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Sleep Quality, Mental and Physical Health: A Differential Relationship

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This study aimed to explore the association between sleep quality and its components and both dimensions of health-related quality of life (HRQoL) in a sample of young adults. The sample comprised 337 participants with a mean age of 19.6 y (SD = 2.22). Sleep quality and HRQoL were measured through the Pittsburgh Sleep Quality Index and the SF-12, respectively. Regression analyses were used to investigate the association between sleep quality and HRQoL. Our results confirm the significant association between sleep quality and both physical ( p = 0.015; β = −0.138; R 2 = 0.07) and mental ( p < 0.001; β = −0.348; R 2 = 0.22) HRQoL in the adjusted models. However, our results also highlight the differential association between sleep quality and mental and physical HRQoL. Whereas all the sleep quality components (except sleep latency; p = 0.349) were significantly associated with mental HRQoL ( p < 0.05), just two subscales (subjective sleep quality; p = 0.021; β = −0.143 and sleep disturbances p = 0.002; β = −0.165) showed a significant association. This study showed that there is a stronger association between sleep quality and mental health than sleep quality and physical health in young adults.

1. Introduction

Sleep is an essential and universal function for humans [ 1 ]. Sleep is now considered one of the three basic pillars of health together with diet and exercise [ 2 ]. Poor sleep quality has a negative impact in different areas related to physical health such as type 2 diabetes [ 3 ], hypertension [ 4 ], chronic pain [ 5 ] and higher levels of body mass index [ 6 , 7 ] among other adverse consequences.

In addition to this, poor sleep quality is also related to negative psychological consequences such as anxiety and depression [ 8 ], aggression [ 9 ], altered cognitive functioning [ 10 ], and attention-deficit/hyperactivity disorder [ 11 ] among others.

The above-cited literature shows the importance of sleep quality for both physical and mental health. Adolescence is a critical period for sleep quality [ 12 ] and is also critical for psychopathology [ 13 ]. The scientific literature reveals that adolescence is a stage of the lifespan with a high vulnerability. There is a high comorbidity between psychiatric disorders and sleep problems [ 14 , 15 ]. This is especially important should we consider that there is a bi-directional relationship between sleep disturbances and mental health [ 8 , 14 ]. Previous research has shown that sleep treatments may have a positive impact not only on sleep outcomes but also on mental health and HRQoL (Health-Related Quality of Life) [ 14 , 16 , 17 ]. Researching the relationship between sleep quality and HRQoL in adolescence and young adulthood might put us in a stronger position to prevent the development (or worsening) of both sleep and health problems since sleep is a modifiable determinant of health [ 18 ].

Sleep quality is a broad concept that includes several measures such as sleep latency, sleep efficiency, sleep disturbances, sleep duration, and use of sleeping medication among others [ 19 ]. Previous research has shown that poor sleep quality among university students is high [ 20 , 21 , 22 ] There is a significant amount of scientific literature that has previously addressed the relationship between sleep quality and HRQoL in adolescents [ 23 ] and young adults [ 24 , 25 ]. It has been found that people suffering from sleep disorders have lower levels of both physical and mental HRQoL showing moderate R 2 for the physical and mental components, although depending on the disorder, the impact of some disorders is more pronounced on the mental component or the physical component (e.g., apnea has a higher impact on physical health whereas insomnia has a higher impact on mental health) [ 26 ]. In addition to this, a study performed with a sample of children showed that distinct sleep quality subtypes could have a differential impact on HRQoL [ 27 ].

Even though sleep quality is a broad concept that has a significant impact on both mental and physical HRQoL, there is a scarcity of research addressing this issue. Therefore, this study was aimed to disentangle the role of the specific components of sleep quality on both physical and mental HRQoL in a sample of young adults controlling for relevant confounders.

2. Materials and Methods

2.1. participants.

All participants were university students from the University of Alicante. The University of Alicante is a public University in the south-east of Spain. Data were collected through an online interview and promoted using email distribution lists and university virtual platforms, during the third term of 2019. No exclusion criteria were applied. However, participants above 30 y (7.67%) were excluded because our target group was young adults and to maintain the sample homogeneously. The final sample comprised 337 participants over 18 y, all of whom provided informed consent. The sample was 78.6% female and the mean age was 19.63 y (SD = 2.22).

2.2. Measures

Sleep quality was measured by means of the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a widely used questionnaire [ 19 ] This questionnaire provides a global score and 7 sub-scales. These seven sub-scales (i.e., subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleeping medication and daytime dysfunction) build the global score which ranges from 0 to 21 (higher scores represent poorer sleep quality).

The Spanish validated version of the PSQI was used in this sample [ 28 ]. This questionnaire has also shown adequate psychometric properties [ 28 ]. To check the internal consistency of this scale, in the current sample, which is how closely a set of items are as a group we calculated Cronbach’s Alpha and the result was 0.67 for the global score.

HRQoL was measured using the SF-12 Health Survey (SF-12) which has been validated in a Spanish population [ 29 ]. This is an instrument that evaluates the quality of life in the general population. It comprises 12 items and has 8 dimensions (i.e., general health, physical functioning, role physical, role emotional, body pain, social functioning, mental health, and vitality). These dimensions yield two summary components: the physical component summary (PCS) and the mental component summary (MCS). These two components range from 1 (“worse health condition”) to 100 (“best health condition”). Scores equal to or less than 30 are considered a risk. The SF-12 is a valid and reliable measurement tool, with an internal consistency exceeding 0.70 [ 25 ]. In the current sample, the Cronbach’s Alpha was 0.81 for the global score.

Diet, stress and exercise were measured using the Lifestyle Indicator questionnaire. The diet component ranges from 0 to 15, exercise from 0 to 24 and stress from 1 to 6. Higher scores represent healthy eating habits, higher levels of exercise and low levels of stress [ 30 ].

2.3. Statistical Analyses

All the analyses were performed using STATA statistical software (v12.0). We performed descriptive statistics for demographics and the key variables involved in this study, sex differences were tested. Both dimensions of HRQoL (i.e., PCS, MCS) were treated as continuous variables and as was the global PSQI. As for sleep quality sub-scales, they were treated as continuous variables when it was possible (i.e., sleep latency, sleep duration, sleep efficiency and sleep disturbances). The rest of the sub-scales were treated as ordinal variables according to the original coding from the PSQI. Sleep latency was measured in minutes, sleep duration in hours and sleep efficiency was calculated following the instructions from the PSQI questionnaire to get the % of sleep efficiency. Finally, sleep disturbances were calculated by the sum of all the possible sleep disturbances presented in the questionnaire and their frequency (i.e., 0: not during the past month; 1: less than once a week; 2: once or twice a week; 3: three or more times a week). We considered age, sex, diet, stress and exercise as covariates. These variables showed an association of p < 0.20 in the univariate model between HRQoL and the covariate. Regression models were applied to test the association between each sub-scale of the PSQI and also the global score. Therefore, sixteen independent regressions models were fitted (one for each PSQI subscale and one for the global score) where HRQoL (PCS or MCS) was the outcome. All these models were fitted adjusted and unadjusted (i.e., Pearson’s correlation between the sleep variable and the HRQoL component) for covariates (age, sex, diet, exercise and stress).

As diet, stress and exercise have shown to be associated with both sleep quality and HRQoL moderation analyses were also performed to investigate if the association between sleep quality and PCS/MCS was moderated by one of these proposed covariates. Therefore, all models were also tested using these covariates as moderators.

Our sample showed 80% of the power to detect correlations above 0.15.

3.1. Descriptive Statistics

Table 1 shows the descriptive statistics. Regarding sleep quality, the mean value for the global score was 7.03 (SD = 3.32). As for the sub-scales, the average sleep latency was 31.62 min (SD = 28.27) and the mean sleep time was 6.88 h (SD = 1.39). The mean values for the SF-12 subscales were 53.28 (SD = 6.94) and 39.01 (SD = 13.42) for physical and mental HRQoL, respectively. No sex differences were found for Sleep quality nor HRQoL. Regarding the covariates, age and stress showed statistically significant differences between men and women ( p < 0.05).

Descriptive statistics.

Note: t tests for independent samples were used to compare differences between men and women. * Significant differences between men and women ( p < 0.05).

3.2. Association between Sleep Quality and Physical Health-Related Quality of Life

A significant relationship between global PSQI score and physical HRQoL was found in both models, unadjusted ( p = 0.002; β = −0.172) and adjusted for covariates ( p = 0.015; β = −0.138) the R 2 values were 0.03 and 0.07 for the unadjusted and adjusted models respectively.

However, when this relationship was analyzed at the scale level, only two subscales presented a significant association with physical HRQoL. These two subscales were subjective sleep quality ( p = 0.021; β = −0.143) and sleep disturbances ( p = 0.002; β = −0.165) with R 2 values of 0.07 for both variables. The rest of the subscales reached the level of significance, neither in the adjusted model nor in the unadjusted model ( Table 2 ).

Sleep quality and physical health (outcome variable: physical health).

Note: PSQI: Pittsburgh Sleep Quality Index; Adjusted models include: age, sex, diet, stress and exercise as covariates; Beta: standardized regression coefficient.

3.3. Association between Sleep Quality and Mental Health-Related Quality of Life

Global PSQI score also presented a significant association with mental HRQoL unadjusted ( p < 0.001; β = −0.410) and adjusted model ( p < 0.001; β = −0.348) the R 2 values were 0.17 and 0.22 for the unadjusted and adjusted models respectively. Interestingly, all the PSQI subscales, except sleep latency ( p = 0.349), showed a significant association ( p < 0.050) with mental HRQoL with beta values ranging from 0.129 to 0.130 for sleep duration and sleep efficiency, respectively, and ranging from −0.143 to −0.398 for subjective sleep quality, sleep disturbances, use of sleeping medication and daytime dysfunction ( Table 3 ). R 2 values ranged from 0.11 to 0.25.

Sleep quality and mental health (outcome variable: mental health).

The relationship between sleep quality and PCS/MCS was not moderated by any of the tested covariates (stress, diet, exercise) ( p > 0.05). Furthermore, moderation models were fitted for all the PSQI subscales but again none of these variables moderated the relationship between sleep quality subscales and PCS/MCS ( p > 0.05).

4. Discussion

This study started with the aim of deepening knowledge about the relationship between sleep quality and HRQoL. Our results confirm the significant association between sleep quality and both dimensions of HRQoL. These results match well with the previous literature where significant associations have also been found [ 24 , 26 , 31 ], although lower R 2 values were found. This could be due to differences related to sample characteristics. Furthermore, this study has also thoroughly examined this relationship to elucidate the underpinnings of it. Our findings indicate a differential association between the different components of sleep quality and the two studied components of HRQoL (i.e., PCS and MCS). Global sleep quality was significantly related to both components of HRQoL. It is important to note that this relationship was not significantly moderated by stress, diet or exercise, variables that are robustly linked to both sleep quality and HRQoL. However, whereas all the PSQI subscales were significantly associated with MCS, except sleep latency, just two subscales were significantly associated with PCS (i.e., subjective sleep quality and sleep disturbances). Therefore, these results reveal that the impact of each component of sleep quality is different for both constructs of HRQoL. Indeed, it seems that the impact of poor sleep quality is more harmful to MCS than for PCS. However, the comparison with other studies is difficult due to the scarcity thereof. Similar results were found in a study with a sample of young adults where some symptoms of insomnia (i.e., trouble falling asleep, sleep latency ≥30 min and daytime sleepiness) were significantly associated with poor mental HRQoL but not with poor physical HRQoL [ 24 ]. Conversely, in another study that used the PSQI, significant correlations were found between both physical and psychological domains [ 32 ] In addition to this, a recent study carried out in a sample of children aged between 9 and 11 y showed a significant association between HRQoL and self-reported quality and quantity of sleep but no association was established with device-measured total sleep time, sleep timing or sleep efficiency [ 33 ]

Our results are also in line with previous research that has shown that some sleep disorders are more related to PCM (e.g., sleep apnea) whereas others are more related to MCS (e.g., insomnia) [ 26 ]. Mechanisms underlying this relationship are diverse and complex. For example, poor sleep quality has been linked with a higher BMI where it seems that poor sleep quality leads to an increase in BMI [ 7 ]. Sleep quality may affect BMI through hormonal and biochemical changes such as variations in leptin, ghrelin and cortisol levels or increased resistance to insulin [ 34 ]. Some mechanisms underlie the relationship between poor sleep quality and depression and anxiety. For example, the corticolimbic circuitry seems to be affected by poor sleep quality which is related to difficulties in affective reactivity and regulation [ 35 ]. Furthermore, the reward-brain related function may be disrupted by poor sleep quality [ 36 ] Those are just a few examples of how poor sleep quality could affect HRQoL. However, an exhaustive review of all the mechanisms underlying these relationships would be out of the scope of this study and require an extensive explanation.

Levels of MCS and PCM are similar to those obtained with similar samples [ 37 ]. Levels of poor sleep quality are in line with previous research (in the upper end) which shows that poor sleep quality is high among university students [ 20 , 21 , 22 ]. This reveals that poor sleep quality is high among adolescents and young adults. This might be due to biological changes associated with adolescence but also social factors [ 38 ] As it has been stated before, adolescence is a critical period for both mental and physical health. It is possible that in our sample the consequences of poor sleep are more notorious in the MCS component since our sample is quite young and physical consequences due to poor sleep may have not appeared yet because they need more time to manifest. This study shed some light on the pattern of relationships between HRQoL and sleep quality. Prevention programs should be applied in the early stages to prevent HRQoL problems and also sleep problems. Further research is needed to confirm these findings in other samples and using longitudinal designs.

Strengths and Limitations

This study has several strengths such as the use of a young adult sample which allows us to study the relationship between HRQoL and sleep quality in a life-span stage where both problems are common. The use of the PSQI questionnaire allowed us to study the impact not only of sleep quality in general but also on each specific component. However, this study is not free of limitations. First of all, our measures were self-reported, but these questionnaires are widely used to measure sleep quality and HRQoL. Another limitation that should be mentioned is the representativeness of the sample. The sample was recruited using the university resources and that could have resulted in a bias of our results. For example, there could be differences between participating and non-participating students. Finally, several confounders were not taken into account such as BMI, socioeconomic status or mental and physical disorders which could affect our results. Therefore, our results must be interpreted considering these limitations and the generalizability of the results is not completely guaranteed. Future studies should address this issue to extend these findings to different populations

5. Conclusions

Our results confirm the significant association between HRQoL and sleep quality even controlling for relevant covariates (i.e., diet, stress and exercise). Our results also show the differential association between sleep quality and MCS and PCS since just two sleep quality subscales were significantly associated with PCS whereas most of them were associated with MCS. Indeed, the impact of poor sleep quality is larger on the MCS component than on the PCS component. This study highlights the importance of considering sleep quality as a multicomponent measure and also could help us develop more specific programs to prevent both sleep problems and HRQoL problems.

Author Contributions

J.J.M.-V., M.R.-A., I.P.-T. and V.C.-C. conceptualized the original idea and constructed the methodology. J.J.M.-V., M.R.-A., I.P.-T. and V.C.-C. participated in data collection. J.J.M.-V. and M.R.-A. performed statistical analyses. V.C.-C. and J.J.M.-V. wrote the original manuscript in consultation with M.R.-A. and I.P.-T. All authors have read and agreed to the published version of the manuscript.

This research was supported by the Program of Networks-I3CE of Investigation in University Teaching (Program Networks) from the Vice-Rectorate of Quality and Educational Innovation and Education Sciences Institute of the University of Alicante (2019–2020). Ref.: (4807).

Institutional Review Board Statement

The research was conducted following the guidelines of the Declaration of Helsinki and the European Union Good Clinical Practice Standards.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Why Is Sleep Important?

Reviewed by Psychology Today Staff

Sleep is the balm that soothes and restores after a long day. Sleep is largely driven by the body’s internal clock, which takes cues from external elements such as sunlight and temperature. The body’s natural sleep-and-wake cycle is reasonably attuned to a 24-hour period.

Perturbations in the sleep cycle are disruptive to the functioning of many body systems. Learning, memory , stamina, general health, and mood are all affected by sleep duration and quality. For many people, sleep is elusive or otherwise troubled. In fact, most people, at some point in their lives, experience difficulty falling asleep or staying asleep. Potential consequences of consistently poor sleep include obesity, cardiovascular disease, and diabetes. Sleep deprivation can also affect judgement and mental acuity.

Sleep needs differ from person to person and across different age groups. One person may need eight full hours, while another can function with less sleep. The good news is that the treatment of sleep disorders is rapidly progressing.

On This Page

• Why do we sleep?
• How much sleep do I need?
• How long should it take me to fall asleep?
• Do some people need more sleep than others?
• Am I a “short sleeper”?
• How can I get better sleep?
• What is the purpose of dreams?
• What is a chronotype?
• How do I find out my chronotype?
• What is “sleep debt”?
• Should I replace my mattress?
• Can weighted blankets and other tools help me sleep?

Despite the universal need for sleep, there remains much about it that scientists don’t understand. It is known that sleep allows for the body and brain to replenish energy and repair themselves in critical ways. Memory consolidation, information processing, physical growth, muscle repair, and countless other processes are theorized to occur during sleep; sleep is also critical for strengthening the immune system and allowing the body to fight off disease.

To learn more about the benefits of sleep, see Sleep and Mental Health or Sleep and Physical Health.

Sleep needs vary by age, and variation exists even within age groups. But in general, The National Sleep Foundation provides these daily sleep guidelines:

• Infants (4-11 months): 12-15 hours
• School-age children (6-13): 9-11 hours
• Teenagers (14-17): 8-10 hours
• Young adults (18-25): 7-9 hours
• Adults (26-64): 7-9 hours
• Older adults (65+): 7-8 hours

To learn more about how sleep needs change over time, see Children and Sleep.

In general, it should take about 10 to 20 minutes for a person to drift off. But if one perceives that it is taking too long—whether it takes 20 minutes or an hour—that can spur anxiety about sleep that negatively affects sleep quality. Falling asleep as soon as one's head hits the pillow is not proof that one is a good sleeper; it's more likely an indication that an individual is sleep-deprived.

For more on recognizing signs of disordered sleep, see Overcoming Insomnia or Sleep Disorders.

Absolutely. Some people may feel great after 7 hours of sleep, while others don’t feel rested unless they get a solid 9. There do appear to be rare individuals who can function on significantly less sleep, which evidence suggests is due to genetics ; conversely, there appear to be some people who require significantly longer amounts of sleep—up to 10 hours a night—to function optimally.

“Short sleepers”—or those who are genetically programmed to require less sleep than average—do exist, and are thought to make up approximately 5 percent of the population . However, many people who think they are functioning well on little sleep may actually be chronically sleep deprived , as evidence suggests that it becomes difficult for people to objectively judge their mental state after several nights of poor sleep.

The standard sleep hygiene advice can be of great help to many poor sleepers: Make sure your bedroom is cool and dark. Use your bed only for sex and sleep. Avoid caffeine from mid-afternoon on. And avoid all screens for at least an hour before turning in; screens' melatonin-inhibiting blue light delays sleep latency by an average of 10 minutes. Falling asleep in front of a TV, as 61 percent of adults confess to having done, is a problem as well: The screen's light penetrates the eyelids, so the brain still experiences exposure to light. This phenomenon prevents the more refreshing stages of deep sleep.

For more on improving sleep, see How to Sleep Better.

Researchers still aren’t entirely sure, but theories abound. Some experts hypothesize that dreams and nightmares—which often consist, at least in part, of real people, places, and life events—help the brain consolidate memories accumulated over the course of the day, identifying which ones to retain for long-term memory and allowing the rest to fade. Others argue that dream scenarios allow us to process emotions, mull over problems, or act out fantasies in a safe environment. Regardless of their purpose, what is known about dreams is that they appear to be universal—even if some people almost never remember having them.

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The word “chronotype” refers to an individual’s preferred sleep/wake schedule, based on their biologically programmed circadian rhythm . The most well-known chronotypes are “night owls”—or those who prefer to stay up late into the evening and awaken later in the day—and “morning larks,” who lean toward an “early to bed, early to rise” schedule. Chronotypes exist on a spectrum; while a few people are at either extreme, the majority of people fall somewhere in the middle.

Most people discover their chronotype by a process of trial and error; they naturally gravitate toward a specific sleep schedule and feel “off” when that schedule is interrupted. For those who are unsure, there also exist online quizzes that purport to help individuals understand their chronotype.

The term “sleep debt” refers to the difference between the amount of sleep someone needs and the amount of sleep they actually get; someone whose body requires 8 hours of sleep per night, for instance, but only gets 6, would accumulate a 14-hour sleep debt over the course of a week. Accumulating a large sleep debt has been associated with increased risk of certain physical and mental health conditions such as diabetes or anxiety.

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An old or poor-quality mattress may be hindering sleep quality. The Better Sleep Council states that mattresses should be replaced every 7 to 10 years; older ones tend to stop providing adequate support, resulting in restless, inadequate sleep; they also accumulate allergens which can further disrupt sleep.

Many sleep experts endorse the use of weighted blankets, and not just for those with conditions like restless leg syndrome. Users find that the blankets provide the same type of comfort as hugs or swaddling for babies. Wearing a sleep-tracking bracelet that can record when one falls asleep and wakes up, and detect interrupted sleep, can also help some people. Ironically, its primary benefit may be providing reassurance to those who believe they’re getting hardly any sleep—a phenomenon known as paradoxical insomnia .

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127 Sleep Essay Topics and Essay Examples

🏆 best sleep topic ideas & essay examples, 👍 good sleep topics to write about, 💡 interesting sleep topics, ❓ research questions about sleep.

• Problem of Sleep Deprivation This is due to disruption of the sleep cycle. Based on the negative effects of sleep deprivation, there is need to manage this disorder among Americans.
• Sleep Habits and Its Impact on Human Mind Activity The researchers paid attention to the quality of sleep and mentioned such characteristics as the time of going to bed and waking up, the duration, and quality of sleep. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Effects of Sleeping Disorders on Human On the other hand, Dyssomnia relates to sleep disorders that develop as a result of lack of adequate sleep. In some cases, antidepressants have been used to cure sleep disorders that are as a result […]
• Cross-Cultural Sleeping Arrangements in Children The aim of this paper is to study the different sleep patterns such as solitary or co sleeping in the United States of America and different cultures around the world.
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• How Sleep Deprivation Affects College Students’ Academic Performance The study seeks to confirm the position of the hypothesis that sleep deprivation leads to poor academic performance in college students.
• Psychology of Sleep: Article Study The field of sleep and sleep disorders has been an integral part of psychological investigations: a number of scientists find it necessary to contribute sleep education and offer the ideas which help people improve their […]
• Insomnia: A Sleeping Disorder Type Causes of insomnia can be classified into two; factors contributing to acute insomnia and chronic insomnia. Chronic insomnia can be as a result of emotional stress.
• Sleep and Its Implication on Animals This paper is set to synthesize the evolution sleep in animals, its benefits and the recent knowledge that is linked to this natural phenomenon of near unconsciousness.”A Third of Life” addressed what is sleep and […]
• Blue Light Effect on Human Sleep The introduction is comprised of a thesis statement and a description of the critical thoughts of the paper. At the end of the paper, recommendations on how to reduce the adversarial effect of the blue […]
• The Importance of Sleeping and Dreaming Finally, I would not take this pill since I love seeing dreams and realize that this “miracle medicine” will cause too many negative consequences.
• Effects of Sleep Deprivation While scientists are at a loss explaining the varying sleeping habits of different animals, they do concede that sleep is crucial and a sleeping disorder may be detrimental to the health and productivity of a […]
• The Effect of Sleep Quality and IQ on Memory Therefore, the major aim of sleep is to balance the energies in the body. However, the nature of the activity that an individual is exposed to determines the rate of memory capture.
• How the Modern Life Has Affected Sleep Czeisler mentioned in the DW documentary about sleep: “The electric light to which we are exposed in terms of resetting our internal clock is like light on steroids”. That is why we should affect the […]
• Sleep May Be Nature’s Time Management Tool by Carey The author states that no one knows why sleep exists therefore setting the context for the article in which she advances the numerous theories that are advanced as to the role that sleep plays.
• Emotions Clusters and Sleep Failure Earlier critics had argued that PANAS was not suitable for children, and this led to the development of specific PANAS-C for children.
• Sleep and Sensory Reactivity in the School-Aged Children The interaction of these elements should be considered in therapies expressly designed to improve sleep disruptions or sensory processing difficulties in children as a possible negative determinant that may adversely affect children’s health and normal […]
• Stages of Sleep, Brain Waves, and the Neural Mechanisms of Sleep As sleep is extremely important for a person’s well-being, I believe it is essential to pay attention to the mechanisms of sleep and how they work.
• The Issue of Chronic Sleep Deprivation The quality of sleep significantly impacts the health and performance of the human body. These findings point to significant promise for the use of exercise in the treatment of sleep disorders, but a broader body […]
• Sleep-Wake, Eating, and Personality Disorders Treatment On the other hand, treatment with prazosin and mianserin was effective; for example, the drug mianserin benefits patients suffering from sleep disorders. Psychotherapy approaches like Cognitive Behavioural Therapy for Insomnia and Imaginary Rehearsal Therapy are […]
• Sleep and Meditation Can Predict an Individual’s Satisfaction With Life This aim of this study is to investigate the effects of quality sleep and mindfulness on life satisfaction. In a nutshell, life satisfaction depends on the quality of sleep and meditation.
• Water Consumption and Sleep Hygiene Practices First, I will discuss that safe and sufficient water facilitates the practice of hygiene and well-being and is a critical determining factor for health.
• Depression Associated With Sleep Disorders Y, Chang, C. Consequently, it directly affects the manifestation of obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder in people with depression.
• How Technology Affects Sleep in Adolescents The critique will focus on the various sections of the article, where the strengths and weaknesses of each are outlined and discussed. The title of the article excellently reflects the essence of the research.
• Sleep Disturbance in Children Any disorder that alters the craniofacial or pharyngeal anatomy predisposes the child to obstructive narcolepsy is considered a medical problem associated with sleep disturbances in children. Central Sleep Apnea is the repeated cessation or decrease […]
• ADHD and Problems With Sleep This is because of the activity of a person in the middle of the day and the condition around them. The downside of the study is that the study group included 52 adults with ADHD […]
• Solving the Sleep Problem through TQM Principles The initiative to address the lack of sleep among employees and consequently improve their performance and the quality of services requires teamwork optimization.
• Effects of Lullaby Music on Quality of Sleep in Adults With Insomnia Insomnia consists of deprivation of the duration and quality of sleep, which affects the psychological and physical condition of people. In addition, the main limitation may be the unreliability of the information provided by the […]
• Eat, Sleep, and Console: Narcotic Abstinence Syndrome in Infants The choice of the quantitative design is justified by the necessity to prove the superiority of the proposed solution to the one that is currently deployed as the alternative way of managing the needs of […]
• Hippocampus-Dependent Memories During Sleep The smell was chosen because it was not necessary to interrupt the integrity of the subjects’ sleep to introduce it into the experiment.
• Programs in Family Sleep Institute She explained to me the sleep cycle of the child and the adult, how many hours my child is supposed to sleep, the bedtime routine, and the method that we had to adopt during the […]
• Sleeping Habits & Physical Health: Students’ Perception Using the survey as the data collection tool, the investigators state that most students do not have appropriate sleep habits, although they agree that their academic success and physical health suffer because of the lack […]
• Sleep Deprivation and Insomnia: Study Sources The topic of this audio record is a variety of problems with sleep and their impact on an organism. They proved the aforementioned conclusion and also paid attention to the impact of sleep deprivation on […]
• Sleep Problems Among Student-Athletes Despite the importance of the topic under study and the conclusions reached, the work raised additional questions and had some limitations.
• Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems The information in the article “Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems” by Calhoun and Fernandez-Mendoza is used to show that heavy daytime sleeping may be a cause of attention, learning, […]
• Sleep Hygiene Intervention Plan for Young Adults The main goals of this plan are to develop a list of guidelines for nurses on how they can offer a kind of educational program to their patients based on which young adults can understand […]
• Neurocognitive Consequences of Sleep Deprivation The CNS consists of the brain and the spinal cord while the PNS consists of all the endings of the nerve extensions in all organs forming the web that extends throughout the entire organ.
• Sleep Apnea, the Heart and the Brain in the Elderly They should get the necessary treatment of heart diseases and neuromuscular disorders Be attentive to yourself and live a full life!
• Sleepiness Level and Degree: Research Instruments A sum ranging from 0 to 24 of the score on the eight items makes the total score of the ESS.
• Evolutionary Biology: Sleep Patterns in Mammals This synthesis addresses the question of the origin of sleep in mammals and traces this phenomenon by studying the evolution of the mammalian brain and suggesting possible external factors that affect sleep patterns.
• “Childbirth Fear and Sleep Deprivation in Pregnant Women” by Hall To further show that the information used is current, the authors have used the APA style of referencing which demand the naming of the author as well as the year of publication of the article/book […]
• African Sleeping Sickness Using the various forms of detection and diagnosis it was discovered that African sleeping sickness is a major problem in Sub-Saharan Africa.
• The Use of Sleephormone in Children With Neuro-Developmental Disorders For the better management of the data that are planned to be retrieved from the clinical trial procedures, the following list of the definitions and acronyms used in the trial process is given.
• Sleep Deprivation and Learning at University It is a widely known fact that numerous people face the problem of lack of sleep. Second, sleeping is essential for increasing the productivity of students in the context of learning.
• Communication Between Sleep, Behavior and Obesity The purpose of the study seeks to evaluate the association between nighttime media use with sleep behaviors and variation in weight status for first-semester college students.
• Obstructive Sleep Apnea and Heart Diseases In children with Down syndrome, incidence rates of hypertension and sleepiness are high, and the problem is compounded in the presence of OSA.
• Sleep is a Vital Stage of a Day Cycle in Humans During the first stage of sleep, the EEG shifts to theta waves, with a frequency of 4 7 Hz. There are numerous sleep disorders, which can affect the well-being of a person.
• “The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices” by Moon The following analysis is related to the article, “The effect of nursing quality improvement and mobile health interventions on infant sleep practices” by Moon et al.
• Sleep Deprivation: Biopsychology and Health Psychology Another theory that has been proposed in relation to sleep is the Circadian theory which suggests that sleep evolved as a mechanism to fit organisms into the light dark cycle of the world.
• Study of the Sleeping Process The paper entails a comprehensive analysis of the sleeping process in addition to evaluating the factors that affect the sleeping process.
• Sleep Disorders: Sleep Deprivation of the Public Safety Officers The effects of sleep disorders and fatigue on public safety officers is a social issue that needs to be addressed with more vigor and urgency so that the key issues and factors that are salient […]
• Sleep, Satisfaction With Life and Cognitive Function Sleep is the state of the mind involving temporary loss of consciousness leading to the resting of the mind. Sleep is one of the most important requirements in individuals so as to ensure the well-being […]
• Sleep Versus Social Demands in Students The effects of has been exhibited more greatly in animals through studies and all animals have been shown to sleep in different forms.
• Sleep Deprivation: Personal Experiment As I had been perplexed, I did not take a step of reporting the matter to the police neither did I inform my neighbors.
• Sleep Patterns and Memory Performance of Children The article presents the essence, the methods and the results of the experiment which had to show the influence of TV and computer games on German children’s sleep.
• Recuperative Versus Circadian Theory of Sleep The Recuperative theory of sleep is based on the premise that humans require sleep to rejuvenate and recoup spent energy during the waking period.
• Biology. Adolescent Sleep Pattern The habit of sleep is very individual specific therefore a study of the pattern of sleep of a group needs to be evaluated to get an understating of the pattern of sleep.
• Non- and Rapid Eye Movement Sleep Non REM sleep represents 75% of sleep duration and occurs in four stages and REM sleep represents stage 5 of sleep.
• Main Information about Sleeping Disorders In the introduction part the paper provides an overview of sleep and sleep disorders. This led to the conclusion that instead of being a quite and peaceful period of rest and resuscitation as everyone would […]
• Memory Consolidation and Reconsolidation After Sleep The memory consolidation of the visual skill tasks is related to the REM sleep and the short wave component of the NREM.
• Sleep Disorders: Narcolepsy, Obstructive Sleep Apnea, Insomnia An important aspect of the pathogenesis is the autoimmune lesion of the orexin neurons of the hypothalamus, which leads to a decrease in the level of hypocretin-1.
• Sleeping Sickness Transmission and Control Measures Most of the cases of sleeping sickness are usually recorded in the Democratic Republic of Congo, Central African Republic, northern parts of Uganda, Sudan, Angola, Zambia, Uganda, Tanzania, and Malawi.
• Electronic Devices Use and Sleep in US Adolescents During the process of data collection, the authors discovered that most of the participants tended to go to bed very late, which affected the quality of their sleep and their ability to normally function over […]
• The Role of Sleep in Humans’ Well-Being Each of the speakers in the videos focuses on a different characteristic of sleep, but all of them agree that without enough sleep, one does not perform to the fullest potential.
• Sleep Helps to Repair Damaged DNA in Neurons The researchers found that the chromosomes in the fish’s neurons would often change shape while their owners slept, enabling the repair of the damage accumulated in periods of activity.
• Co-Sleeping Impact on Child Development At the same time, it is crucial to pay attention to the phases of sleep and the cycles of awakening. It will help to facilitate the process of sleep in the future and eliminate any […]
• Adolescent Sleep and the Impact of Technology Use Particularly, the authors of the study explain why there is the need to know the answer to the question by providing a profound background to the case and stating that innovative technology has a profound […]
• Sleeping Patterns Within Infants Infant A is put to sleep in the bassinet, and the parents use the sleeping bag in order to make the infant’s sleep more comfortable.
• Sleep Deprivation: Research Methods The purpose of the research will be to determine sleep deprivation, what causes it, the effect, and why sleep is important.
• Coffee Effects on Sleeping Patterns: Experiment Consumption of coffee before going to bed will cause individuals to have difficulty falling asleep The amount of coffee the subjects drink before going to bed The time after going to bed that subjects fall […]
• Sleep Disruptions in Healthcare Professionals First of all, the sleep disruption may lead to a lack of coordination in the team because some members would be fatigued during the working hours, which would interfere with their functioning and concentration in […]
• Physical Activity and Sleep Health in Adults In the introduction to the analysed study, a substantial scientific background for the problem of improving physical activity and sleep in adults is presented.
• Sleep-Disordered Breathing and Acute Ischemic Stroke In this case study, the investigator focused on ischemic stroke, one of the most common types of stroke in the world.
• Insomnia and Narcolepsy: Sleeping Disorders Besides, it was established that people with insomnia are inclined to overestimate the negative effect of sleeping disorder and underestimate the total time of sleep.
• Sleep Patterns’ Impact on Academic Performance Because some university classes begin as early as 7 o’clock in the morning and finish in the evening, the only option for such students is to reduce the length of night-time sleep in order to […]
• Prevalence of Sleep Disorders among Medical Students Nightmares and dreams arise in the course of REM sleep as it is linked to desynchronized and quick brain waves, deferral of homeostasis, and failure of muscular tonus.
• Sleep Deprivation and Specific Emotions The purpose of this study is to develop an understanding of the relationship between sleep deprivation and emotional behaviors. The study looks to create a link between the findings of past researches on the emotional […]
• Sleep Disturbance, Depression, Anxiety Correlation The above imply that many questions are still unanswered with respect to the kinds of sleep complaints affecting undergraduates and the impact on their psychological health.
• Relationship Between Depression and Sleep Disturbance It was emphasized that persistent disturbance, its severity, and the intermittent nature of the sleep were not associated with depression and its recurrence in the following years. The sleeping disturbance is a risk factor that […]
• Sleep and Psychopathology Relationships – Psychology Generally, available evidence shows that feelings of negative emotions such as anxiety are characterized by the dysfunction in cognitive and interpersonal spheres.
• Sleep Disorder Consequences on the Immune System Consequently, the research question for this paper is: what are the consequences of sleep disorder on the immune system? The primary goal of the study is to determine the effects of sleep disorder on the […]
• Importance of Sleep – Psychology Precisely, most of the organs of the body are at rest during sleep. It is during sleep that the body encodes the information it obtains during the day into the memory.
• Dream and Sleep Cycle Dreams occur in any of the phases of sleep, nonetheless, the most concise, clear, vivid and memorable dreams are observed in the last phase of sleep (known as the rapid eye movement REM sleep.
• Changes of Sleep in the Course of One Night Furthermore, voltage generated by eye rotation in their sockets and electrical activities of the muscles all help in the study of the cycles of sleep in the course of one night.
• Sleep Deprivation Impacts on College Students Additional research in this field should involve the use of diverse categories of students to determine the effects that sleep deprivation would have on them.
• Relationship Between Sleep and Depression in Adolescence Using SPSS for data analysis, the results indicate the presence of a correlation between elements of depression and sleep duration and quality.
• Ethical Issues in Treating Obstructive Sleep Apnea with Exercise Independently The approaches should ensure that necessary preventive and curative measures are put in place to facilitate the process of eradicating the disease that is causing immense sleep related complications.
• The Eight Hour Dilemma: Sleeping Time Reduction. When a Single Hour Makes a Difference While reducing the amount of sleeping hours to seven and less can possibly lead to sleep deprivation and the further changes for the worse in a human body, eight hours are no longer the borderline […]
• Infant Sleep Disturbance (ISD) The uniqueness of this study stems from the fact that it would provide a clear understanding of the most effective intervention/basis for physicians and parents to pursue in the management of sleep disorders among infants […]
• Underlying Issues Associated with Sleep Disorders and Stress Of fundamental importance to this research paper is the realization that the amount of sleep that an individual gets is one of the internal factors that influence his or her own capacity to handle stress.
• The Consequences of Poor Sleep Conducting a research devoted to human sleep habits in children and feeling the affect on their confidence as adults, the existing data should be evaluated and the conclusions are to be drawn in the sphere […]
• The Role of Melatonin in Determining the Sleep-Wake Cycle Melatonin plays a significant role in the circadian control of sleep as well as in restraining the development of malignant cells.
• The Phantom Menace of Sleep-Deprived Doctors This is one of the problems that should be addressed by hospital administrators. Therefore, it is vital to develop strategies that can improve the work of medical institutions.
• The Biological Basis of Sleep The authors suggest that it needs more accurate measurement of sleep and wake pattern by the use of the electrooculogram, the recording of the movement of the eye, EEG and electromyogram, the recording of the […]
• Sleep and Dreams: How Do They Work? During sleep, the brain is at rest while the rest of the body system is in active state. Thus, to prevent most of the body disorders in human both psychiatrists and health experts recommend sleep.
• Sleep Disorders with Children and Adolescences This study is important in terms of understanding of the effectives of empirical and theoretical research in the field and attracting the scientist’s attention to the problem so that appropriate and effective treatment to be […]
• Sleepwalking Through Life In this case, there is a large context of life that people can be part of which should be understood. All in all, there is a lot that can be done to ensure that people […]
• Sleep Stages and Disorders A more elaborate look into understanding sleep take a look at the two aspects of sleep which is the behavior observed during sleeping periods as well as the scientific explanation of the physiological processes involved […]
• Sleep Process Research There are said to have five sleep stages, which are divided in to two: the rapid eye movement and the non rapid eye movement during which the dreams occur.
• A Day in the Sleep Clinic: Culture and Health The third aspect of the PEN-3 Model looks at the cultural issues and health beliefs. For instance, the Sudanese family belief in superstition may not affect the health outcome in the hands of the doctor.
• Using Depressants During Sleep Time The paper also holds up the notion that, today it is important to control the sleeping patterns, to conform to the lifestyle demands. The drugs are mainly used generally to reduce the sleep delays, thus […]
• Sleep Improves Memory It is possible to replace a traumatic memory with a pleasant one then take a brief moment of sleep to reinforce the pleasant memory.
• How Much Sleep Do You Need by Age?
• What Is an Sleep?
• What Is the Purpose of Sleep?
• What Is Good Sleep?
• Why Is Sleep Important for Health?
• What Happens if We Don’t Sleep?
• Why Is It Called Sleep?
• What Causes Lack of Sleep?
• What Age Gets the Most Sleep?
• What Is the Most Healthy Time to Wake Up?
• Why Do Older People Need Less Sleep?
• How Much Sleep Is Healthy?
• What Are Interesting Facts About Sleep?
• What Happens During Sleep?
• Why Should We Drink Water Before Sleeping?
• How to Fall Asleep Fast Within 5 Minutes?
• Which Foods Make Sleepy?
• What to Drink to Sleep Faster?
• What Are the Sleep Tricks?
• What Part of the Brain Causes Sleep?
• How Can I Get Better Sleep?
• Which Oil Helps You Sleep?
• Does Warm Milk Help You Sleep?
• How Can I Relax When I Can’t Sleep?
• At What Time Is the Body Ready for Sleep?
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103 Sleep Research Topics & Essay Examples

📝 sleep research papers examples, 🏆 best sleep essay titles, 🎓 simple research topics about sleep, ❓ sleep research questions.

• The Five Stages of Sleep Psychology essay sample: While most people tend to think that sleep is the period when the activity in the brain reduces or is minimal, research and study have proved otherwise.
• Bipolar Disorder Overview and Analysis Psychology essay sample: Bipolar disorder is a severe mental illness characterized by extreme episodes of mania, which are referred to as highs, and depression, which is referred to as lows.
• Post Traumatic Stress Disorder in the United States Psychology essay sample: Post Traumatic Stress Disorder (PTSD) is an emotional illness that is characterized by constant anxiety and is often the result of continuing frightening.
• "Introduction to Psychology" by Hawkes Learning Systems Psychology essay sample: The paper is about discussion posts on the Introduction to psychology. The each chapter discuss the human psyche, capabilities and behavior.
• Physical Education Impact on Child Development Psychology essay sample: Inadequate physical activity hampers psychosocial health in children and elevates the risk of cardiometabolic disorders.
• Early Childhood Sleep: Its Types and Consistent Routine Psychology essay sample: Sleep in early childhood begins the process of remodeling learned memories, which may be sufficient to provide short-term benefits in regulating mood and emotions.
• Lack of Sleep at King Fahd University of Petroleum and Minerals Psychology essay sample: This paper aims to explore the detrimental effects of sleep deprivation among KFUPM students and techniques for how they can manage time and stress to get adequate sleep.
• Attention Deficit Hyperactivity Disorder Analysis Psychology essay sample: Although attention deficit hyperactivity disorder is largely a childhood behavioral disorder, it is now considered a lifespan disorder.
• Insomnia as the Most Common Sleep Disorder Psychology essay sample: Insomnia as a sleep disorder needs a more detailed analysis to promote patient literacy and limit the threat of it becoming a public health issue.
• Family Ties: Parental Conflict Psychology essay sample: The parent-child conflicts are in the main focus of the modern science, and the influence of these conflicts on the family relations.
• Problem of Stress and Its Impact on Student Performance Psychology essay sample: The problem of stress and its impact on student performance at Khalifa University is relevant, and the results of the research confirm the value of addressing this issue.
• The Effectiveness of Mindfulness Meditation Intervention in Reducing Stress in Adolescents Psychology essay sample: The research proposed in this work intends to examine adolescent stress when treated via the Mindfulness-Based Stress Reduction Intervention.
• Psychological Disorder Analysis - Marla`S Diagnosis Psychology essay sample: In this case, the social cultural model is highly recommended as a form of treatment. This is because individuals from minority groups abandon therapy earlier than those from other groups.
• Health Psychology in the Popular Press Psychology essay sample: Sleeping pills are generally perceived as a necessary evil in society. While they do help suffering people to get the restful sleep they are also sometimes abused by some people.
• Stress and Anxiety Sources Amongst Students Psychology essay sample: This paper discusses some of the major sources of physiological, social, and psychological stress and anxiety in students.
• Stress Identification and Management Psychology essay sample: Stress can be defined as any type of change in the human body that can cause physiological, emotional, and physical strain.
• Psychology of Depression Among College Students Psychology essay sample: Depression has serious effects among college students: poor academic performance, the development of suicidal thoughts, failed relationships, and loss of zeal for goal achievement.
• Anxiety Disorder and Its Characteristics Psychology essay sample: This paper focuses on the fundamental characteristics of anxiety and its theories and treatment options imperially supported.
• DSM-5 Anxiety Disorders: Causes and Treatment Psychology essay sample: This research paper discusses the DSM-5 anxiety disorders reviewing the diagnosis, a case conceptualization, and a treatment plan.
• Cell Phones and Mental Health Psychology essay sample: Limited use of smartphones, current human companions, makes life easier and enjoyable, while excessive screen time may bring severe mental health consequences.
• Bipolar Disorder in Abnormal Psychology Psychology essay sample: Patients with bipolar disorder present one of the most interesting populations to be studied from the abnormal psychology perspective.
• Counseling Practice: Components, Special Considerations Psychology essay sample: This paper discusses the main components related to counselor self-care, the special considerations regarding healthcare organizations, insurance, and counseling practice.
• Anxiety Disorders and Their Influence on Daily Life Psychology essay sample: Anxiety disorder is abnormal and pathological only when it becomes incredibly intense and unpleasant for a person, makes them suffer, and violates the quality of life.
• The Self-Assessment Inventory Results Analysis Psychology essay sample: In the case of the author's Self-Assessment Inventory, some improvements should be introduced to his strategies for coping with stress factors.
• General Anxiety Disorder Treatment Plan Psychology essay sample: The paper provides a treatment plan for a patient with increased symptoms of General Anxiety Disorder, which results in a state of worry and difficulties falling asleep.
• Psychology: Overview and Understanding Psychology essay sample: Like many sciences, psychology has evolved from philosophy and inherited questions and concepts which philosophy had been developing.
• Maslow's Hierarchy of Needs for a College Student Psychology essay sample: Maslow's theory is a famous approach for measuring human needs. It is interesting to examine how this theory is helpful to a college student.
• The Structure and Style of the Family Psychology essay sample: The interviewed one, the Collins family, is a full one, with a 36-years-old mother, a 36-years-old father, and three children, having White ethnicity and Western cultural background.
• Impactful Dream: An Episode of Sleep Paralysis Psychology essay sample: The paper states that to interpret the dream with sleep paralysis, it is necessary to review real-life events and the avoidance pattern.
• PTSD Among African American Vietnam Veterans Psychology essay sample: Post-traumatic stress disorder is unfortunately common among veterans, and it is especially prevalent among African American Vietnam veterans.
• States of Consciousness: Psychology Psychology essay sample: The most apparent differences between the unconscious and conscious states are manifested in the states of sleep and wakefulness.
• Prolonged Stress: Negative Effects and Management Psychology essay sample: A person affected by prolonged stress is more likely to develop a shorter memory span, anxious behaviors, secretory changes in the amygdala, and poor sleep.
• Analysis of Cognitive and Behavioural Changes of Teenagers Psychology essay sample: Cognitive and behavioral changes are common among adolescents and scientists have conducted studies to understand the neurological changes that make them act the way they do.
• Why People Experience Nightmares Psychology essay sample: The mechanism of how dreams occur has been one of the mysteries that science has failed to solve. This paper investigates how these factors are linked to nightmares.
• Sleep Health and Self-Determination Psychology essay sample: Poor sleep is the problem that affects human motivation and performance chosen for this assessment. Poor sleep has become a ubiquitous issue in modern high-paced society.
• Targeted Memory Reactivation and Naturalistic Longitudinal Observation Psychology essay sample: Two methods that are helpful in improving motor skills, task performance, and behavior through sleep is the Targeted Memory Reactivation and Naturalistic Longitudinal Observation.
• Creating a Tranquil Sleep Environment: Tips for Designing Your Ideal Bedroom
• The Science of Sleep: Understanding the Physiology of Insomnia
• Uncovering the Link Between Exercise and Deep, Restful Sleep
• The Top Tips for Overcoming Bad Sleep and Improving Your Well-Being
• Sleep Deprivation and Its Effects on College Students The paper explores the relationship between quality sleep deprivation and its related effect on the academic performance of college-going students.
• Insomnia in Children: Signs, Symptoms, and Strategies for Parents
• Exploring the Impact of Technology on Sleep Quality
• The Role of Physical Activity in Promoting Healthy Sleep for Kids
• The Link Between Bad Sleep and Weight Gain
• The Power of Power Naps: Maximizing Productivity with Short Rest Breaks
• The Cultural Significance of Nightmares
• Good Sleep and Hygiene among American Citizens Sleep can be defined as a state of partial or complete unconsciousness where a person is inactive and cannot perform voluntary activities of the body.
• Common Sleep Mistakes Parents Make with Toddlers
• The Role of Diet and Nutrition in Managing Insomnia
• The Science of Child Sleep: Understanding the Biology Behind Bedtime
• Sleep Deprivation and Insomnia: The Case Study The identified topic is connected to one of the health behaviors – sleep. The lack of sleep leads to serious health issues, such as heart disease, dementia, obesity, and others.
• Surprising Causes of Insomnia You Might Not Know About
• The Effect of Nightmares on Mental Health
• The Best and Worst Foods for a Good Night’s Sleep
• The Best Natural Sleep Aids and How They Work
• Poor Management of Staff Has Hindered the Quality of Care During the Pandemic Inefficient pandemic control measures across the globe resulted in a surge in the number of cases and COVID-19-related deaths.
• The Science Behind Children’s Sleep Cycles
• Night Terrors vs. Nightmares: How to Differentiate and Soothe Your Child
• The Connection Between Nutrition and Sleep
• The Art of Relaxation: Techniques for Unwinding and Preparing for Sleep
• Bad Sleep and Technology: Uncovering the Connection and Finding Solutions
• The Connection Between Insomnia and Chronic Pain: Finding Relief
• The Surprising Benefits of Mindfulness and Meditation for Insomnia Sufferers
• Sleep and Academic Performance among Students This paper discusses a relationship between Sleep and Academic Performance among international students in Undergraduate Occupational Therapy program at Monash University.
• Interview with a Psychologist: Tips for Managing and Overcoming Nightmares
• The Impact of Screen Time on Children’s Sleep and How to Manage It
• Creating a Calm and Relaxing Sleep Environment
• The Connection Between Nutrition and Children’s Sleep Quality
• Effective Relaxation Techniques for Overcoming Insomnia
• Research Paper Analysis: Report on Sleep Habits This paper critically analyses a research report on sleeping habits among Oxford University students (Jeffrey & William, 2009).
• 7 Surprising Ways Bad Sleep Affects Your Productivity
• Sleep Disorders Demystified: Identifying and Managing Common Sleep Issues
• Lucid Dreaming as a Tool for Confronting Nightmares
• The Benefits of Meditation for Improving Sleep Quality and Reducing Insomnia
• Sleep and Mental Health: Exploring the Bidirectional Relationship
• The Impact of Stress on Sleep: Strategies for Managing Anxiety and Improving Rest
• Effects of Sleep on Academic Performance Sleep and leisure in general have great influence on the performance and achievement of students, both in class and in their future careers.
• A Day in the Life of Someone with Insomnia: A Personal Perspective
• Exploring Different Sleep Positions and Their Effects on Health and Comfort
• Insomnia and Its Impact on Productivity: A Comprehensive Analysis
• The Surprising Impact of Bad Sleep on Your Relationships and Social Life
• Common Nightmares and What They Could Mean for Your Mental Health
• How Your Brain and Body Benefit from Quality Rest?
• How to Sync Your Body’s Natural Clock?
• How to Establish a Consistent Sleep Schedule?
• How to Create the Ideal Sleep Environment for Beating Insomnia?
• How Stress and Anxiety Impact Your Sleep?
• Are Your Nightmares Trying to Tell You Something?
• What the Different Types of Insomnia?
• How Aging Affects Sleep and What to Do About It?
• How Artists Channel Bad Dreams into Creativity?
• What Causes Nightmares and How to Stop Them?
• How Screen Time Affects Your Ability to Sleep?
• The Hidden Dangers of Bad Sleep: How It’s Impacting Your Health?
• Are You Making These Common Mistakes That Sabotage Your Sleep Quality?
• How to Break Free from Bad Sleep Habits?
• How Bad Sleep Impacts Your Professional Life?
• How to Establish a Bedtime Routine That Works for Your Child?
• How to Recognize and Address Sleep Anxiety in Children?
• How to Overcome Recurring Nightmares?
• Nightmares in Literature: How Writers Use Them to Create Tension and Fear?
• Can Food and Diet Affect Your Nightmares?

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Psychological and Physical Approaches for Sleep Disorders: What the Science Says

Clinical Guidelines, Scientific Literature, Info for Patients:  Psychological and Physical Approaches for Sleep Disorders

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Current clinical practice guidelines from the  American Academy of Sleep Medicine (2021) recommend psychological and behavioral interventions in the treatment of chronic insomnia disorder in adults. 

• The American Academy of Sleep Medicine guidelines state: “We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia (CBT-I) for the treatment of chronic insomnia disorder in adults (strong recommendation). We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults (conditional recommendation).” The authors of the guidelines also noted that there were fewer than three studies meeting their inclusion criteria for the use of cognitive therapy, paradoxical intention, mindfulness, biofeedback, and intensive sleep retraining; as a result, no recommendations were made about these treatments.

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• Clinical practice guidelines  issued by the American Academy of Sleep Medicine in 2021 recommend psychological and behavioral interventions for the treatment of chronic insomnia disorder in adults. The guidelines state: “We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia (CBT-I) for the treatment of chronic insomnia disorder in adults (strong recommendation).”
• A 2018 analysis of pooled data from 4 randomized controlled trials of 546 peri- and postmenopausal women with insomnia and bothersome vasomotor symptoms found that CBT-I produced the greatest reduction in Insomnia Severity Index (ISI) from baseline compared to an education control. 
• A  2014 randomized controlled trial  examined the comparative efficacy of cognitive behavioral therapy, tai chi, and a sleep seminar education control in 123 older adults with chronic and primary insomnia. The study found that cognitive behavioral therapy performed better than tai chi and sleep seminar education in remission of clinical insomnia. The cognitive behavioral therapy group also showed greater improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than the tai chi and sleep seminar education groups.

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• CBT-I is considered safe.

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There is a small amount of low-quality evidence that relaxation techniques by themselves can help with chronic insomnia.  Relaxation techniques may be recommended in certain situations, depending on individual preferences, health provider qualifications, and treatment availability. 

Current clinical practice guidelines from the American Academy of Sleep Medicine (2021) conditionally recommend relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. 

• Clinical guidelines from the American Academy of Sleep Medicine (2021) made a conditional recommendation to use relaxation therapy as a single-component therapy based on “a small body of low-quality evidence from five studies showing clinically meaningful improvements in one critical outcome, consideration that some patients prefer relaxation therapy, the fact that mental health providers are trained to deliver this form of treatment, and the potential for relaxation therapy to require only limited resources.”
• A 2018 systematic review looked at 27 studies of psychological interventions to try to improve sleep. The studies involved 2,776 college students who ranged from healthy sleepers to those with a diagnosed sleep disorder. About 22 percent of the studies investigated “relaxation, mindfulness, hypnotherapy” treatments. This review recommended cognitive behavioral therapy to improve sleep in college students. The review also found that relaxation approaches helped somewhat with sleep quality and sleep problems but especially with mental health. The authors recommended that “relaxation, mindfulness, hypnotherapy” treatments be combined with cognitive behavioral therapy as a way to enhance mental health benefits.
• Relaxation therapies for insomnia are considered safe.

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Yoga has been shown to be helpful for sleep in several studies of cancer patients, women with sleep problems, and older adults and in individual studies of other population groups, including people with arthritis and women with menopause symptoms. However, a 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against yoga for treating insomnia.

• A  2020 systematic review and meta-analysis of 19 studies involving a total of 1,832 participants found positive effects of yoga in 16 randomized controlled trials, compared with the control group, in improving sleep quality among women using Pittsburgh Sleep Quality Index (PSQI); however, 2 studies revealed no effects of yoga compared to the control group in reducing insomnia among women using ISI. Seven studies revealed no evidence for effects of yoga compared with the control group in improving sleep quality for women with breast cancer using PSQI, while four studies revealed no evidence for the effects of yoga compared with the control group in improving the sleep quality for peri/postmenopausal women using PSQI.
• A  2020 secondary analysis of a randomized controlled trial involving 320 adults with chronic low-back pain and poor sleep quality prior to the intervention found modest but statistically significant improvements in sleep quality in the yoga (12 weekly yoga classes) and physical therapy groups.
• A  2019 systematic review of 11 studies that evaluated the use of yoga to manage stress and burnout in health care workers concluded that yoga is effective in improving physical problems and quality of sleep, as well as reducing stress levels and burnout. However, the authors of the review noted that it would be necessary to broaden the subject further and acquire more robust scientific evidence by designing and implementing research studies equipped with a solid methodological structure on bigger sample groups.
• A  2013 multicenter, randomized controlled trial evaluated the effect of yoga on sleep quality in 410 cancer survivors suffering from moderate or greater sleep disruption between 2 and 24 months after surgery, chemotherapy, and/or radiation therapy. The study found that compared with standard care, yoga participants demonstrated greater improvements in global sleep quality and subjective sleep quality, daytime dysfunction, wake after sleep onset, sleep efficiency, and medication use at postintervention.
• A  2022 randomized controlled trial  investigated the effects of yoga (duration of 20 weeks) on menopausal symptoms and sleep quality across menopause statuses in 208 women. Based on participant responses to questionnaires, the study found that yoga decreased menopausal symptoms, with the strongest effects noted in postmenopausal women, followed by perimenopausal women. In addition, yoga significantly improved sleep quality in postmenopausal and perimenopausal women after controlling for social support, depression, anxiety, stress, and menopausal symptoms; however, yoga did not affect sleep quality in premenopausal women.
• Yoga is generally considered a safe form of physical activity for healthy people when performed properly, under the guidance of a qualified instructor. However, as with other forms of physical activity, injuries can occur. 
• The most common injuries are sprains and strains, and the parts of the body most commonly injured are the knee or lower leg. Serious injuries are rare. The risk of injury associated with yoga is lower than that for higher impact physical activities.
• Hot yoga has special risks related to overheating and dehydration.
• Pregnant women, older adults, and people with health conditions should talk with their health care providers and the yoga instructor about their individual needs. They may need to avoid or modify some yoga poses and practices. 

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Results of several studies, using objective and subjective measures, have shown that tai chi may be helpful for people with sleep problems. However, a 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was insufficient evidence to recommend for or against using tai chi to treat insomnia.

• A 2020 systematic review and meta-analysis of 20 randomized controlled studies from 5 countries involving a total of 1,703 patients found that compared with nontherapeutic and other active treatments, tai chi has a positive effect on improving sleep quality. An in-depth analysis showed that 24-form and 8-form Yang-style tai chi had significant positive effects on sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI).
• A 2021 randomized controlled trial assigned 320 participants 60 years or older and with chronic insomnia to three groups: 12-week tai chi training, 12-week conventional exercise, and no intervention control. The study found that compared with the control group, the exercise and tai chi groups showed improved sleep efficiency, reductions of wake time after sleep onset, and reduced awakenings as measured by actigraphy. However, there were no significant differences between the exercise and tai chi groups.
• Tai chi appears to be safe. A 2019 meta-analysis of 24 studies (1,794 participants) found that the frequency of adverse events was similar for people doing tai chi, another active intervention, or no intervention. 

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A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to know whether mindfulness meditation is helpful for people with insomnia, and a 2021 clinical practice guideline from the American Academy of Sleep Medicine said there was not enough evidence to make recommendations on using mindfulness by itself for insomnia. 

• A 2022 review of 20 studies and 2,890 participants found that mindfulness-based stress reduction might be ineffective for improving sleep quality in people with insomnia, but the authors noted that the studies were small and showed bias.
• A   2019 systematic review and meta-analysis of 18 studies (1,654 total participants) found that mindfulness meditation practices improved sleep quality more than education-based treatments. However, the effects of mindfulness meditation approaches on sleep quality were no different than those of evidence-based treatments such as cognitive behavioral therapy and exercise.
• Results from a  2015 randomized controlled trial  involving 60 adults aged 75 years and over with chronic insomnia suggest that the mindfulness-based stress reduction program could be a useful treatment for chronic insomnia for this age group. 
• Meditation and mindfulness practices usually are considered to have few risks. 

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A 2022 review of 13 studies with 1,007 adult participants found that listening to music may lead to improved reports of sleep quality among people with insomnia. However, there was not enough good-quality evidence to determine the effect of listening to music on the severity of insomnia or the number of times a person wakes up. 

• A  2022 review of 13 studies with 1,007 adult participants found that listening to music may lead to improved reports of sleep quality among people with insomnia. However, there was not enough good-quality evidence to determine the effect of listening to music on the severity of insomnia or the number of times a person wakes up. The results showed that listening to music may slightly improve sleep-onset latency, sleep duration, sleep efficiency, and daytime effects.
• In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. 
• Because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music.

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A 2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to recommend for or against using acupuncture for insomnia, except for a weak recommendation for auricular acupuncture, which involves specific points on the outer ear. Results from some studies suggest that auricular acupuncture may help improve insomnia; however, many of the studies conducted on acupuncture for sleep disorders are small and are of low quality.

• A  2021 review of 11 studies and 775 participants suggested that acupuncture may help improve insomnia, but the studies were small, differed from each other in many ways (e.g., treatment dosage, acupoint selection), and judged to be low quality. 
• A  2019 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense said there was not enough evidence to recommend for or against using acupuncture for insomnia, except for a weak recommendation for auricular acupuncture, which involves specific points on the outer ear. 
• A  2020 evaluation of 7 systematic reviews (10,001 participants) on auricular acupuncture for insomnia found that the reviews suggested auricular acupuncture may be beneficial, but the quality of most of the reviews was low or critically low and the quality of the studies within the reviews was poor.
• Relatively few complications from using acupuncture have been reported.  However, complications have resulted from use of nonsterile needles and improper delivery of treatments.  When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs, and injury to the central nervous system. 

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• Susanti HD, Sonko I, Chang P-C, et al.  Effects of yoga on menopausal symptoms and sleep quality across menopause statuses: a randomized controlled trial .  Nursing and Health Sciences . 2022;24(2):368-379. 
• Wang W-L, Chen K-H, Pan Y-C, et al.  The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis .  BMC Psychiatry . 2020;20(1):195. 
• Zhang J-X, Liu X-H, Xie X-H, et al.  Mindfulness-based stress reduction for chronic insomnia in adults older than 75 years: a randomized, controlled, single-blind clinical trial .  Explore (NY).  2015;11(3):180-185. 
• Zhao F-Y, Fu Q-Q, Kennedy GA, et al.  Can acupuncture improve objective sleep indices in patients with primary insomnia? A systematic review and meta-analysis .  Sleep Medicine . 2021;80:244-259.

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50+ Research Topics for Psychology Papers

How to Find Psychology Research Topics for Your Student Paper

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

• Specific Branches of Psychology
• Topics Involving a Disorder or Type of Therapy
• Human Cognition
• Human Development
• Critique of Publications
• Famous Experiments
• Historical Figures
• Specific Careers
• Case Studies
• Literature Reviews
• Your Own Study/Experiment

Are you searching for a great topic for your psychology paper ? Sometimes it seems like coming up with topics of psychology research is more challenging than the actual research and writing. Fortunately, there are plenty of great places to find inspiration and the following list contains just a few ideas to help get you started.

Finding a solid topic is one of the most important steps when writing any type of paper. It can be particularly important when you are writing a psychology research paper or essay. Psychology is such a broad topic, so you want to find a topic that allows you to adequately cover the subject without becoming overwhelmed with information.

I can always tell when a student really cares about the topic they chose; it comes through in the writing. My advice is to choose a topic that genuinely interests you, so you’ll be more motivated to do thorough research.

In some cases, such as in a general psychology class, you might have the option to select any topic from within psychology's broad reach. Other instances, such as in an  abnormal psychology  course, might require you to write your paper on a specific subject such as a psychological disorder.

As you begin your search for a topic for your psychology paper, it is first important to consider the guidelines established by your instructor.

Research Topics Within Specific Branches of Psychology

The key to selecting a good topic for your psychology paper is to select something that is narrow enough to allow you to really focus on the subject, but not so narrow that it is difficult to find sources or information to write about.

One approach is to narrow your focus down to a subject within a specific branch of psychology. For example, you might start by deciding that you want to write a paper on some sort of social psychology topic. Next, you might narrow your focus down to how persuasion can be used to influence behavior .

Other social psychology topics you might consider include:

• Prejudice and discrimination (i.e., homophobia, sexism, racism)
• Social cognition
• Person perception
• Social control and cults
• Persuasion, propaganda, and marketing
• Attraction, romance, and love
• Nonverbal communication
• Prosocial behavior

Psychology Research Topics Involving a Disorder or Type of Therapy

Exploring a psychological disorder or a specific treatment modality can also be a good topic for a psychology paper. Some potential abnormal psychology topics include specific psychological disorders or particular treatment modalities, including:

• Eating disorders
• Borderline personality disorder
• Seasonal affective disorder
• Schizophrenia
• Antisocial personality disorder
• Profile a  type of therapy  (i.e., cognitive-behavioral therapy, group therapy, psychoanalytic therapy)

Topics of Psychology Research Related to Human Cognition

Some of the possible topics you might explore in this area include thinking, language, intelligence, and decision-making. Other ideas might include:

• False memories
• Speech disorders
• Problem-solving

Topics of Psychology Research Related to Human Development

In this area, you might opt to focus on issues pertinent to  early childhood  such as language development, social learning, or childhood attachment or you might instead opt to concentrate on issues that affect older adults such as dementia or Alzheimer's disease.

Some other topics you might consider include:

• Language acquisition
• Media violence and children
• Learning disabilities
• Gender roles
• Child abuse
• Prenatal development
• Parenting styles
• Aspects of the aging process

Do a Critique of Publications Involving Psychology Research Topics

One option is to consider writing a critique paper of a published psychology book or academic journal article. For example, you might write a critical analysis of Sigmund Freud's Interpretation of Dreams or you might evaluate a more recent book such as Philip Zimbardo's  The Lucifer Effect: Understanding How Good People Turn Evil .

Professional and academic journals are also great places to find materials for a critique paper. Browse through the collection at your university library to find titles devoted to the subject that you are most interested in, then look through recent articles until you find one that grabs your attention.

Topics of Psychology Research Related to Famous Experiments

There have been many fascinating and groundbreaking experiments throughout the history of psychology, providing ample material for students looking for an interesting term paper topic. In your paper, you might choose to summarize the experiment, analyze the ethics of the research, or evaluate the implications of the study. Possible experiments that you might consider include:

• The Milgram Obedience Experiment
• The Stanford Prison Experiment
• The Little Albert Experiment
• Pavlov's Conditioning Experiments
• The Asch Conformity Experiment
• Harlow's Rhesus Monkey Experiments

Topics of Psychology Research About Historical Figures

One of the simplest ways to find a great topic is to choose an interesting person in the  history of psychology  and write a paper about them. Your paper might focus on many different elements of the individual's life, such as their biography, professional history, theories, or influence on psychology.

While this type of paper may be historical in nature, there is no need for this assignment to be dry or boring. Psychology is full of fascinating figures rife with intriguing stories and anecdotes. Consider such famous individuals as Sigmund Freud, B.F. Skinner, Harry Harlow, or one of the many other  eminent psychologists .

Psychology Research Topics About a Specific Career

​Another possible topic, depending on the course in which you are enrolled, is to write about specific career paths within the  field of psychology . This type of paper is especially appropriate if you are exploring different subtopics or considering which area interests you the most.

In your paper, you might opt to explore the typical duties of a psychologist, how much people working in these fields typically earn, and the different employment options that are available.

Topics of Psychology Research Involving Case Studies

One potentially interesting idea is to write a  psychology case study  of a particular individual or group of people. In this type of paper, you will provide an in-depth analysis of your subject, including a thorough biography.

Generally, you will also assess the person, often using a major psychological theory such as  Piaget's stages of cognitive development  or  Erikson's eight-stage theory of human development . It is also important to note that your paper doesn't necessarily have to be about someone you know personally.

In fact, many professors encourage students to write case studies on historical figures or fictional characters from books, television programs, or films.

Psychology Research Topics Involving Literature Reviews

Another possibility that would work well for a number of psychology courses is to do a literature review of a specific topic within psychology. A literature review involves finding a variety of sources on a particular subject, then summarizing and reporting on what these sources have to say about the topic.

Literature reviews are generally found in the  introduction  of journal articles and other  psychology papers , but this type of analysis also works well for a full-scale psychology term paper.

Topics of Psychology Research Based on Your Own Study or Experiment

Many psychology courses require students to design an actual psychological study or perform some type of experiment. In some cases, students simply devise the study and then imagine the possible results that might occur. In other situations, you may actually have the opportunity to collect data, analyze your findings, and write up your results.

Finding a topic for your study can be difficult, but there are plenty of great ways to come up with intriguing ideas. Start by considering your own interests as well as subjects you have studied in the past.

Online sources, newspaper articles, books , journal articles, and even your own class textbook are all great places to start searching for topics for your experiments and psychology term papers. Before you begin, learn more about  how to conduct a psychology experiment .

What This Means For You

After looking at this brief list of possible topics for psychology papers, it is easy to see that psychology is a very broad and diverse subject. While this variety makes it possible to find a topic that really catches your interest, it can sometimes make it very difficult for some students to select a good topic.

If you are still stumped by your assignment, ask your instructor for suggestions and consider a few from this list for inspiration.

• Hockenbury, SE & Nolan, SA. Psychology. New York: Worth Publishers; 2014.
• Santrock, JW. A Topical Approach to Lifespan Development. New York: McGraw-Hill Education; 2016.

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

CASE REPORT article

Case report: why sleep and dream related psychological treatments, such as sleepcoaching (according to holzinger&klösch) and cbt-i should be implemented in treatment concepts in the public health system—description of the nightmare treatment process in the context of ptsd.

• 1 Institute for Consciousness and Dream Research, Vienna, Austria
• 2 Certificate Program Sleep Coaching, Medical University of Vienna, Vienna, Austria
• 3 Department of Neurology, Medical University of Vienna, Vienna, Austria

In this case report, we explain the story of a woman diagnosed with severe PTSD, suffering from recurrent nightmares involving a traumatizing event. She participated in 6 week lucid dreaming training to help her reduce her nightmare frequency. Our descriptions include her dream reports as well as the results of the psychological assessment conducted. In only 6 weeks, she was able to begin to change her dream plots and to improve several of the psychological measures. In this case, we stated that paying more attention to sleep and, especially nightmares, not only in patients with PTSD, should be standard in treatment processes for psychiatric disorders. We, therefore, underpin our case with literature that explains the benefits of treatments, specifically for sleep problems that do not involve medication.

Introduction

This case study is a part of a sample of “cases” we had the honor to collect in the project “Cognitions in Sleep—Lucid Dreaming as an Intervention for Nightmares in Patients with PTSD,” published 2020 in Frontiers of Psychology ( Holzinger et al., 2020 ). In the context of a nightmare treatment evaluation research project in patients with posttraumatic stress disorder (PTSD) in 2009 at the inpatient rehabilitation clinic in Europe (we do not state specific countries in this article to provide additional protection of any identities), we had the opportunity to offer a lucid dreaming (LD) program, which we also call Cognition in Sleep (CIS) to inpatients with PTSD. LD is characterized by a person being aware that he/she is dreaming and by voluntary control over the dream plot ( Holzinger, 2008 ). Lucid dreaming as a treatment for nightmares is part of our holistic approach called sleepcoaching, which is based on Gestalt Therapy ( Holzinger and Klösch, 2013 ; Holzinger et al., 2019a , b ). Sleepcoaching consists of four elements: sleep education and sleep hygiene, cognitive behavioral therapy for insomnia (CBT-I), relaxation techniques, including medical hypnosis, and dream work, including LD techniques. During this program, our focus, of course, was on LD techniques. Nevertheless, it did incorporate aspects of sleep education and sleep hygiene.

In patients with PTSD, addiction problems and multiple comorbidities were treated in a 3 month psychotherapeutic program. Most of the patients were under excessive medication, as the risk of suicide was considered very high. PTSD is a psychiatric disorder emerging after a traumatic event or situation. Those events or situations evoke strong feelings of desperation in the affected person. Typical symptoms of PTSD are recurrent re-experiencing of an event, intruding memories of the event, dreams, nightmares, and a lingering feeling of numbness and emotional stupor. In addition, symptoms similar to depressive ones, like joylessness, reduced activity, and carelessness, may occur. If those feelings remain over a long time, this can also lead to suicidal thoughts ( World Health Organization, 2017 ). The distress of reliving the traumatic events not only by flashbacks in the daytime but also in nightmares during sleep causes a great extent of psychological strain. Those disturbing dreams and nightmares are the core symptom of PTSD and are very common, as the prevalence of nightmares is 60%, which is the highest among mental health disturbances. The prevalence of PTSD is about 8–9% in the general population ( Krakow et al., 2002 ). Nightmares among patients with PTSD tend to occur in two predominant forms:

1. Intrusive replicative nightmares that reenact parts of the trauma and cause difficulties initiating or maintaining sleep.

2. A form of nightmares corresponding to the re-experiencing and hyperarousal symptom cluster defining PTSD.

( Levin and Nielsen, 2007 ).

Nightmares, in general, are defined as dreams being “extended and extremely dysphoric,” and that “usually involves efforts to avoid threats to survival, security, or physical integrity.” They usually occur during REM sleep and tend to wake up the dreaming subject, remembering the dream vividly ( American Academy of Sleep Medicine, 2014 ).

The case reported in the following sections displays how dream work, including LD training, was able to promote improvements concerning the nightmare and other symptoms in the reported PTSD case very quickly. Furthermore, it represents severe and multiple traumatizations, which conditioned a long history of PTSD with various sleep problems and other comorbidities in the patient.

Case Report of a Female Participant in the Add-On Lucid Dreaming Training Program

The LD program was conducted as an add-on treatment to the regular trauma treatment. The program was offered weekly for 1 h in a group setting for a maximum of eight participants. All patients with PTSD of the rehabilitation center were informed about that service and voluntarily signed up. The ultimate goal of the program was to overcome nightmares by the use of LD techniques (cognition in sleep).

The program offered general information about sleep, sleep hygiene, and also on how to keep a sleep and dream diary, as this was the documentation method to keep track of the dreams of the patients. The core target of the program, to improve nightmare complaints by means of LD, was built on knowledge about dreams, nightmares, and LD and what they might do for us.

From the pool of patients participating in our program, one stuck out. We report the case of a female inpatient at a rehabilitation clinic; she experienced multiple traumas from childhood, for which she received treatment for PTSD. Her process is also described in Lucid Dreaming: New Perspectives on Consciousness in Sleep ( Hurd and Bulkeley, 2014 ).

Mrs. L. (the initial of her name is altered) was traumatized multiple times throughout her life. She was sexually abused by her grandfather several times and was raped by a group of teenagers when she was 13 years old. She was unhappily married and divorced after 3 years. Her ex-husband did not accept this step and stalked her with a gun, and, by holding up the gun to her head, forced her to come back to him. During her marriage and, for some time after, she was living in a different country, but after those incidents, she moved back to where she was born. Shortly after moving, she got involved in a severe car accident, from which she had to recover for several months forcing her into sick leave for that time. After recovering, she started to work as a travel agent in a workspace separated by glass walls. Due to the hectic nature of this demanding job, she oversaw that glass wall and injuring herself severely by a craniocerebral trauma.

All those incidents reinforced insomnia symptoms, characterized by problems of falling and maintaining sleep associated with frequent nightmares. The nightmares, which occurred since childhood, were often recurrent, involving her ex-husband stalking and threatening her, occurring several times a week. As a consequence of these nightmares, Mrs. L. developed aversive feelings toward sleep, especially after nightmare episodes.

Mrs. L., as she had experienced several traumatizing situations in her life, developed a quite pronounced PTSD, which had been treated with psychopharmaceuticals (mornings: Duloxetine, 60 mg, evenings: Trazodone, 15 mg; Quetiapine, 25 mg). Additionally, as she was an inpatient at a rehabilitation clinic, she received the standard psychotherapeutic treatment for PTSD and traumatization in this clinic, which is single and group psychotherapy. She did not receive treatments targeting her sleep problems, except the medication listed.

Before entering the LD program, Mrs. L. had undergone excessive psychometric testing. The results of the Symptom Checklist-90-R ( SCL-90-R : Derogatis, 1977 ) suggested that Mrs. L. had severe somatic complaints, high scores in anxiety, phobic fear, obsessive-compulsive disorder, and depression. The Self-rating Anxiety Scale ( SAS : Zung, 1971 ) was conducted and confirmed an anxiety disorder; the Impact of Event Scale-assessed PTSD and the Self-rating Depression Scale ( SDS : Zung, 1965 ) confirmed high scores in depression. In addition, sleep disorders were also evaluated. The Epworth Sleepiness Scale ( ESS: Johns, 1991 ) yielded pathological daytime sleepiness; the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome ( IRLSSG : Walters et al., 2003 ) revealed the presence of restless leg syndrome. This tool is assessing the severity of restless leg syndrome rather than diagnosing it, but, as it was the only measurement used and when looking at the results, we came to the conclusion that Mrs. L did, indeed, suffer from restless leg syndrome. Furthermore, the Schlaffragebogen-B ( Sf-B : Görtelmeyer, 1986 ) indicated severe insomnia symptoms. Her overall sleep quality as measured by the Pittsburgh Sleep Quality Index ( PSQI : Buysse et al., 1989 ) was 14, indicating chronic sleep disorders. Mrs. L also suffered from nightmares several times a week and thought about them often during the day. Consequently, her overall quality of life, measured by the Quality of Life Index ( QLI : Ferrans and Powers, 1985 ), was very low (a total score of 3.7 in the QLI). The extent of her traumatization was measured by the PTSD Symptom Scale ( PSS : Foa et al., 1993 ), containing three subscales, namely Intrusion, which measures the re-experience of the traumatic event; Avoidance; and Hyperarousal. Additionally, the Impact of Event Scale ( IES: Horowitz et al., 1979 ) was conducted. Both measures indicated severe traumatization of Mrs. L. The measurements listed above and dream reports were collected at the end of the training program and 6 weeks after the end, as a follow-up assessment. Results of all time points are displayed in Table 1 .

Table 1 . Mrs. L.'s scores of psychological measures.

During the 6 week training program, Mrs. L reported two nightmares and two positive dreams in the first week. In the course of the LD-training program, she reported 13 dreams; 10 of them were nightmares, and, of those nightmares, four showed plot changes. In the second week, she reported three nightmares; in the third week, one positive dream; during the fourth week, one nightmare with a changed plot and one positive dream; during the fifth week, she reported three nightmares with changed plots; and during the sixth and final week of the program, there was no information about her dreams.

We started the therapy by explaining to her how she can try to learn LD. Mrs. L. was very motivated to do so and followed the suggested steps. We also discussed several ways and options that she could choose from when dreaming her nightmare to try to change it. Those strategies were developed by asking the whole training group what they could suggest and discussing the ideas in the group. It is important in our approach that solutions are not predetermined by the therapist but developed together with the clients. Examples of the resulting options were searching for a safe place in the dream or looking directly at what is happening to see what is actually scary. After only 1 week, the first moderate changes in her dream were noticeable in her dream report:

Week 1: 02.02.2009 (rated as a nightmare):

I dreamt at around 2 am that my ex (former boyfriend whom she was separated 12 years ago) chases me by car through the city in which we used to live. He yelled: “I'll catch you and I'll kill you.” Running away, I felt bad aches in my legs and couldn't move right. This all happened at night, nevertheless I saw him and his pointed gun. He tried to shoot at me but didn't hurt me. I woke up in my bed sitting [up] .

The next morning (week 1: 02/03/2009) she reported on the following dream:

A colleague of my ex had seen me and told him about that. He, again, chased me through the city in a car — never mind where I ran — he found me everywhere and grinned sadistically. Shortly before he ran me down with his car, I woke up. I fell back asleep and dreamed that dream again .

This time she woke up before something really happened. Her dreams continued to change during the course of the group training, and her dreams started to become more masked and started to be situated in different settings. She reported dreams that she did not perceive as nightmares like the following:

Week 1: 02/05/2009:

I dreamt around 04.30 am that. I was at the dentist, he drilled a tooth, fixed it and said that I will live another 50 years with these teeth. The dental office was also a boutique for women's cloths where I wanted to buy some clothes. However, the dentist paid for everything. Another woman wanted to persuade me to start an affair with him. I refused. She said I should do that and loose my financial problems. I left laughing .

The next week, dreams including her ex-boyfriend recurred:

Week 2: 02/09/2009:

I dreamt at 2.30 thatI was surrounded by many cabs. In each of them I saw the sadistic grin of my ex-boyfriend (who is a cab driver). Through a loudspeaker he yelled that he will catch me and kill me, wherever I ran to, he was everywhere. Woke up around 4 am, continued dreaming. He again was in many taxis, pushed me into a dead end street, I was able to disappear into a house and woke up sweating .

Week 2: 02/10/09:

I dreamt at 2 am that… I was followed by me ex-boyfriend in his cab. Through the window he pointed his pistol towards me and yelled that he will kill me. After having been chased by him for a long time, I turned around and yelled that he should do it and stop torturing me. He shot at me, but didn't hit me and disappeared. I woke up sweating .

Week 2: 02/11/2009:

I dreamt at 2 am that … I was sitting in the cab of my ex-boyfriend, he drove at extreme high speed, I was nauseous and my head was spinning, he yelled at me that he would now kill me. Then we fell down a cliff and I woke up sweating .

All of these three nightmares during the 2nd week included the topic of her ex-husband stalking and threatened her. Even if those dreams cannot be considered to be changed in the plot, there is still a slight shift noticeable. One time, she did manage to escape into a house; the next time, she did escape the role of the victim for a short moment yelling at him, and another time, they both fell down the cliff.

During the 3rd week, she did have some dreams not considered being nightmares and off that topic surrounding her ex-husband.

The changes of the dream plots became more pronounced in dreams about her ex-husband in the 4th week:

Week 4: 02/26/2009:

At around 3 am I dream that my ex chases me, again by cab. I cried for help, many people came out of their houses and together we walked towards him. He disappeared .

Week 4: 02/28/2009:

I dreamt at 2.30 am that … I was driving through a wood with many people. We stopped at a restaurant. At once I was with a former colleague, much younger than I am and I had sex with him on a bench. The others, strangers to me did not notice apparently. Afterwards I yelled at him that I was afraid to catch an illness because his penis was deeply red. I ran away and woke up .

The most fundamental change was that she was now looking for help and did find help. Still, this dream is a nightmare, but her helplessness has disappeared. She gained new strength that allowed her to walk toward the stalker ready to confront him instead of only running away, and he disappeared. We had previously talked about this solution for her nightmare, and, even if she did not dream lucidly, she still incorporated this novel idea in her dream. The technique to find people a safe place or trying to acquire help during a nightmare may occur during PTSD treatment because helplessness is one factor hindering patients to let go of their traumatization. After 27 days of nightmare treatment, Mrs. L. reported the following dream:

Week 5: 03/02/2009:

At around 2:30 am I dreamt again that my ex chased me again in a cab. I ran and ran but was unable to cry for help; no sound came out; my voice had left me. He threatened me again with his gun. At some point, I was able to simply yell, “STOP.” I woke up. After I had fallen asleep again, the dream continued, I ran, stumbled and woke up .

In this first dream, Mrs. L. was able to make a conscious decision to wake up and escape the situation, but she was not able to do the same in the subsequent dream. She kept having this dream, sometimes able to change it, sometimes not. This was her last dream report:

Week 5: 03/03/2009:

My ex chased me in a cab. This time the pointed gun was oversized. With a sadistic grin he yelled that he will kill me. I now yelled back that he should do it. I ran towards a downhill slope, he stumbled and fell down the hill. I looked but couldn't see him anymore. The cab and he had disappeared. I woke up, this time not frightened, but somewhat relieved .

In this dream, one could assume that she lost her fear to some extent. It was not necessary to seek help to confront her victimizer, and she did not choose to wake up. Even though this cannot be interpreted as healing, as the number of nightmares remained stable, it shows a significant change. Moreover, her anxiety and depressive symptoms had decreased. This outcome is very promising as no one expected those multiple traumas to be overcome in just 6 weeks.

Mrs. L. still reported dreams about her ex-husband, but it did not occur as often as before and it showed variations. In the 2 weeks, following the treatment, the contents of helplessness still dominated, maybe because she had to deal with her nightmares on her own again. After that, she was again able to make her ex-husband disappear, rescue herself, or could make herself wake up. Specifically, during the first week following the treatment, we got no information about her nightmares or dreams. In the second and third weeks after the program, she reported one nightmare each. During the fourth week, she reported two nightmares and, during the fifth week, one nightmare. In the sixth follow-up week, we got no information.

We believe that manipulating dreams directly is a more effective way of gaining inner strength than reframing waking fantasies in treatments.

At the end of the LD training, the diagnostic assessment had changed ( Table 1 ). Her sleep quality improved, as, for example, she managed to shorten her sleep latency. However, she still had and remembered nightmares. Additionally, her overall quality of life improved slightly.

An LD training program for only 6 weeks is quite efficient and supportive but may have been too short to change traumatic experiences persistently. Between the end of the training program and the follow-up 6 weeks later, the dreams of the client suggest a form of relapse.

03/29/2009:

I dreamt at 2:30 am that … my ex followed me once more again in his cab, no people, no help! I ran and ran until I stumbled and fell. He drove over me and disappeared .

I dreamt at 2.30 and 4 am that … my ex followed me in his cab and pointed with a pistol towards me. Yelled with a horrible laugh that he will get me and kill me. I was able to slip out of the dream twice, woke up, but fell asleep again and continued the dream. The 3 rd time he shot around like a mad man and I woke up .

04/09/2009:

I dreamt at 2 am that … my ex drove in his cab towards me on the pedestrian zone and yelled hysterically that he will shoot me. He exited the car, pushed me toward the wall of a house and was about to shoot. I yelled, looked him straight in the eyes and he disappeared .

04/10/2009:

I dreamt around 2 am that… I drove with my ex in his cab, and he yelled that he will kill me, nevermind how. He threw me out of the car, turned and wanted to drive over me. I ran and ran and cried for help and woke up .

04/14/2009:

I dreamt at around 3 am that … my ex followed me again in his cab and yelled. I didn't see him much. When he pointed his pistol by the window towards me I yelled “Do it” and he disappeared .

The LD program was very well-received by all participants and was very informative for both sides. One of the most impressive observations on my part was that people with severe psychological problems, including PTSD and addiction problems, also often seem to additionally and substantially suffer from sleeping problems. This indicates that a treatment specifically targeting these problems should be implemented. People coming to a clinic are usually asked at the beginning of in-patient therapy about potential sleep impairment and are then given drugs for curing sleep problems. Pharmaceutics often cause various side effects, such as drowsiness and fatigue, during the day and lead to dependencies in patients with addictions, a common comorbidity of PTSD ( Friedman, 2013 ).

In nightmares, a negative relationship between nightmares and poor sleep quality has frequently been reported ( Schredl, 2003 ). Having frequent nightmares often results in trying to avoid sleeping, to begin with ( Rosenberg and Van Hout, 2014 ), and the impacts of low sleep quality have been explored in the former section. The concern is also the fact that studies have already confirmed that having a nightmare induces behavioral consequences the next day, even in healthy subjects, namely higher anxiousness, mental instability, and even physical complaints ( Köthe and Pietrowsky, 2001 ). Furthermore, having frequent nightmares was associated with declined mental health and sleep quality as well as increased suicide risk in patients suffering from mental disorders ( Lemyre et al., 2019 ). Especially, that nightmares predict suicide risk that is found in several studies ( Tanskanen et al., 2001 ; Sjöström et al., 2009 ; Nadorff et al., 2011 , 2013 , 2014 ) is concerning and further supports the demand to take frequent nightmares as an indicator for severe mental disorders, including suicidal risk ( Nadorff et al., 2011 ), and their individual consequences on mental health, seriously. This notion gets further supported by results that nightmares predicted repeated suicide attempts, while no other sleep problem did so ( Sjöström et al., 2009 ), and that they also predict self-harmful thoughts and behavior in a unidirectional way (meaning that nightmares predicted those thoughts and behaviors, but those thoughts and behaviors did not predict nightmares) ( Hochard et al., 2015 ).

The treatment of nightmares by learning LD has been the topic in a recent review ( de Macêdo et al., 2019 ), with some promising results: decreases in nightmare frequency and reduction in the intensity of psychological distress. But the literature on this topic is still inconclusive, and further studies are needed. The present case further highlights the potential that LD has to help with nightmares.

The aim of this therapeutic approach was to provide patients with the possibility to influence their dreaming, or even allow them to control nightmares while they occur. The aspect of having control is substantial as patients with PTSD often suffer from feelings of helplessness and makes this approach even more promising for this group of patients. Neurophysiologic studies suggest that brain regions associated with self-awareness and semantic understanding are significantly more active during LD as compared with non-lucid dreams ( Holzinger et al., 2006 ). Implementing LD in Gestalt Therapy programs for the treatment of sleep problems was found to reduce symptoms more quickly, and positive effects were even found in patients not able to achieve LD ( Holzinger et al., 2020 ). Own studies show that treating nightmares in patients with PTSD by LD has formerly decreased anxiety and depressive symptoms but did not improve sleep, including nightmares ( Holzinger et al., 2020 ).

Mrs. L did not achieve to learn how to dream lucidly during this very short time period of the 6 week training. Still, it had a positive impact on the distress stemming from those nightmares. After the LD training, we observed that various measures improved. And even though the number of nightmares did not decrease, the nightmare plot changed, and the nightmares were less frightening. We, therefore, concluded that LD helped with nightmares, and, furthermore, that it improved psychological health and sleep quality in general.

The benefits of the training regressed to some extent after it ended. We suggest that had been the training continued, further progress would have been visible. This gets further support by the fact that, as we spoke to Mrs. L to get her consent for the present article, she mentioned the strategies she learned in our LD training are still helpful and her nightmare problems have further improved.

Based on these findings and the effectiveness of Cognitive Behavioral Treatment for Insomnia (CBT-I) ( Morin, 2015 ; Ballesio et al., 2018 ; Baglioni et al., 2020 ), we defined our sleepcoaching concept: Its' theoretical background is Gestalt therapy and it involves CBT-I and relaxation techniques, but is still addressing dreams and nightmares by implementing dream work and nightmare treatment (including LD training programs, particularly for PTSD patients). This inclusion of dream work and LD is the unique selling point, which distinguishes sleepcoaching from other psychotherapeutic approaches to sleep problems. We argue that sleepcoaching, as sleep problems are common comorbidity to various disorders, should be implemented in treatment plans in the public health system by default. Sleep problems and nightmares share a close relationship ( Schredl et al., 2016 ), which gets also visible through the case of Mrs. L., as not only her nightmare symptoms but also other sleep and psychological health-related measures improved. These problems should, therefore, not be treated separately but in one holistic approach, like sleepcoaching. Patients would not only benefit from learning how to dream lucidly, which may improve their overall sleep quality but from sleepcoaching, which is a method to introduce knowledge that promotes healthy sleep habits and better sleep hygiene. Sleep hygiene education has often been proofed to improve sleep quality measures ( de Sousa et al., 2007 ; Chen et al., 2010 ; O'Donnell and Driller, 2017 ). A review of the effectiveness of sleep hygiene education argued that sleep hygiene recommendations are most effective when individually fitted to the life of an individual, which is the case in the context of sleepcoaching ( Irish et al., 2015 ). Another important benefit is that sleepcoaching has no unwanted side effects or interactions and, therefore, is applicable with any medication or disorder. Nevertheless, well-balanced drug treatment is sometimes supportive in combination with CBT-I and sleepcoaching by catalyzing additional improvement. Studies confirmed that several sleep measures improved after just a 2 day seminar on sleepcoaching ( Holzinger et al., 2019a ). This gets additional support as not only nightmares of Mrs. L. seemed to shift but other psychological problems as well. For example, her anxiety, depression, and quality of life score also improved. These changes already occurred over a time period of just 6 weeks.

As mentioned before, sleep problems are frequent comorbidity in various mental disorders and produce psychopathology and psychological distress to a high degree ( Sateia, 2009 ). The urgency of treating sleep problems gets visible as they are present in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, and schizophrenia ( Baglioni et al., 2016 ). In PTSD, studies indicate that sleep mediates the relationship between rumination and more severe PTSD and depressive symptoms ( Borders et al., 2015 ). That is in line with results suggesting that sleep problems hinder the recovery from PTSD ( Babson and Feldner, 2010 ) and that remaining sleep problems after treating PTSD predicted worse treatment outcomes ( López et al., 2017 ). Moreover, non-medical treatment of sleep problems can be as effective as the medical equivalent and can further elevate the effects of treatment for PTSD ( Gilbert et al., 2015 ). Sleep seems to play a substantial role in not only the recovery from psychiatric disorders but also in the recovery from critical illnesses demanding ICU treatment ( McKinley et al., 2013 ). Given that sleep is also correlated with quality of life, this further points to the direction that improving sleep quality could help any patient improve their overall mental state ( Zeitlhofer et al., 2000 ; Košćec Bjelajac et al., 2020 ).

Limitations of the LD and sleepcoaching approach are that they need further empirical proof. Even though sleepcoaching has been proved useful in shift workers ( Holzinger et al., 2019a ) and healthy subjects ( Holzinger et al., 2019a ), it should be further researched in the context of other sleep and mental health problems. We suggest that patient groups with sleep problems like narcolepsy and obstructive sleep apnea would benefit from the program. Furthermore, it should be assessed in the context of other mental health problems involving nightmare and sleep symptoms, such as depression, borderline, and eating disorders. Another limitation to this technique is that LD is not always easy to induce, and empirical evaluations of the induction methods are sparse ( Stumbrys et al., 2012 ). Nevertheless, cognitive techniques combined with wake-up-back-to-bed methods seem promising ( Stumbrys et al., 2012 ), as well as portable devices ( Mota-Rolim et al., 2019 ) and/or support through substances like glantamine ( LaBerge et al., 2018 ).

In conclusion, since sleep problems trigger mental disorders and mental health in general, this may negatively affect recovery from traumas, such as PTSD and other physical illnesses. Nightmares, in turn, have an impact on sleep quality, and they are an indication of psychopathologic underpinnings, including suicide risk. The latter relationship is particularly of interest since this relationship seems to be unidirectional. There is evidence that treating nightmares by LD training programs is effective, as the dreamer might also gain insight into his/her psyche without the disadvantages of long-lasting drug treatments. Applying this approach by including the holistic approach of sleepcoaching into treatment concepts seems especially promising. Sleepcoaching targets various sleep problems; it enables the affected to make informed improvements in their sleep hygiene through education, uses concepts of CBT-I and relaxation techniques, including medical hypnosis, and incorporates dream work through LD techniques.

Data Availability Statement

The data analyzed in this study is subject to the following licenses/restrictions: Psychtherapeutic Confidentiality. Requests to access these datasets should be directed to Brigitte Holzinger, info@schlafcoaching.org .

Ethics Statement

The studies involving human participants were reviewed and approved by Ethics Committee MedUni Vienna. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.

Author Contributions

BH: conceptualization, manuscript, supervision, and LD-training. FN: manuscript, research, and formatting. GK: supervision. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: nightmares, sleepcoaching, PTSD, lucid dreaming, sleep, dreams, CBT-I, public health

Citation: Holzinger B, Nierwetberg F and Klösch G (2021) Case Report: Why Sleep and Dream Related Psychological Treatments, Such as Sleepcoaching (According to Holzinger&Klösch) and CBT-I Should Be Implemented in Treatment Concepts in the Public Health System—Description of the Nightmare Treatment Process in the Context of PTSD. Front. Psychol. 12:733911. doi: 10.3389/fpsyg.2021.733911

Received: 30 June 2021; Accepted: 22 September 2021; Published: 25 October 2021.

Reviewed by:

Copyright © 2021 Holzinger, Nierwetberg and Klösch. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Brigitte Holzinger, info@schlafcoaching.org

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Research uncovers differences between men and women in sleep, circadian rhythms and metabolism

A new review of research evidence has explored the key differences in how women and men sleep, variations in their body clocks, and how this affects their metabolism.

Published in Sleep Medicine Reviews , the paper highlights the crucial role sex plays in understanding these factors and suggests a person's biological sex should be considered when treating sleep, circadian rhythm and metabolic disorders.

Differences in sleep

The review found women rate their sleep quality lower than men's and report more fluctuations in their quality of sleep, corresponding to changes throughout the menstrual cycle.

"Lower sleep quality is associated with anxiety and depressive disorders, which are twice as common in women as in men," says Dr Sarah L. Chellappa from the University of Southampton and senior author of the paper. "Women are also more likely than men to be diagnosed with insomnia, although the reasons are not entirely clear. Recognising and comprehending sex differences in sleep and circadian rhythms is essential for tailoring approaches and treatment strategies for sleep disorders and associated mental health conditions."

The paper's authors also found women have a 25 to 50 per cent higher likelihood of developing restless legs syndrome and are up to four times as likely to develop sleep-related eating disorder, where people eat repeatedly during the night.

Meanwhile, men are three times more likely to be diagnosed with obstructive sleep apnoea (OSA). OSA manifests differently in women and men, which might explain this disparity. OSA is associated with a heightened risk of heart failure in women, but not men.

Sleep lab studies found women sleep more than men, spending around 8 minutes longer in non-REM (Rapid Eye Movement) sleep, where brain activity slows down. While the time we spend in NREM declines with age, this decline is more substantial in older men. Women also entered REM sleep, characterised by high levels of brain activity and vivid dreaming, earlier than men.

Variations in body clocks

The team of all women researchers from the University of Southampton in the UK, and Stanford University and Harvard University in the United States, found differences between the sexes are also present in our circadian rhythms.

They found melatonin, a hormone that helps with the timing of circadian rhythms and sleep, is secreted earlier in women than men. Core body temperature, which is at its highest before sleep and its lowest a few hours before waking, follows a similar pattern, reaching its peak earlier in women than in men.

Corresponding to these findings, other studies suggest women's intrinsic circadian periods are shorter than men's by around six minutes.

Dr Renske Lok from Stanford University, who led the review, says: "While this difference may be small, it is significant. The misalignment between the central body clock and the sleep/wake cycle is approximately five times larger in women than in men. Imagine if someone's watch was consistently running six minutes faster or slower. Over the course of days, weeks, and months, this difference can lead to a noticeable misalignment between the internal clock and external cues, such as light and darkness.

"Disruptions in circadian rhythms have been linked to various health problems, including sleep disorders, mood disorders and impaired cognitive function. Even minor differences in circadian periods can have significant implications for overall health and well-being."

Men tend to be later chronotypes, preferring to go to bed and wake up later than women. This may lead to social jet lag, where their circadian rhythm doesn't align with social demands, like work. They also have less consistent rest-activity schedules than women on a day-to-day basis.

Impact on metabolism

The research team also investigated if the global increase in obesity might be partially related to people not getting enough sleep -- with 30 per cent of 30- to 64-year-olds sleeping less than six hours a night in the United States, with similar numbers in Europe.

There were big differences between how women's and men's brains responded to pictures of food after sleep deprivation. Brain networks associated with cognitive (decision making) and affective (emotional) processes were twice as active in women than in men. Another study found women had a 1.5 times higher activation in the limbic region (involved in emotion processing, memory formation, and behavioural regulation) in response to images of sweet food compared to men.

Despite this difference in brain activity, men tend to overeat more than women in response to sleep loss. Another study found more fragmented sleep, taking longer to get to sleep, and spending more time in bed trying to get to sleep were only associated with more hunger in men.

Both women and men nightshift workers are more likely to develop type 2 diabetes, but this risk is higher in men. Sixty-six per cent of women nightshift workers experienced emotional eating and another study suggests they are around 1.5 times more likely to be overweight or obese compared to women working day shifts.

The researchers also found emerging evidence on how women and men respond differently to treatments for sleep and circadian disorders. For example, weight loss was more successful in treating women with OSA than men, while women prescribed zolpidem (an insomnia medication) may require a lower dosage than men to avoid lingering sleepiness the next morning.

Dr Chellappa added: "Most of sleep and circadian interventions are a newly emerging field with limited research on sex differences. As we understand more about how women and men sleep, differences in their circadian rhythms and how these affect their metabolism, we can move towards more precise and personalised healthcare which enhances the likelihood of positive outcomes."

The research was funded by the Alexander Von Humboldt Foundation, the US Department of Defense and the National Institute of Health.

• Sleep Disorder Research
• Insomnia Research
• Gender Difference
• Sleep Disorders
• Obstructive Sleep Apnea
• Circadian rhythm sleep disorder
• Glutamic acid
• Sleep deprivation

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Materials provided by University of Southampton . Note: Content may be edited for style and length.

Journal Reference :

• Renske Lok, Jingyi Qian, Sarah L. Chellappa. Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine . Sleep Medicine Reviews , 2024; 75: 101926 DOI: 10.1016/j.smrv.2024.101926

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Scientists use wearable technology to detect stress levels during sleep

by University of Vermont

What if changes in a person's stress levels could be detected while they sleep using wearable devices? A new study by University of Vermont researchers published in PLOS Digital Health is the first to find changes in perceived stress levels reflected in sleep data—an important step towards identifying biomarkers that may help flag individuals in need of support.

Given how critical sleep is to physical and mental health , the research team suspected signals might exist in sleep data, says Laura Bloomfield, a research assistant professor of mathematics and statistics and lead author of the study. "Changes in stress are visible."

When parsing baseline sleep data, the researchers found "consistent associations" between people's perceived stress scores and factors such as total sleep time, resting heart rate and heart rate variability , and respiratory rate.

While it's no surprise that most participants received less than the recommended eight to 10 hours of sleep for young adults, the minutes do matter. For every additional hour of sleep recorded, the odds of someone reporting moderate-to-high stress decreased about 38%. Nightly resting heart rates offered more clues. For each additional beat per minute, the odds of experiencing stress increased by 3.6%.

Bloomfield is a principal investigator of the Lived Experience Measured Using Rings Study (LEMURS)—a longitudinal study started at UVM in 2022 that tracks hundreds of first- and second-year college students 24 hours a day using a wearable Oura ring biosensor and through surveys about their well-being. This is the first peer-reviewed paper from LEMURS and shows that data gleaned from wearables can reveal changes in people's mental health status.

"The study showed that sleep measures from the Oura ring were predictive of participants' perceived level of stress. If we are able to identify in real-time that someone is experiencing increased stress, there might be an opportunity to offer helpful interventions," Bloomfield explains. "There are a lot of ways to implement interventions, but the first step is understanding the connection between sleep measures and mental health measures."

About LEMURS

The LEMURS project was conceived by Chris Danforth, professor of applied mathematics at UVM's Vermont Complex Systems Center and fellow of the Gund Institute for Environment and Bloomfield, MD/Ph.D., to determine how wearable technologies could be used to improve young people's health and well-being with personalized health feedback.

College students, in general, don't sleep enough, often feel stressed, and are at greater risk of experiencing mental health issues. The LEMURS research team will also evaluate the effectiveness of interventions such as exercise, excursions into nature, and group therapy—all interventions which have previously shown improvements in health and well-being—to understand which work best and how quickly scalable they are for large populations.

But to do all of this requires identifying biometric data that provide the clearest signals for addressing changes in physical and mental health—a process that involves gathering and sifting through millions of hours of data each year.

LEMURS participants wear Oura rings that quietly collect measurements including temperature, heart rate, breathing rate, and nightly sleep duration as well as complete routine surveys to collect more subjective responses about potential stressors and their emotions.

Location information is also used to calculate the exposure participants have to nature. All this data is then combed by LEMURS researchers like Mikaela Fudolig, research assistant professor of mathematics and statistics, who test specific relationships that could be used to develop health interventions. She co-authored the PLOS Digital Health paper and says there is power in the study's numbers.

Initially, 600 first-year students aged 18 to 20 enrolled in LEMURS. A second cohort of first-year students was added in fall 2023 with a goal of following these individuals through college and far into the future.

"We have been tracking the same students for almost two years now, and there are very few studies that do that," says Fudolig, research assistant professor of mathematics and statistics, who says there is power in the study's numbers.

"We have several sources of data. Taking these all together—your ring data, your survey data, your nature-dose data, we also have blood work done—we will see a lot of different dimensions from these participants. So, combining them is, to me, the most exciting thing of it all."

These potential predictors of stress led to a sleep analysis of LEMURS participants by Fudolig which detected two distinct heart rate curves, particularly among women. We find that those who reported an impairment in their daily life due to anxiety or depression had heart rates that dropped later in the night, she explains.

'A high burden of stress'

The COVID-19 pandemic worsened mental health problems for an already vulnerable population. In the decade before COVID , the Center for Disease Control and Prevention found the percentage of high school students nationwide experiencing persistent feelings of sadness or hopelessness jumped from 26.1% to 36.7%. The CDC's 2021 Youth Risk Behavior Survey showed another jump—42% of students reported feeling persistently sad.

This is one reason Danforth and Bloomfield launched LEMURS in the first place.

"There is a high burden of stress in this population," Bloomfield says, "College is seen as a very carefree period of time where you are coming into your own, but it's also a period with a lot of transition and a lot of additional stressors. There needs to be better, accessible support systems for young adults during this time."

She wasn't surprised to learn that perceived stress scores of LEMURS participants were high—64% of responses were considered moderate-to-highly stressed. These are personal assessments of how individuals feel about problems they encounter and their ability to manage them and responses vary depending on one's life experiences, personality, support, and coping skills. Part of the challenge with interpreting stress signals using biometric data is figuring out when deviations from someone's baseline are problematic and concerning, Bloomfield explains.

"This is a resilient population, they are young and healthy," she continues. "But I think this study is bringing to light important issues facing this population. The ultimate goal with our research is that you can help support people in times of decreased mental health or physical health status."

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Is sleeping on your stomach or back better? Here are some bedtime myths, debunked

You may have heard of the perils of sleeping on your back or your stomach. But, for most people, attempting to change how you sleep can do more harm than good.

How did you sleep last night? If you’re like most people, you assumed your favorite position at bedtime. But once sleep sets in, you likely moved again and again, shifting into multiple positions as you slept.

If you wonder whether there’s an ideal way to sleep, you’re not alone: There’s plenty of conflicting advice and dubious online information linking sleep positions to various benefits or problems, and the market is flooded with devices that promise to keep you from sleeping on your back, the scapegoat of most sleep position science.

But it turns out we have way less control over how we sleep than we might think—and we might be better off not trying.

( These are the mysteries that science is unlocking about sleep .)

“Sometimes there’s more harm than good in trying to control your position,” says Raman Malhotra, past president of the American Academy of Sleep Medicine and a professor of neurology at the Washington University School of Medicine.

Here’s what we do know about sleep positions—and what sleep scientists say is worth focusing on for a good night’s sleep.

Debunking early sleep theories

Are you a Flamingo, a Dutch Wife, or a Royal? The question isn’t part of a party game, though it might sound like it. Those colorful monikers are used to describe the seemingly limitless ways in which our bodies arrange themselves while sleeping.

They’re just a selection of the terms coined by psychologist Samuel Dunkell, who penned a popular psychology book in 1977 calling sleep positions “the night language of the body.” For Dunkell, sleep positions gave clues about an individual’s personality traits and psychology—their bodily position during their most vulnerable hours offering hints of how they move through the waking world.

This analysis prompted a young Joseph De Koninck, a psychologist in Canada, to wonder how people really sleep at night. He created a stop-motion method for photographing sleep positions throughout the night without waking a patient. This system, based on the Super-8 camera, unleashed a torrent of research on how people sleep.

( Here are seven science-backed tips for better sleep .)

But the psychologist, now an emeritus professor at the University of Ottawa, soon concluded that a person’s position during sleep has nothing to do with their personality, preference, or even sleep stage. Moreover, he says, “The position you take during sleep onset is not necessarily the one you use through the night.”

So what does science tell us about our sleeping positions? De Koninck’s research has showed that the number of times people change position during sleep goes down with age and that older adults strongly prefer sleeping on their right side—a position that could help regulate blood pressure. Meanwhile, other studies show that people tend to spend over half of their sleep time on their sides, with older and obese patients moving less than their younger counterparts.

When sleep gets uncomfortable

After dozens of studies on the topic, De Koninck is now convinced that sleeping position is more a reflection of anatomy and physiology than a person’s psychology—and that once you go to sleep, your body’s in charge of its position.

Malhotra agrees. “There are definitely positions that are more comfortable for certain patients,” he says—for example, an injury in your left leg or shoulder might prompt you to sleep mostly on your right side. But he notes that once a person is sleeping, it can be a long, frustrating road to train people to avoid certain positions during their sleep.

“Controlling someone's positions at nighttime is very difficult,” he says. The majority of patients who need to change their sleep position are back sleepers experiencing sleep apnea, in which the airway collapses or does not function properly, causing a person to stop breathing multiple times per night.

( This is the toll that sleep apnea takes on the body .)

Some people turn to fancy sleep training devices to keep them off their backs. Though only a few are FDA-approved, these devices buzz, inflate, and poke patients into different sleep positions. Meanwhile others simply tape a tennis ball to their back to make back sleeping uncomfortable, an old-school method that has actually been shown to work as well as special sleep training devices.

Still, training someone to adopt a different default sleep position can take months—and setbacks are common. Studies show that patients tend to abandon both tennis balls and other devices because of the discomfort they cause.

“Some of the devices we recommend are disruptive to patients’ sleep, Malhotra says. And those months of sleepless nights are themselves associated with all sorts of health issues, from obesity and stroke to accidents and depression.

The future of sleep research

Sleep scientists continue to improve the tech behind sleep studies, using accelerometers and other technology to determine sleep position. But the benefits of certain sleep positions are still unclear—and it’s proven difficult to put the information we do have about sleep positions to use.

For example, studies on sleeping rodents suggest side sleeping is associated with better cognition and a lower risk of dementia, perhaps because it helps clear brain waste. But animal studies don’t always translate in human subjects, and even if you managed to train your body to sleep on the side, it’s unclear whether it would benefit your brain health long-term.

Instead of worrying about something that’s so hard to control, Malhotra says it’s worth asking yourself how you feel when you wake up. “Our best measure of sleep quality is still what someone feels like in the morning,” he says. Overall, the science suggests that if you’re well-rested and don’t have sleep apnea or pain, you don’t need to worry about sleep positions. So next time you go to sleep, close your eyes, relax, and let nature take its course.

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Research uncovers differences between the sexes in sleep, circadian rhythms and metabolism

A new review of research evidence has explored the key differences in how women and men sleep, variations in their body clocks, and how this affects their metabolism.

Published in Sleep Medicine Reviews , the paper highlights the crucial role sex plays in understanding these factors and suggests a person’s biological sex should be considered when treating sleep, circadian rhythm and metabolic disorders.

Differences in sleep

The review found women rate their sleep quality lower than men’s and report more fluctuations in their quality of sleep, corresponding to changes throughout the menstrual cycle.

“Lower sleep quality is associated with anxiety and depressive disorders, which are twice as common in women as in men,” says  Dr Sarah L. Chellappa from the University of Southampton and senior author of the paper. “Women are also more likely than men to be diagnosed with insomnia, although the reasons are not entirely clear. Recognising and comprehending sex differences in sleep and circadian rhythms is essential for tailoring approaches and treatment strategies for sleep disorders and associated mental health conditions.”

The paper’s authors also found women have a 25 to 50 per cent higher likelihood of developing restless legs syndrome and are up to four times as likely to develop sleep-related eating disorder, where people eat repeatedly during the night.

Meanwhile, men are three times more likely to be diagnosed with obstructive sleep apnoea (OSA). OSA manifests differently in women and men, which might explain this disparity. OSA is associated with a heightened risk of heart failure in women, but not men. 

Sleep lab studies found women sleep more than men, spending around 8 minutes longer in non-REM (Rapid Eye Movement) sleep, where brain activity slows down. While the time we spend in NREM declines with age, this decline is more substantial in older men. Women also entered REM sleep, characterised by high levels of brain activity and vivid dreaming, earlier than men.

Variations in body clocks

The team of all women researchers from the University of Southampton in the UK, and Stanford University and Harvard University in the United States, found differences between the sexes are also present in our circadian rhythms.

They found melatonin, a hormone that helps with the timing of circadian rhythms and sleep, is secreted earlier in women than men. Core body temperature, which is at its highest before sleep and its lowest a few hours before waking, follows a similar pattern, reaching its peak earlier in women than in men.

Corresponding to these findings, other studies suggest women’s intrinsic circadian periods are shorter than men’s by around six minutes.

Dr Renske Lok from Stanford University, who led the review, says: “While this difference may be small, it is significant. The misalignment between the central body clock and the sleep/wake cycle is approximately five times larger in women than in men. Imagine if someone's watch was consistently running six minutes faster or slower. Over the course of days, weeks, and months, this difference can lead to a noticeable misalignment between the internal clock and external cues, such as light and darkness.

“Disruptions in circadian rhythms have been linked to various health problems, including sleep disorders, mood disorders and impaired cognitive function. Even minor differences in circadian periods can have significant implications for overall health and well-being.”

Men tend to be later chronotypes, preferring to go to bed and wake up later than women. This may lead to social jet lag, where their circadian rhythm doesn’t align with social demands, like work. They also have less consistent rest-activity schedules than women on a day-to-day basis.

Impact on metabolism

The research team also investigated if the global increase in obesity might be partially related to people not getting enough sleep - with 30 per cent of 30- to 64-year-olds sleeping less than six hours a night in the United States, with similar numbers in Europe.

There were big differences between how women’s and men’s brains responded to pictures of food after sleep deprivation. Brain networks associated with cognitive (decision making) and affective (emotional) processes were twice as active in women than in men. Another study found women had a 1.5 times higher activation in the limbic region (involved in emotion processing, memory formation, and behavioural regulation) in response to images of sweet food compared to men.   

Despite this difference in brain activity, men tend to overeat more than women in response to sleep loss. Another study found more fragmented sleep, taking longer to get to sleep, and spending more time in bed trying to get to sleep were only associated with more hunger in men.

Both women and men nightshift workers are more likely to develop type 2 diabetes, but this risk is higher in men. Sixty-six per cent of women nightshift workers experienced emotional eating and another study suggests they are around 1.5 times more likely to be overweight or obese compared to women working day shifts.

The researchers also found emerging evidence on how women and men respond differently to treatments for sleep and circadian disorders. For example, weight loss was more successful in treating women with OSA than men, while women prescribed zolpidem (an insomnia medication) may require a lower dosage than men to avoid lingering sleepiness the next morning.

Dr Chellappa added: “Most of sleep and circadian interventions are a newly emerging field with limited research on sex differences. As we understand more about how women and men sleep, differences in their circadian rhythms and how these affect their metabolism, we can move towards more precise and personalised healthcare which enhances the likelihood of positive outcomes.”

Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine  is published in  Sleep Medicine Reviews  and is available online.

The research was funded by the Alexander Von Humboldt Foundation, the US Department of Defense and the National Institute of Health.

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