Sleep problems in university students - an intervention

Schlarb A, Friedrich A, Claßen M. Sleep problems in university students - an intervention. Neuropsychiatric Disease and Treatment. 2017;2017(13):1989-2001.Introduction: Up to 60% of all college students suffer from a poor sleep quality, and 7.7% meet all criteria of an insomnia disorder. Sleep problems have a great impact on the students’ daily life, for example, the grade point average. Due to irregular daytime routines, chronotype changes, side jobs and exam periods, they need specialized treatments for improving sleep. “Studieren wie im Schlaf” (SWIS; (studying in your sleep)) is a multicomponent sleep training that combines Cognitive Behavioral Therapy for Insomnia and Hypnotherapy for Insomnia to improve students’ sleep, insomnia symptoms and nightmares. The aim of the present study is to evaluate the acceptance, feasibility and the first effects of SWIS. Methods: Twenty-seven students (mean =24.24, standard deviation =3.57) participated in a study of pre–post design. The acceptance and feasibility were measured with questionnaires. In addition, the Pittsburgh Sleep Quality Index (PSQI), sleep logs and actigraphy were implemented. Further variables encompassed daytime sleepiness, sleep-related personality traits and cognitions about sleep. Results: Seventy-four percent of the participants reported symptoms of an insomnia disorder, and 51.9% fulfilled all criteria of an insomnia disorder according to the Diagnostic and Statistical Manual of Mental Disorders (fifth edition). Correspondingly, the students suffered from clinically relevant sleep problems according to the PSQI. The SWIS sleep training is a well-accepted and feasible program. Significant improvements were observed in the subjective sleep quality and sleep-related personality traits, as well as clinical improvements in objective sleep measures. Discussion: Findings showed that SWIS is a feasible program for the treatment of sleep problems in college and university students due to its various effects on sleep and cognitive outcomes. Further evaluation of follow-up measurements and additional variables, that is, cognitive performance and mental health, is needed

Sleep better, feel better? Effects of a CBT-I and HT-I sleep training on mental health, quality of life and stress coping in university students: a randomized pilot controlled trial

Friedrich A, Claßen M, Schlarb A. Sleep better, feel better? Effects of a CBT-I and HT-I sleep training on mental health, quality of life and stress coping in university students: a randomized pilot controlled trial. BMC Psychiatry. 2018;18(1): 268.Background The SWIS sleep training for university students showed promising results regarding subjective and objective sleep parameters. As sleep disorders and impaired sleep quality are closely related to various aspects of mental health, the current study examines the effects of the SWIS sleep training on mental health in university students. Methods Fifty six university students (M = 25.84, SD = 5.06) participated in the study, 68% were women. Forty one were randomly assigned to the SWIS treatment (pre-post-follow-up), 15 to a Waiting List Control condition (WLC, pre-post). Besides sleep-related measures, the students completed four online questionnaires measuring mental health, quality of life and stress coping strategies. Effect sizes for the pre-post data were compared between the conditions, long-term effects were calculated with repeated measures ANOVA or Friedman ANOVA. Long-term clinical changes were analyzed with the Reliable Change Index (RCI). Results The pre-post comparisons between SWIS and WLC revealed lower depression scores in both conditions, a better physical state in the SWIS condition and less maladaptive stress coping strategies in the WLC students. The long-term results of SWIS provided significant improvements regarding the students’ somatic complaints, reduced anxiety, an improved physical state and a better quality of life with moderate to large effect sizes. Most of the significant improvements occurred between pre- and follow-up measurement. These statistically significant results were also reflected in clinically significant changes from pre- to follow-up-test. Conclusions SWIS and WLC condition both improved in two mental health variables immediately after the training. These findings may be explained by unspecific treatment expectation effects in the WLC. Interestingly, most mental health outcomes showed significant improvements after 3 months, but not immediately after the training. These positive long-term effects of the SWIS training on mental health indicate that the transfer of strategies might simply need more time to affect the students’ mental health

Infatuation and Lovesickness on Sleep Quality and Dreams in Adolescence

Schlarb A, Brock N, Nussbeck FW, Claßen M. Infatuation and Lovesickness on Sleep Quality and Dreams in Adolescence. Health. 2017;9(01):138-152.Background: Infatuation and lovesickness are widespread and significant experiences in adolescence. Less is known about the connection between infatuation/lovesickness and sleep. The few studies, examining the link between infatuation and sleep quality show inconsistent results. The link between lovesickness and sleep as well as the link between infatuation/lovesickness and dreams has not been investigated yet. The aim of this study was to examine whether infatuation and lovesickness are linked to sleep quality and dreams in adolescents. Methods: A self-assessment online questionnaire was constructed to assess adolescents’ infatuation, lovesickness, sleep quality and dreams. In total, data of 630 adolescents and young adults (150 males, 480 females; aged 16 - 21) were analyzed in this study. Results: Infatuation did not relate to overall sleep quality and dreams. Sleep disturbances, as a component of overall sleep quality, were more frequent in infatuated adolescents. Adolescents currently suffering from lovesickness reported a significantly lower sleep quality, more negative dreams and nightmares. Furthermore, nightmares influenced them more strongly the next day. Conclusions: The associations between infatuation/lovesickness and sleep provide evidence for the far reaching effects of infatuation and lovesickness in adolescents’ lives. The fact that lovesickness leads to lower sleep quality and more negative dreams should be integrated in new approaches of insomnia treatment

Did You Sleep Well, Darling?—Link between Sleep Quality and Relationship Quality

Schlarb A, Claßen M, Schuster E-S, Neuner F, Hautzinger M. Did You Sleep Well, Darling?—Link between Sleep Quality and Relationship Quality. Health. 2015;7(12):1747-1756.Background: Relationship quality and sleep quality influenced physiological and psychological health. Therefore, the aim of the present study was to determine a possible connection between relationship satisfaction and sleep quality and to test a theoretical model of sleep quality as related to relationship and psychological well-being. Methods: Fifty-one heterosexual, cohabitating couples between 24 and 70 years old participated. The relationship quality was measured by the German short version of relationship questionnaire. To determine the sleep quality, the Pittsburgh Sleep Quality Index and a two-week sleep diary were implemented. To gather information about psychological well-being, especially depression and anxiety, the German Symptom Checklist was used. Results: Sleep quality was measured by the Pittsburgh Sleep Quality Index and relationship quality correlated significantly negative. In addition, the study found a positive correlation between sleep duration and relationship quality. In a multiple regression model, fighting and mental strain explained 38% of variance of sleep quality. Depression, anxiety and relationship quality showed no further improvement of the model. These findings suggested that relationship quality, constructive partnership behavior and mental strain played an essential role in sleep quality

Sleep and somatic complaints in university students

Schlarb A, Claßen M, Hellmann SM, Voegle C, Gulewitsch MD. Sleep and somatic complaints in university students. JOURNAL OF PAIN RESEARCH. 2017;10:1189-1199.Background: Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students. Samples and methods: In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs). Results: More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality

Schlaf bei Studierenden - Assoziationen schlechter Schlafqualität und Interventionsmöglichkeiten

Claßen M. Schlaf bei Studierenden - Assoziationen schlechter Schlafqualität und Interventionsmöglichkeiten. Bielefeld: Universität Bielefeld; 2023.Sleep problems are common among university students and are associated with lower grades, longer study duration, and psychological problems. Insomnia symptoms are linked with stress, poor quality of life, more anxiety, and more depressive symptoms, but also with increased pain symptoms. Approximately 18% of German universities students experience insomnia symptoms. A widely used model for insomnia is the cognitive model of Harvey: Negative cognitive activity leads to increased arousal, which is associated with a misperception of sleep and a cognitive bias regarding sleep. Consequences of poor sleep quality and the role of sleep are overestimated. At the end of the model, there are actual impairments in nighttime sleep quality as well as daytime functioning; a cycle is created that perpetuates sleep disturbance. In line with this model, in the first study (Study I), negatively colored cognitive activity as a potential trigger of poor sleep quality was influenced using a positive psychology exercise. The second and third studies focused primarily on daytime impairments-both psychological and somatic symptoms (Study II), as well as concentration and memory (Study III). The second study examined the influence of sleep parameters, such as sleep onset latency and sleep duration, on somatic complaints and reviewed the relationship between anxiety, depressiveness, sleep quality, and somatoform complaints. In addition, this was a cross-sectional study of the prevalence of self-reported psychological distress at a German university. In the third study, a cognitive-behavioral intervention with hypnotherapeutic and imaginative elements was conducted for students with poor sleep quality. Its influence on sleep quality and on subjective and objective neurocognitive performance was examined. A total of 134 students were included in the intervention studies and 2443 students in the cross-sectional study in this dissertation. Subjective sleep quality improved with positive thoughts before bedtime, analogous to Harvey's model. Furthermore, there was a correlation between poor sleep quality, increased somatoform symptoms as well as depressiveness and an indirect influence on anxiety in students, which is why the consequences of poor sleep quality according to Harvey's model were also confirmed in this dissertation. In the third study, an improvement in objective neurocognitive performance was observed in the intervention group, but also in the waiting list control group. Here, an improvement in sleep quality in both groups does not allow a clear conclusion. However, the subjective limitations of cognitive performance improved significantly in the intervention group. This dissertation contributes to a better understanding of mental health in university students - with a focus on sleep quality. It also expands the set of trainings for students with sleep problems to help with poor sleep quality, as well as with sleep onset and sleep maintenance problems, and to mitigate any consequences of poor sleep quality. For the first time, the direct influence of anxiety, depression, and poor sleep quality on increased somatoform symptoms was shown in a statistical model (Study II). The improvement of sleep quality by an exercise from positive psychology was shown in the population of university students (Study I) - this result is consistent with recent studies. The interventional improvement of neurocognitive performance, however, could not be achieved, as in other studies on older subjects (Study III)

Sleep better - Think better! - The effect of CBT-I and HT-I on sleep and subjective and objective neurocognitive performance in university students with insomnia

Claßen M, Friedrich A, Schlarb A. Sleep better - Think better! - The effect of CBT-I and HT-I on sleep and subjective and objective neurocognitive performance in university students with insomnia. Cogent Psychology . 2022;9(1): 2045051.Cognitive demands placed on university students are high and so is the prevalence of insomnia in this population. Neurocognitive functions, such as delayed recall, working memory, and flexibility are often impaired in patients with insomnia disorder. Therefore, this study investigates the development of neuropsychological functioning in students with insomnia symptoms over the course of a sleep training. In this pilot-study 54 university students with symptoms of insomnia were included and randomly assigned to a group intervention with cognitive behavioural therapy and hypnotherapy (n = 35) and a waiting-list control condition (n = 19). Sleep quality and objective measures of neurocognitive performance (attention, inhibition, flexibility, memory, and working memory) were assessed before and after the training or a waiting period of 6 weeks. Both the intervention condition and the waiting-list control condition improved with regards to sleep quality, sleep duration, sleep efficiency, and measures of higher cognitive functions. In addition, students in the intervention condition reported less subjective daytime impairments when compared to the waiting-list control condition. The subgroup of students with short sleep duration benefitted significantly from the intervention in flexibility and working memory tasks. In line with previous studies, improved sleep was associated with improved neuropsychological functioning. The additional improvements observed in students with short sleep duration indicate an association between insomnia severity and neuropsychological improvement

Sag mir, was Du studierst, und ich sag Dir, wie Du schläfst - Über den Zusammenhang von Studienfach und Schlaf

Friedrich A, Claßen M, Schlarb A. Sag mir, was Du studierst, und ich sag Dir, wie Du schläfst - Über den Zusammenhang von Studienfach und Schlaf. Somnologie. 2016;20(4):281-287

Cortisol and sleep in infancy and early childhood

Schlarb A, Lollies F, Claßen M. Cortisol and sleep in infancy and early childhood. Somnologie. 2016;20(3):199-211.Introduction Cortisol release is often associated with physiological arousal or perceived stress. Findings in adults as well as in older children and adolescents show that cortisol is also connected to sleep. Furthermore, it is assumed that high-quality sleep is a predictor of regular cortisol release throughout the day. Objective This review summarizes the current literature on how sleep and cortisol levels are associated in early childhood. Methods In order to identify studies on sleep and cortisol in young children, a structured literature search was performed in the PsychINFO, PsycARTICLES, PSYNDEX, and Google Scholar databases. Results A total of 14 studies could be included this review. According to the results of the reviewed publications, daily cortisol release patterns develop within the first 6 months of life. In addition, young children display a cortisol awakening response (CAR) and cortisol levels are influenced by taking naps during the day as well as by the quality of nighttime sleep. Conclusion After reviewing the recent findings in the literature concerning children from birth up to the age of 5 years, it can be assumed that sleep patterns and sleep are associated with cortisol secretion in early childhood. This finding could be included in the creation and further development of interventional sleep training programs.Einleitung Die Ausschüttung von Cortisol wird oft mit physiologischer Erregung oder wahrgenommenem Stress in Verbindung gebracht. Außerdem zeigen Ergebnisse von Erwachsenen oder älteren Kindern und Jugendlichen, dass Cortisol ebenfalls mit Schlaf zusammenhängt. Es wurde gezeigt, dass eine gute Schlafqualität ein Prädiktor für regelmäßige Cortisolauschüttung über den Tag hinweg ist. Ziel der Arbeit In der vorliegenden Übersichtarbeit wird zusammengefasst, wie der Zusammenhang von Schlaf und Cortisol in der frühen Kindheit in der aktuellen wissenschaftlichen Literatur dargestellt wird. Methode Um die bestehenden Studien zu der Thematik von Schlaf und Cortisol im Kleinkindalter zu ermitteln, wurde eine strukturierte Literaturrecherche in den Datenbanken PsychINFO, PsycARTICLES, PSYNDEX und Google Scholar durchgeführt. Ergebnis Es konnten insgesamt 14 Studien berücksichtigt werden. Den Ergebnissen zufolge entwickeln Kinder innerhalb der ersten 6 Monate ihres Lebens regelmäßige Muster in der Cortisolausschüttung. Darüber hinaus zeigen auch junge Kinder eine „cortisol awakening response“ (CAR), und Cortisolspiegel werden durch Tagesschlaf wie auch durch die Qualität des nächtlichen Schlafs beeinflusst. Schlussfolgerung Nach der Sichtung der Studien zum Zusammenhang von Schlaf und Cortisol bei Kindern im Alter von 0 bis zu 5 Jahren kann angenommen werden, dass Schlafmuster und Schlaf mit der Cortisolausschüttung assoziiert sind. Diese Aussage kann bei der Neu- und Weiterentwicklung von Schlaftrainingsprogrammen berücksichtigt werden