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Thesis (Ph. D.)--University of Washington, 1984. / Vita. Bibliography: leaves [73]-82.

Introduction: Sleep-related cognitive and behavioral characteristics play an important role in the maintenance of insomnia. Culture affects individuals’ belief system and behaviors, but few studies have examined how Chinese subjects describe their experiences of insomnia and how they deal with it. This study explored the topic using qualitative and quantitative approaches. Methods: Participants were recruited from the community via advertisements. Their DSMIV diagnosis of primary insomnia for at least 6 months was confirmed by a sleep specialist with the help of the Structured Clinical Interview for DSM-IV and sleep-wake questionnaires. A focus group approach was used to elicit participants’ insomnia experiences. They were also asked to keep a 1-week insomnia experience diary prior to attending the focus group and to complete a set of sleepwake questionnaires, including the 30-item Dysfunctional Beliefs and Attitudes about Sleep Scale after the group meeting. Each focus group comprised 6 to 8 participants. Discussion was led by a facilitator with a pre-determined question route and it was audiotaped, transcribed verbatim, and managed with NVivo software to facilitate coding and analysis. Focus group data collection ceased when data saturation was achieved. All data were fragmented into meaningful units, compared iteratively, and assigned with descriptive codes to condense the emerging meanings. Codes pertaining to the same phenomena were grouped together and a coding framework was built. The findings from the qualitative study were then validated in a quantitative questionnaire survey of a separate group of participants with chronic primary insomnia and good sleepers. Results: A total of 6 focus groups were arranged, involving 31 women and 12 men, with an average age of 51 years. Participants had a mean duration of insomnia of 11.81 years, and an average sleep-diary derived sleep efficiency of 70.57%. There were 16 sub-categories and 4 categories of characteristics. The 16 sub-categories could be grouped under: 1) beliefs regarding the nature and treatment of insomnia, 2) behavioral responses to insomnia, 3) cognitive-emotional and physiological arousal, and 4) emotional experiences associated with insomnia. Significant difference between primary insomniacs and good sleepers was found on 9 out of 14 items of the quantitative scale we developed based on the qualitative study results. Seven items remained significant after Bonferroni correction (p < .003), including 1) puzzlement about cause, 2) realistic sleep expectation, 3) constant search for treatment, 4) nighttime negative emotions and physiological symptoms, 5) heightened vigilance, 6) association of sleep with suffering, and 7) sleep problem not understood by others. Conclusion: The present study serves as the first to use both qualitative and quantitative approaches to identify the subjective experience of Hong Kong Chinese insomnia patients. Questionnaire study confirmed that the identified experience was also found in a separate chronic insomnia sample. It sheds light on tailoring CBT-I for the local population with chronic insomnia. Further research on the efficacy and acceptance of a tailor-made local CBT-I program is needed. / published_or_final_version / Psychiatry / Master / Master of Philosophy

The purpose of this study was twofold: (a) to examine the effects of thought-stopping on chronic primary initial insomniacs, and (b) to test the attribution model of insomnia. Fourteen mid western university undergraduate students reporting chronic primary initial insomnia were trained to apply thought-stopping to their negative self-attributions specific to sleep at bedtime. They were also asked to report on (a) their perceived sleep onset latencies, and (b) their experienced difficulty falling asleep over a one week period before and a one-week period after treatment.The above 14 subjects were trained by six graduate students in counseling psychology, who, in their turn, were trained by the experimenter in using the thought-stopping technique with insomniacs. For purposes of statistical design and reasoning, a control, and an awareness group of 12 subjects each were used for comparing the outcome measures on perceived sleep onset latencies, and experienced difficulty falling asleep.A one-way multivariate analysis of variance showed statistical significance at the .01 level between pre and posttreatment data on both dependent variables. Post hoc Sheffe tests were computed, and rendered posttreatment differences between groups at the .05 level. Pearson correlations between the two outcome measures, perceived sleep onset latencies, and reported difficulty falling asleep, were also computed and found to be consistently significant at levels ranging from .05 to .0001 in all 14 daily observations except those of day 7 in the main treatment group, and days 9, 10, 11, 12 and 13 in the awareness group.Based on the results of the study, thought-stopping used by chronic primary initial insomniacs, trained to apply it to negative sleep related self-attributions at bedtime, results in reduced reported sleep onset latencies, and results of the present study substantiate the attribution model of insomnia, according to which negative self attributions related to perceived sleeping difficulties provoke cognitive arousal at levels incompatible with sleep onset.

Thesis (M. Med. Sc.)--University of Hong Kong, 2008.

Thesis (Ph.D.)--Drexel University, 2009. / Includes abstract and vita. Includes bibliographical references (leaves 90-97).

Thesis (M.S.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains v, 36 p. Includes abstract. Includes bibliographical references (p. 21-24).

Thesis (M. Med. Sc.)--University of Hong Kong, 2010. / Includes bibliographical references (p. 47-58).

People with insomnia overestimate how long it takes to fall asleep and underestimate the total amount of sleep they attain. While memory is normally decreased prior to sleep onset, this decrease is smaller in insomnia. Insomnia generally and the phenomena of underestimation of sleep and greater memory prior to sleep area associated with arousal including cortical, autonomic, and cognitive arousal. The goal of the present study was to simultaneously examine arousal across these domains in relation to memory and accuracy of sleep estimation. Forty healthy adults completed baseline measures of sleep, psychopathology, and memory, then maintained a regular sleep schedule for three nights at home before spending a night in the sleep laboratory. On the night of the sleep laboratory study, participants completed measures of cognitive arousal, were allowed to sleep until five minutes of contiguous stage N2 sleep in the third NREM period. They were then awoken and asked to remain awake for fifteen minutes, after which they were allowed to resume sleeping. For the entire duration that they were awake, auditory stimuli (recordings of words) were presented at a rate of one word per 30 seconds. Participants slept until morning, estimated how long they were awake and then completed memory testing, indicating whether they remembered hearing each of the words previously presented along with an equal number of matched distracter words. Memory was greatest for words presented early in the awakening, followed by the middle and end of the awakening. High cortical arousal prior to being awoken was associated with better memory, particularly for the early part of the awakening. High autonomic arousal was associated with better memory for the late part of the awakening. Cognitive arousal was not associated with memory. Longer duration of sleep prior to being awoken was associated with better memory for the middle of the awakening. Better memory at baseline was associated with better memory, specifically in the middle of the awakening. Contrary to expectation, memory for the awakening was not associated with accuracy of the perceived length of the awakening. The present study found complementary associations between cortical and autonomic arousal and memory for an awakening from sleep. This suggests that decreasing arousal in both domains may reduce the discrepancy between subjective and objective sleep in insomnia. This also suggests the initial magnitude of decrements in cognitive performance after being awoken are related to deeper proximal sleep initially, while speed of improvement in cognitive performance is related to longer prior sleep duration.

M.Tech. (Homoeopathy) / Please refer to full text to view abstract