Identifying the association of hyperarousal and insomnia symptoms: A network perspective

Insomnia, a prevalent public health problem, is characterized by hyperarousal; however, evidence on the comparison of associations between insomnia symptoms and different forms of arousal is limited. This study utilizes network analysis to explore the complex associations between insomnia symptoms and hyperarousal and to identify key symptoms.

A total of 1209 participants with non-clinical sleep disorders were included in the study. Hyperarousal was assessed by the Arousal Predisposition Scale (APS) and the Pre-sleep Arousal Scale (PSAS), which encompasses two forms of state arousal (pre-sleep cognitive/somatic arousal). Insomnia symptoms were assessed by Pittsburgh Sleep Quality Index (PSQI). Gaussian graph networks and directed acyclic graphs (DAG) were applied to examine associations between variables and identify key variables.

Pre-sleep cognitive arousal is the most important variable in the Gaussian network, acting as a "bridge" between the insomnia symptoms and hyperarousal domains, and serving as the gateway that activates most of the insomnia symptoms and hyperarousal in the DAG. Subjective sleep duration is another key driver in the DAG, marking the starting point for insomnia symptoms, while the use of sleep medication represents the endpoint of the pathway.

All forms of hyperarousal are positively associated with insomnia symptoms, and pre-sleep cognitive arousal plays the most important role in the maintenance and activation of the insomnia symptoms-hyperarousal network.