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The current study examined the relationship between pre-sleep processes and sleep in the context of real-world stress exposure in medical students during an internship. Medical students are often exposed to a variety of stressors and potentially traumatic events and have been shown to be at risk to develop psychopathology. Previous research has shown an association between stress, psychological distress, and sleep disturbances. In this context, studies have investigated possible predictors for sleep disturbances. Recently, the period just prior to sleep onset has received increased interest. At the moment, little is known, however, about the influence of such pre-sleep processes. In this study, we investigated the influence of pre-sleep rumination and mindfulness on sleep disturbances. Methods In a prospective study, we examined a sample of 50 medical students from the University of Zurich. All participants completed their first medical internship over 9 months as part of medical school. Pre-sleep processes and sleep were indexed mid-internship using sleep diaries over seven consecutive days. Additionally, a Fitbit tracking device was used to objectively measure sleep. Correlational analyses and multilevel linear models were conducted. Results Results show associations between pre-sleep processes and sleep disturbances in this stress-exposed at-risk population. Multilevel mixed-effects models showed that over the period of 7 consecutive nights, pre-sleep rumination was a significant predictor of lower subjective sleep quality (B = -.085, SE = .036, p = .02), lower subjective total sleep time (B = -.124, SE = .043, p = .005), higher subjective sleep onset latency (B = 1.535, SE = .678, p = .025), and higher subjective wake-up frequency (B = .033, SE = .011, p = .003). Conclusion Together, our data suggest pre-sleep processes as potential targets for stress-prevention programs that could help reduce the negative influence of stress in at risk populations. Support NA

0552 Investigating Pre-Sleep Processes and How They Influence Sleep: A Diary and Actigraphy Study