Journal of Adolescent Health
Volume 38, Issue 6 , Pages 649-655, June 2006

The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders

  • Jane L. Ireland, Ph.D.

      Affiliations

    • Department of Psychology, University of Central Lancashire, Preston, UK
    • Psychological Services, Ashworth High Secure Hospital, Liverpool, UK
    • Corresponding Author InformationAddress correspondence to: Dr. Jane L. Ireland, Department of Psychology, Darwin Building, University of Central Lancashire, Preston PR1 2HE, UK
    • ,
  • Vicki Culpin, Ph.D.

      Affiliations

    • Department of Psychology, University of Central Lancashire, Preston, UK

Received 11 March 2005; accepted 31 May 2005.

Article Outline

Abstract 

Purpose

The current study examines both the quantity and quality of sleep reported by male adolescents detained in prison, with a focus on exploring the association between the quantity and quality of sleep with aggression, impulsivity, or anger. This represents a novel area of study not yet explored among incarcerated male adolescents.

Method

One hundred eighty-four offenders took part; 104 young (average age 19 years) and 80 juvenile (average age 16 years). All completed a questionnaire exploring sleeping problems, and measures assessing aggression, anger, and impulsivity.

Results

Aggression was found to relate both to the quantity and quality of sleep reported, with reduced quantity and quality predicted by increased overall aggression. Across aggression subscales, only increased hostility was predictive of reduced current hours of sleep and increased problems in sleep quality. Apnea risk scores were not predicted by aggression, anger, or impulsivity. Differences in sleep behavior before and during prison were demonstrated, with evidence for increased poor sleeping habits within detention. No differences were observed between young and juvenile offenders.

Conclusions

This study suggests a potential relationship between aggression and sleep among an incarcerated adolescent male sample, highlighting in particular a role for hostility. The findings are discussed in relationship to implications for treatment and directions for future research.

Keywords:  Sleep quantity and quality , Adolescents and sleep , Offenders , Aggression and sleep , Anger and sleep

 

The physiological and psychological consequences of sleep disturbances have been explored for many decades. The quality and quantity of both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep have been affected by variables such as substances use [1], stress [2], depression, and heart disease [3]. Sleep duration has also been found to relate to personality traits [4], [5], [6], [7], with an association also found between sleep and Borderline Personality Disorder and Antisocial Personality Disorder, both of which have diagnostic criteria including problems in impulsivity, aggression, and anger [5].

Research has, however, concentrated on adults, with limited research on adolescents [8]. Although it is generally accepted that sleeping difficulties increase with age [9], the importance of exploring the quality and quantity of sleep among adolescent populations cannot be ignored given the importance of sleep for their development. The prevalence of insomnia and hypersomnia is reportedly common among adolescents [10], with disturbed sleep among adolescents correlated with difficulties in psychological, somatic, and interpersonal domains [10], including suicidal ideation [11]. In one study among college students [12], sleep quality was found to relate better to health, affect, and feelings of tension, depression, and anger/hostility than average sleep quantity, with poor sleep quality significantly correlated with increased feelings across these mood states.

Symptoms of sleep disturbance among adolescents are reportedly more common than DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) sleep disorders [13]. In one study exploring insomnia-related symptoms, insomnia was found to represent a significant risk factor for future somatic dysfunction and also for interpersonal functioning [8]. Furthermore, sleep disorders are reportedly more prevalent among adolescent populations with psychiatric, behavioral, or emotional problems [14], which suggests potential value in exploring sleep difficulties and its correlates among offenders. One area that may prove of particular interest is the potential association between sleep and aggression (including its correlates such as hostility and anger), with aggression a salient example of difficulties in interpersonal functioning.

Although there has been some focus on characteristics that may correlate with aggression (e.g., anger/hostility, difficulties in interpersonal functioning), the specific link between aggression and sleep has received little research attention. One of the first studies to suggest a potential relationship reported aggression and impulsiveness correlated with the duration and frequency of the superficial stages of sleep [15]. Further studies have focused on self-reported irritability and emotional instability after sleep disturbance. These have been conducted almost exclusively with sleep deprivation paradigms, with participants found to demonstrate significantly higher scores on a measure of aggression after one night without sleep [16]. In a later study, participants presented with increased hostility-anxiety post-sleep than pre-sleep deprivation [17].

A number of studies have focused on a specific aspect of sleeping difficulty, namely sleep apnea, with individuals presenting with apnea observed to have or self-reporting the demonstration of irritability, frustration, and increased engagement in conflict [18], [19], [20]. An interaction between sleep apnea, sleep duration, and anger has been reported, with one study reporting that for patients diagnosed with sleep apnea, as their total sleep duration decreased, their levels of self-reported trait anger increased [21].

Within forensic samples, three studies have been completed [22], [23], [24]. In one exploring female juvenile offenders [22], increased emotional instability was found to be related to reduced sleep. Two studies exploring violent adult offenders [23], [24] reported a link between sleep and individual characteristics: one reported that offenders demonstrated more night awakenings and decreased sleep efficiency than controls [23], whereas the other [24] reported that individuals with intermittent explosive disorder presented with more deep sleep and slow wave sleep than those who did not present with this disorder and healthy controls. Although not addressing impulsivity per se, one of these studies [24] did reflect on variations in impulsivity. There is a strong link between impulsivity and aggression evidenced in previous research [25], [26], suggesting that accounting for impulsivity may prove valuable.

Research into the relationship between sleep and aggression among male adolescent offenders is currently nonexistent. There is also an absence of research exploring the relationship between sleeping problems and trait measures of aggression and impulsivity, or state measures of anger. Among young prison samples, anger, aggression, and impulsivity tend to present at elevated rates [27]. The extent to which these behaviors either predict or correlate with sleeping difficulties has yet to be explored.

Insomnia has been reported to be a frequent health problem among prison populations [28], [29], [30], although little is known about its severity [31]. Reasons offered to explain why sleeping difficulties may occur within prisons can be found in the regime structure and conditions present. The physical environment of a prison could be expected to encourage poor sleeping habits. Ensuring a bed is used solely to sleep in, for example, encourages healthy sleep. In a prison, however, a prisoner’s bed also becomes a place where they sit and watch television, eat meals, etc. In terms of regimes, prisoners are placed into a setting where a routine over which they have no choice is imposed on them. This routine includes the time to get up and the time they must go to their cell in the evening. It could be expected, therefore, that the potential for sleeping problems increases as prisoners try to re-adjust to a new routine.

The current study aims to address the lack of research in this area by exploring self-reported sleeping problems among male young and juvenile offenders, with a further aim of exploring if aggression, anger, and impulsivity predict sleep quantity and quality. The study also examines differences in sleeping behavior before and during detention. Participants completed a questionnaire exploring general sleeping problems along with a measure of aggression [32], anger [27], and impulsivity [25]. Although it is possible that inadequate sleep may relate to reduced aggression, impulsivity, or anger, it was felt a more informed hypothesis would be one predicting that sleep difficulties would relate to increases in these measures. It was thus hypothesized that sleeping difficulties would be predicted by all these measures, namely increased aggression, impulsivity, and anger. It was also predicted that reports of sleeping problems, including behaviors associated with a poor sleep pattern, would be higher during than before detention.

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Method 

Participants 

Two hundred fifty male offenders were approached; 186 questionnaires were returned (completion rate 74%), with two multivariate outliers removed. The final sample thus comprised 184 offenders (104 young [age range 18–20 years] and 80 juvenile offenders [age range 14–17 years]).

Young offenders 

Average age was 19 years (SD 1.0). Average current sentence length was 24 months (SD 18.3), with 23% on remand. Average time on current sentence was 4.2 months (SD 5.0). Of those sentenced, 48% were serving for a violent offense, 28% an acquisitive offense, 18% driving offenses, 4% drugs, and 2% for other offenses.

Juvenile offenders 

Average age was 16 years (SD 0.8). Average current sentence length was 19 months (SD 17.0), with 6% on remand. Average time on current sentence was 5.7 months (SD 4.8). Of those sentenced, 62% were serving for a violent offense, 21% an acquisitive offense, 8% driving offenses, and 10% for drug offenses.

Time served on the present sentence did not predict overall sleep complaints [Beta = .04, t = .50 ns], apnea-related symptoms [Beta = .01, t = .14 ns], poor sleep symptoms [Beta = .06, t = .82 ns], or total quantity of sleep [Beta = .07, t = .92 ns].

Measures 

Sleep Complaints Scale (SCS) 

This consisted of 13 items relating to general sleeping problems and sleep apnea-related symptoms based on an assessment originally piloted on a large adult sample exploring sleep problems [33]. All items were rated on a five-point scale ranging from ‘extremely like me’ to ‘extremely not like me’. In addition to an overall sleep complaints score, two scores were calculated; a poor sleep and an apnea risk score.

Sleep behavior in and before prison 

Participants indicated the amount of sleep obtained, number of night awakenings, and the length of time to fall asleep. They were required to indicate engagement in behaviors such as having an irregular bedtime, smoking or exercising before bed, and using their bed for nonsleeping activities. Participants completed all questions with regards to their sleeping behavior before prison and their current behavior.

The Aggression Questionnaire (AQ) 

The AQ [32] is a 29-item scale measuring trait aggression. Each item is scored on a five-point Likert scale ranging from ‘very often applies to me’ to ‘never or hardly applies to me’. It comprises four subscales: physical (nine items), verbal (five items), hostility (eight items), and anger (seven items).

The Anger Management Assessment questionnaire (AMA) 

The AMA [27] consists of 31 items exploring trait anger. Participants are asked to rate how often each item had occurred to them in the previous week on a three-point Likert scale ranging from ‘never’ to ‘more than once’.

The Barratt Impulsivity Scale-II (BIS-II) 

The BIS-II [25] assesses tendency to respond impulsively in certain contexts. It comprises 28 statements. Participants responded on a four-point Likert scale ranging from one ‘I rarely/never do that’ to four ‘I almost always/always do that’.

Procedures 

All questionnaires were administered during the lunchtime ‘lock-up’ period (a period of approximately one hour in which cell doors are not opened) to ensure participants were able to complete the questionnaires individually. To aid informed consent, all questionnaires had a coversheet detailing the nature of the study, informing participants their responses would remain anonymous, and that only the researchers would see their individual questionnaire. The coversheet had been approved by a University Ethics Board. Questionnaires were passed to participants under cell doors and collected after approximately 45 minutes.

Data analysis 

Categorical, variance (analysis of variance [ANOVA] and multivariate analysis of variance [MANOVA]), and regression analyses were employed. The categorical analysis explored differences in sleeping behaviors/patterns before and during prison, with an ANOVA employed to assess differences in sleep quantity. Multiple regressions were conducted to determine predictors of sleep quantity and quality, with the independent variables representing aggression, anger, and impulsivity.

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Results 

Sleeping behavior: quantity and quality 

Table 1 outlines sleeping patterns reported in prison and before prison. Table 2 presents self-reported behaviors reported likely to be associated with poor sleeping patterns.

Table 1. Quality and quantity of sleep across young and juvenile offenders
Sleep variableOverallJuvenilesYoung offenders
In prisonBefore prisonIn prisonBefore prisonIn prisonBefore prison
Hours sleep per night
Mean (SD)7.1(1.8SD)8.5(2.9SD)7.4(1.6SD)9.1(2.9SD)6.8(1.9SD)8.1(2.8SD)
n = 172n = 156n = 72n = 65n = 100n = 91
Number of times waking a night (%)
Never214926531747
Once263626342537
Twice2592510269
Three times+285223327
n = 162n = 170n = 68n = 73n = 94n = 97
Average time to fall asleep (minutes %)
Less than 1014472146948
10–30403437384132
30–601992181910
60+2792183110
n = 167n = 170n = 73n = 72n = 94n = 98
Table 2. Behaviors reported across young and juvenile offenders likely to be associated with poor sleeping pattern
Sleep variableOverallJuvenilesYoung offenders
In prisonBefore prisonIn prisonBefore prisonIn prisonBefore prison
% YES
Irregular bedtime274823412953
n = 168n = 164n = 74n = 70n = 94n = 94
Smoking before bed687451708077
n = 170n = 162n = 72n = 69n = 98n = 93
Exercising before bed452051304013
n = 169n = 164n = 75n = 71n = 94n = 93
Mean (SD)
Hours spent sitting or lying on bed apart from for sleeping9.36(6.2)1.17(2.2)8.54(5.2)1.50(2.5)9.95(6.7).95(1.9)
n = 129n = 146n = 54n = 59n = 75n = 87

Participants reported more sleep before than during prison (F [1,148] = 30.8, p < .001, partial Eta2 = .017). Juveniles reported more hours sleep in prison and before prison than young offenders (F [1,170] = 13.8, p < .04, partial Eta2 = .026; F [1,170] = 39.9, p < .03, partial Eta2 = .031, respectively).

A higher proportion reported night awakenings during than before prison (79% vs. 50%; X2 = 28.2, df = 1, p < .001). A higher proportion reported it took longer to fall asleep in prison than before prison (86% reporting it took longer than 10 minutes during prison vs. 53% reporting this before prison: χ2 = 45.9, df = 1, p < .001). There were no differences between young and juvenile offenders.

A higher proportion reported irregular bedtimes before prison than after (48% vs. 27%; χ2 = 16.4, df = 1, p < .001). There was no overall difference with regards to smoking before bed. More offenders report exercising immediately before sleep in prison than before (45% vs. 20%; χ2 = 35.8, df = 1, p < .001). Offenders were more likely to report using their bed for nonsleeping activities in prison than before (t = 12.77, df = 113, p < .001). The only difference across juvenile and young offenders was found in relationship to smoking, with juveniles more likely to report smoking before bed, before detention (70% vs. 51%; χ2 = 4.90, df = 1, p < .03).

Sleep Complaints Scale (SCS) 

The SCS was reliable (α = .84, n = 184). All item correlations were positive. Both subscales were reliable (poor sleep: α = .83, n = 184; apnea: α = .65, n = 184). Higher scores were indicative of increased problems. Table 3 presents the overall scores.

Table 3. Overall scores from the Sleep Complaints Scale (SCS)
Sleep complaints scaleOverallaJuvenilesbYoung offendersc
Total
Mean40.141.939.3
SD (n)9.4(171)9.6(73)9.2(98)
Poor sleep
Mean23.122.023.9
SD (n)6.8(171)6.9(73)6.6(98)
Apnea
Mean14.914.715.1
SD (n)3.9(171)3.8(73)3.9(98)

a 9 missing.

b 7 missing.

c 2 missing.

A MANOVA across the two SCS scores (poor sleep and apnea) and group (young and juvenile offenders) indicated no multivariate or univariate effects.

Sleeping behavior, aggression, impulsivity and anger 

Aggression Questionnaire (AQ) 

The AQ [32] and its subscales proved reliable (Total: α = .93, n = 184; Verbal: α = .80, n = 149; Physical: α = .82, n = 148; Hostility: α = .82, n = 147; Anger: α = .78, n = 148). All item correlations were positive. Higher scores indicated increased aggression.

Anger Management Assessment (AMA) 

The AMA [27] proved reliable, with all item correlations positive (α = .94, n = 155). Higher scores indicate increased tendency toward experiencing anger.

Barratt Impulsivity Scale (BIS-II) 

The BIS-II [25] also proved to be reliable (α = .70, n = 155). Higher scores indicate an increased tendency toward impulsivity. Again, all item correlations were positive.

Table 4 presents the mean scores for each of these measures.

Table 4. Mean scores across the AQ, AMA and BIS-II: results are shown overall and across young and juvenile offenders
MeasureOverallJuvenilesYoung offenders
Total AQ
Mean87.784.490.1
SD (n)23.6(147)25.9(62)21.8(85)
Physical
Mean28.828.628.9
SD (n)8.5(148)9.4(62)7.8(86)
Verbal
Mean16.616.016.9
SD (n)4.8(149)5.2(63)4.6(86)
Hostility
Mean22.020.523.1
SD (n)7.1(147)7.2(62)6.9(85)
Anger
Mean20.419.421.1
SD (n)6.4(148)7.0(62)5.8(86)
Total AMA
Mean53.752.354.8
SD (n)16.3(155)17.1(64)15.7(91)
Total BIS-II
Mean69.968.471.0
SD (n)9.6(142)9.3(60)9.7(82)

A MANOVA across each of the AQ subscales and across the total AQ, AMA, and BIS-II totals between young and juvenile offenders indicated no main multivariate effects.

Sleeping problems as predictors of aggression, anger and impulsivity 

A series of multiple regression analyses were conducted. The dependent variables represented the total hours of sleep reported, total sleep complaints scores, poor sleep and apnea risk scores. The independent variables represented AQ, AMA, and BIS-II scores. The variables were selected for inclusion in the analysis in accordance to the specific predictions made. Because total AQ scores were comprised of the subscale scores, this analysis was completed separately. Analyses were completed across the overall sample (i.e., juveniles and young offenders) using the enter method.

Sleep quantity 

Total current hours sleep were predicted by total AQ and by the hostility AQ subscale (B = −.02, Beta −.20, t = −2.42, p < .02; B = −.06, Beta −.27, t = −3.22, p < .002, respectively), with less hours sleep predicted by total aggression and increased hostility. Previous hours sleep was also predicted by total AQ scores (B = −.02, Beta −.18, t = −2.16, p < .03), with reduced sleep predicted by increased aggression.

Previous hours sleep was also predicted by impulsivity, with decreased sleep predicted by increased impulsivity (B = −.06, Beta −.22, t = −2.49, p < .01). There were no further predictors of sleep quantity.

Sleep quality 

Overall sleep complaints and poor sleep scores on the SCS were predicted by hostility (B = .47, Beta .36, t = 4.43, p < .001; B = .36, Beta .38, t = 4.69, p < .001, respectively), with increased overall sleep complaints and poor sleep scores predicted by increased hostility. Overall sleep complaints score and poor sleep scores were also predicted by total AQ scores (B = .11, Beta .27, t = 3.28, p < .001; B = .08, Beta .28, t = 3.40, p < .001, respectively). There were no further predictors of sleep quantity. Apnea risk scores on the SCS were not predicted by any of the variables.

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Discussion 

The current study provides evidence that overall aggression is predictive of sleep quantity and quality in a sample of incarcerated adolescent male offenders. It supported the hypothesis that sleep difficulties would be predicted by increased aggression, and is consistent with previous research reporting a link between aggression and sleep difficulties [15]. It is also arguably consistent with research among adolescents indicating an association between sleeping difficulties and problems in interpersonal functioning [8], [10], and feelings associated with negative mood [12].

The study also demonstrated evidence of differences in sleep behavior during detention and before detention, with evidence of increased poor sleeping habits in detention (e.g., exercising before sleep and using their bed for nonsleeping related activities). These results supported the hypothesis that behaviors associated with a poor sleep pattern would be higher during prison than prior. It also lends some support to reports of sleeping difficulties as a potential health issue among prison populations [28], [29], [30].

Regarding the relationship between aggression and sleep, the present study indicates hostility is the most important component of aggression to account for. Although hostility has not been explored in depth in previous research, the current findings can be compared with Pilcher et al [12], who reported reduced sleep quality among adolescents correlated with increased feelings of anger/hostility. Pilcher et al did not, however, include a measure distinguishing between anger and hostility, focusing on affective hostility, whereas the current study focused on cognitive hostility. Nonetheless it provides some potential support for the current finding that, among adolescents, there may be an association between hostility and sleep quality.

Interestingly, although increased aggression predicted reduced sleep quality, it was only predictive of overall sleep complaints and ‘sleep problems’, not of apnea symptoms. This highlights the importance of distinguishing between different types of sleep quality when examining its predictors. The importance of distinguishing between sleep quantity and quality when exploring correlates of reduced functioning among adolescents has been highlighted previously [12], although the importance of distinguishing between types of sleep quality has not.

The hostility subscale of the AQ was the only component predictive of both sleep quantity and quality, with reduced current hours sleep and increased problems in sleep quality predicted by increased hostility. The current results suggest hostility outperforms overall aggression as a predictor of sleep quality and quantity. Hostility is an enduring quality involving both resentment and negative evaluations [34], described as a residual negative quality an individual is left with once feelings of anger have subsided [32], [35]. Hostility, as assessed by the AQ, represents the cognitive component of aggression, and includes items associated with rumination. Although in the absence of a longitudinal design the causal nature of the link between hostility and sleep cannot be determined, an explanation may be that hostility contributes to reduced sleep via a process of cognitive rumination that interferes with sleep. Alternatively, it could be suggested that poor sleep raises an individual’s potential to report hostility. The biases known to promote hostility [36], [37] might become more evident if an individual’s perception of situations is impaired by poor sleep. This would fit with sleep deprivation studies reporting increased hostility-anxiety post-sleep deprivation [17]. Emotions, particularly anger and fear, are known to mediate the relationship between social cognition (e.g., hostile attribution biases) and aggression [36], [38]. The current study tentatively suggests that sleeping difficulties may also play a role in social cognitive processes, i.e., hostility.

The current study also suggests it is relatively stable cognitive symptoms (hostility) that are influential associations with sleeping difficulties and not transient (state) symptoms such as anger or behavioral symptoms such as impulsivity. Indeed, anger, both state and trait, were not predictive of sleep quality or quantity. This was inconsistent with the hypothesis that anger would predict sleep difficulties and inconsistent with previous research among nonincarcerated adolescents reporting that reduced sleep quality was related to increased anger [12].

Although the current study has value in that it provides the first exploration of sleep behaviors among incarcerated adolescent males, further examining an under-assessed area of study by focusing on aggression, anger and impulsivity, it is not without its limitations. Firstly, the study included measures of sleep difficulty that were solely reliant on self-report. Inconsistencies or difficulties in recall may have affected results, particularly when offenders were asked to detail previous sleeping patterns. The current study at most can argue that it has assessed individual perceptions of sleeping behavior. The more experimental and objective designs employing physiological and psychophysiological paradigms were not employed [23], [24] because such paradigms would be difficult, if not impossible, to implement within secure settings. Actigraphy measures may, however, have been an alternative method of measurement that future researchers could consider, with such measures increasingly being employed in clinical settings due to their lower levels of intrusiveness [39], although they do not, however, allow for subjective assessments of sleep quality to be determined.

Secondly, the study did focus on a small number of variables thought to be potentially associated with sleeping difficulties. Health correlates such as depression, anxiety, and suicidal ideation were not explored, although they have been indicated as variables of importance in studies involving adolescents [8], [10], [11], [12]. A focus on psychological health or emotional correlates may therefore be of value as a direction for future research.

Finally, the study is further limited by its inability to denote cause and effect between sleep behavior and reports of aggression and hostility, an examination possible only via a longitudinal design. Such research would be of value, with the importance of identifying causal pathways between disturbed sleep and impaired functioning in adolescents, already indicated in the literature [8].

Nonetheless, the current study provides some preliminary evidence of a link between aggression and sleeping difficulties among an incarcerated adolescent male sample, particularly highlighting a potential role for hostility. Taken collectively with the results regarding differences in sleep patterns and behavior before and during prison, this suggests that intervention packages designed to promote healthy sleep patterns among adolescent male prisoners might prove of value. It could be speculated that providing such intervention may also assist with the effective management of aggression among incarcerated adolescents. Currently, for example, aggression programs for offenders do not include a component focused on the promotion of healthy sleep. Although it is not possible to speculate on a cause and effect relationship between sleeping difficulties and overall aggression and hostility, it does suggest that a useful direction for future research would be the exploration of this relationship in more depth.

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Acknowledgment 

Thanks are extended to Rachel Monaghan for assistance with data collection, and to all the prisoners who took part in the study.

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PII: S1054-139X(05)00295-8

doi:10.1016/j.jadohealth.2005.05.027

Journal of Adolescent Health
Volume 38, Issue 6 , Pages 649-655, June 2006

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