
Daytime Negative Thoughts Have an Impact on Sleep
Recent research shows that daytime thoughts can interfere with sleep just as much as nighttime thoughts.
Most patients are well aware that anxious thoughts at bedtime can keep them up at night. Recent research also shows that it is not just nighttime thoughts that interfere with sleep—daytime thoughts can interfere with sleep as well. Additionally, anxious thoughts involve several distinct features. Worry and rumination are specific types of anxious thoughts. While they often coexist and have some similar features, worry and rumination are not the same, and they each independently impact
Patients often do not seek professional help for managing anxious thoughts. However, many patients do seek help to get treatment for symptoms of fatigue, sleepiness, low energy, and other effects of sleep deprivation. While these issues can be caused by medical problems that should be ruled out, like anemia and heart disease, insufficient sleep due to insomnia is a common cause of daytime symptoms.
Daytime sleepiness caused by insomnia can manifest with difficulty concentrating, diminished ability to multitask, impaired emotional regulation, and falling asleep during activities such as meetings and driving. Objective sleep measures may also reflect shortened daytime sleep latency.
A research study involving 459 adults published in Behavioral Sleep Medicine considered worry and rumination as 2 separate constructs, a distinction that had been established in previous literature. Worry is thinking about future events that may have undesirable outcomes, particularly if there are factors that a person may not be able to control. Rumination involves recurrent negative thoughts and can include repeatedly thinking about problems or events (usually negative events), especially those that have happened in the past and cannot be changed. Using patient self-reports, the researchers found that each of these factors individually contributes to daytime sleep-related impairment. Furthermore, analysis specifically showed that worry was a predictor of sleep disturbance, and that rumination predicted sleep-related daytime impairment.1 This suggests that each of these may have a different impact on patients’
Traditionally,
The impact of daytime thoughts on nighttime sleep suggests that strategies for reducing worry and rumination at the time of sleep might not be enough to alleviate insomnia. To have a greater impact, strategies to reduce worry and rumination can also address the problems of anxious daytime thoughts. Several approaches are used to manage worry and rumination. Habits that help with problem solving and with providing a frequent sense of closure can reduce rumination and worry and may help alleviate anxious daytime thoughts. Additionally, rumination-focused cognitive behavioral therapy can be administered by a qualified therapist. This can relieve symptoms of rumination and has been used as a treatment for different age groups.3 Treatments using a mobile app may be effective for helping patients who have these problems as well.4
In general, worry and rumination are not uncommon, and they can affect patients who do not have a psychiatric condition. Most patients recognize the effects of nighttime anxious thoughts on their sleep. But the impact of daytime
Dr Moawad is associate editor, Humanities in Neurology; clinical assistant professor, Case Western Reserve University School of Medicine, Division of Medical Education; and editor in chief emeritus of Neurology Times (2017-2019).
References
1. Tutek J, Gunn HE, Lichstein KL.
2. Galbiati A, Giora E, Sarasso S, et al.
3. Cook L, Watkins E.
4. Edge D, Newbold A, Ehring T, et al.
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