION

Küskens A, Stricker J, Hertrampf LS, Pietrowsky R, Gieselmann A. Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study. J Clin Sleep Med. 2024;20(3):433-443.

How do teenagers sleep? Analysis of factors related to sleep disorders in a group of Polish high school students

Insomnia is the most common sleep disorder in the adolescent population. Resulting from a complex interplay of genetic, biological, social, and environmental factors, it affects disturbances in everyday functioning in many aspects of life. The aim of the study was to analyze the factors related to the occurrence of insomnia among high school students.

MATERIAL

The study was conducted among 2364 high school students aged between 14 and 19 years old (the average age 17.92 ± 1.10), of which there were 2068 girls and 295 boys.

METHOD

Athens Insomnia Scale (AIS) and authorial demographic data questionnaire involved questions about physical activity during the day, smoking, frequency of upper respiratory tract infections, problems with concentration and memory, school achievements, and the use of mobile devices at bedtime were used to assess examined parameters. The scale and questionnaires were shared on-line via social media.

RESULTS

Analyzing the results obtained in the study group, the average score of 8.42 ± 4.16 was obtained in the AIS, which allows the assessment of sleep disorders bordering on normal. After division into groups of girls and boys, 8.38 ± 4.56 points were obtained, respectively for girls and 8.43 ± 4.27pts. for boys - the difference was not statistically significant. Similarly, statistically significant differences were not found when dividing the groups into the one in which adolescents used the phone just before bedtime and the one that did not use it. The act of sleeping alone or with another person in the room also did not differentiate the groups statistically, as well as the place of residence. Statistically significant worse results in the AIS scale were obtained by people who declared worse physical activity during the day and smoking cigarettes, as well as those who reported more frequent problems with concentration and memory, had worse school performance and suffered from upper respiratory infections more often.

CONCLUSIONS

1). Sleep disorders may be related to factors such as smoking cigarettes or lack of physical activity, as well as difficulties in concentrating attention, memory disorders or worse academic performance and a tendency to contract upper respiratory tract infections. 2). Elimination of factors that may adversely affect the quality of sleep is particularly important in the group of adolescents, in whom the developing structures of the central nervous system may be particularly sensitive to deficiencies in this area. 3). Exploration of the interplay of study duration, screen time, and semester-specific stressors on sleep quality could yield further insights.

Sleep and dropout from upper secondary school: A register-linked study

OBJECTIVE

The present study investigates the association between sleep in late adolescence and completion of upper secondary school.

METHODS

The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked with official educational data in Norway (N = 8838).

RESULTS

High school dropout was more prevalent among adolescents who had insomnia (20.6%) compared to those without insomnia (14.3%; adjusted risk ratios = 1.50; 95% confidence intervals: [2.19-2.92]). There was also a higher rate of school dropout among those who had symptoms of delayed sleep-wake phase (21%) compared to those without delayed sleep-wake phase (14.3%); adjusted risk ratios = 1.43, 95% confidence intervals: (1.28-1.59). School noncompleters were also characterized by reporting 44 minutes shorter sleep duration, longer sleep onset latency, and wake after sleep onset (both approx. 15 minutes) compared to school completers.

CONCLUSION

The importance of sleep for high school dropout rates highlights the importance of including sleep as a risk indicator and a possible target for preventive interventions in late adolescence.

The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional Perfectionism

Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep among individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and posttreatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores posttreatment d = .49. In those receiving treatment, levels of organization d = .49 and parental expectations d = .47 were significantly increased posttreatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicit expectations in patients which are reminiscent of their relationship to their parents.

Sleep Reactivity and Related Factors in Adolescence: An Increased Risk for Insomnia? A Longitudinal Assessment

Purpose

The individual vulnerability for stress-related sleep difficulties (eg, sleep reactivity) is known as a predisposing factor of insomnia in adults, yet relatively little is known about sleep reactivity in adolescence. The study goal is to determine factors related to sleep reactivity and to investigate whether sleep reactivity and related factors predict current and new incidents of insomnia in adolescents.

Patients and Methods

At baseline, 11-to-17-year-olds (N = 185, M_age = 14.3 years, SD = 1.8, 54% female) answered an age-appropriate version of the Ford Insomnia Response to Stress Test, questionnaires about sleep, stress, psychological symptoms, and resources, filled out a sleep diary and used actigraphy. Insomnia diagnoses according to ISCD-3 criteria were assessed at baseline, after 9 months and after one and a half years.

Results

Adolescents with high compared to low sleep reactivity had increased pre-sleep arousal, negative sleep-related cognitions, pre-sleep mobile phone use, stress experience, stress vulnerability, internalizing and externalizing symptoms, less social resources, and a later midpoint of bedtime. High sleep reactivity increased the likelihood for currently having insomnia, but not for the development of insomnia at subsequent assessments.

Conclusion

The findings suggest that high sleep reactivity is related to poor sleep health and mental health but cast doubt on sleep reactivity as a pivotal predisposing factor for the development of insomnia in adolescence.

Dynamic changes in perfectionism dimensions and psychological distress among adolescents assessed before and during the COVID-19 pandemic

This prospective longitudinal study evaluated changes in psychological distress among adolescents, pre-pandemic to intra-pandemic, the extent to which within-person and between-person differences in trait multidimensional perfectionism were associated with such changes, and the role of stress in explaining associations between perfectionism and psychological distress. Adolescents (N = 187; 80% female; 78% White, 7% Asian Canadian, 2% Indigenous Peoples in Canada, 2% Black or African Canadian, 2% Latin Canadian, or 9% Other; M_age  = 17.96 years) completed online surveys assessing perfectionism (i.e., self-oriented perfectionism and socially prescribed perfectionism), depression, anxiety, and stress pre-pandemic (i.e., March 12, 2020 or earlier) and during Ontario, Canada's first (i.e., March 13, 2020 to July 24, 2020) and second (December 26, 2020 to February 7, 2021) government-mandated lockdowns. Between-person differences and within-person changes in multidimensional trait perfectionism were associated with increases in psychological distress and perceived stress. Perceived stress served as an intermediary pathway linking multidimensional trait perfectionism to psychological distress during the pandemic.

Perceived emotional intelligence and subjective well-being during adolescence: The moderating effect of age and sex

Studies focusing on subjective well-being during adolescence are relatively scarce yet necessary, due to the drop in well-being that occurs during this developmental stage. The aim of the present study is therefore: (1) to analyze the variability of perceived emotional intelligence (PEI) and subjective well-being in accordance with sex and age; and (2) to explore the moderating effect of sex and age on the association between PEI and subjective well-being. The sample comprised 1542 students aged between 11 and 18 years, divided into two age groups: younger (11–14 years) and older (15–18 years). All participants completed the Trait Meta Mood Scale and the Satisfaction with Life Scale. Several ANOVAs and MANOVAs were performed using the SPSSv.28 statistical package. The simple moderation models were analyzed using the PROCESSv.4 macro. Age was the socio-personal variable that most significantly affected emotion repair and life satisfaction, whereas sex had a greater effect on the other variables studied. Sex moderated the predictive effect of emotional clarity on negative affect among girls, the predicted the effect of emotional attention on positive affect among boys, as well as the predictive effect of emotional clarity on life satisfaction in both groups. The theoretical and practical implications of these results are discussed.

Multidimensional perfectionism and poor sleep: A meta-analysis of bivariate associations

The link between perfectionism and poor sleep has been intensively debated, and previous studies on perfectionism-sleep associations have yielded mixed results. Recent research suggests that the two-dimensional perfectionism model, differentiating perfectionistic concerns (centered around concerns over imperfections) and perfectionistic strivings (centered around excessively high personal standards), may reconcile previously inconclusive findings, as both dimensions might be differentially related to sleep. Thus, to clarify the perfectionism-sleep link, this meta-analysis investigated relations of perfectionistic concerns and strivings with two well-established self-report measures of poor sleep. A systematic literature search yielded 55 effect sizes from 15 studies (N = 10,275) for inclusion in this meta-analysis. Perfectionistic concerns correlated positively with the Insomnia Severity Index (r⁺ = 0.221, 95% CI [0.102, 0.333], p = .004) and the Pittsburgh Sleep Quality Index (r⁺ = 0.248, 95% CI [0.172, 0.321], p < .001). Perfectionistic strivings correlated positively, albeit less strongly, with the Insomnia Severity Index (r⁺ = 0.114, 95% CI [0.039, 0.189], p = .010), but not significantly with the Pittsburgh Sleep Quality Index (r⁺ = 0.028, 95% CI [-0.026, 0.082], p = .247). These meta-analytic findings indicate that perfectionistic concerns are substantially linked to poor sleep, whereas the relation of perfectionistic strivings with sleep is less evident. Although the identified associations were less robust for perfectionistic strivings than for perfectionistic concerns, previously used labels like "positive" or "adaptive" appear inappropriate for perfectionistic strivings in the context of sleep.