Hyperarousal and Insomnia in Survivors of Cancer

Kristen E Riley; Sheila N Garland; Jun J Mao; Allison J Applebaum; Q Susan Li; Philip R Gehrman; Katherine N DuHamel; Zoe Verrico

doi:10.1007/s12529-021-09962-4

Hyperarousal and Insomnia in Survivors of Cancer

Int J Behav Med. 2021 Dec;28(6):683-691. doi: 10.1007/s12529-021-09962-4. Epub 2021 Feb 24.

Authors

Kristen E Riley^{1

2}, Sheila N Garland³, Jun J Mao¹, Allison J Applebaum¹, Q Susan Li¹, Philip R Gehrman⁴, Katherine N DuHamel¹, Zoe Verrico⁵

Affiliations

¹ Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA.
² Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA.
³ Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, St. John's, Newfoundland and Labrador, A1B 3X9, Canada.
⁴ Perelman School of Medicine, University of Pennsylvania, 3600 Civic Center Blvd., Philadelphia, PA, 19104, USA.
⁵ Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA. zoeverrico13@gmail.com.

Abstract

Background: Cancer survivors are prone to insomnia due to the physical and psychological sequelae of cancer and treatment. Individuals with insomnia may present symptoms of hyperarousal. Cancer survivors with insomnia and trait hyperarousal may require different clinical treatments than patients with insomnia without trait hyperarousal. To our knowledge, no study has examined these factors previously. This study examined the relation between insomnia and trait hyperarousal in cancer survivors.

Methods: The sample included 160 individuals with previous cancer diagnoses who met DSM-5 criteria for insomnia disorder. Measures were collected with cross-sectional batteries of questionnaires, including the Insomnia Severity Index (ISI) and Hyperarousal Scale (HAS). This study is based on baseline data collected in a randomized clinical trial comparing CBT-I to acupuncture for cancer survivors with insomnia (Garland, Gehrman, Barg, Xie, & Mao, 2016).

Results: Hyperarousal was positively associated with insomnia (ISI total score) in bivariate correlations (r = .350, p < .01) and linear regressions (F = 22.06, p < .001). In bivariate correlations, hyperarousal was related to perceptions about the consequences of disturbed sleep rather than reported sleep patterns. For example, hyperarousal was positively related to reported satisfaction (r = .159, p < .05) and worry about sleep (r = .415, p < .01), but not to falling asleep, staying asleep, or awakening too early. In regressions, younger age, insomnia duration, and worry about sleep were uniquely associated with hyperarousal when adjusting for insomnia (B = 0.200, B = 0.177, B = -0.182, p < .05).

Conclusions: Hyperarousal is associated with psychological appraisal of insomnia rather than reported sleep pattern. Younger age and longer duration of insomnia are associated with trait hyperarousal. These findings suggest targeting trait hyperarousal with amplified psychological treatment may lead to more personalized, effective treatment for insomnia.

Keywords: Cancer; Hyperarousal; Insomnia; Sleep.

Publication types

Randomized Controlled Trial

MeSH terms

Arousal
Cancer Survivors*
Cross-Sectional Studies
Humans
Neoplasms* / complications
Sleep
Sleep Initiation and Maintenance Disorders* / epidemiology
Sleep Initiation and Maintenance Disorders* / etiology

Abstract

Publication types

MeSH terms

Grants and funding