Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population

• A longitudinal design was employed to investigate cognitive processes of insomnia.
• Cognitive processes distinguished between persistent insomnia and normal sleep.
• More worry at baseline predicted persistent insomnia but not remission.
• A lowering of selective attention and safety behaviours predicted insomnia remission.
• Theoretical and clinical implications are discussed.

AimInsomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.MethodsIn a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.ResultsCognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.ConclusionsThe findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.