The impact of pre-sleep arousal state and strategy to control unwanted thoughts on sleep quality

Objective: It has been questioned whether elevated pre-sleep cognitive arousal contributes to poor sleep or whether it is the use of maladaptive thought control strategies, used to manage this cognitive arousal, that are responsible. The study aimed to examine how these factors - cognitive arousal (with and without anxiety) and maladaptive thought control strategies contribute to perceived sleep quality (SQ). Design: 129 healthy adults (46 males, 83 females) were exposed to picture-stimuli eliciting either anxious cognitive arousal or non-anxious cognitive arousal at bedtime. The groups were then randomly split and briefed to use either a cognitive distraction or cognitive suppression thought control strategy or no instructions were given (controls). Subjective SQ was measured immediately on waking. Results: Induced anxious cognitive arousal was associated with lower SQ compared to non-anxious cognitive arousal. Analyses revealed a significant interaction between arousal and the strategies used to control unwanted thoughts on SQ. When experiencing anxious cognitive arousal, the strategy of distraction was associated with poorer sleep outcomes. Conclusion: The findings suggest that the efficacy of differing thought control strategies vary depending upon whether cognitive arousal elicits anxiety or not. With that in mind, clinical implications in terms of augmenting the treatment of insomnia are discussed.