Impact of Cognitive and Behavioral Disturbances on Insomnia Symptom Frequency Among Medical Students

Background: About 30% of medical students report insomnia. Insomnia increases risk of depression, anxiety, and mental health disturbances. Both behavioral (e.g., clock watching) and cognitive factors (e.g., worry) contribute to insomnia. We hypothesized that experiencing cognitive and behavioral disturbances would predict more frequent insomnia symptoms among medical students. Methods: Participants were 128 1st/2nd year medical students. Mean age was 24.2 years (SD=3.5) with 61% female, 6% Hispanic, 51% Caucasian, 37% Asian American, and 2% Black. Data were collected during Fall/Spring semesters from 2016/2017. Students gave informed consent prior to reporting on sleep disorder symptoms including insomnia, daytime sleepiness, and sleep habits. Students reporting sleep apnea symptoms were excluded from analyses. Univariate regression analyses determined significant predictors of insomnia symptom frequency. Results: Clock watching (p< 0.001), strong emotions 1-hr before bed (p< 0.001), going to bed upset (p< 0.001) and worrying about school in bed (p=0.037) were significant predictors of more frequent insomnia symptoms. Results also showed trends for napping after 6pm; calm/relaxing activity or being very active 1-hr before bed; stomachache when going to bed; and falling asleep in bright light predicted insomnia symptom frequency. Conclusion: Cognitive disturbances were more likely to predict insomnia symptom frequency among medical students. Behavioral and cognitive disturbances increase physiological arousal, which contributes to insomnia; however, cognitive disturbances are more often associated with a negative interpretation (e.g., worrying about school versus being very active). Findings suggest that sleep hygiene, which targets mainly behavioral factors, is likely not a sufficient intervention for this population.