TOPLINE

Adults reporting sleep starts (SS), brief sleep-onset events that include hypnic jerks, at least weekly had poorer sleep quality, greater insomnia severity, stronger dysfunctional sleep-related beliefs, and higher anxiety symptoms than those with rare or no SS, a study showed.

METHODOLOGY

• Researchers conducted a cross-sectional online survey in Austria and Germany including 194 adults (mean age, 32.79 years; 148 women) from the general population, excluding those who reported having sleep-related movement disorders, sleep apnea, or relevant neurologic or cardiac conditions.
• Participants in the SS group had a weekly SS frequency ≥ 1 (n = 96) and reported sudden awakenings at sleep onset along with at least one other SS symptom. 
• The comparison group (n = 98) had an SS frequency less than 1. The threshold was set post hoc.
• Researchers assessed global and subjective sleep quality, total sleep time, and sleep-onset latency using the Pittsburgh Sleep Quality Index (PSQI), insomnia severity using the Insomnia Severity Index (ISI), daytime sleepiness using the Epworth Sleepiness Scale, dysfunctional sleep-related beliefs using the Meinungen-zum-Schlaf-Fragebogen (MZS), and anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). They also developed questionnaire items to assess SS phenomenology.

TAKEAWAY

• In the adjusted final model, PSQI total (P < .001), MZS (P = .004), and HADS anxiety (P = .014) scores were positively linked to SS frequency; older age was linked to lower SS frequency (P = .030).
• The SS group had a mean ISI score of 10.67 vs 5.55 in the comparison group (P = .002), and a mean PSQI total score of 7.21 vs 5.19 (P = .002). No group difference was observed for daytime sleepiness.
• Within the SS group, common features included muscle jerks (87.5%), alarm or confusion (79.17% each), and sleep-onset dream-like experiences (73.96%); 62.5% reported palpitations or rapid breathing. Overall, 51.04% of participants in the SS group reported prolonged sleep-onset latency and 54.17% reported at least slight distress from actual consequences.
• SS were more commonly reported during psychological stress, and sleep deprivation was not as consistently reported as a modulator. The SS group included a greater proportion of women than the comparison group (P = .022). Sleep disorders (P = .001) and nightmares (P = .005) were reported by a larger share of participants in the SS group.

IN PRACTICE

"These findings support the view that SS should be considered within broader frameworks of sleep-related hyperarousal and cognitive-emotional activation," the authors wrote.

"Interventions targeting arousal regulation, maladaptive sleep-related cognitions, and stress may represent promising directions for future research and clinical practice," they added.

SOURCE

The study was led by Tanja Grünberger, Paris-Lodron-University Salzburg, Salzburg, Austria. It was published online on November 11 in PLOS Mental Health.

LIMITATIONS

The study was limited by its cross-sectional design and the exploratory nature of the analyses. The SS group threshold was set post hoc, and several findings, particularly correlations, varied across alternative cutoffs. The study could not separate SS from similar sleep-onset events such as exploding head syndrome, and phenomenology items were developed by the investigators and were not validated. Data were retrospective self-reports without objective sleep measures, from a nonrepresentative convenience sample.

DISCLOSURES

The study received no specific funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.