The Anxiety and Preoccupation about Sleep Questionnaire (APSQ)

Abstract

The Anxiety and Preoccupation about Sleep Questionnaire (APSQ) is a brief, 10-item psychometrically validated instrument developed to specifically measure the intensity of sleep-related worry and cognitive preoccupation in individuals suffering from insomnia and associated sleep disorders. The scale was designed to overcome limitations of earlier instruments by focusing purely on worry specific to sleep difficulties and by capturing this worry across both the nocturnal and diurnal periods, aligning with the modern conceptualization of insomnia as a 24-hour phenomenon. The APSQ demonstrates strong reliability, high discriminant validity between different sleep groups, and sensitivity to treatment effects, making it a valuable tool for research and clinical assessment.

Keywords

Insomnia, Sleep-related worry, Sleep preoccupation, Chronic insomnia, Psychometric scale, Sleep assessment, Cognitive model, Psychometrics.

Authors

Allison G. Harvey, Nicole Tang.

Purpose

The primary purpose of the Anxiety and Preoccupation about Sleep Questionnaire (APSQ) is to provide a reliable and concise index of sleep-related worry in clinical populations, particularly those diagnosed with insomnia or other relevant sleep pathologies. The development of the scale was driven by the recognition that intrusive and worrisome thinking is a key factor in the maintenance of chronic sleep disorders.

The instrument is intended for use in both clinical settings, aiding in the assessment and monitoring of cognitive factors related to sleep disturbance, and in research settings, where its demonstrated sensitivity to treatment effects makes it an important outcome measure for interventions, such as Cognitive Behavioural Therapy for Insomnia (CBT-I).

Construct

The APSQ measures the psychological construct of intrusive and worrisome thinking specifically concerning sleep. This construct is central to the cognitive model of chronic insomnia, which posits that excessive cognitive arousal and worry perpetuate the disorder. The scale delineates this worry into two main factors: concerns about the adverse consequences of poor sleep and concerns related to the perceived uncontrollability of sleep.

A distinctive feature of the APSQ is its focus on measuring worry associated with sleep difficulties during both the nighttime and the daytime. By acknowledging insomnia as a pervasive 24-hour disorder, the APSQ provides a more comprehensive assessment of the cognitive burden compared to instruments focused solely on nocturnal events.

Validity

The APSQ demonstrates robust evidence of validity, confirming that it accurately measures the intended construct and relates meaningfully to relevant clinical outcomes.

Specific findings regarding validity include:

• Discriminant Validity: The scale successfully differentiates between distinct populations, showing discriminant validity by distinguishing between those with clinical insomnia, poor sleepers (subclinical), and normal sleepers.
• Criterion Validity: Scores on the APSQ are significantly associated with subjective sleep parameters (e.g., perceived sleep latency and quality) and reported measures of daytime impairment, reinforcing that high scores correspond to greater functional and perceived sleep disturbance.
• Clinical Sensitivity: The instrument is sensitive to changes resulting from psychological treatment, suggesting its effectiveness as a measure of therapeutic progress in interventions targeting the cognitive aspects of insomnia.

Reliability

The reliability of the APSQ, assessed through internal consistency (Cronbach’s alpha), is consistently high across the total scale and its constituent factors, indicating homogeneity among the items and stability in measurement.

The reported internal consistency values are:

• Total APSQ scale: alpha (α) = .93.
• First Factor (Worries about consequences): alpha (α) = .91.
• Second Factor (Worries about uncontrollability): alpha (α) = .86.

These coefficients suggest that the 10 items reliably measure the unified construct of sleep-related anxiety and preoccupation.

Factor Analysis

Factor analysis of the APSQ identified a clear and theoretically meaningful two-factor solution, which collectively accounted for 70.7% of the total variance.

The two primary factors are:

1. Factor 1: Worries about the Consequences of Poor Sleep. This factor encompasses anxiety relating to how inadequate sleep will negatively affect daytime performance, health, social ability, and mood. (Items 1, 2, 3, 4, 5, and 7).
2. Factor 2: Worries about the Uncontrollability of Sleep. This factor focuses on the distress caused by the perceived loss of control over the sleep process and the preoccupation resulting from failed efforts to manage or fix the sleep problem. (Items 6, 8, 9, and 10).

Instrument

Test Type: Self-report questionnaire / Cognitive Assessment Tool

Format: 10 items rated on a 10-point Likert scale (1 = Not true; 10 = Very true).

Language Available: English (Original)

Population Group: Clinical and non-clinical adults exhibiting sleep difficulties or insomnia symptoms.

Age Group: Adult (18+)

Population Details: Developed and validated using samples including individuals diagnosed with insomnia, poor sleepers, and healthy control groups.

Test Methodology: Respondents are asked to rate how true each statement has been for them during the past month.

Keywords

Sleep assessment, Cognitive factors, Worry index, Psychometrics, Sleep disorders, Cognitive Behavioural Therapy for Insomnia (CBT-I).

Authors

Author ORCID Identifier: N/A (Information not provided in source)

Affiliation Email addresses: N/A (Information not provided in source)

Correspondence Address: N/A (Information not provided in source)

Permissions & Fee and Test Year

Test Year: 2011 (Year of primary psychometric validation publication)

Permissions/Fee: The APSQ is generally available for non-commercial academic research use. Users seeking permission for clinical or commercial application should contact the primary authors (M. Jansson-Fröjmark or A.G. Harvey).

Reference’s

The primary validation and conceptual papers related to the Anxiety and Preoccupation about Sleep Questionnaire (APSQ) are:

1. Jansson-Fröjmark, M., Harvey, A.G., Lundh, L.G., Norell-Clarke, A., & Linton, S.J. (2011). Psychometric properties of an insomnia-specific measure of worry: The Anxiety and Preoccupation about Sleep Questionnaire. Cognitive Behaviour Therapy, 40, 65-76.
2. Tang, N.K.Y., & Harvey, A.G. (2004). Correcting distorted perception of sleep in insomnia: A novel behavioural experiment? Behaviour Research and Therapy, 42, 27-39.

Items of the The Anxiety and Preoccupation about Sleep Questionnaire (APSQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

APSQ

On the scales provided below, please rate each of the following statements for how true they are for you during the past month.

1     2      3      4      5      6      7      8      9      10

Not true                                                                   Very true

1. I worry about the amount of sleep I am going to get every night 1
2. I worry about how the amount of sleep I had last night is going to affect my day time performance
3. I worry about how the amount of sleep I get is going to afflict my health
4. I worry about how much the amount of sleep I get will weaken my social ability
5. I worry about how much the amount of sleep I get will shake my mood
6. I worry about my loss of control over sleep
7. I worry about my ability to stay awake and alert during the day
8. I put great effort into trying to rectify my sleep problems
9. My failure to rectify my sleep problems troubles me a lot
10. My worry about sleep is persistent