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Role of Stress, Arousal, and Coping Skills in Primary Insomnia

Morin, Charles M. PhD; Rodrigue, Sylvie MPs, and; Ivers, Hans MPS

doi: 10.1097/01.PSY.0000030391.09558.A3

Objective Although stress is often presumed to cause sleep disturbances, little research has documented the role of stressful life events in primary insomnia. The present study examined the relationship of stress and coping skills, and the potential mediating role of presleep arousal, to sleep patterns in good sleepers and insomnia sufferers.

Methods The sample was composed of 67 participants (38 women, 29 men; mean age, 39.6 years), 40 individuals with insomnia and 27 good sleepers. Subjects completed prospective, daily measures of stressful events, presleep arousal, and sleep for 21 consecutive days. In addition, they completed several retrospective and global measures of depression, anxiety, stressful life events, and coping skills.

Results The results showed that poor and good sleepers reported equivalent numbers of minor stressful life events. However, insomniacs rated both the impact of daily minor stressors and the intensity of major negative life events higher than did good sleepers. In addition, insomniacs perceived their lives as more stressful, relied more on emotion-oriented coping strategies, and reported greater presleep arousal than good sleepers. Prospective daily data showed significant relationships between daytime stress and nighttime sleep, but presleep arousal and coping skills played an important mediating role.

Conclusions The findings suggest that the appraisal of stressors and the perceived lack of control over stressful events, rather than the number of stressful events per se, enhance the vulnerability to insomnia. Arousal and coping skills play an important mediating role between stress and sleep. The main implication of these results is that insomnia treatments should incorporate clinical methods designed to teach effective stress appraisal and coping skills.

From Université Laval, Sainte-Foy, Québec, Canada.

Address reprint requests to: Charles Morin, PhD, Professor, Université Laval, École de Psychologie Pavillon F.A.S., Ste-Foy, Québec, Canada G1K 7P4. Email:

Received for publication February 28, 2001; revision received April 26, 2002.

Copyright © 2003 by American Psychosomatic Society
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