E-ISSN: 2458-9101
Sleeping Position, Expression of Anger and Subjective Sleep Quality in University Students
Félix Arbinaga, Inmaculada Tornero-Quiñones, Eduardo Fernández-Ozcorta
Sleep and Hypnosis: A Journal of Clinical Neuroscience and Psychopathology 2018;20(4):267-274
Objective: To analyze the subjective quality of sleep and the expression of anger according to the position adopted during sleep.

Methods: Using an ex-post facto design and an incidental sampling procedure, 729 university students participated in the study, 63% of which were women. The subjective quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and anger was measured using the State-Trait Anger Expression Inventory-2 (STAXI-2). One question was used to determine the body position: "Normally, what position do you adopt when sleeping? [Right Lateral Decubitus (RLD), Left Lateral Decubitus (LLD), Supine Decubitus (SUD), or Prone Decubitus (PD)].

Results: Of our sample, 42.4% reported sleeping in the RLD position, 29.2% in LLD, 10.6% in SUD and 17.8% in PD. Women tended to sleep in RLD and not in SUD, while in men there is a tendency to sleep in the SUD position and not in RLD (?2(3,729)=15.119, p=.002). People who reported sleeping in RLD appeared to have poorer quality of sleep compared with the group that reported sleeping in LLD. Those who adopt the PD position show the highest scores on the scales measuring Feelings of Anger, Trait-Anger, Temperament of Anger, Index of Expression of Anger, and External Expression of Anger.

Conclusion: The data appear to support the existence of relationships between the posture adopted during sleep, the subjective quality of sleep and emotional states. In future research it will be necessary to apply methodologies with greater control of the variables along with objective measures of body position.
Keywords: anger, sleeping position, subjective quality of sleep, college students
Agargun, M.Y., Boysan, M., & Hanoglu, L. (2004). Sleeping Position, Dream Emotions, and Subjective Sleep Quality. Sleep and Hypnosis, 6, 8-13.

Akerstedt, T., Kecklundm G., & Axelsson, J. (2007). Impaired sleep after bedtime stress and worries. Biological Psychology, 76, 170-173. PMID: 17884278

Arbinaga, F. (2017). Subjective quality of sleep and anger. International Journal of Psychology and Behavioral Science, 7, 41-48. doi: 10.5923/j.ijpbs.20170701.07

Brissette, I., & Cohen, S. (2002). The contribution of individual differences in hostility to the associations between daily interpersonal conflict, affect, and sleep. Personality and Social Psychology Bulletin, 28, 1265-1274. doi: 10.1177/01461672022812011

Buysse, D.J., Reynolds, C.F., Monk, T.H., et al. (1989). The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213. doi: 10.1016/0165-1781(89)90047-4

Caska, C., Hendrickson, B., Wong, M., Ali, S., Neylan, T., & Whooley, M. (2009). Anger Expression and Sleep Quality in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study. Psychosomatic Medicine, 71, 280-285. doi: 10.1097/PSY.0b013e31819b6a08

Chida, Y., & Steptoe, A. (2009). The association of anger and hostility with future coronary heart disease: A meta-analytic review of prospective evidence. Journal of the American College of Cardiology, 53, 936-946. doi.org/10.1016

Dang-Vu, T.T., Salimi, A., Boucetta, S., Wenzel, K., O’Byrne, J., Brandewinder, M,…& Gouin JP. (2015). Sleep spindles predict stress-related increases in sleep disturbances. Frontiers in Human Neuroscience, 9(68), 1-9 doi: 10.3389/fnhum.2015.00068

De Koninck, J., Gagnon, P., & Lallier, S. (1983). Sleep positions in the Young adult and their relationship with the subjective quality of sleep. Sleep, 6, 52-59.

Delannoy, J., Mandai, O., Honoré, J., Kobayashi, T., & Sequeira, H. (2015). Diurnal Emotional States Impact the Sleep Course. PLoS ONE, 10(11), e0142721. doi: 10.1371/journal.pone.0142721

Diestel, S., Rivkin, W., & Schmidt, K.H. (2015). Sleep Quality and Self-Control Capacity as Protective Resources in the Daily Emotional Labor Process: Results From Two Diary Studies. Journal of Applied Psychology, 100(3), 809-827. doi: 10.1037/a0038373

Eng, P.M., Fitzmaurice, G., Kubzansky, L.D., Rimm, E.B., & Kawachi, I. (2003). Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosomatic Medicine, 65, 100-110.

Engin, E., Keskin, G., Dulgerler, S.,& Bilge, A. (2010). Anger and alexithymic characteristics of the patients diagnosed with insomnia: a control group study. Journal of Psychiatric and Mental Health Nursing, 17, 692-699. doi: 10.1111/j.1365-2850.2010.01604.x

Fernández, E. (2008). The angry personality: A representation on six dimensions of anger expression. In G.J. Boyle, D. Matthews and D. Saklofske (Eds.). International handbook of personality theory and testing. (vol.2) Personality Measurement and Assessment (pp. 402-419). London, UK: Sage.

Gerin, W., Davidson, K.W., Christenfeld, N.J., Goyal, T., & Schwartz, J.E. (2006). The role of angry rumination and distraction in blood pressure recovery from emotional arousal. Psychosomatic Medicine, 68, 64-72. doi: 10.1097/01.psy-0000195747-12404.aa

Gordon, S.J., Grimmer, K.A., & Trott, P. (2004). Self-reported versus recorded sleep position anobservational study. Internet Journal of Allied Health Sciences and Practice, 2(1). Article 7.

Horne, R.S., Franco, P., Adamson, T.M., Groswasser, J., & Kahn, A. (2002). Effects of body position on sleep and arousal characteristics in infants. Early Human Development, 69, 25-33. doi: 10.1016/S0378-3782(02)00025-7

Ichijo, H., & Akita, M. (2017). Gender difference and laterality of sleep position. Auris Nasus Larynx, 29, pii: S0385-8146(17)30317-6.

Kamphuis, J., & Lancel, M. (2015). The interrelations between sleep, anger and loss of aggression control”. In K.A. Babson and M.T. Feld (Eds.). Sleep and Affect: Assessment, Theory, and Clinical Implications, (pp.247-276). London, Academic Press.

Kitayama, Sh., Park, J., Morozink, J., Miyamoto, Y., Levine, C., Markus, H.R., Karasawa, M., Coe, C., Kawakami, N., Love, G., & Ryff, C. (2015). Anger Expression and Ill-Health in Two Cultures: An Examination of Inflammation and Cardiovascular Risk. Psychology Science, 26, 211-220. doi: 10.1177/0956797614561268.

Lai, C.T., Chen, C.Y., Kuo, T.B., Chen, C.M., & Yang, C.C. (2016). Sympathetic Hyperactivity, Sleep Fragmentation, and Wake-Related Blood Pressure Surge During Late-Light Sleep in Spontaneously Hypertensive Rats. American Journal of Hypertension, 29, 590-597. doi: 10.1093/ajh/hpv154

Lorrain, D., & De Koninck, J. (1998). Sleep position and sleep stages: evidence of their independence. Sleep, 21, 335-404.

Lundh, L.G., & Broman, J.E. (2000). Insomnia as an interaction between sleep-interfering and sleep-interpreting processes. Journal of Psychosomatic Research, 49, 299-310. PMID: 11164054

Macías, J.A., & Royuela, A. (1996). La versión española del Índice de Calidad de Sueño de Pittsburgh. Informaciones Psiquiátricas, 146, 465-472.

Mezick, E.J., Matthews, K.A., Hall, M., Kamarck, T.W., Buysse, D.J., Owens, J.F., et al. (2009). Intra-individual variability in sleep duration and fragmentation: associations with stress. Psychoneuroendocrinology, 34, 1346-1354. doi: 10.1016/j.psyneuen.2009.04.005

Miguel-Tobal, J., Casado, M., Cano-Vindel, A., & Spielberger, C. (2001). Inventario de Expresión de la Ira Estado-Rasgo STAXI-2. Madrid., TEA Ediciones.

Nojiri, A., Okumura, Ch., & Ito, Y. (2014). The present study with A-MES and actigraphy provides the first evidence that sleep posture affects sleep quality and is a convenient, inexpensive and home-based method for studying sleep. Health, 6, 2934-2944. doi: 10.4236/health.2014.621332

Ong, J.C., Carde, N.B., Gross, J.J., & Manber, R. (2011). A two-dimensional approach to assessing affective states in good and poor sleepers. Journal of Sleep Research, 20, 606-610. doi: 10.1111/j.1365-2869.

Pereira, K.D., Rathi, N.K., Fatakia, A., Haque, S.A., & Castriotta, R.J. (2008). Body position and obstructive sleep apnea in 8-12-month-old infants. International Journal of Pediatric Otorhinolaryngology, 77, 897-900. doi: 10.1016/j.ijporl.2008.03.002.

Ramsay, J.M.C., McDermott, M.R., & Bray, C. (2001). Components of the anger-hostility complex and symptom reporting in patients with coronary artery disease: A multi-measure study. Journal of Health Psychology, 6, 713-729. doi: 10.1177/135910530100600615

Roth-Bettlach, C.L., Hasak, J.M., Kraus, E.M., Yu, J.L., Skolnick, G.B., Bodway, G.N., Kahn, L.C., & Mackinnon, S.E. (2017). Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome. Hand (NY). First Published 11-Oct. doi: 10.1177/1558944717735942.

Shin, Ch., Kim, J., Yi, H., Lee, H., Lee, J., & Shin, K. (2005). Relationship between trait-anger and sleep disturbances in middle-aged men and women. Journal of Psychosomatic Research, 58(2), 183-189. doi: 10.1016/j.jpsychores.2004.07.002

Stoia-Caraballo, R., Rye, M.S., Pan, W., Brown, K.J., Lutz-Zois, C., & Lyons, A. (2008). Negative affect and anger rumination as mediators between forgiveness and sleep quality. Journal of Behavioral Medicine, 31, 478-488. doi: 10.1007/s10865-008-9172-5

Spielberger, C.D. (1999). State-Trait Anger Expression Inventory-2 (STAXI-2). Professional Manual. Tampa, FL: Psychological Assessment Resources.

Spielberger, C.D., Jacobs, G., Russell, S., & Crane, R. (1983). Assessment of anger: The state-trait anger scale. In J.N. Butcher and C.D. Spielberger (Eds.), Advances in Personality Assessment (pp. 112–134). Hillsdale: Lawrence Erlbaum.

Taylor, N., Fireman, G., & Levin, R. (2013). Trait Hostility, Perceived Stress, and Sleep Quality in a Sample of Normal Sleepers. Sleep Disorders, Article ID 735812, 8p. doi: 10.1155/2013/735812

VanMaanen, J.P., & de Vries, N. (2014). Long-term effectiveness and compliance of positional therapy with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep, 37, 1209-1215. doi: 10.5665/sleep.3840.

VanMaanen, J.P., Meester, K.A., Dun, L.N., Koutsourlakis, I., Witte, B.I., Laman, D.M., Hilgevoord, A.A., & de Vries, N. (2013). The sleep position trainer: a new treatment for positional obstructive sleep apnea. Sleep and Breathing, 17, 771-779. doi: 10.1007/s11325-012-0764-5

Willinger, M., Ko, C.W., Hoffman, H.J., Kessler, R.C., & Corwin, M.J. (2003). National Infant Sleep Position Study. Trends in infant bed sharing in the United States, 1993-2000: the National Infant Sleep Position study. Archives of Pediatrics and Adolescent Medicine, 157, 43-49. doi: 10.1001/archpedi.157.1.43

Yu, C. K.-C. (2012). The effect of sleep position on dream experiences. Dreaming, 22(3), 212-221. doi: 10.1037/a0029255

Yu, C. K.-C. (2017). Why is self-report of sleep position sometimes unreliable? Sleep and Hypnosis. Advance Online Publication. doi: 10.5350/Sleep.Hypn.2017.19.0140