Sleep hygiene practices in patients with major depression with comorbid insomnia, primary insomnia, and good sleepers

Abstract

Introduction. Inadequate sleep hygiene (SH) is considered factor contributing to insomnia. However, the practice of SH by depressed patients with comorbid insomnia has not been explored. Objective. We aimed to compare the practice of SH between patients with major depression, comorbid insomnia, primary insomnia, and good sleepers. Method. One hundred and eighty-two adult individuals participated: 62 outpatients with major depressive disorder with comorbid insomnia (MDD), 56 outpatients with primary insomnia (PI), and 64 good sleepers (GS). All participants were assessed with a structured psychiatric interview, an insomnia interview, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Practice Scale. We compared the practice of SH as a whole and by domains between the groups and the relation between SH practice, insomnia, and sleep quality. Results. Patients with PI and MDD showed a significantly worse practice of global SH. In the comparison by SH domains, MDD and PI groups had significantly worse scores than GS in all domains. Individuals with MDD showed a significantly worse practice of sleep schedule and arousal related behaviors than PI group. Although, SH practice was significantly related with insomnia and sleep quality in the whole sample, this association remained significant only in the PI. The arousal-related behaviors domain was the main predictor of insomnia and sleep quality. Discussion and conclusion. Although patients with insomnia comorbid with MDD or with PI have a worse SH practice than GS, only arousal-related behaviors and drinking/eating habits contribute significantly to insomnia severity and sleep quality.