Sleep characteristics of Japanese working men who score alexithymic on the Toronto Alexithymia Scale

Insomnia and Alexithymia in Chinese Adolescents with Major Depressive Disorder: A Cross-Sectional Study of Sex Differences and Associations

Purpose

Insomnia is related to alexithymia in adults, but the relationship between insomnia and alexithymia in adolescents with major depressive disorder remains unclear. This study aimed to investigate the sex differences and the association between insomnia and alexithymia in adolescents with major depressive disorder.

Patients and Methods

From October 2020 to April 2022, adolescent patients with major depressive disorder were recruited from psychiatric departments of seven hospitals in Anhui Province, China. Their general demographic and clinical information were collected. The 20-item Toronto Alexithymia Scale, the Center for Epidemiologic Studies of Depression Scale, and the Insomnia Severity Index Scale were used to assess their alexithymia, depression, and insomnia symptoms, respectively. The analysis of variance (ANOVA), Student's t-test and Mann-Whitney U-test were used for continuous variables and chi-square tests for categorical variables. Pearson's correlation analysis and Spearman correlation analysis were used to examine the correlation between ISI and demographic and clinical variables. Multiple binary logistic regression analyses with the "Enter" method were carried out to explore the correlations of insomnia.

Results

The prevalence of insomnia in female adolescent patients was similar to that of male patients (χ2=1.84, p = 0.175). Compared with those without insomnia, patients with insomnia had worse family relationships (F = 7.71, p = 0.021), perceived heavier academic stress (F = 6.32, p = 0.012), more likely to take sedative-hypnotics (F = 5.51, p = 0.019), had higher levels of depression (F = 81.57, p < 0.001) and alexithymia (F = 28.57, p < 0.001). Correlation analysis showed that alexithymia was significantly associated with insomnia in adolescent patients (r = 0.360, p < 0.01). Binary logistic regression analyses showed that, alexithymia was significantly associated with insomnia in female patients (OR = 1.050, p < 0.05) but not male patients.

Conclusion

In female adolescent patients, alexithymia is a risk factor of insomnia, which is of great importance in the understanding of the psychopathological mechanisms, treatments and psychological interventions of insomnia in adolescents with major depressive disorder.

Alexithymia, Phosphorus Levels, and Sleep Disorders in Patients on Hemodialysis

Alexithymia, or the inability to distinguish between bodily feelings and emotions, has been linked to poor sleep quality in some studies. Rare studies examined the associations between electrolyte phosphorus in patients on hemodialysis and their sleep quality, daytime sleepiness, and alexithymia with inflammatory factors. Hemodialysis is a treatment method for terminal renal patients that involves the diffusion of unwanted metabolic products through the dialyzer membrane. Our study aimed to examine whether there was a difference in phosphorus levels, inflammatory factors, and daytime sleepiness according to the hemodialysis patients’ levels of alexithymia. The study involved 170 HD patients that had been treated with chronic dialysis for more than three months. Prior to the hemodialysis procedure, laboratory findings were sampled. Respondents completed the Pittsburgh Sleep Quality Index, the Toronto Alexithymia Scale 26, and the Epworth Sleepiness Scale, and were questioned about depression. The results showed that alexithymic HD patients exhibited significantly higher leukocyte counts, lower predialysis phosphorus values, and more pronounced daily sleepiness than the alexithymia-free group (Mann−Whitney U test, p = 0.02, p = 0.005, and p < 0.001, respectively). We concluded that alexithymia was an independent predictor of high daytime sleepiness in HD patients (OR = 1.05, 95% CI 1.02 to 1.09).

Insomnia affects future development of depression in workers: a 6-year cohort study

The purpose of this study was to investigate the relationship between insomnia and future risk of developing depression. This was a 6-year cohort survey from 2011 to 2017. A questionnaire was conducted with male workers in a manufacturing industry. The questions included the Center for Epidemiologic Studies Depression Scale (CES-D) for evaluating depression and the Athens Insomnia Scale (AIS) for rating insomnia. Data from 1,332 daytime workers aged less than 60 years who had no depressive symptoms at baseline were analyzed. The risk of developing depression in the future was associated with insomnia at baseline, after adjusting for age (hazard ratio [HR] 1.64). Even after adjusting for the covariances of job type, living with family, sleeping time, and undergoing treatment or taking medication, insomnia was associated with the onset of future depression (HR 1.58). In addition, the HR increased as the total AIS score increased: total AIS score 1-3 points (HR 1.99; 95% CI 1.23-3.22), 4-5 points (HR 3.58; 95% CI 2.18-5.89), and 6 points and above (HR 4.24; 95% CI 2.49-7.21). The risk of developing depression in the future increased in correlation with greater severity of insomnia at baseline, suggesting that even slight insomnia can be a risk of future developing depression. It may be important to measure the level of insomnia using an indicator such as AIS, and to improve sleep quality in workers to prevent depression.

Insomnia and depression: risk factors for development of depression in male Japanese workers during 2011-2013

OBJECTIVES

This 3-year cohort study was conducted to investigate the relation between insomnia and development of depression in male workers, and to clarify the association between the severity of insomnia and the onset of depression.

METHODS

Self-administered questionnaire surveys on depression and insomnia were conducted on male workers for 3 years. Depression was assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), and insomnia was examined using the Athens Insomnia Scale (AIS). The analysis was done with 840 men who had no depression at baseline.

RESULTS

Depression symptoms were newly found in 113 men during this study. Cox regression analyses showed that people with insomnia (AIS score of ≥ 1) at baseline had about a 7 times greater risk for onset of depression. Furthermore, compared with those with AIS score of 0 (no insomnia), people with AIS score of 1-3 had a 5.2-fold greater risk of depression and those with a score of 4 or higher indicated about tenfold greater risk.

CONCLUSIONS

A new finding was that the risk for onset of depression increased with the severity of insomnia.

Alexithymia and chronic pain: the role of negative affectivity

OBJECTIVES

Alexithymia has been shown to be associated with key pain-related variables in persons with chronic pain from western countries, but the generalizability of these findings across cultures has not been examined adequately. Also, there remain questions regarding the importance of alexithymia to patient functioning over and above the effects of the general negative affectivity.

METHODS

Alexithymia, pain intensity, pain interference, depression, anxiety, and pain catastrophizing were measured in 128 Japanese patients with chronic pain. Because of the low internal consistency coefficients for 2 of the alexithymia scales (measuring difficulty describing feelings and externally oriented feelings) in our sample, we limited our analyses to a scale assessing difficulty identifying feelings and the total alexithymia scale score.

RESULTS

Although the 20-item Toronto Alexithymia Scale total and the Difficulty Identifying Feelings scale scores were not significantly associated with pain intensity, these scales were associated with pain interference, catastrophizing, and negative affectivity in our sample. However, these associations became nonsignificant when measures of negative affectivity were controlled.

DISCUSSION

The findings support the cross-cultural generalizability of significant associations between alexithymia and both pain interference and catastrophizing. However, whether (1) alexithymia influences patient functioning indirectly by its effects on negative affect or (2) the univariate associations found between alexithymia and measures of patient functioning are a byproduct of both being influenced by negative affect needs to be tested using longitudinal and experimental research.

Job stress factors, stress response, and social support in association with insomnia of Japanese male workers

The aim of the present study was to examine the relation of insomnia with job stress factors, stress response, and social support. A self-completed questionnaire survey was conducted in 212 male Japanese workers at a synthetic fiber plant. With regard to insomnia, subjects were asked the first 5 of the 8 questions on the Athens Insomnia Scale (AIS). Job stress factors, stress response and social support were assessed using the Job Stress Questionnaire. Multiple regression analyses showed that psychological job stress factors of poor appropriateness of work and high qualitative workload were associated with insomnia. The psychological stress response of depression and physical stress responses were also related with insomnia. Depression was also related to appropriateness of work. The present results showed that insomnia was closely related with the psychological job stress factor of appropriateness of work and the psychological response of depression. These mutual relationships between insomnia and poor mental health need be investigated further.

Factors contributing to sleep disturbance and hypnotic drug use in hemodialysis patients

OBJECTIVE

Sleep disturbance and the use of hypnotic medications are common in patients on hemodialysis. Factors that contribute to sleep disturbance and the use of hypnotic medications in hemodialysis patients were investigated.

METHODS

With the use of a questionnaire-based survey, we examined the prevalence of symptoms that reflect sleep disorders such as insomnia, restless legs syndrome (RLS), and snoring and use of hypnotic medications in 252 hemodialysis patients.

RESULTS

The overall prevalence of insomnia was 59.1%, with the prevalence of difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), and early morning awakening (EMA) being 47.6, 24.2, and 28.2%, respectively. Daytime sleepiness and habitual snoring were reported by 42.5 and 33.7%, respectively. The prevalence of routine use of hypnotic drugs was 25.8%. Both RLS and age were significantly associated with insomnia [odds ratio (OR), 3.75; p 0.001, OR, 1.03; p < 0.01]. RLS was a significant factor for DIS, DMS, and EMA (OR, 2.26; p < 0.05, OR, 3.44; p < 0.0005, OR, 4.25; p < 0.0005) and age was a significant factor for DMS and EMA (OR, 1.03; p = 0.053, OR, 1.05; p < 0.005). Both insomnia and snoring were associated with the use of hypnotic drugs (OR, 2.97; p < 0.001, 1.59; p=0.13).

CONCLUSION

Both RLS and sleep-disordered breathing may contribute to sleep disturbance in hemodialysis patients. RLS in particular may be an important factor in insomnia, which in turn is likely responsible for the high prevalence of hypnotic drug use in hemodialysis patients.

An epidemiologic review on occupational sleep research among Japanese workers

Epidemiologic sleep research on Japanese workers has been increasing in recent years. It is timely to give an overview of the sleep issues facing the Japanese working population by reviewing the accumulated epidemiological evidence, which will contribute to the promotion of a sound occupational health policy and the development of occupational sleep research in epidemiology. This paper reviews 24 studies, 13 for non-shift and 11 for shift Japanese workers, identified by using MEDLINE and Japan Cetra Revuo Medicina. The results reviewed are as follows: 1) the prevalence of insomnia and other sleep problems is substantially varied, 5 to 45% for non-shift and 29 to 38% for shift workers, 2) poor sleep quality is related to health, occupational activities and personal relations, 3) the risk or associated factors are identified in pathophysiology (e.g., hypertension), lifestyle behaviors (e.g., diet, alcohol, tobacco), job-related conditions (e.g., job stress, social support, job dissatisfaction, workload, shift schedules) and psychopathology (e.g., depressed mood). The methodological limitations found in the studies and the strategies of future epidemiologic sleep research in workers are discussed.

The relationship between alexithymia, depression, and sleep complaints

The study assessed in normal subjects the hypothesis of a specific association between alexithymia and poor sleep quality, taking into consideration the contribution of depression. Five hundred fifty-four university students (480 F and 74 M) filled out the Italian version of the 20-item Toronto Alexithymia Scale (TAS-20), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Pittsburgh Sleep Quality Index (PSQI). TAS-20 scores were significantly correlated with many measures of self-rated poor sleep quality and also strongly correlated with depression scores. Any association between alexithymia and sleep complaints disappears when the contribution of depression is partialled out by multiple regressions, and only the well-known relationship between depression and impairment of sleep quality is confirmed.

Sleep disturbances and depression in the elderly in Japan

The purpose of the present study was to evaluate the relationship between sleep disturbances and depression in the Japanese elderly.

METHODS

These investigations in the Japanese elderly were carried out with the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, and questions on restless legs syndrome and nocturnal eating disorder. A total of 2023 people (male: 1008; female: 1015; average age: 74.2 +/- 6.3 years) were analyzed by chi2 test and simple and multiple logistic regression. The prevalence of sleep disturbance was 37.3% and that of depression was 31.3%. Female gender and/or older (> or =75 years) age were significantly associated with depression. Characteristics in depressive elderly were poor sleep efficiency, sleep disturbances due to difficulty of initiating sleep (DIS), breathing discomfort, coldness and pain, poor subjective sleep quality and lack of enthusiasm for activities. Sleep disturbances due to using the bathroom, breathing discomfort and coldness and long sleep latency were associated with depression in younger (65-74 years) men. Sleep disturbance due to DIS was associated with depression in older (> or =75 years) men. Sleep disturbance due to pain was associated with depression in younger and older women. Poor sleep efficiency was associated with depression in older women. Poor subjective sleep quality was associated with depression in younger and older men and younger women. Lack of enthusiasm was associated with depression in younger and older men and older women. Restless legs syndrome was statistically significantly associated with depression in younger men. It is concluded that sleep disturbance and depression among the Japanese elderly are closely related symptoms. The features of sleep disturbance with depression differed with sex and age.

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.

Are polysomnographic measures of sleep correlated to alexithymia? A study on laboratory-adapted sleepers

OBJECTIVE

Since recent findings have pointed to a correlation between alexithymia and measures of poor sleep quality during the first night of adaptation to a sleep laboratory, the aim of the current study was to assess the same relation in healthy laboratory-adapted sleepers. As a further measure of rapid eye movement (REM) sleep characteristics, REM density was also measured.

METHODS

Twenty-seven male subjects, without sleep or psychiatric disorders, filled out the 20-item Toronto Alexithymia Scale (TAS-20) and slept for two consecutive undisturbed nights. Polysomnography and REM density were measured in the postadaptation night.

RESULTS

Alexithymia scores did not correlate significantly with any polysomnographic variable or with REM density. Only the Externally Oriented Thinking (EOT) subscale showed a negative association with REM latency. Multiple regression on selected sleep measures as predictors confirmed these results.

CONCLUSION

Results do not extend to normal sleep the association previously found between alexithymia and a poor quality of sleep during the adaptation night in the sleep laboratory. The only polysomnographic measure showing an association, albeit little, with one facet of alexithymia was REM latency.

Alexithymia and polysomnographic measures of sleep in healthy adults

OBJECTIVE

This study examined associations between alexithymia and objective characteristics of sleep (latencies, stages, and amount and patterning of REM sleep) that may contribute to subjective reports of poor sleep quality and impaired dream recall among alexithymic people.

METHODS

Fifty healthy, normally sleeping adults from the community completed the 20-item Toronto Alexithymia Scale and slept uninterrupted for one night in the laboratory while polysomnography was conducted. Various measures of sleep latency, sleep stages, and REM sleep-related variables were obtained, and analyses correlated these sleep measures with alexithymia, controlling for age, sex, and level of depressed affect.

RESULTS

Higher alexithymia scores were significantly related to increased stage 1 (light) sleep and decreased stage 3/4 (deep) sleep. Alexithymia was unrelated to overall sleep efficiency or percentage of stage 2 sleep. Alexithymia was related to more frequent REM episodes and more stage 1 sleep during and immediately after REM episodes but was unrelated to the absolute amount of REM sleep. Alexithymia was also related to an earlier onset of the first REM episode.

CONCLUSIONS

Alexithymia is associated with more light sleep and less deep sleep, which may contribute to subjective reports of poor sleep and increased sleepiness, fatigue, and somatic symptoms. Although alexithymia is not associated with an overall reduction of REM sleep, the increased frequency of episodes of REM that are interrupted and followed by light sleep rather than complete awakenings may contribute to limited dream recall.

Stress coping and social support in glucose tolerance abnormality

We examined coping with stress, including social support, dealing with illness, and mood states, in a sample of 600 persons who underwent primary health-care screening. Subjects were not yet diagnosed as having glucose tolerance abnormality and considered themselves healthy before the examination. Although no significant differences on the existence and perception of social support were found, the utilization of social support was significantly and negatively correlated with the level of glucose tolerance abnormality. The results suggest that poor utilization of social support is associated with the onset of glucose tolerance abnormality.