Sleep hygiene, insomnia and mental health

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This first issue of the Journal of Sleep Research in 2018 focuses on sleep hygiene, insomnia and mental health. Altogether, nine papers deal with various aspects of these topics.
Friedrich and Schlarb (2018) provide us with a systematic review of psychological interventions to improve sleep in college students. In so doing, they fill a gap in the literature: until now, most of the work dedicated to psychological interventions, i.e. cognitive behavioural therapy of insomnia (CBT‐I), has dealt with middle‐aged or elderly patients. We now know that sleep problems are extremely common in college students, and sleep problems such as insomnia, nightmares or impaired sleep quality can have a decisive negative impact on mental health, and can also impair academic performance. Friedrich and Schlarb were able to identify 27 studies meeting their strict inclusion criteria, and they grouped the interventions into (1) sleep hygiene, (2) cognitive behavioural therapy (CBT) for insomnia, (3) relaxation, mindfulness and hypnotherapy and (4) other interventions. Fifteen of the investigated studies were classified as randomized controlled trials. Perhaps not surprisingly for someone familiar with the CBT‐I literature, sleep hygiene interventions showed small to medium effects, whereas large effects could be found for CBT‐I; effects were more variable in the relaxation category, and medium‐sized effects were found for other psychotherapeutic interventions. Summarizing, cognitive behavioural treatment for insomnia can also be classified as a highly effective treatment in college students. This should be seen as a very encouraging finding, stimulating further studies in the field and including CBT‐I‐based sleep counselling in psychological programmes for college students. We all know that this period is an extremnely vulnerable one, and as much help as possible should be provided for students, particularly when they have trouble sleeping.
Strong et al. (2018) provide us with very interesting data concerning sleep hygiene behaviours in adolescents living in Iran. By studying 1,822 healthy adolescents with a mean age of approximately 14 years, they investigated relationships between sleep hygiene behaviours, psychological variables and the construct they call the Theory of Planned Behaviour (TPB). This construct serves to explain how an individual's motivational factors determine the likelihood of actually performing health behaviours. Thus, TPB provides a possible framework for the understanding of adolescent sleep hygiene behaviours. This theory acknowledges that it is not only necessary to know about health behaviours (such as sleep hygiene), but other factors also play a role in whether or not these behaviours are enacted in reality. By using a questionnaire that was developed to measure the TPB and general health questionnaires, sleep hygiene knowledge per se did not predict behavioural intentions significantly, but other factors that predicted the actual behaviour based on the construct of the TPB had to come into play. This seems to be an extremely interesting approach in supporting sleep hygiene behaviours, not only by teaching about them, but by looking at intentional and motivational factors which seem to be most important to enable students to enact these behaviours.
A paper from Skarpsno, Nilsen, Sand, Hagen, and Mork (2018) is based on data from the Health Study in Nord‐Trøndelag (HUNT) study, which was undertaken in Norway. This large‐scaled epidemiological study looked at more than 20,000 Norwegians without sleep problems at baseline in 1995–97 and followed them for insomnia in 2006–08. In this specific analysis, physical activity and body mass index were used to test whether this predicts/modifies the association between chronic musculoskeletal pain and insomnia. Not surprisingly, the authors came to the conclusion that chronic musculoskeletal pain increases the risk of insomnia, particularly among those patients who report not only one but several pain sites.

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