Academic journal article Scandinavian Journal of Work, Environment & Health

Changes in Self-Reported Sleep and Cognitive Failures: A Randomized Controlled Trial of a Stress Management Intervention

Academic journal article Scandinavian Journal of Work, Environment & Health

Changes in Self-Reported Sleep and Cognitive Failures: A Randomized Controlled Trial of a Stress Management Intervention

Article excerpt

Work-related stress is widespread and a major source of sick leave (1). Research indicates that cognitive behav- ioral therapy (CBT) interventions are more effective than other treatments in reducing stress symptoms (2), but only few studies have included patients with clinical levels of stress symptoms. These studies have shown mixed results (2-5). In the current study, stress is understood in terms of Lazarus and Folkman (6), who define it as the subjec- tive experience of demands that are not matched to the abilities of the individual, thereby posing a threat to his or her well-being. The term "work-related stress" refers to the experience of stress in relation to stressors at work, eg, high workload or interpersonal conflicts.

During the past decade, outpatient clinics of occupa- tional medicine in Denmark have seen a rise in patients with work-related stress complaints. Many of these patients are on sick leave and diagnosed with adjustment disorder or reactions to stress [International Classifica- tion of Disease (ICD-10)] (1). Additionally, patients often complain of impaired sleep (5, 7) and cognitive difficulties like memory and concentration problems (5, 7, 8). Such complaints may interfere with work ability and influence sick leave duration (9). Although still uncommon in stress management intervention studies (SMT) (2) it therefore seems highly relevant to report on these outcomes.

Sleep, stress and work

Sleep problems are prevalent in modern society (10) and have been associated with a broad spectrum of negative health outcomes (11-19). Stress is a common self- reported cause (20). A review of early cross-sectional studies found a close association between psychosocial stress and impaired sleep, but research on the relation between real-life work stress and sleep has been sparse (21). A review by Kim & Dimsdale (22) found a small number of studies looking at the effect of daily life stress (occupational and non-occupational) on polysomno- graphic sleep measures, but results were inconsistent. A few prospective studies have found work-related stress in the form of perceived psychosocial work stress- ors to be predictive of development (23, 24, 25) and maintenance of sleep disturbance (25, 26). However, the relation between work stressors and sleep remains unclear. A recent review identified high job demands and low job control as predictors of reduced sleep quality, but effect sizes were small-to-moderate indicating that only a small proportion of the variance in sleep quality is influenced by work characteristics (15). Addition- ally, researchers have drawn attention to discrepancies between objective and subjective sleep measures and the risk of overestimating the effect of work stressors on sleep quality in studies using self-reported sleep measures (27, 28).

Work-related stress may be related to sleep problems through several mechanisms involving both physi- ological stress mechanisms and behavioral changes (10, 29). Psychologically the pivotal point is most likely related to thoughts and ruminations about work prior to sleeping, thereby contributing to continued arousal and wakefulness. Thus, Âkerstedt et al (20) found stress and worries at bedtime to be predictive of sleep quality on a day-to-day basis. In addition, the anticipation of disturbed sleep may also be a stressor in itself making it even more difficult to sleep.

Meta-analyses show that CBT targeted specifically at sleep problems is effective in treating a variety of sleep outcomes (30, 31). It is unclear whether interventions (like the current stress management intervention) that do not explicitly target sleep have a beneficial effect on sleep among stress patients with a clinical need (30). To the best of our knowledge, only one study has found improvements in self-reported sleep among stress patients on sick leave after a CBT-intervention containing some minor instructions on sleep. Apart from improving sleep habits, mechanisms of improved sleep by CBT could be related to reduced stress levels and improved coping strategies contributing to a reduction in rumination and physiological arousal before bedtime. …

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