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The Bidirectional Relation Between Emotional Reactivity and Sleep: From Disruption to Recovery
Abstract
Sleep disturbances are highly prevalent and greatly affect consecutive emotional reactivity, while sleep quality itself can be strongly affected by reactions to previous emotional events. In this review, we shed light on this bidirectional relation through examples of pathology: insomnia and bipolar disorder. We show that both experimental sleep deprivation and insomnia are related to increased emotional reactivity and increased amygdala activation upon emotional stimuli presentation, and that particularly Rapid Eye Movement (REM) sleep is important for emotional processing and reorganization of emotion-specific brain activity. Increased emotional reactivity affects REM sleep quality and sleep spindles, while REM sleep is particularly affected in insomnia, possibly related to condition-specific hyperarousal levels. Normal sleep onset deactivation of brain regions important for emotional processing (amygdala, anterior cingulate cortex (ACC)) is further affected in insomnia. In bipolar disorder, sleep disturbances are common in both symptomatic and nonsymptomatic phases. Both amygdala and ACC volume and function are affected in bipolar disorder, with the ACC showing phase-dependent resting state activity differences. Deficient Gamma-aminobutyric acid (GABA) GABA-ergic activity of this region might play a role in sleep disturbances and their influence on emotional reactivity, given the inhibitory role of GABA on brain activity during sleep and its deficiency in both bipolar disorder and insomnia. Promising findings of normalizing brain activity in both insomnia and bipolar disorder upon treatment may inspire a focus on treatment studies investigating the normalization of sleep, emotional reactivity, and their corresponding brain activity patterns. (PsycINFO Database Record
... /10.5772/intechopen.98298 from poor sleep tend to be leading contributors to emotional dysregulation [69][70][71][72]. REM sleep is hypothesized to play a critical role in emotional processing through the coordinated activation of affect-related brain regions, such as the amygdala and hippocampus, during neurochemical brain states that help to strip away the emotional intensity of memories [69][70][71][72]. ...
... from poor sleep tend to be leading contributors to emotional dysregulation [69][70][71][72]. REM sleep is hypothesized to play a critical role in emotional processing through the coordinated activation of affect-related brain regions, such as the amygdala and hippocampus, during neurochemical brain states that help to strip away the emotional intensity of memories [69][70][71][72]. Through repeated nightly REM sleep sessions, formerly unpleasant or traumatic memories become less potent, helping to maintain emotional health. ...
... Through repeated nightly REM sleep sessions, formerly unpleasant or traumatic memories become less potent, helping to maintain emotional health. Individuals with insomnia, however, often report experiences of non-restorative sleep, restless REM sleep (characterized by frequent REM arousals), as well as disruptions to REM sleep, which may hinder emotion recalibration processes that occur during sleep, further contributing to chronic hyperarousal and emotion dysregulation during the day [69][70][71][72]. Thus, REM sleep is necessary for modulating normal emotional responses to daily events. ...
Since early 2020, the COVID-19 pandemic has had a profound effect on the mental health and wellbeing of much of the population. Rates of depression, anxiety, loneliness, suicidal ideation, and other mental health concerns increased during the first year of the pandemic, with heightened fears of the virus, social isolation, and economic instability. Psychological resilience remains a key factor in sustaining healthy emotional functioning during the crisis and facilitating rapid recovery as we move forward to build a better post-pandemic world. Our research, and that of others, suggests that healthy sleep is one of the most powerful aspects of psychological resilience. This chapter will summarize the current literature on psychological resilience, particularly as it relates to the pandemic, and describe the important role of sleep as a key component of resilience capacity. We will discuss novel empirical data linking sleep and resilience during the pandemic. We will conclude with concrete, empirically based suggestions for modulating sleep to sustain psychological resilience during the present crisis and those that may emerge in the future.
... Women are more likely to have sleep problems in comparison to men [40]. Poor quality of sleep is a common problem related to stress [41]. Further, people sensitive to stress-induced problems in sleep are at an increased risk to develop chronic insomnia [42,43]. ...
... Liu et al. [44] reported better quality of sleep with lesser early morning awakenings in those with less PTSDrelated symptoms during this pandemic. A task force of the European Academy for Cognitive-Behavioral Treatment of Insomnia (European CBT-I Academy) [41] stated that during the lockdown period in the COVID-19 outbreak, there are various factors which challenge the sleep habits of individuals including psychological distress, reduced exposure to sunlight, and reduced physical activity. Sleep plays an important role to regulate emotions, and a problematic sleep at night can have adverse consequences on the next day's emotional functioning [41]. ...
... A task force of the European Academy for Cognitive-Behavioral Treatment of Insomnia (European CBT-I Academy) [41] stated that during the lockdown period in the COVID-19 outbreak, there are various factors which challenge the sleep habits of individuals including psychological distress, reduced exposure to sunlight, and reduced physical activity. Sleep plays an important role to regulate emotions, and a problematic sleep at night can have adverse consequences on the next day's emotional functioning [41]. Taskforce for European CBT-I Academy published practical recommendations [41] to deal with problems related to sleep during confinement at home for various target groups like the general public, women, children, and healthcare staff. ...
Background
With uncertainty surrounding the 2019 coronavirus disease pandemic, there is no knowledge of the psychological impact of this pandemic on the general public from Kashmir. We aimed to understand the psychological impact in the form of depressive symptoms, anxiety symptoms, quality of sleep, and coping during this pandemic.
Methods
This cross-sectional study was conducted using social networking sites. The questionnaire meant for this study was sent as a link to a respondent. Initial part of questionnaire collected the socio-demographic details of the respondents. Depressive and anxiety symptoms were assessed using Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to assess the quality of sleep. There was also an open-ended question to look for coping skills used.
Results
The majority of our respondents were below 45 years (around 95%) with 54.9% from 18 to 30 years age group. 72.3% were males and 27.7% were females. 58.7% were from rural background. 55.7% were employed, and 32.2% were students. In our respondents, 55% had anxiety symptoms, 55% had depressive symptoms, around 53% had poor quality of sleep, and around 30% of used maladaptive coping skills. Significant depressive symptoms were there in the younger age group, 18–30 years ( p = 0.03). Significant depressive symptoms and anxiety symptoms were present in females ( p = 0.01 and 0.006, respectively). In urban population, significant anxiety symptoms ( p = 0.03) were present. The mean score for anxiety symptoms and depressive symptoms was 8.05 ± 4.53 and 8.07 ± 4.56, respectively. Mean global PSQI score was 6.90 ± 3.82 and was positively correlated with score on depressive symptom scale ( p = 0.001) as well as score on anxiety symptom scale ( p = 0.001).
Conclusion
Younger people, females, those living in urban conditions, and those using maladaptive coping skills are likely to have anxiety symptoms and depressive symptoms as well as poor quality of sleep.
... However, PD-pRBD + patients showed an increased connectivity within the ACC compared to PD-pRBD − , which is likely to be related to the presence of RBD. Previous findings have demonstrated that the ACC is more vulnerable to sleep disturbances, and this may eventually lead to altered top-down control of emotional processing and reactions (Altena et al. 2016). An hyperactivity of this area during sleep may determine a state of hyperarousal in sleep disorders (Altena et al. 2016). ...
... Previous findings have demonstrated that the ACC is more vulnerable to sleep disturbances, and this may eventually lead to altered top-down control of emotional processing and reactions (Altena et al. 2016). An hyperactivity of this area during sleep may determine a state of hyperarousal in sleep disorders (Altena et al. 2016). Thus, we hypothesize that an increased FC within the ACC may potentially result in the overactive emotional movement during dreaming occurring in RBD patients. ...
Epidemiological studies have shown that Parkinson’s disease (PD) patients with probable REM sleep behavior disorder (pRBD) present an increased risk of worse cognitive progression over the disease course. The aim of this study was to investigate, using resting-state functional MRI (RS-fMRI), the functional connectivity (FC) changes associated with the presence of pRBD in a cohort of newly diagnosed, drug-naive and cognitively unimpaired PD patients compared to healthy controls (HC). Fifty-six drug-naïve patients (25 PD-pRBD⁺ and 31 PD-pRBD⁻) and 23 HC underwent both RS-fMRI and clinical assessment. Single-subject and group-level independent component analysis was used to analyze intra- and inter-network FC differences within the major large-scale neurocognitive networks, namely the default mode (DMN), frontoparietal (FPN), salience (SN) and executive-control (ECN) networks. Widespread FC changes were found within the most relevant neurocognitive networks in PD patients compared to HC. Moreover, PD-pRBD⁺ patients showed abnormal intrinsic FC within the DMN, ECN and SN compared to PD-pRBD⁻. Finally, PD-pRBD⁺ patients showed functional decoupling between left and right FPN. In the present study, we revealed that FC changes within the most relevant neurocognitive networks are already detectable in early drug-naïve PD patients, even in the absence of clinical overt cognitive impairment. These changes are even more evident in PD patients with RBD, potentially leading to profound impairment in cognitive processing and cognitive/behavioral integration, as well as to fronto-striatal maladaptive compensatory mechanisms.
... Differences in methodology may account for these across-study discrepancies in findings. These methodological differences include variations in the timing and duration of the sleep condition, whether participants obtained REM sleep (this stage of sleep appears to be central to the emotional regulatory benefits of sleep; Gujar et al., 2011;Palagini et al., 2013;Deliens et al., 2014;Altena et al., 2016), the type of waking control used, the kind of emotional stimuli presented, and the primary outcome measure used. However, because sleep can have clear benefits for emotion processing and because spontaneous and unmodulated emotional reactivity is an important influence on human behavior (Levenson, 1999;Gross et al., 2011;Becerra and Campitelli, 2013;Palmer and Alfano, 2017), it is important to determine whether a discernible pattern of sleep-dependent emotional regulation might emerge from this seemingly equivocal literature. ...
... Perhaps the most consequential limitation of the foundational literature, certainly in terms of its influence on our review, is the vast cross-study differences in methodology. These methodological variations include the timing and duration of the sleep condition, the type of waking control used, the kind of emotional stimulus presented, the primary outcome measured, and whether participants obtained REM sleep (a stage previously observed to be central to the emotional regulatory benefits of sleep; Palagini et al., 2013;Altena et al., 2016). The consequence of these variations is heterogeneity among reported results and limited power to draw conclusions from a meta-analysis. ...
Many studies have investigated whether sleep affects cognitively unmodulated reactivity to emotional stimuli. These studies operationalize emotion regulation by using subjective and/or objective measures to compare pre- and post-sleep reactivity to the same emotional stimuli. Findings have been inconsistent: some show that sleep attenuates emotional reactivity, whereas others report enhanced or maintained reactivity. Across-study methodological differences may account for discrepant findings. To resolve the questions of whether sleep leads to the attenuation, enhancement, or maintenance of emotional reactivity, and under which experimental conditions particular effects are observed, we undertook a synthesized narrative and meta-analytic approach. We searched PubMed, PsycINFO, PsycARTICLES, Web of Science, and Cochrane Library databases for relevant articles, using search terms determined a priori and search limits of language = English, participants = human, and dates = January 2006–June 2021. Our final sample included 24 studies that investigated changes in emotional reactivity in response to negatively and/or positively valenced material compared to neutral material over a period of sleep compared to a matched period of waking. Primary analyses used random effects modeling to investigate whether sleep preferentially modulates reactivity in response to emotional stimuli; secondary analyses examined potential moderators of the effect. Results showed that sleep (or equivalent periods of wakefulness) did not significantly affect psychophysiological measures of reactivity to negative or neutral stimuli. However, self-reported arousal ratings of negative stimuli were significantly increased post-sleep but not post-waking. Sub-group analyses indicated that (a) sleep-deprived participants, compared to those who slept or who experienced daytime waking, reacted more strongly and negatively in response to positive stimuli; (b) nap-exposed participants, compared to those who remained awake or who slept a full night, rated negative pictures less negatively; and (c) participants who did not obtain substantial REM sleep, compared to those who did and those exposed to waking conditions, had attenuated reactivity to neutral stimuli. We conclude that sleep may affect emotional reactivity, but that studies need more consistency in methodology, commitment to collecting both psychophysiological and self-report measures, and should report REM sleep parameters. Using these methodological principles would promote a better understanding of under which conditions particular effects are observed.
... There is a bidirectional relationship between psychological distress and sleep quality. Anxiety and stress affect sleep quality by being the main precipitating factors for the development of sleep dysfunction and, on the other hand, sleep quality is an important factor for the regulation of stable emotional control [35][36][37][38]. In a meta-analysis evaluating the psychological and mental impact of COVID 19 on medical staff and the general population, the prevalence of anxiety was found to be rather similar between these groups (26% and 32%, respectively) [37]. ...
... Considerable evidence, especially in the form of cross-sectional studies and systematic reviews, has demonstrated the significant impact of COVID 19 on psychological and mental health outcomes and sleep disorders [35][36][37][38][39][40][41][42][43]. However, until now, limited published studies were available evaluating the changes in the mental health of HCPs during the course of the pandemic and more specifically comparing the differences over the different waves. ...
Background:
During the recent pandemic, Healthcare Professionals (HCPs) presented a significant prevalence of psychological health problems and sleep disturbances. The aim of this study was to assess the impact of COVID-19 on HCPs' sleep and mental stress with a separate analysis for primary care HCPs.
Methods:
A cross-sectional observational study with an online anonymized, self-reported questionnaire was conducted in May 2020 (1st wave) and repeated in December 2020 (2nd wave). Patient health questionnaire-4 (PHQ-4), dimensions of anger reactions-5 (DAR-5) scale, 3-item UCLA loneliness scale (LS) and sleep condition indicator (SCI) were used.
Results:
Overall, 574 participants were included from the 1st wave, 514 from the 2nd and 469 were followed during both. Anxiety and depression were significantly higher during the 2nd wave vs. the 1st (32.8% vs. 12.7%, p < 0.001 and 37.7% vs. 15.8%, p < 0.001). During the 2nd wave, HCPs scored significantly higher in DAR-5 (9.23 ± 3.82 vs. 7.3 ± 3.3, p < 0.001) and LS (5.88 ± 1.90 vs. 4.9 ± 1.9, p < 0.001) with worse sleep quality SCI (23.7 ± 6.6 vs. 25.4 ± 3.2, p < 0.001). This was more evident in primary care HCPs. Significant correlations were found between SCI and PHQ4, DAR5 and LS.
Conclusion:
There is a need to support HCPs' mental health and sleep, especially in those working in primary care.
... Σε συνθήκες εγκλεισμού διαπιστώνεται αρνητική σχέση μεταξύ της ποιότητας του ύπνου και της διάρκειάς του. 15,16 Μια ομάδα ατόμων που φαίνεται να βιώνει και να αντιμετωπίζει πιο δύσκολα την κατάσταση των μέτρων εγκλεισμού είναι τα άτομα εκείνα που πάσχουν από κάποιο χρόνιο νόσημα. 17 Ωστόσο, αποδεικνύεται από τη μελέτη ότι ο καθοριστικός παράγοντας που σχετίζεται με την κατάθλιψη και το άγχος είναι η ένταση των αρνητικών συναισθημάτων που έχει το άτομο σε σχέση με τη νόσο (φόβος, θυμός, θλίψη, αναστάτωση). ...
... 17 Ωστόσο, αποδεικνύεται από τη μελέτη ότι ο καθοριστικός παράγοντας που σχετίζεται με την κατάθλιψη και το άγχος είναι η ένταση των αρνητικών συναισθημάτων που έχει το άτομο σε σχέση με τη νόσο (φόβος, θυμός, θλίψη, αναστάτωση). 15 Είναι φανερό ότι ο κύριος φόβος των Ελλήνων αναφορικά με τις επιπτώσεις της πανδημίας αφορά στην οικονομία τόσο σε εθνικό όσο και σε ατομικό επίπεδο. 11 Η αβεβαιότητα για το μέλλον της οικονομίας και η ανικανότητα του ατόμου να αντεπεξέλθει σε αυτή φαίνεται να σχετίζονται με αυξημένα επίπεδα άγχους και κατάθλιψης, που συναρτώνται άμεσα και με τη χρονική διάρκεια επιβολής των προστατευτικών μέτρων. ...
COVID-19 στην ελληνική κοινωνία Μια έρευνα ερωτηματολογίου σε ενήλικες ΣΚΟΠΟΣ Η διερεύνηση του ψυχικού και κοινωνικού αντίκτυπου της πανδη-μίας και του παρατεταμένου εγκλεισμού στην ελληνική κοινωνία. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ Η μελέτη διενεργήθηκε με τη μορφή ερωτηματολογίου για την εξέταση της επίδρασης της πανδημίας COVID-19 στην ελληνική κοινωνία. Το ερωτηματολόγιο αποτελείται από 24 ερωτήσεις. Οι πρώτες δύο αφορούσαν στον καθορισμό των δημογραφικών χαρακτηριστικών του δείγματος και οι υπόλοιπες στην επίδραση της πανδημίας COVID-19 σε σχέση με ποικίλους τομείς της καθημερινότητας και το κατά πόσο αυτή έχει επηρεαστεί. Στη μελέτη συμμετείχαν 250 ενήλικες (80 άνδρες, 170 γυναίκες). ΑΠΟΤΕΛΕΣΜΑΤΑ Το 88,4% των ερωτηθέντων δήλωσαν ότι είχαν επηρεαστεί σε μεγάλο βαθμό από την πανδημία και το 70,8% ότι ανησυχούσαν αρκετά για το μέλλον. Οι γυναίκες φάνηκε να έχουν επηρεαστεί σε μεγαλύτερο βαθμό. Η μείωση των καθημερινών δραστηριοτήτων τους, καθώς και η εντονότερη ανησυχία για το μέλλον και για την υγεία των οικείων τους, διέφερε σημαντικά από τις αντίστοι-χες των ανδρών. ΣΥΜΠΕΡΑΣΜΑΤΑ Η πανδημία COVID-19 και η επιστράτευση μέτρων καραντίνας-εγκλεισμού ενέχει κινδύνους τόσο σε κοινωνικό όσο και σε οικονομικό επίπεδο. Η ψυχική και η πνευματική υγεία των ανθρώπων έχει επηρεαστεί σε μεγάλο βαθμό και αυτό είναι κάτι που θα πρέπει να ληφθεί σοβαρά υπ' όψιν τους επερχόμενους μήνες. Οι πανδημίες δεν αποτελούν μια σύγχρονη έννοια, καθώς οι πρώτες αναφορές χρονολογούνται ήδη από την αρχαιότητα. Μια πανδημία προκαλεί σημαντικές επιπτώ-σεις όχι μόνο στην υγεία, αλλά και στην οικονομία και στην ψυχολογία του ατόμου. 1 Ένα τυπικό σωματίδιο κορωνοϊού έχει σχήμα σφαιρικό, διάμετρο 120-160 nm και μέγεθος 40.000 kDa. Οι κορω-νοϊοί καλύπτονται από φάκελο που αποτελείται κυρίως από πρωτεΐνη Μ. Η εν λόγω πρωτεΐνη είναι ευαίσθητη σε οξειδωτικούς παράγοντες και μη ιονικά απορρυπαντικά και αυτός είναι και ο λόγος που συστήνεται η τακτική πλύση των χεριών και η χρήση των αντισηπτικών. 2 Πάνω στον φάκελο βρίσκονται πρωτεΐνες S, οι οποίες ομοιάζουν με ακίδες/καρφιά (spikes) και προσδίδουν ένα χαρακτηριστι-κό και μοναδικό σχήμα στην οικογένεια των κορωνοϊών.
... In addition, exposure to some of these environmental stimuli can also act as "desynchronisers" by occurring at the wrong time of day (e.g. exposure to screens late at night), which may have a negative impact on sleep-wake rhythms similar to a jet lag syndrome: difficulty falling asleep, emotional disturbances, and daytime sleepiness (Altena et al., 2016). Furthermore, the stress caused by this context may have a direct impact on the sleep-wake cycle and circadian rhythms (Lo Martire, Caruso, Palagini, Zoccoli, & Bastianini, 2020) and may also induce insomnia symptoms via cognitive and somatic hyperarousal related to the hyperactivation of the stress system (Riemann et al., 2015). ...
... In addition, the circadian system modulates arousal, neurocognitive and affective functions and its desynchronisation can have important consequences on complex daytime functions such as learning, memory, and emotions (Wright, Lowry, & LeBourgeois, 2012). Indeed, sleep has an important role in immunity (Prather, 2019), mood (Stephenson, Schroder, Bertschy, & Bourgin, 2012), and cognitive functions such as judgment and concentration (Cassé-Perrot et al., 2016), but also in emotional processing (Altena et al., 2016), and the consequences of their alterations are crucial to consider in this context, particularly as a reduction in sleep time can have a deleterious impact on vulnerability to infections (Irwin, 2015) and ...
The full 2-month lockdown to fight the coronavirus disease 2019 (COVID-19) pandemic in 2020 led to substantial disruption of daily life and routines. The present study aimed to comprehensively identify the lockdown’s effects on sleep, daily rhythms and emotions of the French population. A survey was published online during the last week of the 2-month full lockdown and 1,627 individuals completed the online survey. The survey was self-administered and included standardised questionnaires. Sleep schedules were delayed during lockdown in more than half of the participants. New severe delayed sleep phase affected 10% of participants with sleep schedules delayed by ≥3 hr during the lockdown compared to before. A significant decrease in exposure to morning (p < 0.001) and evening natural light (p < 0.001), a significant increase in screen exposure time (with a significant screen exposure >3 hr during the evening for 45% of the participants during lockdown versus 18% before lockdown, p < 0.001), an increase in substance use for one-quarter of participants, a poorer sleep quality in 56% of participants, and less regular sleep schedules in 48% of participants were observed. We also found a poorer sleep quality in women than men during lockdown (p = 0.004). The French full lockdown had a severe impact on sleep quality, sleep–wake rhythms, and sleep behaviours. The implementation of public health strategies for the prevention and care of sleep–wake cycles during lockdown are therefore essential.
... Stress can affect sleep (Altena et al., 2016;Lo Martire et al., 2020), and it is well established from a range of naturalistic studies that stressful events, including earthquakes, hurricanes and war, are shown to have a deleterious effect upon sleep (Askenasy & Lewin, 1996;Kato et al., 1996;Mellman et al., 1995). The COVID-19 pandemic, which has been ongoing since March 2020, represents one such stressful event, and potentially represents a stressor of unknown duration, accompanied by a wide range of societal and lifestyle changes (Altena et al., 2020). ...
Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies that can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous hypothalamic-pituitary-adrenal axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response as a marker of hypothalamic-pituitary-adrenal axis function, as cortisol is the end-product of the hypothalamic-pituitary-adrenal axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions ; examining if reducing the impact of stress is effective and, finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.
... As sleep is central to mood and emotion regulation, and because prior emotional events can strongly impact sleep quality more generally [74], the bidirectionality of daytime affect regulation and nighttime sleep disturbance is of particular importance for individuals with BD [75]. There are important clinical implications of sleep and abnormalities of circadian functioning in BD [76], and retrospectively self-reported evidence indicated that sleep disturbance is experienced as the most common early indication of mania [77]. ...
Objectives
People with bipolar disorder (BD) spend more time depressed than manic/hypomanic, and depression is associated with greater impairments in psychosocial functioning and quality of life than mania/hypomania. Emerging evidence suggests psilocybin, the psychoactive compound in “magic mushrooms,” is a promising treatment for unipolar depression. Clinical trials of psilocybin therapy have excluded people with BD as a precaution against possible adverse effects (e.g., mania). Our study centered the experiences of adults living with BD who consumed psilocybin-containing mushrooms, and aimed to (1) understand its subjective impacts on BD symptoms, (2) deepen understanding of Phase I survey results, and (3) elucidate specific contextual factors associated with adverse reactions in naturalistic settings.
Methods
Following an international survey (Phase I), follow-up interviews were conducted with 15 respondents (Phase II) to further understand psilocybin use among adults with BD. As part of a larger mixed-methods explanatory sequential design study, reflexive thematic analysis was used to elaborate findings.
Results
Three major themes containing sub-themes were developed. (1) Mental Health Improvements: (1.1) decreased impact and severity of depression, (1.2) increased emotion processing, (1.3) development of new perspectives, and (1.4) greater relaxation and sleep. (2) Undesired Mental Health Impacts: (2.1) changes in sleep, (2.2) increased mania severity, (2.3) hospitalization, and (2.4) distressing sensory experiences. (3) Salient Contextual Factors for psilocybin use included: (3.1) poly-substance use and psilocybin dose, (3.2) solo versus social experiences, and (3.3) pre-psilocybin sleep deprivation.
Conclusion
Our findings demonstrate both benefits and risks of psilocybin use in this population. Carefully designed clinical trials focused on safety and preliminary efficacy are warranted.
... Сон також можна вважати адаптивним механізмом, що захищає від стресу [10]. Порушення сну мають значний вплив на емоційну реактивність, тоді як саме якість сну може залежати від реакцій на попередні емоційні події [11]. Сучасні наукові дослідження дають нове уявлення про захисну роль сну в емоційному гомеостазі та регуляції людини, сприяючи адаптивній емоційній реактивності в період денного функціонування [12]. ...
Modern scientific sources point out a close connection between depression, anxiety, psychological distress and low quality of life. The purpose of this study is to assess the impact of sleep quality on the quality of life in patients with anxiety disorders of neurotic origin. Examination of 81 patients with anxiety disorders of neurotic origin and dyssomnic disorders was carried out using clinical-psychopathological, psychodiagnostic and statistical research methods. The psychodiagnostic method included determining the level of stress load according to the PSM-25 questionnaire, the level of anxiety and depression by the HADS scale, the severity of the mental and somatic component of anxiety according to the HAM-A scale, assessing the quality of life according to the "SF-36" scale, studying sleep quality disorders according to the PSQI questionnaire. Depending on the level of psychological stress based on the PSM-25 scale, 3 groups were formed: group 1 included 25 (30.7%) people with a low level of stress, group 2 included 29 (35.8%) individuals with an average stress level, and group 3 included 27 people (37.4%) with a high stress level. Analysis according to the HADS scale has shown that anxiety symptoms prevail over depressive symptoms in all examined subjects. According to the HAM-A scale, the average score of the somatic and mental components in the group 1 is significantly lower compared to the group 2 (p<0.001) and the group 3 (p<0.001). This study has demonstrated that as the level of stress increases, there is a tendency for quality of life indicators to decrease in all spheres of functioning. Significantly worse sleep quality scores were found in patients with anxiety disorder and high mental stress level compared to those with moderate or low levels. There is a strong negative correlation between indicators by the "vital activity" scale and such components of sleep quality as "daytime dysfunction", "sleep latency" and the total score of sleep quality, between indicators by the scales "role functioning due to physical condition" and "daytime dysfunction". It has been found out that with increasing pain intensity, all indicators of sleep quality decline. The data obtained should be taken into account in developing patient-centred treatment plan for this group of patients.
... Poor sleep is a risk factor for a range of affective disorders, such as anxiety and depression (e.g., Alvaro et al., 2013). In non-clinical populations, sleep disturbances have been associated with next-day negative affect (Konjarski et al., 2018) and enhanced reactivity to affective stimuli (Altena et al., 2016), although evidence remains mixed (ten Brink et al., 2022). It has been argued that this occurs because sleep plays an important role in affect regulation and poor sleep impairs this process (Walker and van der Helm, 2009;Palmer and Alfano, 2017;Tempesta et al., 2018). ...
There is increasing evidence that sleep plays an important role in affective processing. However, it is unclear whether dreaming-the subjective experiences we have during sleep-also serves an affect regulation function. Here, we investigated the within-person relationship between negative affect experienced in dreams and next-day waking affect level, affect reactivity, and affect regulation. For 5 days, 40 participants reported their dreams and rated their dream affect and post-sleep waking affect level upon morning awakening. Thereafter, they performed an affect reactivity and regulation task which involved viewing neutral and negative pictures with the instruction either to simply view the pictures or to down-regulate the affect evoked by these pictures. Multilevel regression analyses showed that the more negative affect people experienced in their dreams at night, the more negative affect and the less positive affect they reported the next morning. However, negative dream affect was associated neither with affect reactivity to the pictures nor with the ability to down-regulate negative affect in response to these pictures. In fact, Bayesian analyses favored the null hypotheses. These findings fail to provide support for the affect regulation function of dreaming and, instead, speak for affective continuity between dreaming and post-sleep wakefulness.
... No Brasil, nos primeiros meses de medida de prevenção contra o vírus, ocorreu um fechamento das atividades comerciais e a restrição da prática de exercícios nas academias e clubes (2). A adoção de uma rotina de isolamento, distanciamento social, trabalhos em "homeoffice" acabaram causando mudanças em alguns comportamentos, como a diminuição da prática de exercício físico em brasileiros (3), assim como o impacto negativo na saúde mental, resultando no aumento de sentimentos como medo, estresse, mudanças na alimentação e sono (4,5,6,7). Estudos reportaram que esses impactos negativos devido as medidas restritivas em relação ao COVID-19 tendem a ser potencializados em jovens mulheres quando comparados a seus pares (8,9,10). Com a incerteza do fim do distanciamento social e seus impactos negativos como mencionados acima, a prática de exercícios em casa tem sido fortemente recomendada (11,12). ...
O distanciamento social adotado em 2020 como medida preventiva ao Coranavírus (COVID-19), resultou na diminuição dos níveis de atividade física e em respostas negativas na saúde mental da população, principalmente de jovens mulheres. O presente estudo teve como objetivo verificar o efeito de um programa de exercícios em casa para na saúde mental de jovens mulheres. Estudo quase-experimental, com delineamento longitudinal, em que sete mulheres (31,7 ± 7,89 anos de idade), de uma equipe recreacional de voleibol preencheram o questionário Self-Reporting Questionnaire (SQR-20) para as respostas de saúde mental de maneira on-line, antes e após o programa. Estatística descritiva foi utilizada através dos valores obtidos pelo questionário. Os resultados demonstraram que o programa de exercício físico domiciliar não foi efetivo para atenuar os impactos negativos na saúde mental dessas mulheres. Assim concluímos que o confinamento pode se apresentar como negativo a saúde mental de jovens mulheres, e mesmo com o engajamento em um programa de exercícios, seus efeitos continuam ser prejudiciais. Sugere-se que o programa de exercícios em casa seja ajustado de maneira a ser mais efetivo no que tange a melhora da saúde mental, além do engajamento das mulheres em programas multidisciplinares que auxiliem na saúde mental.
... Konjarski's conclusion[1]. This is surprising given the number of qualitative review papers that report increased negative affect following sleep loss and deprivation[2,7,[110][111][112]. Our findings for duration are similar to Konjarksi et al.'s [1] and Tempesta et al.'s [4] conclusions of mixed results. ...
Everyday experience suggests that sleep and affect are closely linked, with daytime affect influencing how we sleep, and sleep influencing subsequent affect. Yet empirical evidence for this bidirectional relationship between sleep and affect in non-clinical adult samples remains mixed, which may be due to heterogeneity in both construct definitions and measurement. This conceptual review proposes a granular framework that deconstructs sleep and affect findings according to three subordinate dimensions, namely domains (which are distinct for sleep and affect), methods (i.e., self-report vs. behavioral/physiological measures), and timescale (i.e., shorter vs. longer). We illustrate the value of our granular framework through a systematic review of empirical studies published in PubMed (N = 80 articles). We found that in some cases, particularly for sleep disturbances and sleep duration, our framework identified robust evidence for associations with affect that are separable by domain, method, and timescale. However, in most other cases, evidence was either inconclusive or too sparse, resulting in no clear patterns. Our review did not find support for granular bidirectionality between sleep and affect. We suggest a roadmap for future studies based on gaps identified by our review and discuss advantages and disadvantages of our granular dimensional framework.
... Konjarski's conclusion[1]. This is surprising given the number of qualitative review papers that report increased negative affect following sleep loss and deprivation[2,7,[110][111][112]. Our findings for duration are similar to Konjarksi et al.'s [1] and Tempesta et al.'s [4] conclusions of mixed results. ...
Everyday experience suggests that sleep and affect are closely linked, with daytime affect influencing how we sleep, and sleep influencing subsequent affect. Yet empirical evidence for this bidirectional relationship between sleep and affect in non-clinical adult samples remains mixed, which may be due to heterogeneity in both construct definitions and measurement. This conceptual review proposes a granular framework that deconstructs sleep and affect findings according to three subordinate dimensions, namely domains (which are distinct for sleep and affect), methods (i.e., self-report vs. behavioral/physiological measures), and timescale (i.e., shorter vs. longer). We illustrate the value of our granular framework through a systematic review of empirical studies published in PubMed (N = 80 articles). We found that in some cases, particularly for sleep disturbances and sleep duration, our framework identified robust evidence for associations with affect that are separable by domain, method, and timescale. However, in most other cases, evidence was either inconclusive or too sparse, resulting in no clear patterns. Our review did not find support for granular bidirectionality between sleep and affect. We suggest a roadmap for future studies based on gaps identified by our review and discuss advantages and disadvantages of our granular dimensional framework.
... Sleep disturbances are those interruptions that affect the quality and timing of sleep [25] . Stress is closely related to sleep disturbances [26] . Confinement by COVID-19 directly influenced the increase in stress, anxiety, depression, and sleep disturbances [27] . ...
Introduction: Bruxism is a behavior that has negative consequences, its prevalence is in 33.65% of children. It can present as probable bruxism, awake bruxism, and sleep bruxism. This has been frequently present during the COVID-19 pandemic. Objective: Analyze the literature about bruxism and its relationship with signs and symptoms, psychological factors, sleep disorders, screen time, and treatment. Methodology: Articles on the subject published through the PubMed, SCOPUS and Google Academic databases were analyzed, with an emphasis on the last 5 years. It was carried out with the words "bruxism", "pediatric dentistry", "treatment", "symptoms" and "signs". Results: The signs and symptoms of bruxism are present more frequently in patients with attention deficit, hyperactivity disorder and with previous bruxism. Stress and anxiety are the psychological factors that influence more the increase of bruxism during the COVID-19 pandemic. Likewise, sleep disturbances have risen, so it is recommended to be more physically active and to reduce screen time to improve health status. Due to the limitations caused by the current pandemic, it is necessary to take advantage of electronic media to guide patients and provide care. Conclusion: Bruxism has increased during the COVID-19 pandemic. Patients present characteristic signs and symptoms, which are affected by different factors such as stress, anxiety, sleep disturbances and screen time. Due to current limitations, it is important to take advantage of teleodontology to guide and care for patients.
... Sleep plays a critical role in mental health and psychosocial adjustment across the lifespan (Palmer & Alfano 2017). Sleep disturbances are highly prevalent (Altena et al. 2016). Generally, sleep loss has been shown to increase the experience of negative emotions, reduce the presence of positive emotions and alter the ways in which individuals understand, express and modify these emotions (Kahn et al. 2013;Palmer & Alfano 2017). ...
Objective:
Our aim is to study changes in sleep and emotions in Spanish population during the confinement period due to first wave of COVID-19.
Methods:
A total of 363 adults (69.4% women) aged between 18 and 65 (Mage = 32.59; SD = 12.57) participated in the study. Socio-demographics, sleep quality and emotional experience were evaluated. The study was longitudinal: a first data collection was developed after 15 d of confinement (asking for a subjective comparison with the pre-confined period), and a second collection after 30 d.
Results:
Results suggest differences in sleep quality depending on the time confined. Difficulty falling asleep increases and daytime activity decreases with longer confined periods. Morning fatigue, sleepiness and nightmares are reduced significantly after 15 d of confinement when compared with the subjective data from pre-confinement. After 15 d of confinement participants felt higher levels of apathy, sadness, irritability and lower levels of euphoria and joy than they remember feeling before confinement. Anxiety, concern and fear seem to increase at 15 d of confinement and decrease at 30 d. Sleep quality and emotional experiences in confinement are closely correlated.
Conclusions:
The confinement in Spain worsened the emotional state and changed sleep habits, although it did not necessarily worsen the quality of sleep. Key pointsThere are differences in sleep quality depending on the time spent in confinement.Confinement situation is related with higher levels of apathy, sadness, and irritability and lower levels of euphoria and joy.Anxiety, concern and fear seem to increase at 15 d of confinement and then decrease at 30 d.Sleep quality and emotional experiences in confinement are closely correlated.After COVID-19, there is a remarkable need of attend the disturbances emerged in sleep habits and daily moods of general popunlation.
... These findings implicated critical and sophisticated roles of sleep patterns in mental disorder development. In terms of mechanisms, although Altena et al have suggested poor sleeping quality might lead to dysregulation of emotional processing [64], pathways from sleep patterns to mental disorders remained elucidated and more work is warranted to further decipher the potential mechanisms. ...
Background:
There is increasing attention on the association of socioeconomic status and individual behaviors (SES/IB) with mental health. However, the impacts of SES/IB on mental disorders are still unclear. To provide evidence for establishing feasible strategies on disease screening and prevention, we implemented Mendelian randomization (MR) design to appraise causality between SES/IB and mental disorders.
Methods:
We conducted a two-sample MR study to assess the causal effects of SES and IB (dietary habits, habitual physical activity, smoking behaviors, drinking behaviors, sleeping behaviors, leisure sedentary behaviors, risky behaviors, and reproductive behaviors) on three mental disorders, including bipolar disorder, major depressive disorder and schizophrenia. A series of filtering steps were taken to select eligible genetic instruments robustly associated with each of the traits. Inverse variance weighted was used for primary analysis, with alternative MR methods including MR-Egger, weighted median, and weighted mode estimate. Complementary methods were further used to detect pleiotropic bias.
Results:
After Bonferroni correction and rigorous quality control, we identified that SES (educational attainment), smoking behaviors (smoking initiation, number of cigarettes per day), risky behaviors (adventurousness, number of sexual partners, automobile speeding propensity) and reproductive behavior (age at first birth) were causally associated with at least one of the mental disorders.
Conclusions:
MR study provides robust evidence that SES/IB play broad impacts on mental disorders.
... The finding that earlier sleep disturbance related to later Nonreactivity may be attributed to the notion that sleep is a restorative process that facilitates adaptive cognitive functioning (Buysse & Harvey, 2017). Whereas sleep disturbance has been shown to increase emotional reactivity (Altena et al., 2016). Thus, it reasons that people who experience higher sleep disturbance are less likely to employ the adaptive cognitive tendency to step back or let go of negative thoughts and beliefs. ...
Objectives
Adult attachment anxiety and avoidance and dispositional mindfulness have been identified as promising targets to address the public health epidemic of sleep disturbance. The current study sought to extend this knowledge by testing whether the five facets of mindfulness indirectly link attachment anxiety and avoidance with sleep disturbance.
Methods
Two independent samples (n = 535 and 195) of emerging adults completed self-report measures on attachment anxiety and avoidance, five facets of mindfulness, and sleep disturbance. Study 1 examined cross-sectional data using mediation analysis and pairwise contrast tests. Study 2 hypotheses were examined via a two-wave cross-lagged panel model for half-longitudinal design.
Results
In study 1, attachment anxiety and sleep disturbance were mediated by Nonjudging (95% BC CI [0.01, 0.09]) and Nonreactivity (95% BC CI [0.01, 0.06]); these specific indirect effects did not differ in size (95% CI [− 0.05, 0.02]). Nonjudging also mediated the relationship between attachment avoidance and sleep disturbance (95% BC CI [0.004, 0.04]). In study 2, attachment anxiety precipitated sleep disturbance via both nonreactivity (95% BC CI [0.01, 0.05]) and nonjudging (95% BC CI [0.002, 0.04]). Nonjudging also mediated the relationship between earlier attachment avoidance on later sleep disturbance (95% BC CI [.002, .03]).
Conclusions
Fear and worry about romantic relationships appear to affect sleep disturbance first through lowering the tendency to employ a nonjudgmental and nonreactive quality of mind. This study adds to research indicating that the consideration of attachment anxiety and avoidance may help augment the effects of mindfulness-based strategies.
... For example, a longer sleep duration may be associated with depression, while anxiety can lead to lower sleep quality or in dysregulated bedtime and waketime. As anxiety and depression symptoms appear to be associated with lockdown in ASD (Oomen et al., 2021;Pellicano et al., 2021) and the general population (Gualano et al., 2020;Hao et al., 2020;Marelli et al., 2020;Vindegaard & Benros, 2020;Wang et al., 2020) and are linked to sleep (Altena et al., 2016), it will be important to take those variables into account in future studies. Fourth, participants reported retrospectively on sleep and wake behavior "before lockdown," leading to a potential recall bias. ...
COVID-related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. The study is a French nationwide online survey assessing sleep-wake rhythms and behaviors known to affect sleep (daily screen time, daylight exposure, and physical activity), before and during COVID-related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Before lockdown, the adults with autism displayed on average later bedtime and waking hours, lower sleep quality, more evening screen time, less exposure to daylight, and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups: poorer self-rated sleep quality as well as a less regular and delayed sleep-wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favorable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviors was similar in both groups, the results highlight that the pre-existing shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown. Lay abstract: COVID-related lockdown led to a radical modification of daily activities and routines known to affect sleep. In a sample of 1800 adults, we observed that, before lockdown, participants with autism displayed significantly higher levels of sleep disturbances and less favorable daily routines known to regulate sleep, compared to the general population. While the deleterious effect of lockdown on sleep was similar in both groups, pre-existing difficulties in adults with autism reached worrying levels during lockdown.
... Prior work supports a bidirectional association between sleep and regulation of emotions; thus, insomnia could also contribute to emotional dysregulation [59]. During sleep, emotional and reward networks are activated to optimize emotional responses during the day [60]. ...
Alcohol craving is associated with insomnia symptoms, and insomnia is often reported as a reason for alcohol relapse. The current study examined associations between emotional regulation, anxiety, and insomnia among a group of 338 patients with alcohol use disorder (AUD). Because insomnia most often develops after stressful experiences, it was expected that anxiety symptoms would mediate the association between emotional dysregulation and insomnia severity. It was also expected that an insomnia diagnosis would moderate the association between emotional dysregulation and anxiety symptoms, namely that higher anxiety levels would be found in individuals with insomnia than in those without insomnia. Insomnia severity was assessed with a total score based on the Athens Insomnia Scale (AIS). Additionally, an eight-point cut-off score on the AIS was used to classify participants as with (n = 107) or without (n = 231) an insomnia diagnosis. Moreover, participants completed the Emotion Regulation Scale (DERS; total score) and the Brief Symptoms Inventory (BSI; anxiety). Individuals with insomnia did not differ from those without insomnia in age (p = 0.86), duration of problematic alcohol use (p < 0.34), mean days of abstinence (p = 0.17), nor years of education (p = 0.41). Yet, individuals with insomnia endorsed higher anxiety (p < 0.001) and higher emotional dysregulation (p < 0.001). Anxiety symptoms fully mediated the association between emotional dysregulation and insomnia severity (p < 0.001). Furthermore, insomnia diagnosis positively moderated the association between emotional dysregulation and anxiety (p < 0.001). Our results suggest that emotional dysregulation can lead to insomnia via anxiety symptoms. Treating anxiety symptoms and emotional dysregulation could help to prevent or alleviate symptoms of insomnia in people with AUD. Moreover, treating insomnia in people with AUD may also have a positive effect on anxiety symptoms.
... contribute to sleep disturbance and suggested that alterations in AI activity may cause disturbances in the sleep-wake circle through the dysregulation of sympathetic-parasympathetic nervous system in terms of emotional-cognitive components (Wu et al., 2019). Under life stress, negative emotional states usually extend into NREM and REM sleep, with multiple instances of arousal (Altena et al., 2016). Additionally, if accompanying AI hyperactivity led to dysregulation of the autonomic nervous system in terms of emotional-cognitive aspects, the risk of sleep disturbance under stress would increase to a greater extent. ...
Background
This study investigated the effects of anterior insula (AI) activation on the association between stress and sleep disturbance as a neurobiological basis of the trait-like degree of sleep reactivity to stress. Additionally, it examined the effects of AI activity on the association between sleep disturbance and depression.
Methods
The participants were 48 adults. To assess AI activation in response to sleep-related stimuli (SS) compared to neutral stimuli (NS), we extracted mean AI parameter estimates for the SS–NS contrast. We examined whether the interaction between life stress and AI activation would predict sleep disturbance and whether the interaction between sleep disturbance and AI activation would predict depression.
Results
At higher levels of bilateral AI activation in response to SS, higher levels of stress were associated with greater sleep disturbance (left AI x stress: b = 1.07, SE = 0.44, p < 0.05; right AI x stress: b = 1.05, SE = 0.48, p < 0.05). In addition, at higher levels of right AI activation, higher levels of sleep disturbance were associated with more severe depressive symptoms (right AI x sleep disturbance: b = 2.55, SE = 1.10, p < 0.05).
Limitation
This study assessed sleep quality and depressive symptoms based on self-reported questionnaires.
Conclusion
This study revealed moderating effects of AI activation on the association between negative life stress and sleep disturbance. Additionally, AI activation strengthened the association between sleep disturbance and depression. AI activation may reflect a crucial etiological diathesis for insomnia and stress-related disorders.
... This could be understood by the fact that such problems may arise due to the anxiety and depression experienced by the people, which lead to changes such as the feeling of nausea, headache, greater tendency to sweat and the feeling of weakness. Stress related sleep problems are common [26] . This is also reflected in the fact that 44.9% of the participants in this study complained of experiencing mild to very severe insomnia. ...
The global COVID-19 pandemic outbreak took origin from the city of Wuhan in China in December, 2019. It caused havoc among the people by the transmission of corona virus from an infected person to a healthy person via the respiratory route. This outbreak, reported in India in the early months of the year 2020, caused the Indian government to enforce strict measurements, policies and precautions to control its spread throughout the country. The Government of India imposed a nationwide lockdown from March 24, 2020, which caused negative effects on the mental status of the people and made them disturbed and afraid of contacting the disease. This study, based on the Hamilton Anxiety Rating (HAM-A) scale, aimed to understand their levels of psychological impact involving anxiety, depression, physiological problems and insomnia during the lockdown. A structured questionnaire was circulated via online platforms such as WhatsApp, Facebook and Instagram through the snowball sampling method so as to collect maximum responses. Informed consent was obtained from the respondents. The results revealed that a majority of people were dealing with anxiety (76.7%), tension (59.6%), fear (69.4%), depression (64.7%) and intellectual problems (59.3%), all ranging from mild to very severe. On the physiological front, majority was towards the negative, with a smaller number of people dealing with cardiovascular problems (13.3%), respiratory problems (12.6%), gastrointestinal problems (23.7%), autonomic problems (27.4%) and somatosensory problems (23.7%) due to the lockdown, again ranging from mild to very severe. Almost half (44.9%) suffered from a certain level of insomnia due to the lockdown. Due to this high level of impact, there is an urgent requirement to attend to the mental issues of the people during the COVID-19 outbreak.
... This in turn affects the regulation of HPA axis activity, which indirectly modulates arousal (Hirotsu et al., 2015). Sleep disturbances affect how we respond to emotional events during the day, and conversely, responses to past emotional events affect sleep quality (Altena et al., 2016). Stress, anxiety, and depression are associated with fatigue and poorer subjective sleep quality (Van Reeth et al., 2000;Valerio et al., 2016;Thorsteinsson et al., 2019;Cox and Olatunji, 2020;Xiao et al., 2020). ...
During the outbreak of the COVID-19 epidemic, fear of disease and its consequences, recommended lifestyle changes, and severe restrictions set by governments acted as stressors and affected people’s mood, emotions, mental health, and wellbeing. Many studies conducted during this crisis focused on affective and physiological responses to stress, but few studies examined how the crisis affected cognition. The present cross-sectional study examined the relationship between physiological, affective, and cognitive responses to the epidemic. In an online survey conducted at the height of the first wave of the epidemic in Slovenia (April 15–25, 2020), 830 Slovenian residents aged 18–85 years reported the effects of stressors (confinement, problems at home, problems at work, lack of necessities, and increased workload), experienced emotions, generalized anxiety, perceived stress, changes in health, fatigue and sleep quality, and perceived changes in cognition during the epidemic. Risk factors for stress (neuroticism, vulnerability, general health, gender, and age) were also recorded. We hypothesized that stressors and stress risk factors will be related to subjective cognitive decline, with negative emotions, generalized anxiety, perceived stress, and physical symptoms acting as mediator variables. On average, the results showed a mild subjective cognitive decline during the epidemic. In structural equation modeling, 34% of its variance was predicted by the mediator variables, with negative emotions and physical symptoms having the largest contribution. Stress risk factors were predictably related to the four mediator variables. Among the stressors, confinement showed the strongest effect on the four mediator variables, implying the importance of thoughtful communication about necessary restrictive measures during emergency circumstances. The results of this study indicate that the possibility of altered cognitive function should be considered when planning work and study activities during the epidemic.
... The observation that sleep-disrupted participants produced less affectively toned memories is inconsistent with our hypotheses but is at least partially consistent with previous literature regarding relations between sleep and emotional reactivity. Although many studies find that sleep disruption is associated with more emotional reactivity in response to negative stimuli specifically (see, e.g., Altena et al., 2016;Rosales-Lagarde et al., 2012), a significant minority report contrary results (see, e.g., Pilcher et al., 2015;Tempesta et al., 2020). ...
Background
Autobiographical memory in trauma-exposed individuals tends to be overgeneral and negatively biased. Although healthy sleep helps consolidate memory traces, and memory for emotional stimuli is better when there is a period of sleep between stimulus exposure and retrieval, and trauma-exposed individuals tend to experience disrupted sleep, no previous study investigates whether specific characteristics of autobiographical memory in these individuals may be accounted for, at least partially, by sleep disruption.
Method
Participants were 20 female sexual assault survivors and 20 women with no history of trauma exposure. We collected data from 1 night of polysomnographically monitored sleep and from a next-morning administration of the Autobiographical Memory Test (AMT).
Results
In response to positive AMT stimuli, trauma-exposed participants with less REM sleep produced more overgeneral autobiographical memories. In response to both negative and neutral stimuli, trauma-exposed participants and participants with more disrupted sleep (e.g., lower sleep efficiency, more spontaneous arousals) produced less emotional autobiographical memories. In response to negative stimuli, trauma-exposed participants with more spontaneous arousals produced less emotional autobiographical memories.
Limitations
Our design did not include a separate group of non-traumatized depressed patients or a sleep adaptation night. Our text processing software did not allow investigation of whether the affective content of AMT responses was congruent with cue valence.
Conclusions
Disrupted sleep, both independently and in interaction with trauma exposure, is associated with less specific and less emotional autobiographical recollections. Sleep-focused behavioral or pharmacological interventions might help alleviate cognitive and affective consequences associated with overgeneral and dispassionate autobiographical memory.
... On another hand, social isolation has not only had its negative consequences on PA and nutritional habits but has also affected the quality of sleep (Pérez-Carbonell et al., 2020). The bidirectional relationship between emotional reactivity and sleep has been shown to play an essential role in the gestation of insomnia (Altena et al., 2016). The dream disturbances have affected a substantial proportion of the general population, having a narrow relation with mental health alterations (anxiety, depression, etc.) (Bigalke, Greenlund, & Carter, 2020;Partinen et al., 2020;Pérez-Carbonell et al., 2020;Zhang et al., 2020). ...
Objective: to determine lifestyle changes, such as physical activity, nutrition, and sleep in an Argentinean university population, caused by confinement during the COVID-19 pandemic. Methods: Cross-sectional study via web survey. 1021 the Argentinean university population (women, n = 645 and men, n = 376) aged between 18-70 years old was participate. Survey was utilized to measure participant physical activity behavior, nutrition, and sleep April to May 2020. Results: the main findings revealed that 4.3% of the sample showed obesity; the highest proportion of the sample stayed more than 6 hours in a sedentary status; 21.74% reported bad sleep quality; a reduction in good feeding pattern; and an increase in subjects who do not perform physical activity. According to socio-demographic and anthropometric factors, being a student (OR 2.19, CI95% 1.18-4, p= .012), overweight (OR 1.71, CI95% 1.19-2.44, p= .003), obesity (OR 4.45, CI95% 2.27-8.7, p< .001), and have been confined more than 45 days was associated with bad feeding. Likewise, low physical activity levels were associated with obesity (OR 3.2 CI95% 1.66-6.18, p= .001), being female (OR 1.61, CI95% 1.14-2.28, p= .006) and get married (OR 1.72, CI95% 1.14-2.61, p= .009). Moreover, being a student was associated with poor sleep quality (OR 43.6, CI95%5.4-350, p< .001). Conclusion: This study suggests that confinement decreased healthy living habits such as good nutrition and physical activity and affected the quality of sleep in young subjects. Resumen. Objetivo: determinar los cambios en el estilo de vida, como la actividad física, la nutrición y el sueño en una población universitaria argentina, causados por el confinamiento durante la pandemia de COVID-19. Métodos: Estudio transversal mediante encuesta por Internet. Participaron 1021 personas de la población universitaria argentina (mujeres, n = 645 y hombres, n = 376) de entre 18 y 70 años de edad. La encuesta fue utilizada para medir el comportamiento de la actividad física, la nutrición y el sueño de los participantes de abril a mayo de 2020.Resultados: los principales hallazgos mostraron que el 4,3% de la muestra presentaba obesidad; la mayor proporción de la muestra permaneció más de 6 horas en estado sedentario; el 21,74% informó sobre la mala calidad del sueño; una reducción de los hábitos correctos de alimentación; y un aumento de los participantes que no realizan actividad física. De acuerdo con factores socio-demográficos y antropométricos, ser estudiante (OR 2.19, CI95% 1.18-4, p= .012), el sobrepeso (OR 1.71, CI95% 1.19-2.44, p= .003), la obesidad (OR 4.45, CI95% 2.27-8.7, p< .001), y haber estado confinado más de 45 días se asoció con una mala alimentación. Asimismo, los bajos niveles de actividad física se asociaron con la obesidad (OR 3,2; IC95% 1,66-6,18, p= .001), ser mujer (OR 1,61; IC95% 1,14-2,28, p= .006) y estar casado (OR 1,72; IC95% 1,14-2,61, p= .009). Además, ser estudiante se asoció con una mala calidad de sueño (OR 43,6, CI95% 5,4-350, p< .001). Conclusión: Este estudio sugiere que el confinamiento disminuyó los hábitos de vida saludables como la buena nutrición, la actividad física, y afectó la calidad del sueño en sujetos jóvenes.
... In fact, the sleep-wake rhythm depends on biological and environmental parameters: in particular exposure to daylight, physical activity during the day and especially in the morning, meals at times, regular and social interactions [9]. During the lockdown period, the majority of these parameters (light, physical activity, diet, social interactions) are totally modified or even eliminated, and as a result sleep disorders can appear [10]. In addition, the lockdown is a significant stressor, which increases the risk of developing symptoms of insomnia or even a sleep disorder. ...
Background: The pandemic coronavirus (Covid-19) currently represents both physical and psychic major risk to public health. The elderly people (aged 60 plus) are the most vulnerable to the coronavirus from the rest of the population. They are in fact more exposed to complications, atypical clinical presentation and therapeutic difficulties. However, this epidemic situation generates stress added to the stress related to their clinical condition, which could negatively affect their quality of life. Objective: specify if the pandemic Covid-19 and its consequences had a short- and medium-term impact on mental health and quality of life of elderly patients after the introduction of containment measures. Methods: We conducted an online survey from 09 May to 9 June 2020 through a questionnaire published on social networks using Google Forms and comprising several items, student demographics, overall health, and the elements of the SF-12 quality of life scale. Results: The study population consisted of 135 elderly subjects. The average age was 65.3 years, 53% were male. 6.7% had a psychiatric history, 61.5% had a somatic illness and 42.2% reported having sleep disorders since the starting of lockdown. In our study, participants had an average scores of physical and mental health (40.62 and 38.63) significantly lower than that of the general population (= 50). Mental health was statistically more impaired in subjects having somatic illness, those who were not used to staying at home. Female gender was associated with physical health impairment. The presence of sleep disturbances has been statistically associated with impaired mental and physical health. Conclusions: Infection with the Covid-19 is particularly serious in elderly patients with a high risk of death and a negative psychological impact affecting their quality of life. Particular attention should be brought to this vulnerable population and the implementation of various programs to reduce the negative psychological impact and offer them a better quality of life.
... Furthermore, we found a correlation between stress/ anxiety and poor sleep quality confirming their negative effect on sleep of the pediatric HWs during COVID-19 pandemic. On one hand, stress and anxiety are considered the main precipitating factors for insomnia [31,32]. On the other hand, sleep quality is an important factor regulating behaviors and emotions [33] revealing the bidirectional relationship between sleep quality and psychological distress. ...
Objective
The aim of this study was to evaluate sleep quality and psychological effects on pediatric healthcare workers during the first wave of COVID-19 epidemic in Italy and to evaluate differences between primary and secondary care operators. Pediatric healthcare workers were involved in an online survey to assess sleep quality, stress and anxiety level, self-efficacy and social support in Italian pediatric healthcare workers during COVID-19 pandemic.
Results
We found that 67.4% of our sample suffered from sleep disturbance and 19.4% of subjects suffered from anxiety. Lower values of anxiety and social support were found in primary care staff compared to secondary care one. The associations between healthcare professional figures (being primary or secondary care operators) and mental health outcomes were not statistically significant. However, sex, age and having a SARS-CoV-2 infected relative/friend had an independent effect on mental health outcomes. It is crucial to provide social and psychological support to pediatric healthcare workers. A tailored psychological screening would be desirable for female healthcare workers and for those who have a SARS-CoV-2 infected relative/friend.
... Stress-related sleep problems are common (Altena et al. 2016). Those who are sensitive to stress-related sleep disruption are more likely to experience chronic sleep problems (Ellis et al. 2012;Gouin et al. 2015). ...
This study aimed to investigate the symptoms of trauma, depression, anxiety, and irritability in children with attention deficit hyperactivity disorder (ADHD) during home confinement due to COVID-19. The sample of this single-center, cross-sectional study consisted of 42 children with ADHD and their parents. There were significant differences in the severity of depression, anxiety, irritability, and ADHD symptoms between the group that experienced pathological trauma reactions and the group that did not. According to the results of mediation analyses, the irritability score was found to be the full mediating factor in the relationship between trauma reaction scores/emotional symptom scores and the severity of ADHD symptoms. Because of the modest sample size due to the exclusion of ADHD patients with comorbidities, we recommend that future research focus on reproducing the role of irritability, in larger samples, as the full mediator on the path from cognition to behavior in children with ADHD under home confinement during the pandemic.
... The impact of stress and anxiety on sleep has been well-documented (Van Reeth et al., 2000;Alvaro et al., 2013;Altena et al., 2016), such as disruptions in sleep after negative life events (Lavie, 2001;Gregory et al., 2006;Vahtera et al., 2007;Mezick et al., 2009), depression (Benca et al., 1992) or post-traumatic stress disorders (Ross et al., 1994;Lavie et al., 1998;Miller et al., 2017). ...
In response to the COVID-19 pandemic, a variety of social distancing measures to mitigate the virus outbreak have been implemented. These measures may have unintended consequences on individuals’ well-being, such as increased stress, anxiety, and sleep disruptions. We investigated the extent to which individuals’ mental health status is associated with perceived changes in sleep amount and sleep quality among a sample of adult twin pairs (N = 909 pairs; 77% MZ, 23% DZ), less than a month after the outbreak was declared a pandemic by the World Health Organization. About half of participants reported no change in sleep amount (50.1%) or sleep quality (55.6%). Approximately one-third of the participants had increased amount of sleep (29.8%), and 32.9% reported a decrease in sleep quality. We found that stress and anxiety levels were associated with sleep reduction (ORs = 2.36 and 3.12 for stress and anxiety, respectively) and poorer sleep quality (ORs = 2.45 and 3.73 for stress and anxiety, respectively), even after taking into account between-family confounds. A much smaller association was observed between levels of stress and anxiety and increased sleep amount (ORs = 1.42 and 1.60 for stress and anxiety, respectively) and sleep quality (OR = 1.21 and 1.29 for stress and anxiety, respectively), which was no longer significant after controlling for between-family confounds. Our results demonstrate that stress and anxiety associated with the COVID-19 pandemic and social distancing measures may be linked to reduced sleep amount and quality.
... For example, a longer sleep duration may be associated with depression, while anxiety can lead to lower sleep quality or in dysregulated bedtime and waketime. As anxiety and depression symptoms appear to be associated with lockdown in ASD (Oomen et al., 2021;Pellicano et al., 2021) and the general population (Gualano et al., 2020;Hao et al., 2020;Marelli et al., 2020;Vindegaard & Benros, 2020;Wang et al., 2020) and are linked to sleep (Altena et al., 2016), it will be important to take those variables into account in future studies. Fourth, participants reported retrospectively on sleep and wake behavior "before lockdown," leading to a potential recall bias. ...
Objectif
Le confinement lié au Covid-19 a conduit à un changement des activités et routines du quotidien des français, pouvant affecter le sommeil différemment selon les populations. Notre étude est la 1ère à comparer l’effet du confinement sur les rythmes veille-sommeil et les comportements associés chez des sujets avec trouble du spectre autistique (TSA) et la population générale.
Méthodes
Une enquête en ligne nationale a permis de recruter 207 adultes avec TSA (56 % femmes) et 1652 contrôles (77 % femmes), d’un âge moyen égal (35 ans [17-70]).
Résultats
Avant le confinement, les sujets avec TSA avaient un sommeil plus tardif que les contrôles (13 % se couchant après 1 h et 6 % se levant après 11 h, contre 4 % et 0,6 %, p < 0,01), un rythme veille-sommeil plus irrégulier (15 % pouvant décaler leur rythme de plus de 2 h d’un jour à l’autre, contre 7 % chez les contrôles, p < 0,001), et un temps passé devant les écrans plus grand (21 % ≥ 4 heures par jour contre 9 % pour les contrôles, p < 0,001). L’ensemble des variables de sommeil et comportement associés ont été affecté significativement par le confinement (heure de lever et de coucher plus tardif, rythme veille-sommeil plus irrégulier, exposition aux écrans plus élevé, exposition à la lumière du jour réduite), la différence avant/pendant confinement était proche dans les deux populations.
Conclusion
Les rythmes veille-sommeil se sont détériorés pendant le confinement pour les sujets avec TSA et population générale. En revanche, les sujets TSA présentant déjà des difficultés avant le confinement, le décalage de phase et l’irrégularité des rythmes étaient encore plus extrêmes.
... Stress-related sleep problems are common in adults, but this frustrating relationship is rather bidirectional (Altena et al., 2016). ...
The COVID-19 confinement has dramatically altered daily routines, causing decreased sleep quality in adults. This necessitates careful observation, as sleep plays a crucial role in brain maturation and poor sleep increases the risk of psychopathology, particularly in the young population. Through an online survey with one baseline (April 2020) and two follow-up assessments (May and June 2020), we examined the effect of confinement on sleep quality in 452 babies (0-35 months) and 412 preschool children (36-71 months) from several, mainly European, countries. An acute decrease in sleep quality was found in both groups of children. However, at follow-up assessments, this effect rebounded to the level reported for the period before the confinement. Importantly, caregiver's stress level was identified as a substantial risk factor determining lower sleep quality in both groups of children across assessments. Protective factors conserving children's sleep quality included caregiver's engagement in mindfulness techniques or childcare, and the presence of siblings and pets. In the near future, we may repeatedly experience the circumstances of abruptly enforced confinement. Our findings reveal promising pathways of action to protect young children's sleep, with which to essentially mitigate the long-term consequences of the pandemic on brain development and mental health.
... We observed patients who reported shorter sleeping duration and worse self-rated general condition had a higher SRQ score response. Emotional events easily caused sleep disturbance and vice versa24 . One recent study suggested that participants reported lower posttraumatic stress symptoms during COVID-19 outbreak when they had a better sleep25 . ...
Background
This study aimed to find out eight months into the COVID-19 outbreak, how much psychological effect was experienced by convalescent psychiatric patients, and identify the potential risk and protective factors related to their psychological response.
Methods
Data from 136 convalescent psychiatric patients were collected. We used binary logistic regression analyses to identify participants’ SRQ score and the factors associated with it.
Results
There were 47 (34.5%) participants scored eight or higher. Working or marital status and annual income were significantly associated with a higher score in SRQ. Similarly, sleep duration, interpersonal relationship, exercise time, special events, and general condition were linked to SRQ grade.
Conclusions
Eight months into the COVID-19 pandemic, this widespread virus psychologically impacted convalescent psychiatric patients. This result was related to less annual income, which stressed the necessity to provide closer follow-up and financial support in this crisis's late stage.
... Stress-related sleep problems are quite common (6). The group that is sensitive to stress-related sleep disorders generally develops chronic insomnia (7). ...
Aim: Sleep can be affected for various reasons such as social isolation, online education, shift work, etc. during the coronavirus disease 2019 (COVID-19) pandemic. People who have comorbid psychiatric or sleep disorders before the pandemic are thought to be more affected. The aim of this study was to investigate the effect of the COVID-19 pandemic on sleep quality and insomnia. Material and Methods: Our study was a retrospective study, and patients who admitted to the sleep outpatient clinic with insomnia complaints during the COVID-19 pandemic were included. The complaints, sociodemographic characteristics, and diagnosis of the patients were obtained from medical records. Results: Fifty-three patients diagnosed with insomnia according to the International Classification of Sleep Disorders third edition (ICSD-3) were included in the study. The mean sleep time before the pandemic was 6.8±1.2 hours, while it was 5.9±1.7 hours after the pandemic. After the pandemic, 13 (24.5%) patients had shortened sleep duration. There was no difference in clinical features between those whose sleep duration decreased and did not change during the pandemic. Twenty (37.7%) patients' complaints of insomnia started during the pandemic. Most of the patients whose complaints started during the pandemic were male (n=12, 60.0%). Their main complaint was difficulty in falling asleep (n=18, 90.0%). The anxiety symptoms were remarkable. Conclusion: Sleep disorders during the pandemic are an important problem for everyone. However, some individuals have a higher risk of sleep problems. Therefore, the results of our study may contribute to the interventions aimed at improving sleep quality during pandemic.
... Insomnia is a common, preceding symptom or precipitating factor in new onset mental illness, such as depression, anxiety, and posttraumatic stress disorder [11], whereas suicide is the most severe outcome of psychiatric disorders over a lifetime [12]. Stress-related sleep problems are common [13], and poor sleep quality has been identified as having mental health consequences as a result of social isolation [14]. In the absence of a vaccine and effective treatment for COVID-19, one of the most vital strategies for slowing the pandemic is social distancing. ...
Background:
Real-time global mental health surveillance is an urgent need for tracking the long-term impact of the COVID-19 pandemic.
Objective:
This study aimed to use Google Trends data to investigate the impact of the pandemic on the population mental health through three keyword searches indicating the varied extent of mental distress, namely insomnia, depression, and suicide.
Methods:
We estimated the increase of search queries for each country by the actual daily search value from March 20 to April 19, 2020, higher than the 95% confidence intervals of the forecast from the three-month baseline via autoregressive integrated moving average modelling. We examined the correlation between the increase of COVID-19 deaths and the number of days with significant increased search volumes for insomnia, depression, and suicide among 19 countries.
Results:
The countries with the greatest increases in searches for insomnia were Iran, Spain, the United States, and Italy, and these countries showed a significant increase in insomnia searches more than 10 of the 31 days observed. The number of increased death cases was positively correlated to the number of days with an increased search for insomnia among the 19 countries, with the Spearman's correlation coefficient (rho) of 0.64, P = 0.003. By contrast, there was no significant correlation between increased death cases and increased searches for depression (rho = -0.12, P = 0.633) or suicide (rho = -0.07, P = 0.788).
Conclusions:
Our analysis suggests that insomnia could be a part of routine screening for mental health during the COVID-19 pandemic.
Clinicaltrial:
Although sleep loss is theorized to increase aggression risk, knowledge regarding the sleep–aggression relationship or explanatory psychological processes is limited. In this study, we examined whether recent sleep duration predicted subsequent laboratory aggression and whether neurocognitive indices of attentional and motor inhibition and negative emotional processing explained the sleep–aggression relationship. Participants ( n = 141) wore Fitbit Flex devices and kept a sleep diary for 3 days. Event-related potentials were measured during an emotional-linguistic go/no-go task, followed by a laboratory aggression paradigm. Results of mixed-model repeated measures analyses of variance linked shorter sleep duration with reduced motor inhibition processing during negative and neutral word blocks and greater aggression. However, neurocognitive indices did not explain the sleep–aggression link. This is the first evidence that naturally occurring sleep loss predicts increases in laboratory aggression across the task and suggests that shorter sleepers are more vulnerable to rash action in negative and neutral contexts. Implications of these findings for understanding aggression are discussed.
Purpose:
We examined the association between social distancing and trouble sleeping during the COVID-19 outbreak in adults 65+, and underlying potential mechanisms.
Methods:
We used data from the extensive Survey of Health, Aging, and Retirement in Europe (SHARE). Logistic regression analysis tested the direct and indirect associations between social distancing and trouble sleeping during the pandemic, the mediation effect of depression, and the moderating-mediation effects of perceived economic status and employment status.
Findings:
Social distancing was associated with a higher probability of sleeping problems, partially mediated by depression and moderated by employment status and perceived economic status. Depression had a greater effect on trouble sleeping among those unemployed and those who perceived their economic status as difficult or partially difficult.
Conclusion:
COVID-19 policy of lockdowns and physical distancing has negative consequences on sleeping and the development of depressive symptoms among older adults.
Clinical and policy relevance:
Clinicians should be aware of sleep problems in older adults during the pandemic and after, and try to reduce depressive symptoms. Policymakers should determine future policies and regulations that encourage employment among older adults and improve their economic resilience during pandemics.
Aim:
To investigate the effects of the coronavirus disease 2019 (COVID-19) lockdown on sleep habits in the Croatian general population.
Methods:
In this cross-sectional study, 1173 respondents from the general population (809 women) completed a self-report online questionnaire that gathered demographic data and data on sleep habits and mood changes before and during the COVID-19 lockdown.
Results:
During the lockdown, bedtime (from 23:11±1:07 to 23:49±1:32 h, P<0.001) and waketime were delayed (from 6:51±1:09 to 7:49±1:40 h, P<0.001). Sleep latency increased from 10 (5-20) to 15 (10-30) minutes (P<0.001). Bedtime and waketime delays were more pronounced in women and respondents younger than 30. Compared with other age groups, respondents younger than 30 more frequently reported insomnia for the first time during the lockdown and had less frequent night-time awakenings (P<0.001), less common problems falling asleep (P<0.001), less frequently felt calm (P<0.001) and rested (P<0.001), but more frequently felt sadness (P<0.001) and fear (P=0.028).
Conclusion:
The effect of the lockdown on sleep needs to be better understood. Sleep hygiene education could serve a first-line lifestyle intervention for people in lockdown experiencing sleep disruption.
Background and Purpose
Anger is implicated in nearly every social pathology, from war to bullying to child abuse. Yet, it is also the spark of reform for nearly every positive social movement, from civil rights to labor rights to handicapped rights. This article examines how anger has been understood and misunderstood across different discursive spaces in society, research, and education to offer a peace-promoting, emotional ecology theory of anger to foster emotional growth and political change.
Research Design
This article employs theoretical research, which is a logical exploration of a system of beliefs and assumption to increase understanding, develop new theory, and explore implications.
Findings
Anger is reconceptualized as a crucial emotional and political experience rooted in the emotional ecologies and histories of family, school, and society. Three distinctive features characterize it: An ethical response, an emotional response, and an action response. Five steps to anger resolution follow from this analysis including: mindfulness, compassion, insight, action, and a therapeutic response (or MCIAT).
Recommendations
Future studies on anger should span developmental stages and include ways anger intersects with curricula, emotional experience and intellectual understanding. Teachers, social workers, and therapists must work together to address the emotional and political aspects of anger in education. Addressing our most painful and angering global challenges in all their complexity requires full integration of the personal, educational, civic, and therapeutic dimensions of emotional ecology and this worthy enterprise should inspire interdisciplinary dialogue and future research.
Childhood maltreatment has a range of long-term developmental and health consequences. Emerging research suggests that sleep disturbances may be a key behavioral health risk factor implicated in the relationship between maltreatment and poor health across the lifespan. This systematic review examined the association between maltreatment and behavioral sleep disturbances in childhood and adulthood. Studies were identified through PsycINFO, PubMed, and alternative search strategies such as Google Scholar and reference list checks, with an end date of July 2021. Quantitative, peer-reviewed articles examining behavioral sleep outcomes and/or characteristics among maltreatment-exposed samples were included. We assessed the potential risk of bias by examining study design and sleep and maltreatment assessment methods. Across 73 studies included in this review, there was a robust association between childhood maltreatment and behavioral sleep disturbances. Findings suggest that linkages between maltreatment and sleep outcomes diverge with respect to maltreatment characteristics, type of behavioral sleep disturbance assessed, use of subjective versus objective measures, and study design. Given that behavioral sleep disturbances are modifiable, more research is needed that incorporates objective measures of sleep and longitudinal designs to identify specific points of intervention to mitigate the potential long-term impacts of childhood maltreatment on health across socio-demographically diverse populations.
Amaç: Bu çalışmanın amacı COVID-19 salgını sırasında sağlık çalışanlarının psikolojik sorunlarını saptamaktır. Gereç ve Yöntem: Araştırmaya 93 gönüllü sağlık çalışanı dâhil edildi. Her bir katılımcı bir sosyo-demografik veri formu ile beraber Hamilton Depresyon Ölçeğine, Hamilton Anksiyete Ölçeği, Uykusuzluk Şiddeti İndeksine ve Yale Brown Obsesif Kompulsif Ölçeğine göre değerlendirildi. Bulgular: Kadınlarda, erkeklere göre depresyon, anksiyete, obsesif kompulsif bozukluk, uykusuzluk ve sağlık anksiyetesi ölçek skorları daha yüksek saptandı. Ancak sadece anksiyete ve OKB ölçeklerinde kadınlarda, erkeklere göre istatiksel olarak anlamlı bir farklılık saptandı (p=0.021, p=0.005). Post-hoc analiz sonuçlarına göre, anksiyete, depresyon ve uyku bozukluğu belirtilerinden yüksek skorlar hemşirelerde, sonra doktorlarda yüksek bulunmuş olup diğer sağlık çalışanlarında ise en düşüktü. Sonuç: Çalışmamız; depresyon, uykusuzluk, anksiyete belirtilerinin cinsiyet ve meslek alt tipleri arasında anlamlı farklılıklar olduğunu göstermiştir. Bu sebeple, sağlık çalışanlarının ruhsal yakınmalarına yönelik sağlık uygulamalarında sosyo-demografik farklılıkların da göz önünde bulundurulması faydalı olabilir. Ayrıca yıllar sonra yeniden pandemi gerçeği ile karşı karşıya gelen sağlık çalışanlarının, ruh sağlığını göz önünde bulundurmanın gerekliliğini ve önemini vurgulamaktayız.
Empathy for pain has a strong adaptive function. It plays a protective role in survival and exerts a vital impact on successful social interaction. Sleep loss, however, is commonplace in current society, and people are increasingly plagued by it. Previous studies have investigated whether sleep loss affects empathy for pain, yet the results were undecided. We aimed to determine whether this effect is existed and further explore the temporal and frequency dynamics of neural activities involved in this effect by recording the electroencephalogram (EEG) signals. We recruited 25 healthy adults (11 females) who were required to perform a pain judgement and unpleasantness rating about the presented nociceptive and neutral pictures after nocturnal sleep (NS) or sleep deprivation (SD), and their neuronal activities were recorded by event-related potentials (ERPs). Results showed a significantly decreased amplitude in the early components (N2, N340) of vicarious pain processing after SD. In further time-frequency (TF) analysis, a reduced energy occurred in theta2 (5–7 Hz) band under SD condition. Moreover, the decreased theta2 was positively correlated with the subjective ratings of both other's pain and self-unpleasantness only under SD condition. Our results indicated that SD impairs affective sharing of empathy for pain.
This study aims to investigate the relationship between chronotype preferences/sleep problems and trauma symptoms during the COVID-19 outbreak of adolescents diagnosed with Anxiety Disorder (AD) in the pre-COVID-19 period. The sample of this study consisted of 71 adolescents with AD. Trauma symptoms were evaluated using the Children’s Event Impact Scale (CRIES-13); sleep habits were assessed using the Pittsburgh Sleep Quality Index (PSQI); and chronotype was evaluated using the Children’s Chronotype Questionnaire (CCQ). The CRIES-13 arousal scores and PSQI sleep latency scores were significantly higher in the eveningness type group compared with the non-eveningness type group. The CRIES-13 arousal scores of adolescents with AD were related to the CCQ and PSQI scores. In linear regression analysis, sleep problems were found to be an associated factor on the CRIES-13 scores. The findings of the present study suggest that during the COVID-19 pandemic, the chronotype may play an important role in the adversities experienced by adolescents with AD. In addition, it was thought that the association between sleep problems and trauma in adolescents with AD who spent a lot of time in the home environment during the pandemic period needs further evaluation.
Objective
The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, and many studies point to large modifications in several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during the pandemic has been substantially overlooked. Since hyperarousal represents one of the main factors for the development and the perpetuation of chronic insomnia disorder, the assessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinically relevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and pre-sleep arousal in an Italian sample during the COVID-19 lockdown.
Methods
We used an online survey to collect self-reported sociodemographic, environmental, clinical, sleep, and sleep-related data. Our final sample included 761 participants.
Results
Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results show that almost half of the sample suffered from clinically relevant levels of at least one component (i.e., cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleep quality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related measures, depressive and event-related stress symptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components. Moreover, specific sociodemographic and environmental variables were uniquely related to sleep quality, cognitive or somatic pre-sleep arousal.
Conclusions
These findings suggest that the assessment of specific sleep-related factors (i.e., pre-sleep arousal), together with more global measures of sleep quality, may be crucial to depict the complex impact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.
Background:Bipolar Disorder is a severe chronic mental disorder. There is a bidirectional relationship between disease course and circadian phase. Significant circadian phase shifts occur during transitions between episodes but episodes can also be elicited during euthymia by forced rapid changes in circadian phase. Although an instability of circadian phase has been described in multiple observational reports; no studies quantifying the propensity to phase shift following an experimental standardized stimulus have been published. This study therefore aimed to assess whether patients with bipolar-I-disorder are more prone to phase delay following blue light exposure in the evening compared to healthy controls.
Methods:Euthymic participants with SCID-I confirmed Bipolar-I-Disorder (BP; n=32) and healthy controls (HC; n=55) underwent a three day phase shift protocol involving exposure to a standardized dose of homogenous, constant, narrow bandwidth blue light (478 nm, half bandwidth = 18 nm, photon flux = 1.29x10¹⁵ photons/cm²/s) for 2 h at 21.00 h via a Ganzfeld dome on day 2. On days 1 and 3 serial serum melatonin assessments during total darkness were performed to determine the Dim-Light-Melatonin-Onset (DLMO).
Results:Significant differences in the light-induced phase shift between Bipolar-I-Disorder and healthy control participants were detected (F(1,82)=4.110; p=0.046), the bipolar disorder patients exhibiting an enhanced phase delay (η²=0.49). There were no significant associations between the magnitude of the phase shift and clinical parameters.
Conclusion: Supersensitvity of patients with bipolar-I-disorder to light-induced phase delay may contribute to the observed phase instability and vulnerability to forced phase shifts associated with the disorder.
Due to the effects of sleep on the central nervous system, it is thought that sleep disorders have a special importance in the onset, course and treatment of psychiatric diseases. Although the negative effects of sleep problems on the occurrence, recurrence and clinical course of psychiatric disorders are well known, it is reported that clinicians do not spend enough time for sleep problems in practice. This may be related to the fact that patients underreport their complaints for various reasons, insufficient examination time, and clinicians’ lack of knowledge about the importance of the subject. Pharmacotherapy, psychological and behavioral interventions are options among the therapeutic approaches to sleep problems. But, it seems that clinicians tend to prefer pharmacological approaches for the treatment of sleep problems.
However, it is important to choose the appropriate treatment option with considering the method preferred by the patients, who already use many and high doses of pharmacological agents, the nature of the psychiatric disorder and the sleep problem. In this context, chronotherapeutic approaches such as bright light, sleep deprivation, interpersonal relations and social rhythm therapy, and cognitive behavioral therapy techniques adapted for patients with bipolar disorder can be used in the treatment of suitable patients. In this article, the current literature about sleep-related problems observed in patients with schizophrenia and bipolar disorder is reviewed comprehensively with presenting clinical phenotypes and treatment approaches.
The proper development of sleep and sleep-wake rhythms during early neonatal life is crucial to lifelong neurological well-being. Recent data suggests that infants who have poor quality sleep demonstrate a risk for impaired neurocognitive outcomes. Sleep ontogenesis is a complex process, whereby alternations between rudimentary brain states—active vs. wake and active sleep vs. quiet sleep—mature during the last trimester of pregnancy. If the infant is born preterm, much of this process occurs in the neonatal intensive care unit, where environmental conditions might interfere with sleep. Functional brain connectivity (FC), which reflects the brain’s ability to process and integrate information, may become impaired, with ensuing risks of compromised neurodevelopment. However, the specific mechanisms linking sleep ontogenesis to the emergence of FC are poorly understood and have received little investigation, mainly due to the challenges of studying causal links between developmental phenomena and assessing FC in newborn infants. Recent advancements in infant neuromonitoring and neuroimaging strategies will allow for the design of interventions to improve infant sleep quality and quantity. This review discusses how sleep and FC develop in early life, the dynamic relationship between sleep, preterm birth, and FC, and the challenges associated with understanding these processes.
Sleep in early life is essential for proper functional brain development, which is essential for the brain to integrate and process information. This process may be impaired in infants born preterm.
The connection between preterm birth, early development of brain functional connectivity, and sleep is poorly understood.
This review discusses how sleep and brain functional connectivity develop in early life, how these processes might become impaired, and the challenges associated with understanding these processes. Potential solutions to these challenges are presented to provide direction for future research.
Background and Objectives: The aim of this study was to determine the predictive variables of emotional distress and their relative importance in patients with breast cancer. The aim of this study was to determine the predictors of emotional disturbance variables and their relative importance in patients with breast cancer. Material and Methods: The present research method was fundamental in terms of purpose, descriptive and exploratory in nature, so a high sample size was applied. The sample was among the patients with breast cancer who referred to Shohada Hospital in Tajrish, 736 patients ,19-to 80 years old people with breast cancer who referred to the hospital during the first 8 months of 2019. Whole samples were selected but screened based on inclusion and exclusion criteria. Then the psychological scale of self-empowerment skills, interpersonal interaction quality scale, and emotional turmoil Scale were administered to assess participants. Results: The results showed that self-empowerment skills, quality of interpersonal interactions, age and head of household status showed a significant relationship with emotional turmoil. More precisely, it was found that the variables of the quality of interpersonal interactions and self-empowerment skills have the greatest impact on predicting emotional turmoil, respectively. Conclusion: According to the results of this study, it can be said that interpersonal relationships, self-empowerment skills and demographic characteristics of patients with breast cancer play an important role in the emotional distress of patients. Therefore, it is suggested that psychologists pay special attention to these concepts in monitoring the mental state and improving the mental health of patients.
Developmental exposure to ethanol has a wide range of anatomical, cellular, physiological and behavioral impacts that can last throughout life. In humans, this cluster of effects is termed fetal alcohol spectrum disorder and is highly prevalent in western cultures. The ultimate expression of the effects of developmental ethanol exposure however can be influenced by post-exposure experience. Here we examined the effects of developmental binge exposure to ethanol (postnatal day 7) in C57BL/6By mice on a specific cohort of inter-related long-term outcomes including contextual memory, hippocampal parvalbumin-expressing neuron density, frontal cortex oscillations related to sleep-wake cycling including delta oscillation amplitude and sleep spindle density, and home-cage behavioral activity. When assessed in adults that were raised in standard housing, all of these factors were altered by early ethanol exposure compared to saline controls except home-cage activity. However, exposure to an enriched environment and exercise from weaning to postnatal day 90 reversed most of these ethanol-induced impairments including memory, CA1 but not dentate gyrus PV+ cell density, delta oscillations and sleep spindles, and enhanced home-cage behavioral activity in Saline- but not EtOH-treated mice. The results are discussed in terms of the inter-dependence of diverse developmental ethanol outcomes and potential mechanisms of post-exposure experiences to regulate those outcomes.
Bailemian (BLM) is reportedly used for the treatment of insomnia as a traditional Chinese medicine in China for many years. However, the anti-insomnia mechanisms of BLM are still unknown. The present study aims to investigate the anti-insomnia activity of BLM by evaluating its influence on the relevant neurotransmitters and gut microbiota in p-chlorophenylalanine (PCPA) induced insomnia mice. The results indicated that the level of GABA, 5-HT, DA, and NE is significantly decreased in the PCPA-induced insomnia model group compared with the control group, while the level of Glu is higher than the control group. Treatment with BLM could ameliorate the symptoms of insomnia and significantly modulate the levels of the neurotransmitters mentioned above in brain and colonic faeces. Furthermore, the structure and composition of gut microbiota were changed after the administration of BLM and can increase the percentage of beneficial bacterial species in gut microbiota. These results indicated that Bailemian could ameliorate the symptoms of insomnia, and its effects may be through modification of the neurotransmitters levels and gut microbiota composition.
Objectives:
The epidemic of coronavirus disease 2019 (COVID-19) brought psychological stress to the public, especially to patients. This study aims to investigate the mental health of patients with COVID-19 in Changsha.
Methods:
We took cross-section investigation for the mental health of 112 patients with COVID-19 via questionnaires. Mann-Whitney U test, Chi-square test, and Fisher's exact test were performed to compare general and clinical data between the slight-ordinary patients and severe patients. Single sample t-tests were used to compare the difference between the factor scores of the Symptom Check-List 90 (SCL-90) in COVID-19 patients with the norm of 2015 and factor scores of SCL-90 in patients with the severe acute respiratory syndrome (SARS).
Results:
The obsessive-compulsive, depression, sleep and eating disorders had the highest frequency among the positive symptoms of SCL-90 in patients with COVID-19 in Changsha. The factor scores of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 were higher than those of the norm (P≤0.001 or P<0.05). Slight-ordinary patients with COVID-19 in Changsha showed lower factor scores of somatization, depression, anxiety, and hostility compared with the patients with SARS (P<0.001 or P<0.05). There was no difference in factor scores of SCL-90 between the patients with severe COVID-19 and those with SARS(P>0.05).
Conclusions:
The levels of somatization, depression, anxiety, phobia anxiety, sleep and eating disorders in patients with COVID-19 in Changsha are higher than those of the norm. However, the mental health of slight-ordinary patients with COVID-19 is better than that of patients with SARS. It needs to provide targeting psychological interventions depending on the severity of patients.
Introduction:
Disruptions in sleep and circadian rhythms are observed in individuals with bipolar disorders (BD), both during acute mood episodes and remission. Such abnormalities may relate to dysfunction of the molecular circadian clock and could offer a target for new drugs.
Areas covered:
This review focuses on clinical, actigraphic, biochemical and genetic biomarkers of BDs, as well as animal and cellular models, and highlights that sleep and circadian rhythm disturbances are closely linked to the susceptibility to BDs and vulnerability to mood relapses. As lithium is likely to act as a synchronizer and stabilizer of circadian rhythms, we will review pharmacogenetic studies testing circadian gene polymorphisms and prophylactic response to lithium. Interventions such as sleep deprivation, light therapy and psychological therapies may also target sleep and circadian disruptions in BDs efficiently for treatment and prevention of bipolar depression.
Expert opinion:
We suggest that future research should clarify the associations between sleep and circadian rhythm disturbances and alterations of the molecular clock in order to identify critical targets within the circadian pathway. The investigation of such targets using human cellular models or animal models combined with 'omics' approaches are crucial steps for new drug development.
Predisposing factors place certain individuals at higher risk for insomnia, especially in the presence of precipitating conditions such as stressful life events. Sleep spindles have been shown to play an important role in the preservation of sleep continuity. Lower spindle density might thus constitute an objective predisposing factor for sleep reactivity to stress. The aim of this study was therefore to evaluate the relationship between baseline sleep spindle density and the prospective change in insomnia symptoms in response to a standardized academic stressor.
Twelve healthy students had a polysomnography recording during a period of lower stress at the beginning of the academic semester, along with an assessment of insomnia complaints using the insomnia severity index (ISI). They completed a second ISI assessment at the end of the semester, a period coinciding with the week prior to final examinations and thus higher stress. Spindle density, amplitude, duration, and frequency, as well as sigma power were computed from C4-O2 electroencephalography derivation during stages N2-N3 of non-rapid-eye-movement (NREM) sleep, across the whole night and for each NREM sleep period. To test for the relationship between spindle density and changes in insomnia symptoms in response to academic stress, spindle measurements at baseline were correlated with changes in ISI across the academic semester.
Spindle density (as well as spindle amplitude and sigma power), particularly during the first NREM sleep period, negatively correlated with changes in ISI (p < 0.05).
Lower spindle activity, especially at the beginning of the night, prospectively predicted larger increases in insomnia symptoms in response to stress. This result indicates that individual differences in sleep spindle activity contribute to the differential vulnerability to sleep disturbances in the face of precipitating factors.
Insomnia is one of the most prevalent health complaints afflicting approximately 10 % of the population in Western industrialized countries at a clinical level. Despite the proposition that both biological and psychological factors play a role in the experience of insomnia, the field continues to puzzle over so-called "discrepancies" between objective and subjective measurements of sleep and daytime functioning. The promise of neuroimaging is to uncover physiological processes that may readily explain patient reports. However, while there has been an explosion in the number of studies investigating the neural correlates of insomnia with neuroimaging technologies, there appears to be little consistency in findings across studies. We suggest a number of methodological reasons which may, at least partially, explain variability in findings across neuroimaging studies in insomnia.
Objectives
Recent neuroimaging studies have identified a potentially critical role of the amygdala in disrupted emotion neurocircuitry in individuals after total sleep deprivation (TSD). However, connectivity between the amygdala and cerebral cortex due to TSD remains to be elucidated. In this study, we used resting-state functional MRI (fMRI) to investigate the functional connectivity changes of the basolateral amygdala (BLA) and centromedial amygdala (CMA) in the brain after 36 h of TSD.
Materials and Methods
Fourteen healthy adult men aged 25.9±2.3 years (range, 18–28 years) were enrolled in a within-subject crossover study. Using the BLA and CMA as separate seed regions, we examined resting-state functional connectivity with fMRI during rested wakefulness (RW) and after 36 h of TSD.
Results
TSD resulted in a significant decrease in the functional connectivity between the BLA and several executive control regions (left dorsolateral prefrontal cortex [DLPFC], right dorsal anterior cingulate cortex [ACC], right inferior frontal gyrus [IFG]). Increased functional connectivity was found between the BLA and areas including the left posterior cingulate cortex/precuneus (PCC/PrCu) and right parahippocampal gyrus. With regard to CMA, increased functional connectivity was observed with the rostral anterior cingulate cortex (rACC) and right precentral gyrus.
Conclusion
These findings demonstrate that disturbance in amygdala related circuits may contribute to TSD psychophysiology and suggest that functional connectivity studies of the amygdala during the resting state may be used to discern aberrant patterns of coupling within these circuits after TSD.
Study objectives:
Alterations in emotional reactivity may play a key role in the pathophysiology of insomnia disorder (ID). However, only few supporting experimental data are currently available. We evaluated in a hypothesis-driven design whether patients with ID present altered amygdale responses to emotional stimuli related and unrelated to the experience of insomnia and, because of chronic hyperarousal, less habituation of amygdala responses.
Design:
Case-control study.
Setting:
Departments of Psychiatry and Psychotherapy and of Radiology of the University of Freiburg Medical Center.
Participants:
There were 22 patients with ID (15 females; 7 males; age 40.7 ± 12.6 y) and 38 healthy good sleepers (HGS, 21 females; 17 males; age 39.6 ± 8.9 y).
Interventions:
N/A.
Measurements and results:
In a functional magnetic resonance imaging session, five different blocks of pictures with varying emotional arousal, valence, and content (insomnia-relatedness) were presented. Pictures were presented twice to test for habituation processes. Results showed that patients with ID, compared to HGS, presented heightened amygdala responses to insomnia-related stimuli. Moreover, habituation of amygdale responses was observed only in HGS, but not in patients with ID who showed a mixed pattern of amygdala responses to the second presentation of the stimuli.
Conclusions:
The results provide evidence for an insomnia-related emotional bias in patients with ID. Cognitive behavior treatment for ID could benefit from strategies dealing with the emotional charge associated with the disorder. Further studies should clarify the role of ID with respect to habituation of amygdala responses.
Little attention has been paid to the relation between daily affect and sleep, as most prior studies have focused instead on the role of pathological mood in the context of sleep disturbance. However, understanding the transaction between normal variations in emotional experiences and sleep can shed light on the premorbid vulnerabilities that trigger the evolution of affect and sleep into more problematic states. The present study used a two-week daily sampling approach to examine the impact of day-to-day variations in positive and negative affect on nightly self-reported sleep onset latency, sleep duration, and sleep quality in a sample of young women. Hierarchical linear modeling revealed temporal relations between positive and negative affect states and sleep parameters. Specifically, different aspects of both positive and negative affect were uniquely predictive of sleep indices, with sadness and serenity acting as the most consistent predictors. Additionally, better sleep quality was predictive of greater happiness the following day. These results highlight the importance of how our daily emotional experiences influence our nightly sleep and, in turn, how our sleep has an impact on our daily affect. Moreover, our findings may offer insight into the progression of normative levels of affect and sleep as they develop into comorbid depression, anxiety, and insomnia.
Bipolar disorder (BD) is a common, severe mental disorder with a high recurrence rate. Lithium (Li) is the cornerstone of BD treatments to reduce recurrence, suicide, and mortality risks. However, only 30% of patients treated with Li achieve complete remission, and few markers of the response to treatment have yet been identified for application in routine practice. Circadian biomarkers may be relevant predictors of individual responses to Li because (1) Li has been shown to affect circadian rhythms, (2) disrupted circadian rhythms are a core expression of susceptibility to BD, and (3) circadian abnormalities during euthymia are associated with relapses.
Study Objectives: To prospectively assess sleep reactivity as a diathesis of insomnia, and to delineate the interaction between this diathesis and naturalistic stress in the development of insomnia among normal sleepers.
Design: Longitudinal.
Setting: Community-based.
Participants: 2316 adults from the Evolution of Pathways to Insomnia Cohort (EPIC) with no history of insomnia or depression (46.8 ± 13.2 y; 60 % female).
Interventions: None.
Measurements and Results: Participants reported the number of stressful events they encountered at baseline (Time 1), as well as the level of cognitive intrusion they experienced in response to each stressor. Stressful events (OR = 1.13; p < .01) and stress-induced cognitive intrusion (OR = 1.61; p < .01) were significant predictors of risk for insomnia one year hence (Time 2). Intrusion mediated the effects of stressful events on risk for insomnia (p < .05). Trait sleep reactivity significantly increased risk for insomnia (OR = 1.78; p < .01). Further, sleep reactivity moderated the effects of stress-induced intrusion (p < .05), such that the risk for insomnia as a function of intrusion was significantly higher in individuals with high sleep reactivity. Trait sleep reactivity also constituted a significant risk for depression (OR = 1.67; p < .01) two years later (Time 3). Insomnia at Time 2 significantly mediated this effect (p < .05).
Conclusions: This study suggests that premorbid sleep reactivity is a significant risk factor for incident insomnia, and that it triggers insomnia by exacerbating the effects of stress-induced intrusion. Sleep reactivity is also a precipitant of depression, as mediated by insomnia. These findings support the stress-diathesis model of insomnia, while highlighting sleep reactivity as an important diathesis.
Introduction
Findings from actigraphic studies suggesting that sleep and circadian rhythms are disrupted in bipolar disorder (BD) patients have been undermined by methodological heterogeneity and the failure to adequately address potential confounders.
Method
Twenty-six euthymic BD cases and 29 healthy controls (HC), recruited from University Paris-Est and matched for age and gender, were compared on subjective (Pittsburgh Sleep Questionnaire Inventory; PQSI) and objective (mean scores and variability in actigraphy) measures of sleep as recorded by over 21 consecutive days.
Results
Multivariate generalized linear modelling (GLM) revealed significant differences between BD cases and HC for five PSQI items (total score and four subscales), four actigraphy variables (mean scores) and five actigraphy variability measures. Backward stepwise linear regression (BSLR) indicated that a combination of four variables (mean sleep duration, mean sleep latency, variability of the fragmentation index over 21 days, and mean score on PSQI daytime dysfunction sub-scale) correctly classified 89% of study participants as cases or controls (Chi-square=39.81; df=6; p=0.001).
Limitations
The sample size (although larger than most actigraphy studies) and incomplete matching of cases and controls may have influenced our findings. It was not possible to control for potential effects of psychotropic medication or differences in employment status between groups.
Conclusions
When potential confounders of sleep and circadian profiles are adequately taken into account (particularly age, gender, daytime sleepiness, mood symptoms, body mass index, and risk of sleep apnoea), a selected subset of quantitative (mean scores) and qualitative (variability) features differentiated euthymic BD cases from HC.
How emotions interact with cognitive processes has been a topic of growing interest in the last decades, as well as studies investigating the role of sleep in cognition. We review here evidence showing that sleep and emotions entertain privileged relationships. The literature indicates that exposure to stressful and emotional experiences can induce changes in the post-exposure sleep architecture, whereas emotional disturbances are likely to develop following sleep alterations. In addition, post-training sleep appears particularly beneficial for the consolidation of intrinsically emotional memories, suggesting that emotions modulate the off-line brain activity patterns subtending memory consolidation processes. Conversely, sleep contributes unbinding core memories from their affective blanket and removing the latter, eventually participating to habituation processes and reducing aversive reactions to stressful stimuli. Taken together, these data suggest that sleep plays an important role in the regulation and processing of emotions, which highlight its crucial influence on human's abilities to manage and respond to emotional information.
Bipolar disorder (BD) is a severe chronic multifactorial disease that requires maintenance therapy with mood stabilizers (MS). Even with medications, the rate of response among patients with BD is low and the risk of relapse is high. Therefore, in this context of the urgent need for reliable and reproducible predictors of individual responses to MS, pharmacogenetics research is expected to provide helpful progress. Most pharmacogenetic studies of MS have focused on the response to lithium with several good putative candidate genes but informative results are sparse. There have been few studies on valproate, lamotrigine or atypical antipsychotics. Overall, the results of pharmacogenomics studies have not provided sufficient data to change daily practices in BD significantly and further investigation is warranted to identify highly relevant genetic predictors of response their roles. Although progress still remains to be made, the clinical assessment of a subject including the identification of specific individual phenotypic and pharmacogenetic characteristics is likely to become a powerful instrument for the development of personalized therapies.
The goal of this article is to provide a review of the literature on conceptual aspects and measurement of emotional reactivity, and to propose a new measurement of emotional reactivity that addresses the problems identified in the review. We discussed the Behavioral Inhibition/Behavioral Activation (BIS/BAS) scale, the Early Adolescence Temperament Questionnaire (EATQ), the Affect Intensity Measure (AIM), the Emotion Intensity Scale (EIS), and the Emotional Reactivity Scale (ERS). Our review concluded that most of the scales are either too broad (BIS/BAS, EATQ), or too narrow (EIS, AIM). Moreover, ERS, which does not suffer from this problem, does not include valence and it was mainly validated with adolescents. We therefore introduced a new scale–the Perth Emotional Reactivity Scale (PERS)–which overcomes the identified problems. PERS is guided by the tripartite model of emotional reactivity (activation, intensity and duration) and it also includes valence (positive and negative emotions). It contains 5 positive valence items and 5 negative valence items in each dimension. Thus, it contains 30 items. Moreover, PERS includes three non-scorable items to measure subjective report of physiological changes. We conclude that PERS might prove to be a useful tool to assess emotional reactivity more precisely.
Insomnia is prevalent, severe and partially heritable. Unfortunately, its neuronal correlates remain enigmatic, hampering the development of mechanistic models and rational treatments. Consistently reported impairments concern fragmented sleep, hyper-arousal and executive dysfunction. Because fronto-striatal networks could well play a role in sleep, arousal regulation and executive functioning, the present series of studies used an executive task to evaluate fronto-striatal functioning in disturbed sleep. Patients with insomnia showed reduced recruitment of the head of the left caudate nucleus during executive functioning, which was not secondary to altered performance or baseline perfusion. Individual differences in caudate recruitment were associated with hyper-arousal severity. Seed-based functional connectivity analysis suggested that attenuated input from a projecting orbitofrontal area with reduced grey matter density contributes to altered caudate recruitment in patients with insomnia. Attenuated caudate recruitment persisted after successful treatment of insomnia, warranting evaluation as a potential vulnerability trait. A similar selective reduction in caudate recruitment could be elicited in participants without sleep complaints by slow-wave sleep fragmentation, providing a model to facilitate investigation of the causes and consequences of insomnia.
The diagnosis of insomnia is based solely on subjective complaints. This has contributed to the low reliability and validity of the current nosology of insomnia as well as to its lack of firm association with clinically relevant outcomes such as cardiometabolic and neurocognitive morbidity. We review evidence that insomnia with objective short sleep duration is associated with physiological hyperarousal, higher risk for hypertension, diabetes, neurocognitive impairment, and mortality as well as with a persistent course. It also appears that objective short sleep duration in poor sleepers is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of physiological hyperarousal or medical complications. Thus, short sleep duration in insomnia may be a reliable marker of the biological severity and medical impact of the disorder. We propose that (a) objective measures of sleep be included in the diagnosis of insomnia and its subtypes, (b) objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment and diagnosis of insomnia in a clinician's office setting, and (c) insomnia with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.
There is growing recognition that bipolar disorder (BPD) has a spectrum of expression that is substantially more common than the 1% BP-I prevalence traditionally found in population surveys.
To estimate the prevalence, correlates, and treatment patterns of bipolar spectrum disorder in the US population.
Direct interviews.
Households in the continental United States.
A nationally representative sample of 9282 English-speaking adults (aged >or=18 years).
Version 3.0 of the World Health Organization's Composite International Diagnostic Interview, a fully structured lay-administered diagnostic interview, was used to assess DSM-IV lifetime and 12-month Axis I disorders. Subthreshold BPD was defined as recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania. Indicators of clinical severity included age at onset, chronicity, symptom severity, role impairment, comorbidity, and treatment.
Lifetime (and 12-month) prevalence estimates are 1.0% (0.6%) for BP-I, 1.1% (0.8%) for BP-II, and 2.4% (1.4%) for subthreshold BPD. Most respondents with threshold and subthreshold BPD had lifetime comorbidity with other Axis I disorders, particularly anxiety disorders. Clinical severity and role impairment are greater for threshold than for subthreshold BPD and for BP-II than for BP-I episodes of major depression, but subthreshold cases still have moderate to severe clinical severity and role impairment. Although most people with BPD receive lifetime professional treatment for emotional problems, use of antimanic medication is uncommon, especially in general medical settings.
This study presents the first prevalence estimates of the BPD spectrum in a probability sample of the United States. Subthreshold BPD is common, clinically significant, and underdetected in treatment settings. Inappropriate treatment of BPD is a serious problem in the US population. Explicit criteria are needed to define subthreshold BPD for future clinical and research purposes.
Anterior cingulate cortex (ACC) is a part of the brain's limbic system. Classically, this region has been related to affect, on the basis of lesion studies in humans and in animals. In the late 1980s, neuroimaging research indicated that ACC was active in many studies of cognition. The findings from EEG studies of a focal area of negativity in scalp electrodes following an error response led to the idea that ACC might be the brain's error detection and correction device. In this article, these various findings are reviewed in relation to the idea that ACC is a part of a circuit involved in a form of attention that serves to regulate both cognitive and emotional processing. Neuroimaging studies showing that separate areas of ACC are involved in cognition and emotion are discussed and related to results showing that the error negativity is influenced by affect and motivation. In addition, the development of the emotional and cognitive roles of ACC are discussed, and how the success of this regulation in controlling responses might be correlated with cingulate size. Finally, some theories are considered about how the different subdivisions of ACC might interact with other cortical structures as a part of the circuits involved in the regulation of mental and emotional activity.
Impairments in the identification of facial and vocal emotional expression were demonstrated in a group of patients with ventral frontal lobe damage who had socially inappropriate behaviour. The expression identification impairments could occur independently of perceptual impairments in facial recognition, voice discrimination, or environmental sound recognition. The face and voice expression problems did not necessarily occur together in the same patients, providing an indication of separate processing. Poor performance on both expression tests was correlated with the degree of alteration of emotional experience reported by the patients. There was also a strong positive correlation between the degree of altered emotional experience and the severity of the behavioural problems (e.g. disinhibition) found in these patients. A comparison group of patients with brain damage outside the ventral frontal lobe region, without these behavioural problems, was unimpaired on the face expression identification test, was significantly less impaired at vocal expression identification and reported little subjective emotional change. The expression identification deficits in ventral frontal patients may contribute to the abnormal behaviour seen after frontal lesions, and have implications for rehabilitation.
Study Objectives: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates. Design: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail. Measurements and Results: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors. Conclusions: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.
Insomnia and depression are highly comorbid conditions that show a complex, bidirectional relationship. This study examined whether cognitive-behavioral therapy for insomnia (CBT-I) delivered by a therapist compared with self-help CBT-I (written materials only) reduces insomnia and depression severity in individuals with comorbid insomnia and depression. A total of 41 participants (18-64 years; 25 females) with comorbid depression and insomnia, treated with antidepressants for at least 6 weeks,