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Bedtime rumination mediates the burnout-insomnia link in emergency department staff

This study found that cognitive pre-sleep arousal (bedtime rumination) fully mediated the association between burnout and insomnia in emergency department physicians and nurses. Vulnerable shift adaptors, defined by lower-than-expected sleep metrics given their schedule load, reported higher burnout, emotional exhaustion, and insomnia.

Last updated: Jul 9, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score32/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Bedtime rumination mediates the burnout-insomnia link and relates to shift adaptation in emergency department staff.

observational

Schmidt L, Claverie D, Douplat M, Tazarourte K, Mazza S, Trousselard M · Scientific reports (2026)

Participants: N/A
Duration: N/A
Intervention: Observational analysis of burnout, insomnia, pre-sleep arousal, and shift adaptation profiles; no experimental intervention tested
Outcome: Insomnia Severity Index, Maslach Burnout Inventory, Pre-Sleep Arousal Scale (cognitive subscale), actigraphy-derived total sleep time and sleep regularity
Effect Size: N/A
Population: 58 physicians and nurses working in emergency departments

Result:

PubMed: 42401609DOI: 10.1038/s41598-026-47128-y

Mechanism Graph

Burnout increases cognitive pre-sleep arousal (bedtime rumination)
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Bedtime rumination disrupts sleep initiation and maintenance
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Sleep disruption leads to insomnia symptoms
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Result: Cognitive pre-sleep arousal fully mediates the burnout-insomnia relationship

Limitations

  • ⚠Small sample size (n=58) limits generalizability
  • ⚠Cross-sectional mediation analysis cannot establish causality
  • ⚠Secondary analysis of a pre-intervention dataset may introduce selection bias

Frequently Asked Questions

What is bedtime rumination?▼

Bedtime rumination refers to cognitive pre-sleep arousal, such as worrying or mentally replaying stressful events, which interferes with falling asleep.

How was shift adaptation measured?▼

Shift adaptation was classified using actigraphy-derived total sleep time and sleep regularity, comparing actual sleep metrics to expected values based on schedule-related load.

Does this study prove that burnout causes insomnia?▼

No, the study shows a strong association and mediation by bedtime rumination, but due to its cross-sectional design, causality cannot be confirmed.

What population was studied?▼

The study included 58 physicians and nurses working in emergency departments, a group with high prevalence of burnout and sleep disturbances.

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References

  1. 1.Schmidt L, Claverie D, Douplat M, Tazarourte K, Mazza S, Trousselard M. "Bedtime rumination mediates the burnout-insomnia link and relates to shift adaptation in emergency department staff.." Scientific reports, 2026. PMID: 42401609 DOI: 10.1038/s41598-026-47128-y
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.