Impact of Sleep and Psychological Flexibility on Young Adults’ Physical and Mental Well-being

Impact of Sleep and Psychological Flexibility on Young Adults’ Physical and Mental Well-being | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Impact of Sleep and Psychological Flexibility on Young Adults’ Physical and Mental Well-being Miho Ishii, Miyu Hakoda, Isa Okajima This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7512649/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Young adults frequently report sleep issues, especially insomnia, delayed sleep phase, and sleep debt, with each of these contributing to distinct physical and mental well-being issues. This study explored the characteristics of sleep issues (Trisleep; sleep quantity, sleep quality, and sleep–wake rhythm) and psychological flexibility (Hexaflex; acceptance, cognitive defusion, self-as-context, commitment, values, and mindfulness) among young adults, analyzing their association with physical and mental well-being. All questionnaire data were collected online from 525 university students in Japan (men = 101, women = 414, unspecified = 10; M age =19.96 ± 1.42 years). Their responses to questionnaires on sleep problems and psychological flexibility were analyzed via cluster analyses. Generalized linear models were used to compare the impacts of Trisleep and Hexaflex types on physical and mental well-being. In a cluster analysis, Four Trisleep types (good sleep, sleep–wake rhythm problems, sleep debt, and compound problems) and four Hexaflex types, differentiated by overall levels rather than distinct features (flexibility, medium flexibility, mild flexibility, and inflexibility) were identified. Trisleep types, especially compound sleep problems, were strongly associated with physical well-being. The interaction between Trisleep and Hexaflex types significantly predicted mental well-being, with Hexaflex having a greater impact. The findings underscore the importance of addressing both biological and psychological factors to enhance physical and mental well-being, with targeted interventions for sleep and psychological flexibility, potentially yielding effective outcomes for young adults. Health sciences/Health care Biological sciences/Neuroscience Biological sciences/Psychology Social science/Psychology insomnia circadian rhythm sleep debt psychological flexibility mental well-being physical well-being Figures Figure 1 Figure 2 1. Introduction Sleep problems are common during adolescence and up to young adulthood, with three primary issues frequently identified: insomnia, delayed sleep phase, and sleep debt [ 1 ]. Each of these factors contributes to distinctive physical and mental well-being issues. Sleep debt has been associated with increased physical pain, decreased academic performance, and a higher likelihood of depressive mood [ 2 – 5 ]. Delayed sleep-wake phase is often linked to depressive symptoms [ 6 ], while insomnia tends to manifest as headaches, abdominal pain, or depressive mood [ 7 – 9 ]. Prior research has consistently shown that sleep disorders significantly affect both physical and mental well-being; however, there are no comprehensive studies examining these triangular sleep issues (we named them “Trisleep” for convenience), simultaneously in young adults. A proven approach to addressing physical symptoms and mental health concerns is acceptance and commitment therapy (ACT), which is based on the assumption that psychological vulnerability, referred to as psychological inflexibility, underlies human psychopathology [ 10 ]. Six concepts, characterized as “Hexaflex,” are used to assess the degree of psychological flexibility: acceptance, cognitive defusion, self-as-context, commitment, values, and mindfulness. As a transdiagnostic intervention, ACT aims to improve psychological inflexibility, and has shown to benefit both physical and mental well-being. Some studies have examined how each of these six variables is related to different disorders. Regarding physical symptoms, an association between each component of psychological inflexibility and chronic pain has been previously reported. Meta-analyses and systematic reviews on ACT for patients with chronic pain have demonstrated that it improves mindfulness and pain acceptance, leading to reduced pain severity and improved quality of life [ 11 ]. Moreover, experiential avoidance and cognitive fusion have been thought to contribute to emotional distress and lower quality of life, highlighting the importance of addressing them to reduce depression and anxiety [ 12 – 14 ]. Research has shown that psychological flexibility is associated with well-being in patients with obesity [ 15 ], and ACT interventions enhance well-being [ 16 ]. These findings suggest that each component of psychological flexibility influences physical and psychological well-being. Although correlations between total psychological flexibility and chronic pain have been demonstrated [ 17 ], no studies have examined the relationship between the overall Hexaflex and physical and mental well-being. While both psychological flexibility and sleep problems have been individually implicated in mental and physical well-being, their interrelationship appears weak and potentially independent [ 18 , 19 ]. Nevertheless, each has been identified as a contributing factor to well-being. Therefore, a simultaneous and comprehensive examination of these variables may help elucidate their combined and distinct contributions to overall health. Apropos this, the present study aimed to (1) examine the characteristics of Trisleep and Hexaflex using each variable to understand sleep problems and psychological inflexibility in young adults, and (2) explore how these comprehensive categories associate with young adults’ physical and mental well-being. 2. Methods 2.1 Participants This study was conducted in August 2023 in Japan. The participants included university students randomly recruited by the internet survey company, Cross Marketing, Inc. Participants’ age ranged from 18 to 22 years. The study included only university students; students with other educational levels (e.g., high school and vocational school) were excluded. Overall, 600 completed responses were obtained. Among the respondents, 525 university students (men = 101, women = 414, unspecified = 10; mean age: 19.96 ± 1.42 years), who had completed the questionnaire and had a sleep debt index (SDI) score of zero or more, were selected and analyzed, based on previous research [ 20 ]. Informed consent in writing was acquired from each participant. The study was conducted in accordance with the principles of the Declaration of Helsinki, and approved by the Ethics Committee of Tokyo Kasei University (Approval No. R5-14). 2.2 Measurements 2.2.1 Demographic Information The participants were asked about their age, gender, and educational level to identify the university students most suited for the study. 2.2.2 Primary Outcomes 2.2.2.1 Somatic Symptom Scale-8 (SSS-8) The study used the SSS-8 to assess participants’ physical well-being [ 21 , 22 ]. This self-administered scale included eight items addressing physical symptoms such as stomatic or bowel problems and back pain. Each item was scored on a 5-point Likert scale (0–4), with total scores ranging from 0–32; higher total scores indicated worse somatic symptoms. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .86 [ 22 ]. 2.2.2.2 Subjective Well-Being Scale (SWBS) This study used the SWBS to assess mental well-being [ 23 ]. This self-administered scale consists of 15 items, each scored on a 4-point Likert scale (1–4); total scores range from 15–60. The higher the overall score, the greater the level of well-being. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .84 [ 23 ]. 2.2.2.3 Sleep Problems 2.2.2.3.1 Athens Insomnia Scale (AIS) This study employed AIS to assess insomnia [ 24 ]. The self-administered scale comprises eight items evaluating sleep quality over a month, with each item scored on a 4-point Likert scale (0–3). The higher the total score (range: 0–24), the more severe the insomnia. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .88 [ 24 ]. 2.2.2.3.2 Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) This study used the BRIAN to assess delayed sleep-wake phase symptoms [ 25 ]. It is an interviewer-administered instrument that examines five domains—sleep, sociability, activities, eating, and biological rhythms—and comprises 21 questions related to delayed sleep–wake phase disorders [ 25 ]. The study used a self-administered questionnaire where each item is scored on a 4-point Likert scale (1–4); total scores range from 21 to 84. The higher the score, the greater the biological rhythm disturbance. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .82 [ 25 ]. 2.2.2.3.3 Sleep Debt Index (SDI) This study used the SDI to assess sleep debt [ 20 ]. This self-administered scale consists of three questions: Please tell us about your sleep patterns over the past month: (1) How long do you get nocturnal sleep on a weekday? (2) How long do you sleep on weekends? (3) Considering your own “feeling best of performance” rhythms, for how long would you sleep if you were free for an entire day? The SDI score is calculated as the discrepancy between self-reported ideal and real sleep time. 2.2.2.4 Psychological Flexibility 2.2.2.4.1 Cognitive Fusion Questionnaire (CFQ) The CFQ was employed to evaluate cognitive fusion as the process by which thoughts and reality are confused [ 26 ]. The self-administered scale includes 13 items that investigate two domains: “cognitive fusion” and “cognitive defusion.” This study used only the “cognitive defusion” factor (4 items). Each item is scored on a 7-point Likert scale (1–7), with total scores ranging from 13–91 and scores for “cognitive defusion” ranging from 4–28. The higher the score the greater the cognitive defusion. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .68 [ 26 ]. 2.2.2.4.2 Values of Younger Ages Scale (Voyage) This study utilized the Voyage to assess valued living [ 27 ]. This self-administered scale comprises 15 items that examine two domains: Clarification of Value and Commitment (10 items) and Continuation of Avoidance (5 items). The study used only the “Clarification of Value and Commitment” domain to assess clarity or lack of it in values and commitment of psychological flexibility. Each item is scored on a 4-point Likert scale (0–3), with total scores ranging from 0 to 30; the higher the score, the greater the clarity of values and commitment. Internal consistency of the scale was reported as acceptable, with a McDonald’s ω of .89 in university students [ 27 ]. 2.2.2.4.3 Three Senses of the Selves Questionnaire (TSSQ) The TSSQ was used to assess the three senses of the selves [ 28 ]. This self-administered scale encompasses 33 items, exploring four domains: “acting actively and flexibly in the world,” “conceptualized self,” “distancing from private events,” and “feeling the present moment.” In this study, “distancing from private events (3 items)” and “feeling the present moment (4 items)” domains were used to assess self as context and contact with the present moment (i.e., mindfulness) aspects of psychological flexibility. Each item is scored on a 7-point Likert scale (1–7), with scores ranging from 3–21 for “distancing from private events,” and 4–28 for “feeling the present moment”; the higher the score, the greater the self-as-context and contact with the present moment. Internal consistency of 'distancing from private events' and 'feeling the present moment' was reported as acceptable (Cronbach's α = .78 and .72, respectively) [ 28 ]. 2.2.2.4.4 Acceptance Process Questionnaire (APQ) This study used the APQ [ 29 ] to calculate acceptance, which is the willingness to be open, receptively flexible, and non-judgmental toward ever-changing experiences. This self-administered scale comprises 13 items, examining four domains; the middle- or long-term factors are “expanding behavioral repertoire” and “being receptive to the real world,” while behavioral content factors are “making a choice not to avoid private events,” and “stopping reactions.” Each item is scored on a 7-point Likert scale (0–6), with total scores ranging from 0–78; higher scores indicated greater acceptance. Internal consistency of the scale was reported as acceptable, with a Cronbach’s alpha of .86 [ 29 ]. 2.2.3 Statistical Analysis A hierarchical cluster analysis was conducted using Ward’s method to classify the types of Trisleep and Hexaflex. For types of Trisleep, the AIS, SDI, and BRIAN scales were used for the three dimensions of sleep quality, quantity, and biological rhythm, respectively. For types of Hexaflex, Voyage, TSSQ, CFQ, and APQ were used with the six dimensions of value and commitment, self-as-context and mindfulness, cognitive defusion, and acceptance, respectively. However, because of the one-factor structure of the Voyage scale, values and commitment were used without any distinction. Subsequently, to visually clarify the characteristics of each cluster of Trisleep and Hexaflex types, the z-score of each scale was converted to deviation values and a radar chart was created. Furthermore, generalized linear models (GLMs) were used to compare the impacts of Trisleep and Hexaflex types on physical and mental well-being of the participants. A GLM of gamma distribution with a log-link function was used to account for bias in the distributions of physical (SSS-8) and mental (SWBS) well-being. Given that the SSS-8 is a 5-point scale that includes 0 and is not suitable for gamma distribution, it was converted into a 5-point scale of 1–5 only during the analysis of GLM. The fixed effects were Trisleep clusters, Hexaflex clusters, and their interactions, and the dependent variables were SSS-8 and SWBS. A one-factor analysis of variance was conducted using a χ2 distribution to determine the difference in deviance between the models, including the factor to be tested (full model) and the model excluding the factor. Multiple comparisons were then conducted using a cluster of healthy participants as the criterion in the model, in which the difference in the level of deviance was significant. After examining the correlation coefficients for each of the explanatory variables (sleep and psychological flexibility) and the objective variables (wellbeing and physical symptoms) from previous studies, the correlation coefficient for the combination with the lowest (sleep debt and well-being) was used to calculate the effect size (f2). Thereafter, with each of the two predictors, a significance level of 0.05, a power of 0.80, and an expected effect size of f² = 0.02 [ 30 ], the required sample size was estimated to be ≥ 484. Accounting for exclusions from the analysis, the required sample size was set at 600. All statistical analyses were performed using the R Studio version 2023.12.1 Build 402. The R packages stats [ 31 ], psych [ 32 ], multcomp [ 33 ], emmeans [ 34 ], pwr [ 35 ] were also used. 3. Results 3.1 Classification of Trisleep and Hexaflex clusters Table 1 presents the demographic data, means, and standard deviations (SDs) for each scale. For Trisleep, four clusters were identified: Cluster 1 was named “good sleep type,” characterized by low values of all the scales (n = 125); Cluster 2 was named “sleep debt type,” characterized by high values of SDI (n = 86); Cluster 3 was named “sleep-wake rhythm problem type,” characterized by high values of BRIAN (n = 239); and Cluster 4 was named “compound problems type,” characterized by high values of all the scales (n = 75) (Fig. 1). Table 1 Demographic data and descriptive statistics of scales. AIS; Athens Insomnia Scale, APQ; Acceptance Process Questionnaire, BRIAN; biological rhythm was a Biological Rhythms Interview of Assessment in Neuropsychiatry, CFQ; Cognitive defusion, SD; Standardized deviation. SDI; Sleep debt index. SSS-8; Somatic Symptom Scale-8, SWBS; Subjective Well-Being Scale, TSSQ; Three Senses of the Selves Questionnaire, Voyage; Values of Younger Ages scale. The valuables of cognitive defusion was a domain of CFQ, Clarification of value and commitment was a domain of Voyage, distancing from private events and feeling the present moment were domains of TSSQ, and acceptance was total score of APQ. Valuables subcategory Mean SD Age 19.96 (1.42) Sex (%) Men 19.24 Women 78.86 N/A 1.90 AIS 5.26 (4.49) BRIAN 40.95 (12.61) SDI 1.19 (1.15) CFQ Cognitive defusion subscale 13.25 (4.84) Voyage Clarification of value and commitment 13.95 (7.20) TSSQ Distancing from private events 10.74 (3.82) Feeling the present moment 14.02 (4.48) APQ global score 32.97 (13.60) SSS-8 14.81 (6.78) SWBS 38.60 (8.03) [Please insert Table 1 about here] [Please insert Fig. 1 about here] For Hexaflex, four clusters were identified and classified according to the total score on each scale. Cluster 1 was named “flexibility” (n = 56), Cluster 2 “medium flexibility” (n = 236), Cluster 3 “mild flexibility” (n = 185), and Cluster 4 “inflexibility” (n = 48) (Fig. 2). The means and SDs of each variable for each cluster are presented in Table 2 . Table 2 Means and standard deviations for each variable by cluster for Trisleep and Hexaflex. AIS; Athens Insomnia Scale, APQ; Acceptance Process Questionnaire, BRIAN; biological rhythm was a Biological Rhythms Interview of Assessment in Neuropsychiatry, CFQ-cd; cognitive defusion subscale of Cognitive Fusion Questionnaire, SD; Standardized deviation. SDI; Sleep debt index. SSS-8; Somatic Symptom Scale-8, SWBS; Subjective Well-Being Scale, TSSQ-dp; distancing from private events subscale of the Three Senses of the Selves Questionnaire, TSSQ-fq; feeling the present moment subscale of the Three Senses of the Selves Questionnaire Voyage-cvc; clarification of value and commitment subscale of the Values of Younger Ages scale. Trisleep Hexaflex Cluster 1: Good sleep type Cluster 2: Sleep debt type Cluster 3: Sleep-wake rhythm problem type Cluster 4: Compound problems type Cluster 1: Flexibility Cluster 2: Medium flexibility Cluster 3: Mild flexibility Cluster 4: Inflexibility N 125 86 239 75 56 236 185 48 AIS 1.69 (1.89) 4.13 (2.86) 5.59 (3.59) 11.45 (4.83) 4.48 (4.33) 5.45 (4.87) 5.42 (3.98) 4.63 (4.49) BRIAN 27.06 (4.72) 32.99 (5.73) 46.74 (9.03) 54.76 (9.35) 37.89 (13.93) 41.14 (12.54) 42.83 (12.08) 36.35 (11.86) SDI 0.36 (0.37) 2.22 (0.84) 0.75 (0.60) 2.78 (1.27) 1.17 (1.11) 1.11 (1.03) 1.24 (1.18) 1.40 (1.57) CFQ-cd 13.37 (5.31) 13.14 (4.97) 13.39 (4.52) 12.72 (4.94) 18.86 (4.62) 14.66 (3.69) 11.44 (3.84) 6.75 (2.72) Voyage- cvc 14.58 (8.75) 14.31 (7.33) 18.83 (6.46) 12.88 (6.36) 24.55 (4.00) 14.92 (5.67) 11.43 (6.26) 6.52 (4.96) TSSQ-dp 10.98 (4.01) 10.83 (4.16) 10.58 (3.51) 10.73 (4.08) 15.45 (3.13) 12.52 (2.55) 8.65 (2.09) 4.52 (1.68) TSSQ-fp 14.74 (4.95) 14.03 (4.62) 13.92 (4.22) 13.15 (4.20) 20.77 (2.97) 15.72 (2.80) 11.66 (2.56) 6.90 (2.51) APQ 33.72 (14.33) 34.70 (13.73) 32.28 (12.97) 31.89 (14.20) 50.09 (11.77) 38.28 (8.37) 26.64 (9.19) 11.25 (9.50) SSS-8 2.85 (4.57) 4.74 (5.97) 7.77 (6.34) 12.72 (7.13) 7.34 (8.38) 6.59 (6.60) 7.16 (6.42) 5.92 (7.05) SWBS 39.99 (9.22) 41.40 (6.43) 38.72 (7.09) 36.08 (8.37) 46.13 (6.29) 39.27 (7.05) 36.03 (7.75) 34.76 (8.39) [Please insert Table 2 about here] [Please insert Fig. 2 about here] 3.2 Impacts of Both Trisleep and Hexaflex on Physical Well-being A GLM of gamma distribution with a log-link function was used to explore the differences in physical well-being between the Trisleep and Hexaflex clusters (Table 3 ). Deviance analysis was performed to verify the difference in deviance between the full model and the model excluding each factor. Significant differences were found in the deviance analysis, excluding the Trisleep cluster (Deviance = 75.262, p < .0001). The results of multiple comparisons using the good sleep cluster as the criterion in the interaction model showed that the types of sleep debt (t =-8.498, p = 0.048), sleep–wake rhythm (t =-5.677, p < .0001) and compound problem (t =-6.971, p < .0001) significantly predicted physical well-being. Table 3. Effects of characteristics of Trisleep and Hexaflex on physical well-being. df; Degrees of Freedom, Emmean; Estimated Marginal Mean, p; p-value, SE; Standard Error, t; t-value, 95%CI; 95% Confidence Interval. Physical well-being Deviance df Emmean (95%CI) SE t p Contrasts Null 99.249 - Hexaflex 98.844 3 0.484 Trisleep 75.262 3 <.0001 Hexaflex*Trisleep 74.230 9 0.714 Trisleep characteristics 1: Good sleep 509 2.39 (2.30-2.47) 0.042 -2.591 - - 2: Sleep debt 509 2.56 (2.46-2.66) 0.052 -8.498 0.048 1 < 2 3: Sleep-wake rhythm 509 2.77 (2.70-2.84) 0.036 -5.677 <.0001 1 < 3 4: Compound problems 509 3.01 (2.89-3.13) 0.061 -6.971 <.0001 1 < 4 [Please insert Table 3 about here] 3.3 Impacts of Both Trisleep and Hexaflex on Mental Well-being A GLM of gamma distribution with a log-link function was used to examine the differences in mental well-being between Trisleep and Hexaflex clusters (Table 4 ). Deviance analysis was performed to verify the difference in deviance between the full model and the model excluding each factor. Significant differences were found in the deviance analysis, excluding the Hexaflex cluster (deviance = 22.831, p < .0001), Trisleep cluster (deviance = 21.458, p < .0001), and their interactions (deviance = 20.809, p = .0326). Multiple comparisons were subsequently conducted using a cluster of healthy participants (i.e., good sleep type or flexibility type) as criteria in the interaction model. In the good sleep type, the estimated marginal means (EMMs) were significantly lower in the mild flexibility (t = 3.951, p = .001) and inflexibility clusters (t = 6.530, p < .0001) than in the flexibility type. Comparing the EMMs for each psychological flexibility type and flexibility type, the medium flexibility (t = 2.588, p = .049) and mild flexibility (t = 3.905, p = .001) were significantly lower for sleep debt type; medium flexibility (t = 3.227, p = .007), mild flexibility (t = 4.766, p < .0001), and inflexibility (t = 4.158, p = .0002) were significantly lower for sleep–wake rhythm problem type; and mild flexibility (t = 3.513, p = .003) and inflexibility type (t = 2.795, p = .028) were significantly lower for compound problem type. Similarly, comparing the EMMs for each sleep type and good sleep type, sleep–wake rhythm problem (t = 3.287, p = .006) and compound problem (t = 5.364, p < .0001) were significantly lower for medium flexibility; compound problem (t = 3.765, p = .001) was significantly lower for mild flexibility; and sleep debt problem (t =-3.033, p < .014) was lower for the inflexibility type. Table 4. characteristics of Trisleep and Hexaflex on mental well-being. df; Degrees of Freedom, Emmean; Estimated Marginal Mean, p; p-value, SE; Standard Error, t; t-value, 95%CI; 95% Confidence Interval. Mental well-being Deviance df Emmean (95%CI) SE t p Contrasts Null 26.396 - Hexaflex 22.831 3 <.0001 Trisleep 21.458 3 3 4: Inflexibility 509 3.42 (3.32-3.53) 0.052 6.530 4 Sleep debt 1: Flexibility 509 3.88 (3.77-3.99) 0.057 - - - 2: Medium 509 3.71 (3.65-3.77) 0.031 2.588 0.049 1 > 2 3: Mild 509 3.61 (3.54-3.68) 0.036 3.905 0.001 1 > 3 4: Inflexibility 509 3.67 (3.55-3.80) 0.063 2.416 0.075 - Sleep-wake rhythm problem 1: Flexibility 509 3.81 (3.73-3.90) 0.043 - - - 2: Medium 509 3.66 (3.62-3.69) 0.018 3.227 0.007 1 > 2 3: Mild 509 3.58 (3.55-3.62) 0.020 4.766 3 4: Inflexibility 509 3.55 (3.46-3.64) 0.045 4.158 0.0002 1 > 4 Compound problems 1: Flexibility 509 3.77 (3.62-3.92) 0.077 - - - 2: Medium 509 3.54 (3.47-3.60) 0.033 2.795 0.028 1 > 2 3: Mild 509 3.47 (3.40-3.54) 0.036 3.513 0.003 1 > 3 4: Inflexibility 509 3.53 (3.40-3.66) 0.067 2.383 0.082 - (continued) Flexibility 1: Good sleep 509 3.86 (3.78-3.95) 0.042 -0.198 0.997 - 2: Sleep debt 509 3.88 (3.77-3.99) 0.057 1.026 0.734 - 3: Sleep-wake rhythm problem 509 3.81 (3.73-3.90) 0.043 -0.198 0.997 - 4: Compound problems 509 3.77 (3.62-3.92) 0.077 0.872 0.820 - Medium Flexibility 1: Good sleep 509 3.76 (3.71-3.81) 0.025 - - - 2: Sleep debt 509 3.71 (3.65-3.77) 0.031 1.288 0.571 - 3: Sleep-wake rhythm problem 509 3.66 (3.62-3.69) 0.018 3.287 0.006 1 > 3 4: Compound problems 509 3.54 (3.47-3.60) 0.033 5.364 4 Mild flexibility 1: Good sleep 509 3.65 (3.59-3.72) 0.031 - - - 2: Sleep debt 509 3.61 (3.54-3.68) 0.036 0.846 0.832 - 3: Sleep-wake rhythm problem 509 3.58 (3.55-3.62) 0.020 1.922 0.220 - 4: Compound problems 509 3.47 (3.40-3.54) 0.036 3.765 0.001 1 > 4 Inflexibility 1: Good sleep 509 3.42 (3.32-3.53) 0.052 - - - 2: Sleep debt 509 3.67 (3.55-3.80) 0.063 -3.033 0.014 1 < 2 3: Sleep-wake rhythm problem 509 3.55 (3.46-3.64) 0.045 -1.867 0.244 - 4: Compound problems 509 3.53 (3.40-3.66) 0.067 -1.251 0.595 - [Please insert Table 4 about here] 4. Discussion The primary objective of this study was to examine the characteristics of sleep problems (Trisleep) and psychological flexibility (Hexaflex) among young adults. Additionally, it sought to explore the associations of Trisleep and Hexaflex with their physical and mental well-being. 4.1 Classification of Trisleep and Hexaflex Clusters Cluster analysis was conducted to categorize Trisleep and Hexaflex profiles, which revealed four distinct clusters. Trisleep clusters were identified as types of good sleep, sleep debt, sleep–wake rhythm problems, and compound problems; the findings aligned with those of previous studies. Sleep–wake rhythms and sleep debts are commonly observed during adolescence and early adulthood [ 1 , 5 , 6 ]. Insomnia increases with age due to changes in sleep architecture [ 36 , 37 ]. The findings of this study are likely a part of a more compound constellation of sleep problems rather than an isolated issue for university students experiencing insomnia. The current study found sleep–wake rhythm problems to be the most prevalent, aligning with previous findings [ 1 ]. In addition, in a cohort study of teenagers, 20% of them were found to be short sleepers (≤ 6h) at baseline, which increased to 25% after a year [ 38 ]. In this study, sleep debt and compound sleep types together accounted for 30.7% of the total sleep debt, consistent with previous studies [ 1 ]. Furthermore, the co-occurrence of sleep issues during late adolescence has been documented in previous studies [ 1 ]. Among 10,220 adolescents, the prevalence of insomnia disorder comorbid with delayed sleep wake phase disorder (DSWPD) was 56% compared to 12% without DSWPD. This finding suggests that sleep phase regression and insomnia are more likely to co-occur in adolescents [ 39 ]. Contrary to our expectations, no prominent feature was observed between the Hexaflex clusters, aside from variations in the overall size of the pentagonal representation. This study is among the first to explore Hexaflex comprehensively, although the factors influencing these results remain unclear. One of the possibilities is that among university students, enhancing a single Hexaflex variable may indirectly improve overall psychological flexibility. This suggests the importance of individualized interventions targeting specific processes within the ACT framework rather than addressing all variables equally. Further research is required to clarify this point. 4.2 Impacts of Both Sleep Problems and Psychological Flexibility on Physical and Mental Well-being The influence of Trisleep and Hexaflex on physical well-being examined in this study revealed that only Trisleep was significantly associated with physical well-being. Individuals with compound sleep problems are more likely to report severe physical symptoms. Previous studies have shown that insufficient sleep or insomnia exacerbates physical pain, which is consistent with the current findings [ 2 , 8 , 9 ]. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to effectively reduce pain severity and pain-related disability, and is superior to pain-focused therapies such as CBT for pain in many measurements [ 40 ]. Additionally, a secondary analysis of randomized control trials on generalized anxiety disorder (GAD) interventions found that daytime dysfunction improvements were predominantly related to insomnia improvements, but not GAD-related symptoms [ 41 ]. These findings underscore the critical role of sleep improvement in alleviating physical symptoms. In contrast, the influence of Trisleep and Hexaflex clusters on mental well-being revealed that both showed significant interaction associations. Sleep problems and psychological inflexibility were associated with lower mental well-being, aligning with previous research [ 5 – 7 , 15 – 16 ]. However, the interaction effects suggested that Hexaflex may play a more critical role in mental well-being than Trisleep, considering its consistent impact. These results imply that, while both psychological (Hexaflex) and biological (Trisleep) factors influence mental well-being, improving mental health may be of greater importance in young adults. Studies on ACT interventions for insomnia have focused on helping individuals achieve psychological distancing from insomnia symptoms. Both ACT-I and CBT-I have demonstrated efficacy in improving sleep [ 42 , 43 ]. Conversely, CBT-I has not shown strong improvements in quality of life [ 44 ]. In light of these considerations and the results of this study, targeting only sleep improvement or psychological flexibility may be insufficient to achieve broader functional improvements, including enhancing physical and mental well-being. Finally, by incorporating sleep–wake rhythms and sleep debt, along with insomnia symptoms, this study provides a comprehensive understanding of sleep problems in young adults. Notably, individuals with insomnia alone were not identified, whereas those with sleep–wake rhythm or sleep debt issues showed poorer mental and physical well-being than those without sleep problems. Although the effects of CBT-I on insomnia symptoms in young adults have been reported [ 45 ], this study highlights the necessity of addressing both biological and psychological factors during young adulthood to achieve optimal outcomes. 4.3 Limitations of the Study Considering that the present study was conducted on healthy university students, the results may likely differ if psychiatric patients or patients with sleep problems were targeted. In addition, it is uncertain whether these results are applicable to other age groups. Furthermore, the study did not include an assessment of social well-being (e.g., absenteeism from school, academic performance, interpersonal relationship etc.) or mental health issues such as depression and anxiety. A comprehensive study including these aspects would perhaps provide more wide-ranging findings. 5. Conclusion The results of this study highlight the importance of regulating both biological and psychological factors in physical and mental well-being of the youth. It may be possible to reduce physical symptoms and increase well-being through a dual approach of intervention during daytime waking hours (psychological flexibility) and regulation of sleep conditions. Declarations Ethical Considerations The study was conducted in accordance with the principles of the Declaration of Helsinki, and approved by the Ethics Committee of Tokyo Kasei University (Approval No. R5-14). Funding This study was supported by JSPS KAKENHI (grant number: 22H01096). Author Contributions Miho Ishii : Data curation, Methodology, Validation, Roles/Writing-original draft. Miyu Hakoda : Conceptualization, Formal analysis, Investigation, Methodology, Writing-review & editing. Isa Okajima : Conceptualization, Funding acquisition, Methodology, Project administration, Writing-review & editing. Data Availability The data that support the findings of this study are openly available in Zenodo at https://doi.org/10.5281/zenodo.15043139 Acknowledgements We thank Editage (http:// www. editage. com) for editing the manuscript. ChatGPT (OpenAI) was partially used for the English translation of this manuscript. The authors then reviewed and revised the translated content to ensure its accuracy and integrity. Competing Interests The authors declare no conflict of interest. However, Isa Okajima received grants from NEC Solution Innovators Ltd. and Infocom Co.; consulting fees from NEC Solution Innovators Ltd. and Suntory Wellness Ltd.; and an honorarium from MSD LLC, Shionogi & Co., and Eisai Co., Ltd. for projects unrelated to the submitted work. References Kansagra, S. Sleep disorders in adolescents. Pediatrics 145 (2), S204–S209. 10.1542/peds.2019-2056I (2020). Chang, J. R. et al. 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Guerrini Usubini, A. et al. The impact of psychological flexibility on psychological well-being in adults with obesity. Front. Psychol. 12 , 636933. 10.3389/fpsyg.2021.636933 (2021). Iturbe, I., Echeburúa, E. & Maiz, E. The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review. Clin. Psychol. Psychother. 29 (3), 837–856. 10.1002/cpp.2695 (2022). Sundström, F., Lavefjord, A., Buhrman, M. & McCracken, L. Assessing psychological flexibility and inflexibility in chronic pain using the Multidimensional Psychological Flexibility Inventory (MPFI). J. Pain . 24 (5), 770–781 (2023). McCracken, L. M., Buhrman, M., Badinlou, F. & Brocki, K. C. Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility? J. Contextual Behav. Sci. 26 , 187–192. 10.1016/j.jcbs.2022.10.003 (2022). Zakiei, A., Korani, D., Sahraei, Z., Rostampour, M. & Khazaie, H. Predicting sleep quality and insomnia severity using the components of the acceptance and commitment therapy (ACT) model: A new perspective. J. Contextual Behav. Sci. 26 , 227–233. 10.1016/j.jcbs.2022.10.006 (2022). Okajima, I., Komada, Y., Ito, W. & Inoue, Y. Sleep debt and social jetlag associated with sleepiness, mood, and work performance among workers in Japan. Int. J. Environ. Res. Public. Health . 18 (6), 2908. 10.3390/ijerph18062908 (2021). Matsudaira, K. et al. Development of a linguistically validated Japanese version of the Somatic Symptom Scale–8(SSS–8). Jpn J. Psychosom. Med. 56 , 931–937 (2016). Matsudaira, K. et al. Development of a Japanese version of the Somatic Symptom Scale-8: Psychometric validity and internal consistency. Gen. Hosp. Psychiatry . 45 , 7–11. 10.1016/j.genhosppsych.2016.12.002 (2017). Ito, Y., Sagara, J., Ikeda, M. & Kawaura, Y. Reliability and validity of subjective well-being scale. Shinrigaku Kenkyu . 74 (3), 276–281. 10.4992/jjpsy.74.276 (2003). Okajima, I., Nakajima, S., Kobayashi, M. & Inoue, Y. Development and validation of the Japanese version of the Athens Insomnia Scale. J. Occup. Health . 53 (3), 188–196. 10.1111/pcn.12073 (2011). Kanda, Y. et al. Reliability and validity of the Japanese version of the Biological Rhythms Interview of assessment in neuropsychiatry-self report for delayed sleep-wake phase disorder. Sleep. Med. 81 , 288–293. 10.1016/j.sleep.2021.02.009 (2021). Shima, T., Kawai, T., Yanagihara, M. & Kumano, H. Validation of the Japanese version of the Cognitive Fusion Questionnaire: the 13-item content revised version and the 7-item version. Japanese J. Behav. Therapy . 42 (1), 73–83. 10.24468/jjbt.42.1_73 (2016). Ishizu, K., Ohtsuki, T., Shimoda, Y. & Takahashi, F. Bon Voyage: Developing a scale for measuring value among younger populations and examining its reliability and validity. J. Contextual Behav. Sci. 15 , 153–161. 10.1016/j.jcbs.2019.12.007 (2020). Yanagihara, M., Shima, T., Saito, J., Kawai, T. & Kumano, H. Development of the Three Senses of the Selves Questionnaire and confirmation of its reliability. Japanese Association Behav. Cogn. Ther. 41 (3), 225–238. 10.24468/jjbt.41.3_225 (2015). Shima, T. et al. Development of the acceptance process questionnaire and confirming its reliability and validity. Japanese J. Behav. Therapy . 43 (1), 1–13. 10.24468/jjbt.15-152 (2017). Takano, Y., Iwano, S., Ando, T. & Okajima, I. Sleep debt mediates the relationship between work-related social factors, presenteeism, and well-being in Japanese workers. Int. J. Environ. Res. Public. Health . 20 (7), 5310. 10.3390/ijerph20075310 (2023). R Core Team. A language and environment for statistical computing (Computer software). (2024). Retrieved from https://www.r-project.org/ Revelle, W. Procedures for Psychological. Psychometric, and personality research (Version R package version 2.4.6) (Computer software). (2024). Retrieved from https://cran.r-project.org/package=psych Hothorn, T., Bretz, F. & Westfall, P. Simultaneous inference in general parametric models. Biometrical J. (Biometrische Zeitschrift) . 50 (3), 346–363. 10.1002/bimj.200810425 (2008). Lenth, R. V. & emmeans Estimated Marginal Means, aka Least-Squares Means (Version R package version 1.10.4) (Computer software). (2024). Retrieved from https://cran.r-project.org/package=emmeans Champely, S. & pwr Basic functions for power analysis. (Version R package 1.3-0) (Computer software). (2020). Retrieved from https://CRAN.R-project.org/package=pwr Neubauer, D. N. Sleep problems in the elderly. Am. Fam Physician . 59 (9), 2551–2558 (1999). Ohayon, M. M. Epidemiology of insomnia: What we know and what we still need to learn. Sleep. Med. Rev. 6 (2), 97–111. 10.1053/smrv.2002.0186 (2002). Roberts, R. E. & Duong, H. T. The prospective association between sleep deprivation and depression among adolescents. Sleep 37 (2), 239–244. 10.5665/sleep.3388 (2014). Sivertsen, B. et al. Delayed sleep phase syndrome in adolescents: Prevalence and correlates in a large population based study. BMC Public. Health . 13 (13), 1163. 10.1186/1471-2458-13-1163 (2013). Enomoto, K. et al. Comparison of the effectiveness of cognitive behavioral therapy for insomnia, cognitive behavioral therapy for pain, and hybrid cognitive behavioral therapy for insomnia and pain in individuals with comorbid insomnia and chronic pain: A systematic review and network meta-analysis. Sleep. Med. Rev. 66 , 101693. 10.1016/j.smrv.2022.101693 (2022). Okajima, I. & Chen, J. The effect of insomnia on changes in anxiety, depression, and social function after a transdiagnostic treatment targeting excessive worry. Sleep. Biol. Rhythm . 15 (3), 243–249. 10.1007/s41105-017-0102-1 (2017). Perotta, B. et al. Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students. BMC Med. Educ. 21 (1), 111. 10.1186/s12909-021-02544-8 (2021). Rafihi-Ferreira, R. E. et al. Acceptance and commitment therapy-based behavioral intervention for insomnia: A pilot randomized controlled trial. Braz J. Psychiatry . 43 (5), 504–509. 10.1590/1516-4446-2020-0947 (2021). Rafihi-Ferreira, R., Morin, C. M., Hasan, R., Brasil, I. S. & Ribeiro, Z. Cecília Toscanini, A. A pilot randomized controlled trial (RCT) of acceptance and commitment therapy versus cognitive behavioral therapy for chronic insomnia. Behav. Sleep. Med. 21 (2), 193–207. 10.1080/15402002.2022.2071272 (2023). Alimoradi, Z. et al. Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep. Med. Rev. 64 (101646). 10.1016/j.smrv.2022.101646 (2022). Additional Declarations Competing interest reported. Isa Okajima received grants from NEC Solution Innovators Ltd. and Infocom Co.; consulting fees from NEC Solution Innovators Ltd. and Suntory Wellness Ltd.; and an honorarium from MSD LLC, Shionogi & Co., and Eisai Co., Ltd. for projects unrelated to the submitted work. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7512649","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":513318885,"identity":"0ee3f24c-0bd0-4721-8f9a-a5c398fb5695","order_by":0,"name":"Miho Ishii","email":"","orcid":"","institution":"Senzoku Stress Coping Support office","correspondingAuthor":false,"prefix":"","firstName":"Miho","middleName":"","lastName":"Ishii","suffix":""},{"id":513318886,"identity":"5f246224-8719-46f6-943d-e897710088f6","order_by":1,"name":"Miyu Hakoda","email":"","orcid":"","institution":"Noda Campus, Azusa Daiichi High School","correspondingAuthor":false,"prefix":"","firstName":"Miyu","middleName":"","lastName":"Hakoda","suffix":""},{"id":513318887,"identity":"ad66f60f-1242-4c7c-96a0-96a48515fea0","order_by":2,"name":"Isa Okajima","email":"data:image/png;base64,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","orcid":"","institution":"Tokyo Kasei University","correspondingAuthor":true,"prefix":"","firstName":"Isa","middleName":"","lastName":"Okajima","suffix":""}],"badges":[],"createdAt":"2025-09-02 02:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7512649/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7512649/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91158760,"identity":"951eb676-8bda-475c-84df-dbb12563dbc4","added_by":"auto","created_at":"2025-09-12 08:38:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":241366,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1.Theresultofclusteranalysisofsleepproblems..jpg","url":"https://assets-eu.researchsquare.com/files/rs-7512649/v1/cfc295d91ce042eb4756cda3.jpg"},{"id":91158765,"identity":"d985d0dc-1903-4e35-a42d-8af67021a775","added_by":"auto","created_at":"2025-09-12 08:38:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":305902,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure2.Theresultofclusteranalysisofpsychologicalflexibility..jpg","url":"https://assets-eu.researchsquare.com/files/rs-7512649/v1/1e6406e91046097272cf32b6.jpg"},{"id":91160878,"identity":"e8dffc63-bdc0-4454-a8fe-3a13354196fa","added_by":"auto","created_at":"2025-09-12 09:10:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1801856,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7512649/v1/c6af3974-8aae-4350-b401-111a5fd08a08.pdf"},{"id":91158767,"identity":"7956beb3-e217-4573-813b-b8cc66b08f3d","added_by":"auto","created_at":"2025-09-12 08:38:09","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":150469,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.ResultsofHierarchicalClusterAnalysisBasedonTrisleepVariables..jpg","url":"https://assets-eu.researchsquare.com/files/rs-7512649/v1/87db4ce20d2860912141d71c.jpg"},{"id":91158766,"identity":"5d079c32-14bb-4689-a2ce-05350580f25e","added_by":"auto","created_at":"2025-09-12 08:38:09","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":217651,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2.ResultsofHierarchicalClusterAnalysisBasedonHexaflexVariables..jpg","url":"https://assets-eu.researchsquare.com/files/rs-7512649/v1/c21fc3d3d661581bcd057632.jpg"}],"financialInterests":"Competing interest reported. Isa Okajima received grants from NEC Solution Innovators Ltd. and Infocom Co.; consulting fees from NEC Solution Innovators Ltd. and Suntory Wellness Ltd.; and an honorarium from MSD LLC, Shionogi \u0026 Co., and Eisai Co., Ltd. for projects unrelated to the submitted work.","formattedTitle":"\u003cp\u003eImpact of Sleep and Psychological Flexibility on Young Adults’ Physical and Mental Well-being\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSleep problems are common during adolescence and up to young adulthood, with three primary issues frequently identified: insomnia, delayed sleep phase, and sleep debt [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Each of these factors contributes to distinctive physical and mental well-being issues. Sleep debt has been associated with increased physical pain, decreased academic performance, and a higher likelihood of depressive mood [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Delayed sleep-wake phase is often linked to depressive symptoms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], while insomnia tends to manifest as headaches, abdominal pain, or depressive mood [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Prior research has consistently shown that sleep disorders significantly affect both physical and mental well-being; however, there are no comprehensive studies examining these triangular sleep issues (we named them \u0026ldquo;Trisleep\u0026rdquo; for convenience), simultaneously in young adults.\u003c/p\u003e\u003cp\u003eA proven approach to addressing physical symptoms and mental health concerns is acceptance and commitment therapy (ACT), which is based on the assumption that psychological vulnerability, referred to as psychological inflexibility, underlies human psychopathology [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Six concepts, characterized as \u0026ldquo;Hexaflex,\u0026rdquo; are used to assess the degree of psychological flexibility: acceptance, cognitive defusion, self-as-context, commitment, values, and mindfulness. As a transdiagnostic intervention, ACT aims to improve psychological inflexibility, and has shown to benefit both physical and mental well-being. Some studies have examined how each of these six variables is related to different disorders. Regarding physical symptoms, an association between each component of psychological inflexibility and chronic pain has been previously reported. Meta-analyses and systematic reviews on ACT for patients with chronic pain have demonstrated that it improves mindfulness and pain acceptance, leading to reduced pain severity and improved quality of life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Moreover, experiential avoidance and cognitive fusion have been thought to contribute to emotional distress and lower quality of life, highlighting the importance of addressing them to reduce depression and anxiety [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research has shown that psychological flexibility is associated with well-being in patients with obesity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and ACT interventions enhance well-being [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These findings suggest that each component of psychological flexibility influences physical and psychological well-being.\u003c/p\u003e\u003cp\u003eAlthough correlations between total psychological flexibility and chronic pain have been demonstrated [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], no studies have examined the relationship between the overall Hexaflex and physical and mental well-being. While both psychological flexibility and sleep problems have been individually implicated in mental and physical well-being, their interrelationship appears weak and potentially independent [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nevertheless, each has been identified as a contributing factor to well-being. Therefore, a simultaneous and comprehensive examination of these variables may help elucidate their combined and distinct contributions to overall health. Apropos this, the present study aimed to (1) examine the characteristics of Trisleep and Hexaflex using each variable to understand sleep problems and psychological inflexibility in young adults, and (2) explore how these comprehensive categories associate with young adults\u0026rsquo; physical and mental well-being.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Participants\u003c/h2\u003e\u003cp\u003eThis study was conducted in August 2023 in Japan. The participants included university students randomly recruited by the internet survey company, Cross Marketing, Inc. Participants\u0026rsquo; age ranged from 18 to 22 years. The study included only university students; students with other educational levels (e.g., high school and vocational school) were excluded. Overall, 600 completed responses were obtained. Among the respondents, 525 university students (men\u0026thinsp;=\u0026thinsp;101, women\u0026thinsp;=\u0026thinsp;414, unspecified\u0026thinsp;=\u0026thinsp;10; mean age: 19.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 years), who had completed the questionnaire and had a sleep debt index (SDI) score of zero or more, were selected and analyzed, based on previous research [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Informed consent in writing was acquired from each participant. The study was conducted in accordance with the principles of the Declaration of Helsinki, and approved by the Ethics Committee of Tokyo Kasei University (Approval No. R5-14).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Measurements\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1 Demographic Information\u003c/h2\u003e\u003cp\u003eThe participants were asked about their age, gender, and educational level to identify the university students most suited for the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2 Primary Outcomes\u003c/h2\u003e\u003cdiv id=\"Sec7\" class=\"Section4\"\u003e\u003ch2\u003e2.2.2.1 Somatic Symptom Scale-8 (SSS-8)\u003c/h2\u003e\u003cp\u003eThe study used the SSS-8 to assess participants\u0026rsquo; physical well-being [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This self-administered scale included eight items addressing physical symptoms such as stomatic or bowel problems and back pain. Each item was scored on a 5-point Likert scale (0\u0026ndash;4), with total scores ranging from 0\u0026ndash;32; higher total scores indicated worse somatic symptoms. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .86 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section4\"\u003e\u003ch2\u003e2.2.2.2 Subjective Well-Being Scale (SWBS)\u003c/h2\u003e\u003cp\u003eThis study used the SWBS to assess mental well-being [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This self-administered scale consists of 15 items, each scored on a 4-point Likert scale (1\u0026ndash;4); total scores range from 15\u0026ndash;60. The higher the overall score, the greater the level of well-being. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .84 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section4\"\u003e\u003ch2\u003e2.2.2.3 Sleep Problems\u003c/h2\u003e\u003cdiv id=\"Sec10\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.3.1 Athens Insomnia Scale (AIS)\u003c/h2\u003e\u003cp\u003eThis study employed AIS to assess insomnia [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The self-administered scale comprises eight items evaluating sleep quality over a month, with each item scored on a 4-point Likert scale (0\u0026ndash;3). The higher the total score (range: 0\u0026ndash;24), the more severe the insomnia. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .88 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.3.2 Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN)\u003c/h2\u003e\u003cp\u003eThis study used the BRIAN to assess delayed sleep-wake phase symptoms [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is an interviewer-administered instrument that examines five domains\u0026mdash;sleep, sociability, activities, eating, and biological rhythms\u0026mdash;and comprises 21 questions related to delayed sleep\u0026ndash;wake phase disorders [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The study used a self-administered questionnaire where each item is scored on a 4-point Likert scale (1\u0026ndash;4); total scores range from 21 to 84. The higher the score, the greater the biological rhythm disturbance. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .82 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.3.3 Sleep Debt Index (SDI)\u003c/h2\u003e\u003cp\u003eThis study used the SDI to assess sleep debt [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This self-administered scale consists of three questions: Please tell us about your sleep patterns over the past month: (1) How long do you get nocturnal sleep on a weekday? (2) How long do you sleep on weekends? (3) Considering your own \u0026ldquo;feeling best of performance\u0026rdquo; rhythms, for how long would you sleep if you were free for an entire day? The SDI score is calculated as the discrepancy between self-reported ideal and real sleep time.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section4\"\u003e\u003ch2\u003e2.2.2.4 Psychological Flexibility\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.4.1 Cognitive Fusion Questionnaire (CFQ)\u003c/h2\u003e\u003cp\u003eThe CFQ was employed to evaluate cognitive fusion as the process by which thoughts and reality are confused [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The self-administered scale includes 13 items that investigate two domains: \u0026ldquo;cognitive fusion\u0026rdquo; and \u0026ldquo;cognitive defusion.\u0026rdquo; This study used only the \u0026ldquo;cognitive defusion\u0026rdquo; factor (4 items). Each item is scored on a 7-point Likert scale (1\u0026ndash;7), with total scores ranging from 13\u0026ndash;91 and scores for \u0026ldquo;cognitive defusion\u0026rdquo; ranging from 4\u0026ndash;28. The higher the score the greater the cognitive defusion. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .68 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.4.2 Values of Younger Ages Scale (Voyage)\u003c/h2\u003e\u003cp\u003eThis study utilized the Voyage to assess valued living [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This self-administered scale comprises 15 items that examine two domains: Clarification of Value and Commitment (10 items) and Continuation of Avoidance (5 items). The study used only the \u0026ldquo;Clarification of Value and Commitment\u0026rdquo; domain to assess clarity or lack of it in values and commitment of psychological flexibility. Each item is scored on a 4-point Likert scale (0\u0026ndash;3), with total scores ranging from 0 to 30; the higher the score, the greater the clarity of values and commitment. Internal consistency of the scale was reported as acceptable, with a McDonald\u0026rsquo;s ω of .89 in university students [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.4.3 Three Senses of the Selves Questionnaire (TSSQ)\u003c/h2\u003e\u003cp\u003eThe TSSQ was used to assess the three senses of the selves [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This self-administered scale encompasses 33 items, exploring four domains: \u0026ldquo;acting actively and flexibly in the world,\u0026rdquo; \u0026ldquo;conceptualized self,\u0026rdquo; \u0026ldquo;distancing from private events,\u0026rdquo; and \u0026ldquo;feeling the present moment.\u0026rdquo; In this study, \u0026ldquo;distancing from private events (3 items)\u0026rdquo; and \u0026ldquo;feeling the present moment (4 items)\u0026rdquo; domains were used to assess self as context and contact with the present moment (i.e., mindfulness) aspects of psychological flexibility. Each item is scored on a 7-point Likert scale (1\u0026ndash;7), with scores ranging from 3\u0026ndash;21 for \u0026ldquo;distancing from private events,\u0026rdquo; and 4\u0026ndash;28 for \u0026ldquo;feeling the present moment\u0026rdquo;; the higher the score, the greater the self-as-context and contact with the present moment. Internal consistency of 'distancing from private events' and 'feeling the present moment' was reported as acceptable (Cronbach's α\u0026thinsp;=\u0026thinsp;.78 and .72, respectively) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section5\"\u003e\u003ch2\u003e2.2.2.4.4 Acceptance Process Questionnaire (APQ)\u003c/h2\u003e\u003cp\u003eThis study used the APQ [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] to calculate acceptance, which is the willingness to be open, receptively flexible, and non-judgmental toward ever-changing experiences. This self-administered scale comprises 13 items, examining four domains; the middle- or long-term factors are \u0026ldquo;expanding behavioral repertoire\u0026rdquo; and \u0026ldquo;being receptive to the real world,\u0026rdquo; while behavioral content factors are \u0026ldquo;making a choice not to avoid private events,\u0026rdquo; and \u0026ldquo;stopping reactions.\u0026rdquo; Each item is scored on a 7-point Likert scale (0\u0026ndash;6), with total scores ranging from 0\u0026ndash;78; higher scores indicated greater acceptance. Internal consistency of the scale was reported as acceptable, with a Cronbach\u0026rsquo;s alpha of .86 [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3 Statistical Analysis\u003c/h2\u003e\u003cp\u003eA hierarchical cluster analysis was conducted using Ward\u0026rsquo;s method to classify the types of Trisleep and Hexaflex. For types of Trisleep, the AIS, SDI, and BRIAN scales were used for the three dimensions of sleep quality, quantity, and biological rhythm, respectively. For types of Hexaflex, Voyage, TSSQ, CFQ, and APQ were used with the six dimensions of value and commitment, self-as-context and mindfulness, cognitive defusion, and acceptance, respectively. However, because of the one-factor structure of the Voyage scale, values and commitment were used without any distinction. Subsequently, to visually clarify the characteristics of each cluster of Trisleep and Hexaflex types, the z-score of each scale was converted to deviation values and a radar chart was created.\u003c/p\u003e\u003cp\u003eFurthermore, generalized linear models (GLMs) were used to compare the impacts of Trisleep and Hexaflex types on physical and mental well-being of the participants. A GLM of gamma distribution with a log-link function was used to account for bias in the distributions of physical (SSS-8) and mental (SWBS) well-being. Given that the SSS-8 is a 5-point scale that includes 0 and is not suitable for gamma distribution, it was converted into a 5-point scale of 1\u0026ndash;5 only during the analysis of GLM. The fixed effects were Trisleep clusters, Hexaflex clusters, and their interactions, and the dependent variables were SSS-8 and SWBS. A one-factor analysis of variance was conducted using a χ2 distribution to determine the difference in deviance between the models, including the factor to be tested (full model) and the model excluding the factor. Multiple comparisons were then conducted using a cluster of healthy participants as the criterion in the model, in which the difference in the level of deviance was significant. After examining the correlation coefficients for each of the explanatory variables (sleep and psychological flexibility) and the objective variables (wellbeing and physical symptoms) from previous studies, the correlation coefficient for the combination with the lowest (sleep debt and well-being) was used to calculate the effect size (f2). Thereafter, with each of the two predictors, a significance level of 0.05, a power of 0.80, and an expected effect size of f\u0026sup2; = 0.02 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], the required sample size was estimated to be \u0026ge;\u0026thinsp;484. Accounting for exclusions from the analysis, the required sample size was set at 600.\u003c/p\u003e\u003cp\u003eAll statistical analyses were performed using the R Studio version 2023.12.1 Build 402. The R packages stats [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], psych [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], multcomp [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], emmeans [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], pwr [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] were also used.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Classification of Trisleep and Hexaflex clusters\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic data, means, and standard deviations (SDs) for each scale.\u003c/p\u003e\n \u003cp\u003eFor Trisleep, four clusters were identified: Cluster 1 was named \u0026ldquo;good sleep type,\u0026rdquo; characterized by low values of all the scales (n\u0026thinsp;=\u0026thinsp;125); Cluster 2 was named \u0026ldquo;sleep debt type,\u0026rdquo; characterized by high values of SDI (n\u0026thinsp;=\u0026thinsp;86); Cluster 3 was named \u0026ldquo;sleep-wake rhythm problem type,\u0026rdquo; characterized by high values of BRIAN (n\u0026thinsp;=\u0026thinsp;239); and Cluster 4 was named \u0026ldquo;compound problems type,\u0026rdquo; characterized by high values of all the scales (n\u0026thinsp;=\u0026thinsp;75) (Fig.\u0026nbsp;1).\u003c/p\u003e\n \u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eDemographic data and descriptive statistics of scales. AIS; Athens Insomnia Scale, APQ; Acceptance Process Questionnaire, BRIAN; biological rhythm was a Biological Rhythms Interview of Assessment in Neuropsychiatry, CFQ; Cognitive defusion, SD; Standardized deviation. SDI; Sleep debt index. SSS-8; Somatic Symptom Scale-8, SWBS; Subjective Well-Being Scale, TSSQ; Three Senses of the Selves Questionnaire, Voyage; Values of Younger Ages scale. The valuables of cognitive defusion was a domain of CFQ, Clarification of value and commitment was a domain of Voyage, distancing from private events and feeling the present moment were domains of TSSQ, and acceptance was total score of APQ.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValuables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003esubcategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(4.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBRIAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(12.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCFQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCognitive defusion subscale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(4.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVoyage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClarification of value and commitment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(7.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTSSQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistancing from private events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(3.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeeling the present moment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(4.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eglobal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(13.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSSS-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(6.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e(8.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e[Please insert Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e about here]\u003c/p\u003e\n \u003cp\u003e[Please insert Fig.\u0026nbsp;1 about here]\u003c/p\u003e\n \u003cp\u003eFor Hexaflex, four clusters were identified and classified according to the total score on each scale. Cluster 1 was named \u0026ldquo;flexibility\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;56), Cluster 2 \u0026ldquo;medium flexibility\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;236), Cluster 3 \u0026ldquo;mild flexibility\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;185), and Cluster 4 \u0026ldquo;inflexibility\u0026rdquo; (n\u0026thinsp;=\u0026thinsp;48) (Fig. 2). The means and SDs of each variable for each cluster are presented in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMeans and standard deviations for each variable by cluster for Trisleep and Hexaflex. AIS; Athens Insomnia Scale, APQ; Acceptance Process Questionnaire, BRIAN; biological rhythm was a Biological Rhythms Interview of Assessment in Neuropsychiatry, CFQ-cd; cognitive defusion subscale of Cognitive Fusion Questionnaire, SD; Standardized deviation. SDI; Sleep debt index. SSS-8; Somatic Symptom Scale-8, SWBS; Subjective Well-Being Scale, TSSQ-dp; distancing from private events subscale of the Three Senses of the Selves Questionnaire, TSSQ-fq; feeling the present moment subscale of the Three Senses of the Selves Questionnaire Voyage-cvc; clarification of value and commitment subscale of the Values of Younger Ages scale.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 7.1464%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\" style=\"width: 34.5833%;\"\u003e\n \u003cp\u003eTrisleep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\" style=\"width: 26.707%;\"\u003e\n \u003cp\u003eHexaflex\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003eCluster 1:\u003c/p\u003e\n \u003cp\u003eGood sleep type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003eCluster 2:\u003c/p\u003e\n \u003cp\u003eSleep debt type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003eCluster 3:\u003c/p\u003e\n \u003cp\u003eSleep-wake rhythm problem type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003eCluster 4:\u003c/p\u003e\n \u003cp\u003eCompound problems type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003eCluster 1:\u003c/p\u003e\n \u003cp\u003eFlexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003eCluster 2:\u003c/p\u003e\n \u003cp\u003eMedium flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003eCluster 3:\u003c/p\u003e\n \u003cp\u003eMild flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003eCluster 4:\u003c/p\u003e\n \u003cp\u003eInflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003cp\u003e(1.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003cp\u003e(2.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e5.59\u003c/p\u003e\n \u003cp\u003e(3.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e11.45\u003c/p\u003e\n \u003cp\u003e(4.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e4.48\u003c/p\u003e\n \u003cp\u003e(4.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e5.45\u003c/p\u003e\n \u003cp\u003e(4.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e5.42\u003c/p\u003e\n \u003cp\u003e(3.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e4.63\u003c/p\u003e\n \u003cp\u003e(4.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eBRIAN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e27.06\u003c/p\u003e\n \u003cp\u003e(4.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e32.99\u003c/p\u003e\n \u003cp\u003e(5.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e46.74\u003c/p\u003e\n \u003cp\u003e(9.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e54.76\u003c/p\u003e\n \u003cp\u003e(9.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e37.89\u003c/p\u003e\n \u003cp\u003e(13.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e41.14\u003c/p\u003e\n \u003cp\u003e(12.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e42.83\u003c/p\u003e\n \u003cp\u003e(12.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e36.35\u003c/p\u003e\n \u003cp\u003e(11.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eSDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003cp\u003e(0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e2.22\u003c/p\u003e\n \u003cp\u003e(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003cp\u003e(0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e2.78\u003c/p\u003e\n \u003cp\u003e(1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003cp\u003e(1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003cp\u003e(1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003cp\u003e(1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003cp\u003e(1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eCFQ-cd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e13.37\u003c/p\u003e\n \u003cp\u003e(5.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e13.14\u003c/p\u003e\n \u003cp\u003e(4.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e13.39\u003c/p\u003e\n \u003cp\u003e(4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e12.72\u003c/p\u003e\n \u003cp\u003e(4.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e18.86\u003c/p\u003e\n \u003cp\u003e(4.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e14.66\u003c/p\u003e\n \u003cp\u003e(3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e11.44\u003c/p\u003e\n \u003cp\u003e(3.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e6.75\u003c/p\u003e\n \u003cp\u003e(2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eVoyage-\u003c/p\u003e\n \u003cp\u003ecvc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e14.58\u003c/p\u003e\n \u003cp\u003e(8.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e14.31\u003c/p\u003e\n \u003cp\u003e(7.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e18.83\u003c/p\u003e\n \u003cp\u003e(6.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e12.88\u003c/p\u003e\n \u003cp\u003e(6.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e24.55\u003c/p\u003e\n \u003cp\u003e(4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e14.92\u003c/p\u003e\n \u003cp\u003e(5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e11.43\u003c/p\u003e\n \u003cp\u003e(6.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e6.52\u003c/p\u003e\n \u003cp\u003e(4.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eTSSQ-dp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e10.98\u003c/p\u003e\n \u003cp\u003e(4.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e10.83\u003c/p\u003e\n \u003cp\u003e(4.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e10.58\u003c/p\u003e\n \u003cp\u003e(3.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e10.73\u003c/p\u003e\n \u003cp\u003e(4.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e15.45\u003c/p\u003e\n \u003cp\u003e(3.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e12.52\u003c/p\u003e\n \u003cp\u003e(2.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e8.65\u003c/p\u003e\n \u003cp\u003e(2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e4.52\u003c/p\u003e\n \u003cp\u003e(1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eTSSQ-fp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e14.74\u003c/p\u003e\n \u003cp\u003e(4.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e14.03\u003c/p\u003e\n \u003cp\u003e(4.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e13.92\u003c/p\u003e\n \u003cp\u003e(4.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e13.15\u003c/p\u003e\n \u003cp\u003e(4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e20.77\u003c/p\u003e\n \u003cp\u003e(2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e15.72\u003c/p\u003e\n \u003cp\u003e(2.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e11.66\u003c/p\u003e\n \u003cp\u003e(2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e6.90\u003c/p\u003e\n \u003cp\u003e(2.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eAPQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e33.72\u003c/p\u003e\n \u003cp\u003e(14.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e34.70\u003c/p\u003e\n \u003cp\u003e(13.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e32.28\u003c/p\u003e\n \u003cp\u003e(12.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e31.89\u003c/p\u003e\n \u003cp\u003e(14.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e50.09\u003c/p\u003e\n \u003cp\u003e(11.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e38.28\u003c/p\u003e\n \u003cp\u003e(8.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e26.64\u003c/p\u003e\n \u003cp\u003e(9.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e11.25\u003c/p\u003e\n \u003cp\u003e(9.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eSSS-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e2.85\u003c/p\u003e\n \u003cp\u003e(4.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e4.74\u003c/p\u003e\n \u003cp\u003e(5.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e7.77\u003c/p\u003e\n \u003cp\u003e(6.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e12.72\u003c/p\u003e\n \u003cp\u003e(7.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e7.34\u003c/p\u003e\n \u003cp\u003e(8.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e6.59\u003c/p\u003e\n \u003cp\u003e(6.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e7.16\u003c/p\u003e\n \u003cp\u003e(6.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e5.92\u003c/p\u003e\n \u003cp\u003e(7.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.1464%;\"\u003e\n \u003cp\u003eSWBS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e39.99\u003c/p\u003e\n \u003cp\u003e(9.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.5083%;\"\u003e\n \u003cp\u003e41.40\u003c/p\u003e\n \u003cp\u003e(6.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.5292%;\"\u003e\n \u003cp\u003e38.72\u003c/p\u003e\n \u003cp\u003e(7.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.6986%;\"\u003e\n \u003cp\u003e36.08\u003c/p\u003e\n \u003cp\u003e(8.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.933%;\"\u003e\n \u003cp\u003e46.13\u003c/p\u003e\n \u003cp\u003e(6.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e39.27\u003c/p\u003e\n \u003cp\u003e(7.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 8.5501%;\"\u003e\n \u003cp\u003e36.03\u003c/p\u003e\n \u003cp\u003e(7.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.0815%;\"\u003e\n \u003cp\u003e34.76\u003c/p\u003e\n \u003cp\u003e(8.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e[Please insert Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e about here]\u003c/p\u003e\n \u003cp\u003e[Please insert Fig.\u0026nbsp;2 about here]\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Impacts of Both Trisleep and Hexaflex on Physical Well-being\u003c/h2\u003e\n \u003cp\u003eA GLM of gamma distribution with a log-link function was used to explore the differences in physical well-being between the Trisleep and Hexaflex clusters (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Deviance analysis was performed to verify the difference in deviance between the full model and the model excluding each factor. Significant differences were found in the deviance analysis, excluding the Trisleep cluster (Deviance\u0026thinsp;=\u0026thinsp;75.262, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001). The results of multiple comparisons using the good sleep cluster as the criterion in the interaction model showed that the types of sleep debt (t =-8.498, p\u0026thinsp;=\u0026thinsp;0.048), sleep\u0026ndash;wake rhythm (t =-5.677, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) and compound problem (t =-6.971, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) significantly predicted physical well-being.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003eTable 3. Effects of characteristics of Trisleep and Hexaflex on physical well-being. df; Degrees of Freedom, Emmean; Estimated Marginal Mean, p; p-value, SE; Standard Error, t; t-value, 95%CI; 95% Confidence Interval.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"97%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDeviance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmmean (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContrasts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNull\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e99.249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"4\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHexaflex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e98.844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTrisleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e75.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHexaflex*Trisleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTrisleep characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1: Good sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.39 (2.30-2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-2.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2: Sleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.56 (2.46-2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-8.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 \u0026lt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3: Sleep-wake rhythm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.77 (2.70-2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-5.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 \u0026lt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4: Compound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.01 (2.89-3.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e-6.971\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 \u0026lt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003e[Please insert Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e about here]\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Impacts of Both Trisleep and Hexaflex on Mental Well-being\u003c/h2\u003e\n \u003cp\u003eA GLM of gamma distribution with a log-link function was used to examine the differences in mental well-being between Trisleep and Hexaflex clusters (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). Deviance analysis was performed to verify the difference in deviance between the full model and the model excluding each factor. Significant differences were found in the deviance analysis, excluding the Hexaflex cluster (deviance\u0026thinsp;=\u0026thinsp;22.831, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), Trisleep cluster (deviance\u0026thinsp;=\u0026thinsp;21.458, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), and their interactions (deviance\u0026thinsp;=\u0026thinsp;20.809, p\u0026thinsp;=\u0026thinsp;.0326).\u003c/p\u003e\n \u003cp\u003eMultiple comparisons were subsequently conducted using a cluster of healthy participants (i.e., good sleep type or flexibility type) as criteria in the interaction model. In the good sleep type, the estimated marginal means (EMMs) were significantly lower in the mild flexibility (t\u0026thinsp;=\u0026thinsp;3.951, p\u0026thinsp;=\u0026thinsp;.001) and inflexibility clusters (t\u0026thinsp;=\u0026thinsp;6.530, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) than in the flexibility type. Comparing the EMMs for each psychological flexibility type and flexibility type, the medium flexibility (t\u0026thinsp;=\u0026thinsp;2.588, p\u0026thinsp;=\u0026thinsp;.049) and mild flexibility (t\u0026thinsp;=\u0026thinsp;3.905, p\u0026thinsp;=\u0026thinsp;.001) were significantly lower for sleep debt type; medium flexibility (t\u0026thinsp;=\u0026thinsp;3.227, p\u0026thinsp;=\u0026thinsp;.007), mild flexibility (t\u0026thinsp;=\u0026thinsp;4.766, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001), and inflexibility (t\u0026thinsp;=\u0026thinsp;4.158, p\u0026thinsp;=\u0026thinsp;.0002) were significantly lower for sleep\u0026ndash;wake rhythm problem type; and mild flexibility (t\u0026thinsp;=\u0026thinsp;3.513, p\u0026thinsp;=\u0026thinsp;.003) and inflexibility type (t\u0026thinsp;=\u0026thinsp;2.795, p\u0026thinsp;=\u0026thinsp;.028) were significantly lower for compound problem type.\u003c/p\u003e\n \u003cp\u003eSimilarly, comparing the EMMs for each sleep type and good sleep type, sleep\u0026ndash;wake rhythm problem (t\u0026thinsp;=\u0026thinsp;3.287, p\u0026thinsp;=\u0026thinsp;.006) and compound problem (t\u0026thinsp;=\u0026thinsp;5.364, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) were significantly lower for medium flexibility; compound problem (t\u0026thinsp;=\u0026thinsp;3.765, p\u0026thinsp;=\u0026thinsp;.001) was significantly lower for mild flexibility; and sleep debt problem (t =-3.033, p\u0026thinsp;\u0026lt;\u0026thinsp;.014) was lower for the inflexibility type.\u003c/p\u003e\n \u003cp\u003eTable 4. characteristics of Trisleep and Hexaflex on mental well-being. df; Degrees of Freedom, Emmean; Estimated Marginal Mean, p; p-value, SE; Standard Error, t; t-value, 95%CI; 95% Confidence Interval.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"96%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eMental well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003eDeviance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003edf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003eEmmean (95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003eContrasts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eNull\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e26.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 13.0435%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eHexaflex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e22.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eTrisleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e21.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eHexaflex*Trisleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e20.809\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.0326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eGood sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.86 (3.78-3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.76 (3.71-3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e2.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.65 (3.59-3.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e3.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Inflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.42 (3.32-3.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e6.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eSleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.88 (3.77-3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.71 (3.65-3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e2.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.61 (3.54-3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e3.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Inflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.67 (3.55-3.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e2.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eSleep-wake rhythm problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.81 (3.73-3.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.66 (3.62-3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e3.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.58 (3.55-3.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e4.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Inflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.55 (3.46-3.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e4.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003eCompound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.77 (3.62-3.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Medium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.54 (3.47-3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e2.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.47 (3.40-3.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e3.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e1 \u0026gt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26.8116%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Inflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 5.6159%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0435%;\"\u003e\n \u003cp\u003e3.53 (3.40-3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.3333%;\"\u003e\n \u003cp\u003e2.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.3261%;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7681%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e(continued)\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"96%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003eFlexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Good sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.86 (3.78-3.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Sleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.88 (3.77-3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e1.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Sleep-wake rhythm problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.81 (3.73-3.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Compound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.77 (3.62-3.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003eMedium Flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Good sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.76 (3.71-3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Sleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.71 (3.65-3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e1.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Sleep-wake rhythm problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.66 (3.62-3.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e3.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e1 \u0026gt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Compound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.54 (3.47-3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e5.364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e1 \u0026gt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003eMild flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Good sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.65 (3.59-3.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Sleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.61 (3.54-3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Sleep-wake rhythm problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.58 (3.55-3.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e1.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Compound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.47 (3.40-3.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e3.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e1 \u0026gt; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003eInflexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1: Good sleep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.42 (3.32-3.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2: Sleep debt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.67 (3.55-3.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-3.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e1 \u0026lt; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3: Sleep-wake rhythm problem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.55 (3.46-3.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-1.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27.8293%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4: Compound problems\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.9054%;\"\u003e\n \u003cp\u003e509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.4712%;\"\u003e\n \u003cp\u003e3.53 (3.40-3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.1725%;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.3989%;\"\u003e\n \u003cp\u003e-1.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16.5121%;\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.7106%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e[Please insert Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e about here]\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe primary objective of this study was to examine the characteristics of sleep problems (Trisleep) and psychological flexibility (Hexaflex) among young adults. Additionally, it sought to explore the associations of Trisleep and Hexaflex with their physical and mental well-being.\u003c/p\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Classification of Trisleep and Hexaflex Clusters\u003c/h2\u003e\u003cp\u003eCluster analysis was conducted to categorize Trisleep and Hexaflex profiles, which revealed four distinct clusters. Trisleep clusters were identified as types of good sleep, sleep debt, sleep\u0026ndash;wake rhythm problems, and compound problems; the findings aligned with those of previous studies. Sleep\u0026ndash;wake rhythms and sleep debts are commonly observed during adolescence and early adulthood [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Insomnia increases with age due to changes in sleep architecture [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The findings of this study are likely a part of a more compound constellation of sleep problems rather than an isolated issue for university students experiencing insomnia. The current study found sleep\u0026ndash;wake rhythm problems to be the most prevalent, aligning with previous findings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition, in a cohort study of teenagers, 20% of them were found to be short sleepers (\u0026le;\u0026thinsp;6h) at baseline, which increased to 25% after a year [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In this study, sleep debt and compound sleep types together accounted for 30.7% of the total sleep debt, consistent with previous studies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Furthermore, the co-occurrence of sleep issues during late adolescence has been documented in previous studies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Among 10,220 adolescents, the prevalence of insomnia disorder comorbid with delayed sleep wake phase disorder (DSWPD) was 56% compared to 12% without DSWPD. This finding suggests that sleep phase regression and insomnia are more likely to co-occur in adolescents [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContrary to our expectations, no prominent feature was observed between the Hexaflex clusters, aside from variations in the overall size of the pentagonal representation. This study is among the first to explore Hexaflex comprehensively, although the factors influencing these results remain unclear. One of the possibilities is that among university students, enhancing a single Hexaflex variable may indirectly improve overall psychological flexibility. This suggests the importance of individualized interventions targeting specific processes within the ACT framework rather than addressing all variables equally. Further research is required to clarify this point.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Impacts of Both Sleep Problems and Psychological Flexibility on Physical and Mental Well-being\u003c/h2\u003e\u003cp\u003eThe influence of Trisleep and Hexaflex on physical well-being examined in this study revealed that only Trisleep was significantly associated with physical well-being. Individuals with compound sleep problems are more likely to report severe physical symptoms. Previous studies have shown that insufficient sleep or insomnia exacerbates physical pain, which is consistent with the current findings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to effectively reduce pain severity and pain-related disability, and is superior to pain-focused therapies such as CBT for pain in many measurements [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additionally, a secondary analysis of randomized control trials on generalized anxiety disorder (GAD) interventions found that daytime dysfunction improvements were predominantly related to insomnia improvements, but not GAD-related symptoms [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. These findings underscore the critical role of sleep improvement in alleviating physical symptoms.\u003c/p\u003e\u003cp\u003eIn contrast, the influence of Trisleep and Hexaflex clusters on mental well-being revealed that both showed significant interaction associations. Sleep problems and psychological inflexibility were associated with lower mental well-being, aligning with previous research [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the interaction effects suggested that Hexaflex may play a more critical role in mental well-being than Trisleep, considering its consistent impact. These results imply that, while both psychological (Hexaflex) and biological (Trisleep) factors influence mental well-being, improving mental health may be of greater importance in young adults.\u003c/p\u003e\u003cp\u003eStudies on ACT interventions for insomnia have focused on helping individuals achieve psychological distancing from insomnia symptoms. Both ACT-I and CBT-I have demonstrated efficacy in improving sleep [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Conversely, CBT-I has not shown strong improvements in quality of life [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In light of these considerations and the results of this study, targeting only sleep improvement or psychological flexibility may be insufficient to achieve broader functional improvements, including enhancing physical and mental well-being.\u003c/p\u003e\u003cp\u003eFinally, by incorporating sleep\u0026ndash;wake rhythms and sleep debt, along with insomnia symptoms, this study provides a comprehensive understanding of sleep problems in young adults. Notably, individuals with insomnia alone were not identified, whereas those with sleep\u0026ndash;wake rhythm or sleep debt issues showed poorer mental and physical well-being than those without sleep problems. Although the effects of CBT-I on insomnia symptoms in young adults have been reported [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], this study highlights the necessity of addressing both biological and psychological factors during young adulthood to achieve optimal outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec26\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Limitations of the Study\u003c/h2\u003e\u003cp\u003eConsidering that the present study was conducted on healthy university students, the results may likely differ if psychiatric patients or patients with sleep problems were targeted. In addition, it is uncertain whether these results are applicable to other age groups. Furthermore, the study did not include an assessment of social well-being (e.g., absenteeism from school, academic performance, interpersonal relationship etc.) or mental health issues such as depression and anxiety. A comprehensive study including these aspects would perhaps provide more wide-ranging findings.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe results of this study highlight the importance of regulating both biological and psychological factors in physical and mental well-being of the youth. It may be possible to reduce physical symptoms and increase well-being through a dual approach of intervention during daytime waking hours (psychological flexibility) and regulation of sleep conditions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki, and approved by the Ethics Committee of Tokyo Kasei University (Approval No. R5-14).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by JSPS KAKENHI (grant number: 22H01096).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMiho Ishii\u003c/strong\u003e: Data curation, Methodology, Validation, Roles/Writing-original draft.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMiyu Hakoda\u003c/strong\u003e: Conceptualization, Formal analysis, Investigation, Methodology, Writing-review \u0026amp; editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIsa Okajima\u003c/strong\u003e: Conceptualization, Funding acquisition, Methodology, Project administration, Writing-review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are openly available in Zenodo at\u003c/p\u003e\n\u003cp\u003ehttps://doi.org/10.5281/zenodo.15043139\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Editage (http:// www. editage. com) for editing the manuscript. ChatGPT (OpenAI) was partially used for the English translation of this manuscript. The authors then reviewed and revised the translated content to ensure its accuracy and integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest. However, Isa Okajima received grants from NEC Solution Innovators Ltd. and Infocom Co.; consulting fees from NEC Solution Innovators Ltd. and Suntory Wellness Ltd.; and an honorarium from MSD LLC, Shionogi \u0026amp; Co., and Eisai Co., Ltd. for projects unrelated to the submitted work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKansagra, S. 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Rev.\u003c/em\u003e \u003cb\u003e64\u003c/b\u003e (101646). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.smrv.2022.101646\u003c/span\u003e\u003cspan address=\"10.1016/j.smrv.2022.101646\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"insomnia, circadian rhythm, sleep debt, psychological flexibility, mental well-being, physical well-being","lastPublishedDoi":"10.21203/rs.3.rs-7512649/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7512649/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eYoung adults frequently report sleep issues, especially insomnia, delayed sleep phase, and sleep debt, with each of these contributing to distinct physical and mental well-being issues. This study explored the characteristics of sleep issues (Trisleep; sleep quantity, sleep quality, and sleep\u0026ndash;wake rhythm) and psychological flexibility (Hexaflex; acceptance, cognitive defusion, self-as-context, commitment, values, and mindfulness) among young adults, analyzing their association with physical and mental well-being. All questionnaire data were collected online from 525 university students in Japan (men\u0026thinsp;=\u0026thinsp;101, women\u0026thinsp;=\u0026thinsp;414, unspecified\u0026thinsp;=\u0026thinsp;10; \u003cem\u003eM\u003c/em\u003e\u003csub\u003e\u003cem\u003eage\u003c/em\u003e\u003c/sub\u003e =19.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 years). Their responses to questionnaires on sleep problems and psychological flexibility were analyzed via cluster analyses. Generalized linear models were used to compare the impacts of Trisleep and Hexaflex types on physical and mental well-being. In a cluster analysis, Four Trisleep types (good sleep, sleep\u0026ndash;wake rhythm problems, sleep debt, and compound problems) and four Hexaflex types, differentiated by overall levels rather than distinct features (flexibility, medium flexibility, mild flexibility, and inflexibility) were identified. Trisleep types, especially compound sleep problems, were strongly associated with physical well-being. The interaction between Trisleep and Hexaflex types significantly predicted mental well-being, with Hexaflex having a greater impact. The findings underscore the importance of addressing both biological and psychological factors to enhance physical and mental well-being, with targeted interventions for sleep and psychological flexibility, potentially yielding effective outcomes for young adults.\u003c/p\u003e","manuscriptTitle":"Impact of Sleep and Psychological Flexibility on Young Adults’ Physical and Mental Well-being","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-12 08:38:04","doi":"10.21203/rs.3.rs-7512649/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-14T04:09:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-11T17:02:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293754201079511760819516883861562728882","date":"2025-10-26T14:01:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T14:56:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11548753317615057356936088483254348532","date":"2025-10-21T12:46:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-20T10:57:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246605052007312652128837559852969276895","date":"2025-10-12T10:14:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-05T08:23:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-05T08:04:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T04:15:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T07:02:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-04T06:59:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"332e1316-1c99-4f1a-9ea9-0be9b4d3581e","owner":[],"postedDate":"September 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":54612976,"name":"Health sciences/Health care"},{"id":54612977,"name":"Biological sciences/Neuroscience"},{"id":54612978,"name":"Biological sciences/Psychology"},{"id":54612979,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-14T03:24:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-12 08:38:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7512649","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7512649","identity":"rs-7512649","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}