Changes in Sleep Patterns
To test the relationship between stress and sleep and the mod- erating role of coping style, we used a repeated-measure analysis of variance based on the general linear model (GLM) analysis (SAS, 1990), with gender and age as control variables and EFC, PFC, and DE as three linear independent measures. All of the predictors and control variables were simultaneously entered into the model. The sleep measures on each testing period (low and high stress) were used as the dependent measures, with period as the independent repeating measure (with two levels for low- and high-stress measurement periods).
The test of our hypotheses regarding the moderating role of coping lies in the interactions between the period and the coping scale scores. As shown in Table 1, significant Period � EFC interaction effects were found for sleep period and true sleep time. These interactions indicate that high EFC scores were associated with reduction in sleep period in true sleep time (high-stress period in comparison with low-stress period). The Period � DE interac- tion was marginal and failed significance test with Bonferroni correction.
Significant main effects were found only for PFC for the sleep measures. High PFC scores were associated with longer sleep period and true sleep time (on both study periods). None of the main period effects were significant.
We retested the results of this model using a model of planned comparisons for our specific hypothesis regarding EFC and DE and obtained the same results. For an additional illustration of our findings, we divided the participants into two groups based on their EFC scores (high EFC for those above the median score and low EFC for those below the median score). Participants with low EFC score increased their true sleep time by 33 min (from the low- to the high-stress period), whereas true sleep time of participants with high EFC scores decreased by 23 min, respectively.
The subjective reports also yielded a significant Period � EFC interaction effect for the perceived sleep quality ratings of the
participants, F(1, 32) � 9.95, p � .005. Individuals with high EFC reported decreased perceived sleep quality during the high-stress period in comparison with the low-stress period, whereas the opposite was true for those with low EFC. Furthermore, a signif- icant correlation was found between the change in perceived sleep quality (from the low-stress to the high-stress period) and the change in level of stress between these periods, r � .45, p � .01. Increase in stress level was associated with significant decrease in perceived sleep quality.
Discussion
This study is, to the best of our knowledge, the first to assess, in a prospective manner, how individual coping styles moderate the response of the sleep–wake system to significant stress. The nat- uralistic design of the study enabled documenting sleep using objective measures in the regular sleep environment and subjective stress response using daily subjective ratings. However, the limi- tations of our study should also be emphasized. Our study relied on measuring stress and sleep during one low-stress period (regular school week) and one high-stress period (screening week), and some order effects cannot be ruled out. Although attempts were made to contact the participants to ensure completion of the daily reports, the compliance with the protocol of the daily reports could not be determined. In addition, the use of multivariate analysis and a number of different measures with a relatively small sample is also a limitation that should be noted, as it might have compro- mised the reliability of the findings. The significant increase in the stress level documented by the subjective daily stress ratings indicated that the period of evaluation for the clinical psychology graduate program was indeed a stressful period in comparison with the low-stress week that preceded it by 2–3 months.
In line with our hypotheses, changes in sleep were significantly moderated by the individual’s coping style. Individuals with high EFC shortened their sleep, whereas those with low EFC extended their sleep during the high-stress period. Furthermore, individuals with low EFC improved their perceived sleep quality during the high-stress period, whereas the opposite was true for those with high EFC. These results support earlier findings linking shortened sleep and insomnia with high EFC (Hicks et al., 1991; Morin et al., 2003). Thus, shortened sleep may reflect ineffective coping. This result is consistent with other findings suggesting that EFC is
Table 1 Multivariate Analysis Based on GLM Analysis: F Values and Significance of Effects (With Bonferroni Correction for Multiple Comparisons)
Analysis for sleep measure Age Gender EFC PFC DE
Period � EFC
Period � PFC
Period � DE
Sleep onset time 0.03 0.16 0.85 0.24 0.07 1.04 0.69 0.29 Morning rise time 1.01 0.08 0.03 2.49 0.11 6.15 0.48 0.65 True sleep time 2.34 6.66 5.09 17.20** 0.03 15.70** 0.08 4.72 Sleep period 1.36 1.37 2.09 10.40* 0.00 15.00** 0.01 2.19 Sleep percentage 0.26 7.67 1.86 1.73 0.05 1.49 0.42 2.12 Night wakings 0.35 8.10 3.16 2.34 0.00 1.14 0.18 0.54
Note. For all effects, dfs � 1, 30. Effects not included in the table were all nonsignificant in all of the analyses. GLM � general linear model; EFC � emotion-focused coping; PFC � problem-focused coping; DE � disengagement coping; period � low–high stress period. * p � .05. ** p � .005.
544 BRIEF REPORTS
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ineffective in stressful situations in which the individual has some level of control (Martelli, Auerbach, Alexander, & Mercuri, 1987).
Our hypothesis that the disengagement coping style would be associated with extended sleep during stress received little support in our study. The Period � DE interaction was only marginally significant and failed to reach significance after the Bonferroni correction. Therefore, the role of DE in moderating the relation- ships between stress and sleep could not be determined from our research and should be further explored.
Our findings indicate that, on the basis of actigraphic measures, changes in sleep patterns from the low-stress to the high-stress period were mainly manifested in measures related to sleep period and not in sleep fragmentation measures. It is not clear whether sleep quality was not affected by the stress or our actigraphic measures were not sensitive enough. An interesting significant finding that emerged from our results is the positive association between PFC and the sleep quantity measures (sleep period and true sleep time). A high PFC score was associated with more sleep regardless of the specific period (vis-à-vis stress level). We failed to find any similar finding in the literature and address it as a preliminary finding that requires replication.
In conclusion, our study is the first prospective study that has documented distinct patterns of change in sleep period in response to stress, using objective sleep measures. Our results, emphasizing the role of coping style as a moderating factor, may explain some of the conflicting, or lack of, findings in previous studies (Pillar et al., 2000; Sadeh, 1996; Van Reeth et al., 2000). If coping style had not been considered as a moderating factor in our study, the significant changes in sleep would have been lost, because indi- viduals responded in a variety of ways, according to their coping style.
The biobehavioral mechanisms underlying the role of emotion- focused coping in moderating the relationships between sleep and stress should be further explored. The relationships between cop- ing and anxiety may offer some insight. In a prospective study on coping and anxiety in college students, Zeidner (1994) reported that high EFC predicted increased anxiety during the high-stress period (college examinations) and concluded that EFC is associ- ated with poor adaptation to this specific stress. Furthermore, increased reported anxiety and arousal level have been linked to insomnia and high EFC (Morin et al., 2003). Thus, the underlying mechanism might be that individuals with high EFC tend to react to stressful situations with elevated anxiety, which leads to an increased arousal level that is associated with compromised sleep.
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545BRIEF REPORTS
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