An Examination of Relationship Between Anxiety and Insomnia

Anxiety is commonly associated with insomnia. Many research have been done in this area. The results of the previous research studies often revealed strong relationships between anxiety and insomnia. Often, anxiety and insomnia can be frequently associated with depression. This research study was conducted among Hunter College students in order to investigate a relationship between anxiety and insomnia. There were 22 students participating in the research, between ages 18 and 34. Twelve of them were males and ten were females.
There was a multiple-choice questionnaire, adapted from other research studies, with four possible answers from 0 – not at all bothered to 3 – severely bothered. The obtained results fully supported the hypothesis that there is a significant positive correlation between anxiety and insomnia. The higher is anxiety level, the higher is insomnia level. Nevertheless, the research had its own limitations, and further modifications of a research design could be done in this area of study. An Examination of a Relationship Between Anxiety and Insomnia Anxiety is commonly associated with insomnia.
A number of research studies in this area support the idea that insomnia and anxiety have common mechanisms that underlie or maintain these difficulties (Fairholme, 2012). Some studies investigate the association between anxiety, depression and insomnia, which often co-occur at the same time (Jansson-Frojmark, 2008). However, the question about cause-effect in this relationship between anxiety and insomnia still remains. In his article, Pacana (2010) stated that the anxiety disorders became the most common mental disorders in the United States.

Nineteen percent of the population suffers from these afflictions every year. There are six major types of anxiety – Generalized Anxiety Disorder, Phobias, Social Anxiety, Panic Disorder, Obsessive Compulsive Disorder, and Post-traumatic Stress Disorder. Approximately one fifth of individuals seek treatment for these disorders. The estimated coast of anxiety disorders in the country is about 50 billion dollars in any given year. Pacan (2010) also wrote, that anxiety is a “product “ of the central nervous system’s physiological and emotional response to ambiguous sense of fear or threat.
Anxiety may appear even when there is no presence of actual life or health threats. Sometimes, anxiety can be so overwhelming and exhausting that it becomes a threat itself after a while. An Anxiety Disorder develops after the anxiety becomes severe, easy to trigger, occurs too frequent, or stays for too long. According to Pacan (2010), an anxiety is difficult to describe or measure. Luckily, psychologists have a number of tools for assessing a person’s level of anxiety. A Beck Anxiety Inventory (BAI) is one of the methods administered by Aaron Beck.
It’s a 21question multiple-choice questionnaire that measures an individual’s anxiety level. There are four possible answers for each question scored from 0 (NO not at all) to 3 (YES and I could barely stand it). Each answer indicates the emotional state of an individual in the last week, expressed as common symptoms of anxiety (such as unsteadiness, wobbliness, nervousness, or difficulty in breathing, etc. ). The cumulative scores range from 0 to 63, which measure the anxiety level. The higher the score is, the more severe is the anxiety level.
The higher scores indicate that an individual may have very serious and health-threating implications, like sleep disturbance or more severe form of sleep deprivation – insomnia. Jansson (2007) indicated that insomnia is another prevalent condition in the population of the United States and worldwide. The prevalence of insomnia ranges from nine to twelve percent in adulthood. Generally, insomnia is viewed as a persistent condition and defined as number of intertwined conditions, such as difficulty getting to sleep at bedtime, waking up too early in the morning, not getting enough sleep at night, etc.
Individuals experiencing insomnia also complain about negative daytime symptoms, like distress or impairment in social, or other vital areas of functioning. According to Bogan (2007), insomnia is associated with significant health-related consequences. The estimated healthcare coast of insomnia in the United States is approximately 14 billion dollars. People with abnormal sleep are more likely to experience anxiety and depression and suffer other serious consequences, like drug or alcohol abuse and an increased incidence of medical and psychiatric disorders.
Unfortunately, severe insomnia may cause driving-related accidents and an overall increase in mortality rate. Although there are many factors that can contribute to sleeping disturbance, one of the most known is Anxiety. Buckner (2008) stated that insomnia is commonly associated with anxiety, and that sleep quality impairments, such as insomnia, can constitute a significant risk factor for development of anxiety disorders. The study used bivariate correlations to examine a relationship between social anxiety and insomnia in the undergraduate students.
There was an association found between social anxiety and sleep dissatisfaction, sleep-related functional impairment, perception of a sleep problem to others, and distress about sleep problems. Jansson-Frojmark (2008) conducted research study about bidirectional relationship between anxiety and depression and insomnia. The revealed results indicate that anxiety and insomnia are significantly inter-correlated. The study used bidirectional correlation to demonstrate the relationship between anxiety and depression separately, and then their relationship with insomnia, using a prospective design in the general population.
Although the research showed the bidirectional interrelationship between anxiety, depression and insomnia, the question about cause-effect relationship, where anxiety and depression influence insomnia, or vise versa, still remains. In 2012, Fairhome conducted research study about emotional disorders, insomnia, and common factors that underlie or maintain these difficulties. The results supported a hypothesis that common mechanisms are involved for emotional disorders and insomnia. One of the factors that may explain these mechanisms is anxiety sensitivity (AS).
AS might function as a mechanism for the maintenance of sleep deprivation in order of anxiety and mood disorders. Anxiety sensitivity is a fear of anxiety-related sensations, which has been theorized as a heritable risk factor involved in development and maintenance of emotional disorders. For instance, an individual can believe that racing heart will cause a heart attack or that temporal loss of a sense of reality will transform into insanity. That is, an individual’s faulty beliefs of the danger of emotional disorders or sleep disturbance may increase physical symptoms of anxiety or insomnia, or both.
The aim of this research study is to examine the relationship between anxiety and insomnia among college students. It was hypothesized that there will be a positive correlation between anxiety and insomnia, that the higher is an anxiety level the higher is an insomnia level. Method Participants A convenience sample of Hunter College students was used. There were 22 participants (N = 22) voluntarily participating in the research study, from the ages of 18 to 34 years old, with an average age of 21 (SD = 3. 28). There were twelve males (54. 5%) and ten females (45. %) of different demographic backgrounds, living mostly in the city of Manhattan or the other four boroughs of New York City. All of the participants were randomly selected and were proposed to participate in the research. Materials A questionnaire form was used to collect the data (See Appendix). Twenty questions about anxiety were adapted from Beck Anxiety Inventory (BAI) (Beck, 1988), and 20 questions about insomnia were adapted from Pittsburg Insomnia Rating Scale (PIRS) administered by Moul, D. E. and other researchers in their preliminary study of the test-retest reliability and concurrent validities of the PIRS in 2002.
There are 66 questions (For example, “Consider the quality of your sleep in the last week: Difficulty getting to sleep at bedtime”) multiple-choice questionnaire with four possible answers for each question (For example 0 – Not at all bothered; 1 – Slightly bothered; 2 – Moderately bothered; 3 – Severely bothered) (Moul, 2002). The ordered response options for the questions were adapted from PIRS (Moul, 2002). For the answers for each of 40 questions the Likert scale was used from zero to three (0 – Not at all bothered, 1 – Slightly bothered, 2 – Moderately bothered, 3 – Severely bothered).
I went to the third floor of the Hunter College (695 Park Ave building), during the fall 2012 semester and started asking passing by students to participate in my research. Each participant received a consent form and a self-report questionnaire. They were asked to fill in questionnaire about factors that influence good sleep patterns. The participants were told to finish all 40 questions by filling in the numbers that best corresponded to their opinion about each item. After the data was collected, the cumulative scores for anxiety and insomnia were counted for each participant, and the data were collected in an excel file.
Then the SPSS program was run in order to organize and interpret the raw data. Results A total number of 22 participants (N = 22, SD = 3. 28) participated in the research. Ten of them were females (45. 5%) and twelve were males (54. 5%), with an average age of 21 (36. 4%), a variance of 10. 7, and a range of 16. The youngest participant was 18 years old, and the eldest was 34 years old (See Table 1). The mean anxiety score was 15. 95 (SD = 10. 55), with a range of 40. A mean score for insomnia was 24. 27 (SD = 15. 63), with a range of 54. The minimum scores for anxiety and insomnia were zero and five, and the maximum scores were 40 and 59.
To determine whether there was a significant positive correlation between anxiety and insomnia, the Pearson’s Correlation test was conducted. There was a significant correlation obtained for anxiety and insomnia, r (22) = . 74, p < . 01 (See Table 2). Discussion The obtained results fully support the hypothesis that there is a relationship between anxiety and insomnia. The results indicate that the relationship between anxiety and insomnia is strong and positive (See Figure 1), meaning that anxiety and insomnia levels change in the same direction.
For instance, when the anxiety level goes up, the insomnia level goes up too. Generally speaking, the association between anxiety and insomnia indicates that individuals who are vulnerable to stress and other emotional disturbances are more likely to experience sleep deprivation at normal sleep time hours. Individuals who suffer from bad night sleep are more likely to feel anxious the next day. In this research the minimum score of zero for anxiety (See Table 1) indicates that at least one participant did not fill in any number other than zero within the anxiety questions in the questionnaire.
However, the minimum score of five within the insomnia questions means that all of the participants experienced insomnia at the time of conducting research. All of that could probably have different explanation for student’s insomnia. It could be caused by something other than anxiety, like a physical problem, or loud neighborhood, etc. The student could simply not be honest about his or her anxiety, filling in zeros for every anxiety question.
The results that were obtained in this research study are very similar to the results from previous research studies about anxiety and insomnia relationships, which were mentioned above (Buckner, J. D. , 2008, Fairhokme, C. P. , 2012, Jansson-Frojmark, M. , 2008, and Jansson, M. , 2007). In the Fairholme (2012) research it was discussed that individuals with anxiety sensitivity have a fear that their sleeping problems are related to some kind of health problem, which can make the individuals even more anxious and more likely to acquire serious disorders, like chronic insomnia.
In this case a situation becomes a vicious circle. An individual gets more anxious because cannot sleep well at night, and he or she gets problems with falling asleep because he or she is too anxious about whole situation. It is possible that some of the students from our research have AS, which affected their good sleep patterns. This research results do not show any evidence for cause-effect relationship between anxiety and insomnia, though. It is hard to say whether anxiety causes insomnia, or the other way around, or whether anxiety and insomnia cause each other.
It is hard to draw serious conclusions about what actually caused insomnia and anxiety in the observed students in this research study. It is also hard to say if participants had anxiety, or depression, or both due to the lack of possibility to differentiate anxiety from depression in this research. Sometimes anxiety and depression have the same symptoms, and that could have resulted in some errors in the questionnaire in this research. In the Jansson-Frojmark (2008) research study it was stated that relationship between anxiety and depression and insomnia is inter-correlated.
Moreover, it was said that these three factors could simply co-occur in some cases. For example, an individual suffers from anxiety, which makes him or her experience insomnia, and whole that situation makes an individual be depressed. In this study, the combination of anxiety, depression and insomnia could be present conditions for some or for all of the participants. Although we cannot approve a cause-effect relationship between anxiety and insomnia, it is essential to say that sleep quality impairments can serve as a significant factor for anxiety disorders development or vice versa.
According to Buckner research study (2008) individuals with history of insomnia are at greater risk for the later emergence of an anxiety disorder. When an individual had bad night sleep, he or she can feel weak, disorganized, tired, or simply he or she can feel moody or even mad. If the individual experiences the same problems over and over again for a long-term period, he or she can develop a fear from experiencing problems with sleep. For example, “I am so afraid I will not be able to fall asleep tonight again, and that makes me so anxious. After a while, that fear of insomnia can be transformed into an anxiety disorder. In this research a maximum score for insomnia is 59, comparing to anxiety maximum score of 40 can indicate that on average insomnia occurs in bigger degree than anxiety in these participants. That could possibly mean that insomnia in the participants was associated with factors other than anxiety during the time of conducting the study. For example, a participant has a snoring roommate, or there is construction outside making an annoying noise early in the morning.
In this case, without talking to each participant individually, it is impossible to conclude what was a real reason for the sleep disturbance, and for how long a participant has been experiencing it. There are few possible limitations of this research study, like a small size of a sample, specific population – Hunter College students, and lack of access to information about participants. The convenient sample size is not quiet enough for generalizing the obtained results. Twenty-two participants cannot fully reflect the real situation regarding relationship between anxiety and insomnia.
Small sample in this research could lead to getting a Type I error, the obtained result is probably not significant as we think it is. Perhaps, most of the participants were interested in the research just because they did have both problems – anxiety and insomnia presented in their lives at a moment of conducting the research study. Moreover, any college students often have anxiety and insomnia occurring in the end of the semester (the research study was conducted in the end of the semester of fall, 2012).
Conceivably, students were getting through the tests and exams at this particular time, and all that could cause anxiety and insomnia during a short-term period. Another reason to be concerned about a validity of the results is that we do not know enough information about the participants, like if they have anxiety or insomnia occurred earlier, and how many times before. Some of the participants could simply be taking some medications, which were prescribed to prevent or trigger the emergence of anxiety and insomnia. Despite these limitations, this research study contributes to the future revenue of anxiety and insomnia research studies.
For the future work in this area, it would be interesting to add some questions about depression to questionnaire, and ask more details about participant’s life events and possible stressors. Gender differences may also play a substantial role in this research study. Females are more likely to experience emotional disruptions than males. For instance, according to Bogan (2007) young women are especially vulnerable to insomnia and it seems to increase with age by 20% – 50%. Men experience insomnia 1. 4 – 1. 7 times less than women. It is essential to make a gender type as an independent variable for the future research design.