Associations of sleep and emotion regulation processes in childhood and adolescence - a systematic review, report of methodological challenges and future directions

Abstract

Sleep and emotions are closely associated; however, the methodological challenges in the examination of sleep and the processes of emotion regulation in children and adolescents have not been investigated so far. Additionally, there is the demand to identify the levels of emotion regulating processes in which problematic or restricted sleep causes effect. Experimental sleep deprivation as well as prevalent sleep problems have been found to have negative influence on mental health and regulating functions. This review focuses first on the methodological protocols of the included studies. Subsequently, the results are summarized in the context of a multilevel model of emotion regulation. Thereafter, suggestions for future directions are given. Sleep problems and sleep deprivation are associated with a decrease of functional emotion regulating behavior and impaired emotion generation, and prolonged sleep enhances better mood and affect states, positive emotion expression, and faster sensory processing in response to emotional stimuli. This literature review highlights the limitations in current research, focusing on types of measurements, task characteristics, and data analysis. At the conclusion, suggestions are given for the future research direction in the field of sleep and emotion regulation in children and adolescents.

Full text

Sleep Sci. 2022;15(4):490-514
490 Sleep and emotion regulation in young people
w
Associations of sleep and emotion regulation processes in childhood
and adolescence - a systematic review, report of methodological
challenges and future directions
REVIEWS
*Corresponding author:
Friederike Lollies
E-mail: friederike.lollies@uni-bielefeld.de
Received: May 28, 2021;
Accepted: November 3, 2021.
DOI: 10.5935/1984-0063.20220082
ABSTRACT
Sleep and emotions are closely associated; however, the methodological challenges in the
examination of sleep and the processes of emotion regulation in children and adolescents have
not been investigated so far. Additionally, there is the demand to identify the levels of emotion
regulating processes in which problematic or restricted sleep causes effect. Experimental sleep
deprivation as well as prevalent sleep problems have been found to have negative influence on
mental health and regulating functions. This review focuses first on the methodological protocols of
the included studies. Subsequently, the results are summarized in the context of a multilevel model
of emotion regulation. Thereafter, suggestions for future directions are given. Sleep problems and
sleep deprivation are associated with a decrease of functional emotion regulating behavior and
impaired emotion generation, and prolonged sleep enhances better mood and affect states, positive
emotion expression, and faster sensory processing in response to emotional stimuli. This literature
review highlights the limitations in current research, focusing on types of measurements, task
characteristics, and data analysis. At the conclusion, suggestions are given for the future research
direction in the field of sleep and emotion regulation in children and adolescents.
Keywords: Sleep; Sleep Deprivation; Emotions; Child; Emotional Regulation.
Friederike Lollies1*
Marisa Schnatschmidt1
Isabell Bihlmeier2
Jon Genuneit3
Tina In-Albnon4
Martin Holtmann5
Tanja Legenbauer5
Angelika Anita Schlarb1,2
1Bielefeld University, Faculty for Psychology
and Sports - Bielefeld - North Rhine
Westphalia - Germany.
2University of Tuebingen, Faculty of
Science, Clinical Psychology - Tuebingen -
Baden -Wuerttemberg - Germany.
3Leipzig University, Pediatric Epidemiology,
Department of Pediatrics, Medical Faculty -
Leipzig - Saxony - Germany.
4University of Koblenz-Landau, Clinical
Child and Adolescent Psychology and
Psychotherapy - Koblenz-Landau -
Rhineland Palatinate - Germany.
5Ruhr University Bochum, LWL -
University Hospital Hamm for Child and
Adolescent Psychiatry - Hamm - North
Rhine Westphalia - Germany.
Article published online: 2023-12-01

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INTRODUCTION
Problematic sleep and the risk for mental health
The relevance of sleep to emotional and affect regulating
processes has been well established1,2. This becomes even more
important, considering that about 15%-30% of children and
adolescents experience difficulties with sleep, characterized by
symptoms of insomnia such as sleep onset delay or prolonged
nocturnal awakenings, and poor sleep quality3,4. This high prevalence
is concerning, as the health risk associated with problematic sleep
includes the development of affective and emotional problems1,5,6,
and shortcomings in multiple domains of emotion regulation
functioning7,8. According to cross-sectional data, inadequate sleep
patterns seem to be associated with symptoms of childhood anxiety
and impulsivity9, higher levels of hyperactivity and more conduct
and peer problems10. It was also postulated that persistent sleep
problems in childhood predicted adulthood anxiety disorders and
affective dysregulation as long-term effects2,11. Furthermore, studies
following an experimental design have brought evidence for a direct
interconnectedness of sleep and emotion regulation processes;
when sleep of healthy people has been manipulated with nights
of sleep deprivation, evidence was found of more negative affect
states12,13, less positive mood, with more feelings of tension and
anxiety14, more symptoms of depression15, and less happiness16.
Whereas the enlightening of the associations between
sleep and emotion regulation in children and adolescents is
necessary to develop a better understanding about their impact
on developmental processes, investigation of these associations
is still challenging because emotion regulation is a broadly used
construct, whose operationalization as well as outcomes are
poorly defined17.
Emotion regulation - a multifaceted framework from
developmental perspective
The process model of emotion regulation by Gross
(1998)18 seems to be one of the most cited available theoretical
frameworks to understand emotion regulation19. Whereas
this well-established conceptualization of emotion regulation
primarily focuses on intrinsic emotional response modifying
processes to accomplish the individual goals, developmental
aspects of emotion and affect regulation, as children’s social
interaction with others are left out of consideration20. Especially
developmental research favored a multilevel definition of
emotion regulation, including different dimensions of regulation
processes21, considering the intrapersonal, as well as social
aspects of emotion regulation22. Within this conceptualization
emotion regulation is considered as an adaptive system including
physiological, attentional, emotional, behavioral, cognitive, and
interpersonal levels22,23. However, the question of “what is
regulated” per level remains open24. A multifaceted systemic
scheme organizes the umbrella term of emotion regulation into
a structured framework with an encompassing range of concrete
objectives related to different levels of emotion regulation24 (see
Table 1).
Table 1. Summary of levels of emotion regulation (Calkins and Fox,
2002)22 and related process objectives (Thompson, 1994)24.
Emotion regulation level Emotion regulation processes/objectives
Physiological level • Regulation of reactions of the nervous system
• Regulation of arousal through, e.g. response
inhibition
• Interpretation of biological cues related to
emotional arousal
Attentional level • Shifting/redirecting attention
• Behavioral distraction
• Speed of processing
Emotional level • Evaluation of positive or negative affect
• Regulation of upcoming tension
Behavioral level • Controlling the intensity of emotional reactions
with consideration of environmental demands
• Estimation and implementation of appropriate
behavioral reaction
• Fight or flight decision
Cognitive level • Cognitive coping
• Construal’s of emotionally arousing events
• Reattribution of emotional content
• Defense mechanisms
Interpersonal level • Interpersonal coping
• Estimation of emotional requirements of familiar
settings
• Selecting settings with which being emotional
comfortable
Within neurophysiological processes, the activity of
the nervous system to manage emotional arousal is central.
Regions of the temporal cortex, particularly the amygdala
is a key component of the cortical emotional processing25
known to show promptly responses of the nervous systems
to a manifold of arousing stimuli26,27. The competence of e.g.
inhibitory control over emotional arousal or executive cognitive
functioning, growths proportional to the progress of cortical
development28.
Governance of attentional processes is one of the first
attempt of emotion regulation expected to appear during infancy
and continues to be used in late adulthood29,30. Already young
children are able to escape from emotionally arousing events
through shifting their attention towards stimuli voluntarily to
reduce their emotional reactivity30. Those regulation strategies
of attention management become more complex with age and
involve the internal redirection of attention, as thinking positive
during distressing experience31 or behaviorally distraction32.
Measurement of these attentional processes in response to
emotional stimuli is somewhat difficult due to its internal
character, but reaction times, as well as measuring accuracy to
e.g. spatial cues with emotion eliciting content represent an
opportunity to objectivate attentional processing33.
Whereas regulation of attention towards emotion
eliciting events at young age can be governing extrinsic, e.g.,
through parental assistance, the intrinsic component of emotion
regulation is represented by constructs of emotionally arousing
events and emerge with age24. Such cognitive self-defense
mechanisms include rationalization as well as reappraisal, which
involves deliberately changing the way individual think about the
meaning of an emotionally arousing stimulus or situation32,34.

Sleep Sci. 2022;15(4):490-514
492 Sleep and emotion regulation in young people
Therefore, these mechanisms are expected to result in modified
personal causal attributions of affect and emotion arousing
events24.
Next, the encoding of biological emotional cues is also
an attempt to regulate emotional arousal. Biological indices for
an advanced affective state are increased heart, and breathing rate
or perspiration35,36. As an increased heart rate is the physiological
response towards an external stimulus37 the emotional response
of fear is the result of the perception process and an individual is
willing to assume that fleeing will be the appropriate behavioral
response38. Consequently, the interpretation of biological cues
regulates the behavioral response.
Additionally, the access to coping strategies is an
important facet of emotion regulation. When people believe
they possess sufficient resources to cope with stressors, they
experience a challenge response associated with positive
outcomes such as mastering a challenging situation or feeling
resilient39. In contrast, when situational demands are perceived
as exceeding resources, individuals experience threat resulting in
e.g. impairment of executive functioning and decision-making40.
In early childhood material coping, such as playing with a favorite
toy or listen to a radio play, as well as interpersonal coping
mechanisms such as seeking (physical) proximity to caregivers
under stressful situations, is common41. With increasing age,
interpersonal coping becomes superior, e.g. peers are sought
out for their expected emotional support42. Subsequently,
individuals create their everyday life interactions, as well as their
environmental life-style setting, as social relationships, work-
place, family, memberships, etc., in accordance to their self-
perceived needs, including emotional demands which is valued
as comfortable and manageable43.
Finally, the process of choosing a functional expression
of emotion means generating an appropriate behavioral
reaction representing the individually perceived emotional
arousal. For example, a careful analysis of the emotions of all
parties involved in a peer conflict, combined with an insight
into the negative interpersonal consequences of anger and
aggression, may help a person to find a satisfactory way out of
this challenging situation by trying to get others to support him
or her and protest together against an unjust state of affairs
instead of blindly lashing out in anger24.
The gap in methodological discussion
Recently, a variety of subjective and objective
measurements was used in studies to assess the association of
sleep and emotion regulation. In addition, different paradigms
with stimuli that address affect and emotion, such as separation
scenarios or puzzle tasks, emotional images or faces, have been
implemented to assess how sleep influences children’s and
adolescents’ responses to those stimuli in an objective manner.
These reviews addressing sleep and emotion regulation processes
in children have focused on sleep and psychopathological
symptoms6, or on general consequences of sleep loss44. Of
course, there are reviews investigating the association of sleep
and emotion in adults1,2,45. These have concentrated on sleep
effects on individual constructs of emotion, e.g. social emotion2.
One integrative review concerned sleep effects on levels of
emotion regulation in adults1, but a methodological discussion
component was lacking. Especially this discussion is important,
because differences in methods can cause different results.
In sum, the question remains open2 about the influences
of sleep manipulation or sleep problems on different constructs
of a multifaceted concept that represents emotion regulation
processes for a young population, as well as the questions of
methodological challenges to evaluate the association of sleep
and emotion regulation. The present review has been initiated to
fill this gap and, it is intended to be a practical, methodological
assistance to researchers when planning and analyzing future
research on the association of particular levels of emotion
regulation processes and sleep in children and adolescents.
OBJECTIVES AND METHODS
The primary goal of this review was to initiate a
systematic review focusing on the methodological protocols,
thus involving different paradigms and designs of the current
literature investigating the effect of sleep on levels of emotion
regulation processes in children and adolescents. In detail,
we began by systematically reviewing the sleep and emotion
literature, including their subjective and objective outcome
measures, as well as experimental tasks and their longitudinal
and cross-sectional designs. Secondly, the results of the
investigation are summarized and discussed in the context of the
introduced processes of emotion regulation24. Additionally, key
methodological limitations are discussed. This review concludes
by suggesting some future directions for further research.
Criteria of study selection
Inclusion and exclusion criteria are based on the
recommendation of the preferred reporting items for systematic
reviews and meta-analysis (PRISMA) statement46 (see Table 2).
It should be noted, that this systematic search was not restricted
to a particular study design, due to our aim to figure out the
complexity as well as the heterogeneity while investigating the
association of sleep and emotion regulation.
Regarding the chosen outcome measure of emotion
regulation processes, we attempt to outline differences in
assessment and study results through the span from early
childhood to adolescence. Because data assessment of infants
or toddler’s emotion regulation includes usually subjective,
parental report, objective measures are more common in older
children and adolescents47. Therefore, we did not restrain
our search to studies including either subjective or objective
methods. Furthermore, different regulation processes are
assessed differently, a constraint to certain methods, such
as emotional tasks making use of emotional stimuli or stress
inducing paradigms, would lead to fail the aim of the present
review.
Additionally, to enlighten the influence of distinct
assessment and parameters of sleep on the outcome measure
of emotion regulation, the authors decided to include papers

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Table 2. Inclusion and exclusion criteria according to the PRISMA
recommendation.
Inclusion criteria
Study characteristics - Articles were available via the chosen
databases
- Unpublished studies were included if they
are available
- Written in English
- The title, abstract or keywords contained
the listed search terms
Types of studies - Experimental studies
- Correlation studies
- Data gathering based on parental, teacher
or self-report
- Objective and subjective measurement of
sleep
Participants - Families with healthy and normally
developed children
- Adolescent persons
- 0-18 years of age
- Participants are in normal physical and
psychological health and without medication
- Participants suffer from problematic sleep
Types of intervention - Trials investigating the effect of
experimentally induced sleep restriction or
scheduled sleep manipulation
- Cross-sectional and longitudinal
Types of outcome measures - Sleep duration, quality, efficiency
- Temperament, mood, emotional-
responses, knowledge, problems,
functioning, regulation
Exclusion criteria
Types of studies - Studies of sleep restriction omitting the
investigation of emotional components
- Studies, that are no longer publicly
available and there was no response from
the corresponding authors
Types of publication - Book chapters, commentaries and reviews
Participants - Studies with samples of participants older
than 18 years of age
- Samples with diagnosed psychological
disorders, chronically diagnosed illness, or
special medical circumstances
with subjective and objective assessment of sleep parameters
as sleep quality, efficiency and duration, as well as experimental
sleep manipulation as nap deprivation in toddlers and night sleep
deprivation in older children and adolescents.
Strategy of search and sources of literature
A systematic literature search according to the
recommendations of Moher et al. (2009)46 was conducted
using the electronic databases considered appropriate for health
and psychology. MEDLINE, PsychINFO, PsycARTICLES,
PSYNDEX, and Google Scholar were chosen databases.
Publications up to beginning of May 2021 were included. Keywords
representing the part of sleep were “sleep”, “sleep deprivation”,
“shortened sleep”, “sleep duration”, “sleep disturbances”, “sleep
problems”, “sleep disorder”, and “insomnia”. Search terms for
emotion regulation were “emotion”, “regulation”, and “affect”.
To complete the search formula “toddler”, “children” and
“adolescent” were added to represent the relevant age groups.
Search terms were combined by the Boolean operators OR and
AND. Titles, abstracts, and keywords were checked to ensure
that only articles dealing with the specific terms were included.
Additionally, we reviewed lists of suggestions from the search
engines, and articles included in the references of the chosen
documents were reviewed for their relevance.
Collection process and study information management
One author (FL) screened titles and abstracts of possible
research papers. As a second stage, studies were evaluated for
their eligibility according to the inclusion criteria by two authors
(FL, MS, process was supervised by AS). The whole paper was
read and information was collected in accordance with Bonvanie
et al. (2017)48. This structure contains: 1) aim and study designs,
2) sample characteristics, 3) details of the study, 4) outcome
measures, and 5) results. Figure 1 provides the flowchart of the
literature search and selection process. The resulting 32 papers
were organized to their measurement to assess emotion related
processes in combination with and without experimental sleep
manipulation, as well as to their longitudinal character. The
papers are summarized in Table 3.
Figure 1. Summary of literature search and selection process.
It should be mentioned, that during the literature
collection and selection process it was conspicuous, that almost
95% of the originally 814 studies were rejected because they
were not eligible for the review. Reasons for that high rejection
rate were, e.g., that despite defining a young population without
appreciable health related limitations in the search formula, also
a great number of studies with adults and participants suffering

Sleep Sci. 2022;15(4):490-514
494 Sleep and emotion regulation in young people
Table 3. Summary of studies included to the review.
Author Subjects
N (Mage in years)
Design Task Stimuli Measures Sleep Measures Result
1 Bastien et al.
(2019)85
82 (2.1) Longitudinal - - Toddler behavior assessment
questionnaire.
Actigraphy. Shorter nighttime sleep duration
and lower sleep efficiency at the
age of 2 years predicted more
anger at 3 years. Higher rates of
social fear at 2 years predicted
shorter day- and nighttime sleep
duration at 3 years.
2 Baum et al.
(2014)69
50 (15.5) Between-subjects.
SR: 6.5hrs of sleep
SE: 10hrs of sleep
for 4 nights.
- - Vanderbilt assessment scale,
Emotion control subscale of
the behavior rating inventory of
executive functioning, POMS.
Sleep diary, actigraphy. SR predicted increased levels
of tension and anxiety,
oppositionality, and less emotion
regulation.
Mood dimensions deteriorate,
except depressive mood.
3 Bayes and
Bullock
(2020)79
114 (8.4) Cross-sectional - - Conner’s behavior rating scale. Sleep disorders inventory for
students-children and adolescents.
Sleep problems seem to be
moderately associated to
emotional distress, aggressive
behavior, and impulsivity/
hyperactivity
4 Berger et al.
(2012)62
10 (2.8) Within-subjects.
Afternoon nap
deprivation.
Affective
response task.
Unsolvable
puzzle task.
11 emotional
images (5 positive,
3 neutral, 3
negative).
Incorrect piece in
the puzzle.
Behavioral rating. Sleep diary, CSHQ, actigraphy. ND predicted significant more
negative/less positive affect to
emotional images, and duration
of emotional responses during
the puzzle is affected by ND.
5 Bolinger et al.
(2018)49
16 (9,3) Within-subjects. Encoding and
recognition
task.
444 emotional
images of the
IAPS.
PANAS, LPP, HRD. Stanford sleepiness scale, PSG. After nocturnal sleep, emotional
responses that are automatic as
HRD increase, and cognitive
emotional responses as
subjective behavioral ratings
and neurological activity LPP
decreased.
6 Cho et al.
(2017)60
123 (2.0) Longitudinal A 5 min
version of
laboratory
temperament
assessment
battery. Snack
delay task.
6 laboratory
episodes
Puppet show
Clown interaction
Stranger approach
Stranger working
Spider
Robot
Behavioral ratings, ITSEA, and
ECG.
Sleep diary. Longer sleep duration predicted
fewer internalizing symptoms in
children showing a higher RSA.
7Cremone et
al. (2017)52
43 (4.6) Between-subjects Dot-probe
task.
32 happy/neutral
and angry/neutral
face pairs on a
screen.
Trial: xation
(500ms), stimuli
presentation
(1000ms), probe
(1100ms).
Accuracy and reaction times. PSG measures. No emotional attention bias
following N.
ND exhibit bias to negative and
positive stimuli.
Greater SWA during N predicted
faster responding to emotional
stimuli.
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Lollies F, et al.
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Author Subjects
N (Mage in years)
Design Task Stimuli Measures Measures-Sleep Result
8 Dagys et al.
(2012)68
47 (13.1) Within-subjects.
SR: 2hrs of sleep
SE: 8.5hrs of sleep
for 2 nights.
- - PANAS-C, children’s
morningness-eveningness
preferences scale.
Duke structured interview
for sleep disorder, sleep diary,
actigraphy.
SE predicted more positive affect,
positivity.
No difference concerning
negative affect between SE and
SR.
Evening as well as morning
chronotypes displayed less
positive affect after SR.
9 DeLeon and
Karraker
(2007)65
41 (0.7) Cross-sectional - - Revised infant temperament
questionnaire, Infant/Toddler
symptom checklist.
Infant care diary. Rhythmic and adaptable infants
took longer naps and slept more
at night.
Distractible children took shorter
and more frequent naps.
11 Foley and
Weinraub
(2017)82
1057 Longitudinal.
Assessment took
place at the age of
54 months in grade
1, 3, and 5.
- - Generated questionnaire for
feelings, risky behavior and
emotional regulation.
Child behavior checklist.
Children’s depression inventory.
CBCL. Early sleep problems predicted
anxious-depressed symptoms in
the middle childhood, a higher
rate of emotional reactivity in the
preadolescence.
Gender differences in temporal
development of sleep and
emotion problems exist.
12 Gregory and
O’Connor
(2002)81
490
Assessments
from 3 to
15 years of
age.
Longitudinal - - CBCL. CBCL. Early sleep problems at 4y
predicted depression/anxiety,
attention problems, and
aggression in adolescent age
No evidence of early depression/
anxiety symptoms predicting later
sleep problems.
13 Gruber et al.
(2012)77
33 (8.6) Within-subjects.
SR/SE: 1hr later/
earlier to bed for 5
nights.
- - Connors’ global index-teacher. SE predicted significant lower
emotional lability and restless-
impulsivity.
14 Gruber et al.
(2020)80
122 (8.6) Cross-sectional - - CBCL. CSHQ, actigraphy. Children scored above the
cut-off of the CSHQ had more
emotional problems.
Data is in consent with the
subjective sleep data.
Table 3. Summary of studies included to the review.
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496 Sleep and emotion regulation in young people
Author Subjects
N (Mage in years)
Design Task Stimuli Measures Measures-Sleep Result
15 Han (2014)66 14 (4.8) Within-subjects.
Afternoon nap
deprivation.
Affective
response task.
34 emotional
images with
appropriate
auditory stimuli
(8 strong negative
and positive, 8
weak positive and
negative).
Trial: 11s,
fixation (2s),
cue to attention
(2s), stimuli
presentation (7s).
fEMG. Sleep diary, actigraphy. ND predicted greater emotional
responses to strong negative
and positive stimuli. No change
in affective responses to weak
stimuli. Emotional responses to
emotional pictures were lower
after the N.
16 Kouros and
El-Sheik
(2015)72
142 (10.7) Cross-sectional - - Daily mood report, Personality
inventory for children.
Actigraphy. Sleep latency, efficiency, mood
and behavioral problems were
found to be interconnected
significantly.
17 Lo et al.
(2016)55
56 (16.6) Between-subjects.
SR: 5hrs of sleep
SE: 9hrs of sleep
for 7 nights.
- - PANAS. Karolinska sleepiness scale,
Pittsburgh sleep quality index,
actigraphy, PSG.
SR predicted a decrease of
positive affect with a lowest point
at the last day of sleep restriction.
No significant change of negative
mood through sleep restriction.
18 McMakin et
al. (2016)67
48 (13.3)
16 (14.5)
Within subjects.
SR to 4hrs of sleep
for 2 nights
SR to 6hrs of sleep
on 1 night, and 2hrs
of sleep on the
second night.
SE: 10hrs of
nocturnal sleep.
Peer conflict
task.
Auditory
valence
identification
task.
Affective
response task.
Individual real-life
disagreements. 42
emotion eliciting
sound clips (14
positives, negative,
neutral).
Trial: 15s,
orientation
(1s), stimuli
presentation (6s),
rating interval (8s).
Behavioral rating, accuracy,
reaction times, pupillography and
by subjective self-report.
PSG SR predicted more self-reported
and objective measured negative
affect.
SR predicted less positive affect
in study 1, not in study 2.
Negative affective behavior was
significant higher after sleep
restriction.
19 Miller et al.
(2015)61
12 (2.8) Within-subjects.
Afternoon nap
deprivation.
Unsolvable
puzzle.
Incorrect piece in
the puzzle.
Rating observation. Sleep diary, CSHQ, actigraphy. ND predicted less skepticism,
and negative self-appraisal.
ND predicted more physical
self-soothing, perseveration, and
tenancy.
20 Raynolds
(2017)73
20 (15.7) Within-subjects.
SE: 1hr earlier to
bed for 5 nights.
Online social
interaction task.
Paced auditory
serial addition
task.
Getting to know
an unknown
person.
Fast calculating.
Daily mood questionnaire.
The self-assessment Manikin.
Computer based linguistic
inquiry and word count, facial
expressions valence.
Sleep diary, actigraphy. SE predicted more negative facial
expression and higher levels of
facial expression variability.
No change in emotional language,
subjective report of emotion
regulation, persistence or task
performance.
Table 3. Summary of studies included to the review.
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Lollies F, et al.
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Author Subjects
N (Mage in years)
Design Task Stimuli Measures Measures-Sleep Result
21 Reddy et al.
(2017)57
42 (14.8) Between-subjects.
SR: 2hrs later to
bed.
SE: 9.5hrs in bed.
Emotion
reactivity and
regulation task.
40 emotional
images (8 positive
and neutral, 24
negative).
Trial: 18s,
10s stimulus
presentation, 8s
rating interval.
PANAS, State-trait anxiety
inventory for children. Emotional
reactivity and ER was assessed
by subjective valence, intensity/
arousal, and reappraisal ratings.
Epworth’s sleepiness scale,
BEARS sleep screen, sleep diary,
actigraphy.
SR predicts subjective decrease
of positive affect and increase of
state and trait anxiety.
No change in emotional reactivity
and regulation.
22 Ross and
Karraker
(1999)63
40 (1.3) Between subjects.
20 subjects were
assessed before
The other 20
subjects were
assessed after their
regular nap.
Rieser-Danner’s
plexiglas barrier
task.
Parts of the
Laboratory
temperament
assessment
battery.
Ainsworth’s
strange
situation
procedure.
5 Stressing
episodes,
Toys in jar,
Remote-controlled
toy approach,
Maternal
separation,
Attractive toy,
Mother busy.
Behavioral rating.
Infant behavior questionnaire.
- Fatigue sensitizes infants to
certain stressors instead of
simply increasing irritability and
interferes with infants’ coping
responses.
Exhausted children exhibited
a higher degree of fatigue
frustration.
23 Rubens et al.
(2017)78
285
Assessments
from 3rd to
5th grade
Longitudinal - - Children’s emotion management
scales,
Pediatric anxiety scale of the
patient-reported outcomes
measurement Information
system,
Short mood and feelings
questionnaire, Affective reactivity
index,
Self-report scale for deviant
behavior,
Self-reported reactive/proactive
social behavior.
Sleep quality was assessed by
subjective 4-item child self-report
scale.
Better sleep quality predicted
lower self-reported emotional and
behavioral problems.
Regarding gender effects girls
scored higher on the anxiety
scale and lower on irritability,
delinquency engagement and
reactive aggression.
24 Saenz et al.
(2015)84
47 (1.6) Longitudinal - - BITSEA. Sleep diary, actigraphy. In girls, shorter sleep duration at
the age of 3 months predicted
significant more externalizing
problems at the age of 18
months.
25 Schumacher
et al. (2017)53
19 (3.8) Between-subjects.
SR: 3hrs later to bed
for 1 night.
A go/no-go
task.
Unsolvable
puzzle.
No-go trial (pig).
Incorrect piece in
the puzzle.
Accuracy, rating observers. Sleep diary, actigraphy. No significant effects of sleep
restriction on response inhibition
or self-regulation.
Interaction effect of response
inhibition and sleep condition
on adaptive self-regulation and
maladaptive self-regulation.
Table 3. Summary of studies included to the review.
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Sleep Sci. 2022;15(4):490-514
498 Sleep and emotion regulation in young people
Author Subjects
N (Mage in years)
Design Task Stimuli Measures Measures-Sleep Result
26 Settineri et al.
(2010)71
529 (17.1) Cross-sectional - - Mood was assessed by subjective
measurement with an 8-item
scale.
TST, napping and sleepiness
was assessed by subjective
measurement with a 4-item scale.
Well-being at awakening had a
negative correlation with sadness,
apathy, anhedonia, and pessimistic
thoughts.
Well-being at awakening was
positively correlated with TST,
negatively with afternoon naps
and daytime drowsiness.
27 Short and
Louca
(2015)70
12 (16.2) within-subjects.
SR: 36hrs of
wakefulness
- - POMS - short form. Sleep diary, Karolinska sleepiness
scale, actigraphy, PSG.
Dimensions of mood significantly
deteriorate during a night of sleep
restriction.
Increased anxiety in females but
not in male participants after sleep
restriction.
Only girls reported an increase of
depressive mood in response to SR.
28 Soffer-Dudek
et al. (2011)56
94 (10.5
at the 1st
assessment)
Longitudinal Balloons task. Faces on balloons
showing different
emotional
expressions.
Accuracy on judgments. Sleep diary, actigraphy. More night awakenings predicted
less task performance on the
face-emotion processing task.
29 Troxel et al.
(2013)76
776
Assessments
at 1, 6, 24,
and 36, and
54 months.
Longitudinal - Neutral parent-child
interaction at home
was videotaped for
15 minutes during
the visit.
Negative emotionality was
behavioral rated by researcher.
CBCL-parent and teacher version. Early sleep problems and negative
emotionality predicted later
internalizing behavior.
30 Vaughn et al.
(2015)58
62 (4.1) Cross-sectional Denham’s
emotion
knowledge
task.
Faces showing
different emotional
expressions.
Emotional knowledge was rated
on the documented subjects’
ratings during the task.
Sleep diary, actigraphy. Sleep duration had positive
correlations with emotional
knowledge.
31 Vriend et al.
(2013)54
32 (9.8) Within-subjects.
1hr SE/SR for 4
nights.
Affective
response task.
33 emotional
images
Subjective affect rating on visual
analogue scales.
Child’s pictorial sleepiness
scale, CSHQ, Sleep evaluation
questionnaire,
Epworth sleepiness scale,
actigraphy.
SR predicted less positive affective
response and poorer parental
reported ER. No change in
negative affect responses or ER.
32 Wang et al.
(2019)83
1625
Assessments
from 5 to 17
years of age
Longitudinal - - Dysregulation profile of the
CBCL.
CBCL Persistent sleep problems,
measured over a span from five
to 17 years found to contribute
to a ten-time increased risk for
developing regulatory difficulties.
33 Weissbluth
(1981)64
60 (0.6) Cross-sectional - - Carey infant temperament
questionnaire.
Sleep interview. Significant negative correlations
between TST and mood,
adaptability, rhythmicity,
withdrawal, and persistence.
Children described as “difficult”
had shorter sleep duration than
“easy” children.
Abbreviations: Bedtime issues, Excessive daytime sleepiness, Night awakenings, Regularity and duration of sleep, Snoring (BEARS); (Brief) infant-toddler social emotional assessment (B)ITSEA); Child behavior checklist (CBCL);
Children’s sleep habits questionnaire (CSHQ); Electrocardiography (ECG); Emotion regulation (ER); Facial electromyography (fEMG); Heart rate deceleration (HRD); International affective picture system (IAPS); Late positive
potential (LPP); Napping (N); Nap deprivation (ND); Polysomnography (PSG); Positive and negative affect schedule (for children) (PANAS (-C); Profile of mood states (POMS); Respiratory sinus arrhythmia (RSA); Strengths and
difficulties questionnaire (SDQ); Sleep extension (SE); Sleep restriction (SR); Slow wave activity (SWA); Total sleep time (TST).
Table 3. Summary of studies included to the review.
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499
Lollies F, et al.
Sleep Sci. 2022;15(4):490-514
from chronical illness were found in the result pool of the
literature search process.
Missing data
If full-texts were missing, correspondence authors
were contacted once via mail and asked to provide the full text,
if those papers were not provided, they have been excluded
from further analysis in this review (n=2).
RESULTS
Effect of sleep on neurophysiological processes linked
to emotion regulation
In order to assess the effect of sleep on emotion
related neurophysiological activity researchers utilized EEG
measurement.
Cortical activity. Bolinger et al. (2018)49 were interested
in recordings of late positive potentials (LPP), which are
recognized to be a neurophysiological marker for emotion
regulation in children and is modulated by conscious cognitive
processes50. They assessed the processing and recognition
of neutral, as well as emotional visual stimuli. Two points of
assessment were planned in a sample of children; first, an
encoding phase included affective ratings of pictures with
emotional content, second the recognition phase took place ten
hours later, in the evening following encoding for the “no sleep”
condition, and on the next morning for the “sleep” condition.
The accuracy of recognition increased significantly after sleep.
Thus, sleep seemed to enhance stimuli processing in a way that
may preserve a person’s autonomic reactivity. It is striking, that
while be tested in the evening (no-sleep condition), participants
achieved better recognition accuracy to pictures with negative
emotional content compared to be tested after sleep.
Researcher also implemented facial emotional stimuli
to investigate the effect of napping on behavioural responses to
emotion eliciting stimuli in pre-school children51
.
Cremone et al.
(2017)52 utilized EEG recordings during a nap to assess the slow
wave activity (SWA) reflecting neocortical oscillations, which
contribute to emotional processing. During measurement of
attention bias to emotional stimuli, the allocation of attention
toward or away from emotional stimuli was assessed. Within the
task, children had to click on the right or left button of the
mouse to indicate the location of the stimulus as quickly and as
accurately as possible. In contrast to the findings in school-aged
children, accuracy and reaction times in pre-school children for
negative and positive affective stimuli did not differ between
the nap conditions. However, being tested before sleep was
associated to greater attention bias. There was not a significantly
difference for positive or negative trials. Furthermore, results
indicated a greater slow wave activity (SWA) while napping was
associated with a faster response to the stimuli.
Those results support the assumption that sleep seems
to enhance cortical activity, and cognitive processes in school-
aged children49, as well as the automatic direction of attention
in response to presentation of emotional stimuli in pre-school
children51. It would be very interesting to get more detailed
insight into discriminating power of the emotional category
of stimuli on neurophysiological reactions towards sleep
deprivation in children.
Effect of sleep on attentional processing linked to
emotion regulation
Whereas the effect of sleep on attentional regulation
processes as defined by Thompson (1994)24 were not assessed
in the included studies, measures as accuracy and speed of
attentional processing are summed up.
Response inhibition. In order to investigate the effect
of sleep on attentional processing, sleep deprived toddlers53,
children54, and adolescents55 were investigated on their response
inhibition. During a go/no-go task the subjects’ accuracy to
inhibit the button response in the case of the presented no-
go stimulus was assessed. No main effects of sleep deprivation
on response inhibition were reported after one night going to
bed three hours later than usual53 and after one hour of night
sleep extension or restriction54. Contrary to the findings in
children53,54, the reaction times and accuracy in discriminating
behaviour in adolescents deteriorated significantly after night
sleep deprivation and did not re-establish to the baseline
performance after two nights of recovery55.
An additional study looked for indication of the
effects of sleep quality on emotional information processing in
early adolescents56. To meet this goal, subjects had to respond
via mouse-click to gender or to particular positive and negative
emotions represented by faces on balloons which arose from
the bottom of a computer screen. More night awakenings and
lower sleep efficiency were found to predict only lower success
on the face-emotion task; accuracy in responses to gender
trials seemed to be unaffected. These results demonstrated that
emotion information processing change as a function of night
awakenings and sleep efficiency.
Effect of sleep on reasoning processes linked to emotion
regulation
Cognitive reappraisal and emotional reasoning. To assess the
relation between sleep restriction and reasoning processes in
response to emotion eliciting stimuli belonging to the IAPS,
Reddy et al. (2017)57 assessed adolescent’s cognitive reappraisal
techniques as distancing from the reality of the picture, thinking
about improvement, or creation of a positive explanation.
According to their results, one night of sleep deprivation had
no main-effect on adolescent’s ability generating reappraisal
statements as well as on their efficacy in regulating negative
emotions. Contrasting results were presented by another study
investigated the association of sleep parameter and emotional
reasoning58. During the Denham’s affect knowledge task,
children had to name and reason about emotion expressions
represented on images59. Whereas sleep latency and efficiency
had no significant correlation with emotion cause score, the
parameter of sleep duration had positive correlations with the
ability to reason about emotions58.

Sleep Sci. 2022;15(4):490-514
500 Sleep and emotion regulation in young people
Effect of sleep on biological cues linked to emotion
regulation
Evidence for associations between sleep and affect was
also found in physiological measures.
Heart rate. To assess the internal biological cues
of emotion regulation, Bolinger et al. (2018)49 recorded the
participants’ heart rate deceleration (HRD) in response to
emotion eliciting stimuli. In contrast to the already described
LPP, the HRD response to emotional stimuli decreased in the
case of wakefulness. Testing after night sleep led to an increase
in the HRD response to pictures with negative emotional
content, whereas the HRD seem to be unaffected in case of
neutral stimuli49.
Parasympathetic activity. Cho et al. (2017)60 investigated
the association between sleep duration and emotion regulation
problems in toddlers. To assess the regulation capacity, children
participated in a series of short, mildly stressing, social
interaction tasks. Parents reported their children’s regulatory
behavior responses and, for parasympathetic reactivity, the
respiratory sinus arrhythmia reactivity (RSA) was assessed. The
authors report evidence of increased RSA reactivity to any
interaction episodes, in combination with longer sleep duration
and less internalizing symptoms. Longer sleep duration predicted
fewer internalizing symptoms in children showing a higher RSA
reactivity to the fear-eliciting stimuli. Subjects with shorter sleep
durations showed decreased parasympathetic response, which is
associated with less capacity for regulation60.
Effect of sleep on coping processes linked to emotion
regulation
From research in nap deprived children, it was also
reported that toddlers react differently depending upon whether
they are sleepy or well-rested.
Self-regulation. To assess coping processes, children were
confronted with an age-appropriate, but unsolvable puzzle either
one hour after their habitual nap or one hour after the habitual
nap would normally have occurred (nap vs. nap deprivation)61,62.
One minute after all pieces, except the incorrect one, were
successfully placed, children were encouraged to finish. After
nap deprivation, perceived scepticism about the piece would
match, decreased. Physical self-soothing, as repetitive bodily-
directed behaviors, and focussing on the piece that would not fit,
thus perseverance and tenancy to complete increased after nap
deprivation. Additionally, negative self-appraisal, as discrediting
the competence to solve the puzzle in the unsolvable puzzle
task, and display of confusion to the challenging situation,
decreased after nap-deprivation61,62.
Another study found sleep deprivation had no direct
effects on self-regulation strategies in three years old children53.
Though, a mediating effect of response inhibition was assumed.
It was reported that children with better response inhibition
before sleep restriction were more likely to use adaptive self-
regulation strategies, while poor response inhibition predicted
increased use of maladaptive self-regulation strategies in
response to the unsolvable puzzle task after sleep restriction.
To examine the effect of fatigue on infants’ emotional
coping, visiting and assessment of children took place 1
hour after the infant’s regular nap would have occurred (nap
deprivation) or actually occurred (nap condition)62. Another
study used the time point of mother’s expectation of her infant
to be awake or the time when the infant’s habitual morning
or afternoon nap started to assess differences between alert
and fatigued children63. The emotional stimuli included five
mild stress inducing episodes. To assess children’s frustration
toleration, infants were encouraged to play with toys placed
in an unopenable jar. Fatigued children looked more often to
the experimenter and were less persistent in exploring the jar.
While separated from their mothers’, fatigued children were
more focused on proximity seeking, and fatigued children
showed also more self-soothing behaviour during an episode
of prohibiting to play with an attractive toy. This study supplied
evidence that, in response to different stressors, fatigued infants
are more emotionally reactive and less mature in their emotion
regulation capacities than rested infants.
These findings are supported by cross-sectional
research by Weissbluth (1981)64. He found significant negative
correlations between total sleep duration and infants’ resilience.
Furthermore, children described as “difficult” were negative
in mood, less adaptable, approachable, and rhythmical and
had shorter total sleep times per day, than “easy” children.
“Difficult” children also had a higher level of activity and
lower sensory thresholds than “easy” children. This is in line
with another study65, with the additional finding that infants,
described as rhythmic and adaptable, also took longer naps
than distractible children did. Furthermore, infants described
with persistent night awakenings were described as displaying
more maladaptive stress-coping, as dysregulation behavior, e.g.
higher levels of separation distress, than was so with continuous
sleepers.
Effect of sleep on emotion expression
According to Thompson (1994)24, emotion regulation
encompasses generation of appropriate emotional expressions.
Therefore, upcoming emotions and affects have to be processed
and appropriate behavior has to be generated. Within the
following paragraph the effect of sleep on the emergence of
these affective responses will be summed up.
Affective response ratings. Focus has been on the effects of
experimental sleep deprivation on affective responses to emotion
eliciting stimuli. Therefore, sleep deprived and control subjects
were compared on their affective arousal after confrontation
with images or sounds representing pleasant, unpleasant, or
neutral stimuli. To evaluate emotional responses of infants
after nap restriction, emotion assessment was implemented
at home62. To observe and quantify the children’s emotion
expressions towards pictures from the International Affective
Picture System (IAPS) on a screen, researchers analyzed
the videotaped task sessions. Nap restriction contributed
to more negative affect in response to neutral pictures and
conversely positive pictures induced fewer positive reactions62.

501
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A comparable task was implemented in pre-school children66.
The assessment contained strong and weak emotional visual
stimuli of the IAPS, which were paired with an appropriate
auditory stimulus. Affective responses were assessed by facial
electromyography (fEMG). After nap-deprivation, results also
demonstrated greater affective responses to strong negative and
positive pictures. No sensitivity was reported of affect states
to weak stimuli after nap-deprivation. Affective responses of
nocturnal sleep restricted school-aged children were rated
via self- and parental report after presentation of the IAPS
stimuli54. Short sleep condition predicted less positive affective
responses and more problems in emotion regulation. The study
by Bolinger et al. (2018)49 also made use of IAPS stimuli and
they assessed the subjective emotional response by asking their
participants directly for their valence ratings of the stimuli after
first presentation and after a recognition session following the
night sleep or in the evening (sleep vs. wake condition). Whereas
the valence rating leaves unchanged in the wake condition, in the
sleep condition the negative valence rating of negative stimuli
decreased from encoding to recognition session and neutral
stimuli were rated as more negative49. One study protocol
included the affective response task with only auditory stimuli67.
During the task, adolescents were confronted with short sound
clips. Measurement was based on subjective reports, as well as
objective pupillography assessment. As reported in the visual
stimuli studies, negative affect rating was significant higher in
the restriction group and positive affect rating was lower after
sleep restriction. Additionally, the puzzle task was implemented
to evaluate the outcome measure of affective responses62. Nap
restricted children had shorter positive emotion responses; they
expressed less joy and pride after solving the puzzle. Without
their afternoon nap, children also showed longer negative
emotions, in particular worry and anger, when faced with an
unsolvable puzzle62.
Another study displayed significant differences in
subjective reports of positive affect between sleep extended
and restricted adolescents68. Adolescents scored higher for
positive affect when they were in the rested condition. No
difference concerning negative affect was found between sleep
conditions. Regarding participants’ chronotype, evening as well
as morning chronotypes displayed less positive affect if they
were sleep deprived. This result is congruent to the finding
of a steadily decrease of positive affect during the seven-day
period of sleep deprivation55. Data for negative affect showed
no significant change due to sleep restriction. This suggests that
subjective positive affect is more sensitive to sleep deprivation
than subjective negative affect. Overall, studies of the effects
of sleep on the affective responses to emotional stimuli reveal
a rather heterogenous picture, reflecting the complexity of
physiological as well as cognitive and behavioral processes of
emotion regulation.
Mood dimensions. To assess different mood dimension,
the profile of mood states with mood describing adjectives, was
completed after sleep restriction in adolescents69,70. Whereas
Baum et al. (2014)69 used the POMS only twice, after a baseline
and after sleep restriction week, in the study by Short and Louca
(2015)70 the (POMS)-short form was completed every two
hours during the night of strict sleep deprivation. Participants
of Baum et al. (2014)69 reported increased levels of different
mood dimensions, except depression. The contrary findings of
Short and Louca (2015)70 revealed that all dimensions of mood,
inclusive depressive mood significantly deteriorate after sleep
deprivation, whereas anxiety was found only in females, and
depressive mood only marginally in male participants.
A short telephone inquiry was given to adolescents,
to investigate the relationship between their mood states in
the morning and their night sleep71. A good sleep quality was
positively correlated to a better mood in the morning and
negatively correlated to daytime drowsiness. Results were
comparable to those in young children72. Children with longer
sleep latency and low sleep efficiency had a decline in positive
mood for the next day, which predicted higher sleep activity
during the following night and longer sleep latencies again.
Subjects showing longer sleep latencies also had an averaged
negative mood stretching across the seven days of assessment,
which was associated with higher levels of internalizing and
externalizing symptoms in general.
While previous studies have investigated the
emergence and association of positive or negative emotional
states and sleep manipulation or sleep parameter, other authors
have been focused on how emotions are expressed during social
interaction.
Social interaction. Responses to tasks of social interaction
seemed also to be sensitive to sleep deprivation67. By that
method, individual recent disagreements with friends were
sorted by their relevance. During the visit at the experimental
laboratory, participants’ real-life friends were invited and asked
to discuss one of the two most highly rated conflicts with the
participants. Behavior during the task was rated by a researcher
on facial expressions and on verbal content, and these summary
scores of negative and positive affect behaviors were included
in the analysis67. Observed negative affective behavior, such as
conflict withdrawal and dominance during the peer conflict task,
was significantly higher after sleep restriction.
The implemented task adopted in the study
of Raynolds (2017)73 distinctly differed to those already
described67. Within this study, the association of typical or
extended sleep and emotion regulation was investigated.
From a non-manipulated session, the task protocol consisted
of adolescents getting to know an unfamiliar person for five
minutes via an iPad. Thereafter adolescents were briefed that
the next unfamiliar person had lost the phone, thus the subjects’
waiting time could be used to complete the Paced auditory serial
addition task (PASAT)74. This task required participants to sum
numbers sequentially as they appeared on the computer screen,
and was designed to increase frustration and negative mood.
After the task, participants did not have time to recover from
the frustrating task before beginning the manipulated social
interaction task, with the instruction to make the other person,
who had lost the phone, feel better. Sleep extended adolescents

Sleep Sci. 2022;15(4):490-514
502 Sleep and emotion regulation in young people
had more negative facial expression and higher levels of facial
expression variability than the typical sleep group throughout the
manipulated task. Emotional language regulation, persistence,
and the PASAT score did not achieve statistically significant
effects.
In order to evaluate children’s negative emotionality,
representing a predictor for being less confident and more
vulnerable while faced with either positive or negative
circumstances75, the mother-infant dyad was observed at a
home visit during normal interaction76. Children with high
scores for negative emotionality at the age of 6 months had
more internalizing problems at the age of 54 months, when
having had more sleep problems at the age of 36 months.
Additionally, teachers were asked to value emotion regulation
behavior of school-aged children to assess the influence of sleep
manipulation77. The emotional outcome scores of emotional
lability and restless-impulsive behavior improved after sleep
extension, whereas these measures deteriorated in children
experiencing sleep restriction. The finding that sleep deprivation
affects facets of emotion regulation and oppositionality in
a social context is supported by parental and self-report in
adolescents69.
Whereas parental reporting is necessary while
assessing data of infants and toddlers, school-aged children
can give ratings on subjective measures on their own78. Better
sleep quality was associated with less emotional and behavior
problems79. Regarding gender effects, results indicate that
girls score higher on the anxiety scale and lower on reactive
aggression. Furthermore, emotional dysregulation was rated as
low when children rate their sleep quality as high and young
children’s dysregulation was rated high due to continues night
awakenings. Thus, dysregulation seems to be sensitive to sleep
parameters in infants64 as well as in school-aged children78.
The positive correlation between good sleep
and emotion regulation ratings reached significance in the
correlational studies including subjective measurements of
sleep and affect in children and adolescents64,65,78-80. Because it
is often asked if results regarding emotional outcome measures
differ in consequence of making use of whether subjective or
objective sleep measurement, one study displayed that parental
reported presence of children’s sleep disturbances is a reliable
predictor of objectively assessed inappropriate sleep schedules80.
Unfortunately, results of these studies cannot investigate the
interconnectedness of temperament, emotion regulation,
and sleep, because assessment of affective constructs was at
a single point of measurement. To assess the diverse mutual
developmental trajectories of sleep and emotion regulation
longitudinal research is needed.
Interconnectedness of sleep and development of
emotion regulation competence
Within their longitudinal study, Gregory and
O’Connor (2002)81 were interested in changes of sleep
and behavioral problems over the period of childhood.
Results suggest that early sleep problems predict behavioral
problems, in particular emotional problems, in later lifetime.
However, no evidence was found for early depression, anxiety
or aggression symptoms predicting more sleep problems in
mid-adolescence. Further, no differences between the sexes
were detectable. Foley and Weinraub (2017)82 researched the
topic of sleep and emotional adjustment in children, and
found more early sleep problems predicted more anxious-
depressed symptoms in the middle childhood in both boys
and girls, and this was found to be associated with higher rates
of emotional reactivity in the preadolescence. In contrast
to Gregory and O’Connor (2002)81, gender differences
were found. For boys, earlier anxious-depressed symptoms
predicted more problematic sleep in the preadolescence; and
more negative affective temperament in early childhood was
correlated with more sleep problems and anxious-depressed
symptoms at all points of measurement. For girls, more
early sleep problems predicted less social competence in
school and this was associated with more anxious-depressed
symptoms in preadolescence. Additive, higher levels of
sleep problems in the middle childhood in girls predict
higher levels of emotional reactivity in preadolescence. The
interconnectedness of sleep and emotional problems is also
displayed by a longitudinal research based on parental-report
data83. According to the published results, it was concluded
that sleep problems and problems in emotion regulation
are strongly associated in their development over time, and
those participants suffering from persistent sleep problems
have a 10 times increased risk to develop problems with
emotion regulation83.
To overcome the limitation of exclusive subjective
sleep measurement, a study in young children implemented
actigraphy for five nights when infants were three months of
age84. Emotional problems were assessed by subjective parental
reports when infants were 20 months. Regression analysis of
externalizing-, internalizing-, and dysregulation problems,
sleep efficiency and sleep duration led to no detectable main
effects in boys. In girls, shorter sleep duration at the age of 3
months predicted significantly more externalizing problems at
the age of 18 months. Whereas the finding of existing gender
differences was incongruent to another longitudinal study81,
longitudinal research of Foley and Weinraub (2017)82 supported
an association of insufficient sleep in infancy and later affective
problems in girls, and in contrast with Saenz (2015)84, this was
also found in boys. Differences might be explained by the source
of data; parental report of sleep81,82 may be not associated with
actigraphy assessment of sleep84. A further longitudinal study
includes objective sleep measures in toddlers to investigate the
mutual dependence of sleep and emotional outcomes85. They
display that short sleep duration and low sleep efficiency at age
two are associated to more frustration and anger one year later.
There were also indices for high rates of social fear at the age of
2 being associated to shorter day- and nighttime sleep duration at
measurement one year later. Nevertheless, it may be informative
to include actigraphy standardly in future longitudinal research
on sleep and affect and emotion.

503
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Manipulation of sleep
To give a short insight to the differences in schedules
of sleep manipulation we added this section to our review. This
could be understand as hint for upcoming research, because
differences in scheduling sleep for experimental research of
emotion regulation could lead to different outcomes. However,
a full discussion of this relationship will go beyond the scope
of the review.
In sum 14 studies implemented sleep manipulation
in their studies (for a detailed overview about the different
protocols of sleep manipulation, they are summed up for the
age groups of infants and young children, school-aged children,
and adolescents in the Appendix).
Five studies implemented sleep restriction protocols
or nap restriction in young children. Except one51, all of them
implemented a sleep stabilization period of five or seven
nights before sleep manipulation. Four studies restricted the
afternoon nap to assess the effect of sleep loss on emotional
reactions51,61,62,66. One study implemented a form of night-
sleep restriction in young children53. Regarding the points of
measurement, testing took place after respectively the normal
and the sleep or nap restriction condition. Whereas Cremone
et al. (2017)52 implemented the dot probe task, three studies
included the unsolvable puzzle task to assess emotional
regulation in toddlers. The assessment battery of Berger et al.
(2012)62 as well as Han (2014)66 included emotional stimuli of
the IAPS and the IADS.
In school-aged children, two studies implemented
experimental sleep restriction. They implemented a stabilization
period over four or six nights80. Within this period, children
went to bed as they normally do. After stabilization, children
were randomly assigned to the sleep restricted or sleep extended
condition, with bedtimes one hour later or earlier than usual.
Blinded teacher rated children’s emotional lability and restless-
impulsivity, and the Conner’s global index-teacher was completed
on the day after sleep stabilization period (baseline) as well
on the last night of sleep manipulation period. Vriend et al.
(2013)54 mixed objective (tasks) and subjective (questionnaires)
measurements to assess emotion.
With regard to adolescents, five studies applied a
stabilization period, which ranged from three nights55 to one
week70. Instructions in the stabilization period were individual
or normal, self-selected bedtimes68,69; advised bedtimes70,55 or
the order to stay in bed for a minimum of 7.5 hours per night57.
One study directly started with sleep restriction or extension67.
SUMMARY AND DISCUSSION
Although different methodological tasks and
measurements have been summarized above, the measurements
and results were discussed in accordance to the introduced
multifaceted model of emotion regulation24.
Regarding neurophysiological processes, research
utilizing EEG measurements49,51 supported the finding that
sleep has a positive influence on the perception of emotional
stimuli, as well as on the processing of automatic responses, due
to an increase of neurological activity49,51. The reported results
regarding cortical activity are congruent to comparable studies
in adults86.
In contrast to adolescent’s55, children’s53,54 generation
of a behavioral response to attention attracting neutral stimuli
seem not to be affected by sleep manipulation. One explanation
of the missing effect of sleep manipulation on attentional
processes in children may relate to the small amount of sleep
deprivation in children. It would be interesting to repeat the
task by implementing longer periods of wakefulness to assess
their consequences on children’s attention regulation processes.
Regarding the results from research utilizing emotion eliciting
stimuli, it could be concluded, that low sleep quality reduces
the accuracy in processing emotional stimuli in adolescents56.
Whereas studies including sleep manipulation utilize neutral
stimuli, one study, concerning the influence of sleep quality
on emotional processing, discriminated between the effect of
neutral versus emotional stimuli. Unfortunately, the effect of
either positive or negative emotional content of the stimuli
was disregarded. Whereas recent research assessed attentional
processes in an objective manner, future research should assess
the influence of sleep deprivation as well as sleep parameters on
children’s and adolescents’ use of attention regulation processes.
Those processes according to Thompson (1994)24 encompass,
e.g. the use of concrete strategies of conscious avoidance of
emotion eliciting stimuli.
The effect of sleep deprivation on emotional reasoning
is inconsistent to the effect of low sleep quality on it. Reddy
et al. (2017)57 suggested that one night of sleep deprivation
has no significant effect on reappraisal tactics and reasoning in
adolescents, whereas a short sleep duration seemed to be linked
to a decrease of emotional reasoning58. According to the results
emotional reasoning seems not to be sensitive to sleep deprivation,
whereas shortcomings in sleep quality cause lower performance
in emotional reasoning. Regarding the operationalization of
emotional reasoning, both studies made use of static pictures,
differing in representing either emotion eliciting context57 or
emotional facial expressions58. Unfortunately, in both studies,
the emotion specificity of the results regarding the emotional
reasoning did not report the differences in positive or negative
reasoning distinctively. Future research should shed light on
influence of longer periods of sleep restriction on emotional
reasoning; consider reporting effect of sleep parameters on
positive and negative reasoning about emotional states, and
utilization of less static sources of stimuli, as short sequences of
video clips with emotional content.
Results of studies concerning the physiological
background of emotion regulation49,60 indicate a mutual
dependence of emotional stimuli, physiological responses,
and parameters of sleep. Findings support the idea, that rather
than acting as a unity entity, emotion regulation and emotional
responses emerge from interaction between automatic
generating responses and cognitive processes, while both
systems are sensitive for sleep. Beyond, future studies might

Sleep Sci. 2022;15(4):490-514
504 Sleep and emotion regulation in young people
wish to consider the implementation of behavioral ratings, as
well as physiological and neuroimaging measures, to provide
support to the body of literature regarding influencing factor
of sleep on the association between physiological and emotion
regulating processes in children and adolescents.
While focussing on coping, results of studies are
supporting the assumption, that day and night sleep deprivation
affects young children’s emotional coping competencies,
whereas afternoon nap deprivation preserves increase use of
maladaptive strategies in response to puzzle tasks61,62, as well as to
stressing situations63. Findings of these observational studies are
supported by findings from cross-sectional studies examining a
longer night64 and day65 sleep duration to be associated positively
to functional use of coping strategies. Another study found
indirect, instead of direct effects of mild night sleep restriction
on self-regulation strategies, mediated by children’s performance
regarding response inhibition before being sleep restricted53.
Therefore, future studies might wish to consider children’s’
coping predisposing factors as e.g. response inhibitation53
in more depth. Additionally, the incongruent finding of
direct61,63 versus indirect53 effects of sleep manipulation on
coping strategies may contribute to the difference in restricting
day61,63 or night sleep53 in young children. Additionally, Berger
et al. (2012)62 introduced the puzzle challenge with a “solving
segment”, thus children finished the puzzle and were praised
for their performance. How a previous successful event could
be linked to self-regulation strategies, while performing the
unsolvable puzzle task after restriction of night sleep is therefore
a subject of debate. Furthermore, children’s reactivity when
they were exposed to the unsolvable puzzle was significantly
decreased after nap deprivation61,62. This may be an indication
of reduced cognitive engagement and lowered motivation to
retrieve information from the environment87.
Studies of affective response ratings with young
children are with each other comparable to the result of
greater negative responses to negative visual stimuli after nap-
deprivation62,66; this is congruent with the results after nocturnal
sleep deprivation in adolescents67. Discrepant to the results of
lower positive responses on positive stimuli in toddlers62 was
the result of greater positive responses towards positive pictures
after nap-deprivation in young children66. Furthermore, ratings
of negative affect were not influenced after sleep deprivation
in school-aged children54. One explanation may relate to the
selected stimuli, and their ratings of valence and arousal. The
precise identification number of stimuli and the total ratings
were not specified54,62,66 and cannot be consulted for discussion.
Furthermore, two studies consulted additional objective
measurements to rate subjects’ responses66,67, whereas another
study used ratings by a human rater66, thus discrepancies in
ratings can contribute to differences in evaluation of emotional
responses. Finally, there was inclusion of an auditory stimulus;
thus, the additionally activation of the auditory sense can have
an influencing effect on the emotional response66,67. Future
studies should investigate the listed reasons for incongruent
results in more depth.
A decline in responses of subjective positive
affect ratings on the positive and negative affect schedule
(PANAS)88 was observable after two68 and also seven55 nights
of sleep deprivation. Thus, different periods of nocturnal sleep
restriction had no effects on the PANAS results. However,
unlike in behavioral studies implementing the PANAS57, the
effect on negative affect seemed to remain unchanged after sleep
deprivation. Keeping in mind the subjective character of the
PANAS, subjects may express test items representing a negative
affect state, e.g. “guilty”, “scared” or “afraid” as irrelevant,
thus negative affect stays unaffected55. Behavioral studies with
additional activation of visual or auditory senses57,67 found sleep
deprivation to increase ratings of negative affect stimuli and
therefore support the presented explanation. In the case of this
difference, future research should choose the implementation
of different measures and stimuli to investigate the effect of
sleep deprivation on affect states.
Whereas Baum et al. (2014)69 found no increase of the
dimension of depression after partial sleep deprivation for four
nights, Short and Louca (2015)70 reported that girls significantly,
and boys instead of males marginally, reported an increase
of the feeling of being depressed after a night of strict sleep
restriction. In contrast to the other mood states assessed in the
POMS89, depressed mood seemed not that sensitive to moderate
sleep deprivation69 than to strict sleep deprivation70. Secondly,
the items of the POMS depressive subscale are comparable
to those of the negative affect states in the PANAS, thus,
they may be valued as irrelevant and consequently depressive
mood seemed nearly unaffected. However, female’s sensitivity
regarding depression and anxiety following experimental strict
sleep deprivation was only reported by Short and Louca (2015)70.
This is in line with the results of a longitudinal study; girls
with early sleep problems displayed more anxiety-depressive
symptoms in preadolescence82. These findings demonstrate
interrelatedness between the female gender and the sensitivity
for problematic or restricted sleep. Taken together, these results
suggest significant effects of sleep loss on subjective affect and
mood states, but some striking results regarding sleep loss and
indices of depression. Furthermore, the influence of female
gender needs to be clarified in future research.
Due to the results, a mutual association between mood
dimensions and sleep quality can be assumed71,72. These results are
also supported by observational and behavioral studies in young
children62,63 and adolescents67. Regardless of their diligence in the
selection of instruments and sampling procedures, these studies
cannot meet the aim of giving insight into long-term development
of affect and sleep, due to its cross-sectional character.
Differences in the effect of sleep manipulation on
social emotion regulation behavior are also somewhat striking.
These differences can be explained with reasons, e.g. the
deviating moment of assessment of social emotion regulation
behavior as well as by different schedules of sleep manipulation.
Whereas participants in the study by McMakin et al. (2016)67
were tested after restricting their sleep to respectively four
and two hours on two consecutive nights, participants in the

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study by Raynolds (2017)73 were investigated after extending
their sleep to one additional hour for five consecutive nights.
Another explanation might contribute to the analysis’s outcome
measures. Methodologically, McMakin et al. (2016)67 also
assessed facial expressions, as well as verbal content but, in
contrast to Raynolds (2017)73, the two composite scores were
calculated by averaging one summary score. The question about
the effects of sleep restriction on respectively affective facial
expressions and language remains open in the study by McMakin
et al. (2016)67. Additionally, differences between human rating
and computer results of these measurements in the context of
sleep manipulating studies have not been conducted yet. Future
studies should investigate the listed reasons for incongruent
results in more depth.
The finding of moderating effect of sleep problems on
the association of a child’s early negative emotionality and later
internalizing behavior must be considered in a critical light of
methodological limitations. Negative emotionality was assessed
when children were 6 months of age on a 15 minutes’ interaction.
Biasing factors such as mood, representing the mental state that
temporarily predisposes a person to act to a variety of events90,
were not controlled. Whereas the longitudinal association of
negative emotionality, sleep problems and behavior must be
given more attention in future research, longitudinal research
should also implement assessment of the variables at more
frequent points of measurement to detect their individual
development as well as their mutual associations. Similar points
of criticisms are given to Gruber et al. (2012)77. Even if the
children’s and adolescents’ emotion regulation behavior is
affected by sleep loss, according to subjective measurement, this
result is one-dimensional and can be biased by un-controlled
day-to-day influences in their environment. Thus, future
research should be interested in the implementation of more
objective measurements and task paradigms67,73, to assess the
effect of sleep loss or sleep extension on regulatory behavior in
the school or daily-life context.
Results from longitudinal research provide inconsistent
results regarding the mutual developmental pathways of sleep
and emotion regulation81,82. Reasons for these striking results do
not contribute to the measurement of sleep problems, because
the child behavior checklist (CBCL)91 was employed and the
sources of information were the subjects’ mothers in both cases.
However, statistical analyses differed; whereas Gregory and
O’Connor (2002)81 made use of hierarchical regression analysis,
Foley and Weinraub (2017)82 proceeded through seven stages
for testing longitudinal cross-lagged panel models, which is a
more sensitive analysis because of the control of autoregressive
effects and covariation among variables91,92.
An association between development of emotional
problems due to early sleep problems can be assumed81,82,85,
whereas the reverse association is still to debate81,82. According
to Wang et al. (2019)83 the chance to rehabilitate from emotional
problems increased in consequence of improvement of sleep
problems.
On the one hand experimental sleep manipulation
studies have the power to demonstrate cause and effect
relationships because of its strict sleep schedules55,68,69, a few
studies reduced the explanatory power due to unrealistic and
extreme70 or short-term67 sleep manipulations. On the other hand,
correlational studies have focused on natural circumstances, but
have not allowed for cause-effect conclusions64. While the present
review sums up results as well as the methodological approach
the findings from experimental nap and sleep manipulation
converge with each other and it could be assumed that real-
world associations between sleep and emotion regulation reflect
a true cause and effect association.
In sum, the reliance on self-, parental-, and teacher
reports rather than objective measures of sleep and emotional
constructs represented a considerable limitation in these
longitudinal studies. Furthermore, there is still the request of
research to address the temporal development of problematic
sleep and behavioral regulation problems, and the influencing
conditions under which sleep and regulation may develop into
a negative cyclical pattern. The clarification of the hen egg
problem remains a challenge for future studies.
Strengths and limitations
As demanded2, this review is the first attempt to identify
the relationship between the impact of sleep manipulation
as well as sleep parameters on different emotion regulation
processes across the youth upcoming from a developmental,
multifaceted model of emotion regulation. Studies methods and
instruments are aggregated and serve as a structure for future
research that is interested in the assessment of sleep and affect
regulation in a young population. According to our selection
criteria, studies addressing children and adolescents suffering
from diagnosed mental or sleep disorders, chronic illness, or
in special medical circumstances were excluded. Therefore, it
should be kept in mind that results are representative only for
healthy and normally developed children and adolescents.
Studies in infants or toddlers rely on parental report54,64,65
and observational methods62,76 in large part, because very young
children have considerable limitations reporting intrapersonal
emotional experiences17. It is important to consider, that
reliance on parental report might lead on to misinterpretation
and overestimation of the results due disregarding influence of
potential parental covariates on their statements17.
Furthermore, as research has shown, studies assessing
emotion regulation processes under controlled conditions
increases the probability of activating special emotions39. A
distinction of naturalistic or laboratory settings is essential
to be able to assume that upcoming emotional affect regulate
behavioural expressions, as a successful event can enforce a
children’s resilience through frustrating situations62 or that
emotional affect can be regulated e.g. adolescent’s positive
reappraisal reduced their negative affect states57. Thus,
disregarding the interference between a constructed setting and

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506 Sleep and emotion regulation in young people
emotional responses prevent an integral understanding of the
context of emotion regulation.
With respect to the implementation of emotional
images from the IAPS54,62,66 the precise identification of chosen
images was not specified in all cases; studies that implement
images with increasingly gradients may exaggerate the effects
of sleep deprivation and while IAPS is the source of stimuli
in all studies, affective reactivity may differ in accordance with
specific images, so methodological diligence is demanded for
the transparency and validity of the research.
It must be stated that studies differ in their techniques
of analysis as well as in data generation62,73. When comparing the
studies, a change in a sum score in the affect relating variables62
does not have that interpretability as its individual reactivity to
manipulated sleep73. To avoid a generalizing conclusion of the
associations between sleep and affect, these differences and
analytical details must be considered during the interpretation of
results. Additional studies which did not report the significance
of group differences are also less representable77.
However, some measures of implemented subjective
affect57 were not as sensitive to sleep deprivation as others77,
because the test items may not be relevant to the sample.
Furthermore, assessment an infant’s manageability by one
item might be somewhat insufficient64,65. Thus, when preparing
research, it is necessary to be careful when verifying the suitability
of the instruments for measurement in the target group.
Key limitation
A key limitation of the studies including sleep
manipulation was that there were only two sleep or nap
conditions. The contrast between the experimental groups of
sleep or nap restriction and unmanipulated condition offers
evidence of causation, but does not considering the individual
preferences and sleep habits of participants. This negotiation
may lead to exaggeration or underestimation of the effects of
sleep or nap deprivation on emotion regulation outcomes. While
the relationships between sleep manipulation and outcome
measures of emotion regulation are debated, it seems important
to attempt to identify the threshold at which sleep or nap
deprivation affects emotions in young children and adolescents.
Therefore, future experimental research should vary in sleep
duration, as well as in bed and raise times to assess potential
differences in impact on emotional outcomes.
Future directions
According to the remarks of this systematic review,
the implications for future research are related to: 1) diversity
of measurements and sources, 2) variety of task characteristics
and procedure, 3) requirements for longitudinal research, and 4)
gender vulnerabilities of sleep and affect.
Diversity of measurements and sources
Affect processes. Affective processing has several
elements affected by sleep, such as the generation of affect
states57, the duration of emotional expressions62, and emotional
response behavior63. Therefore, individual measures may
provide an incomplete picture of the interconnection of sleep
and affect. Emotion regulation is complex, and only two studies
assessed cortical activity, which contributes towards emotion
regulation behavior49,51. Physiological as well as neuroimaging
measurements provide information for the neural and physical
responses while recepting an affective stimulus. Parental or
teacher reports in toddlers and children, or self-report can be
implemented to assess subjective measurements of affective
and emotion states. Keeping in mind, that implementation
of a specific questionnaire itself can have influence on the
result69,70. It is the same for objective ratings and observations
by humans, as well as by computer, to provide information on
the emotion regulation, and emotion responding behaviors. To
investigate the influencing effect of sleep on the whole process
of affect processes, behavioral, physiological, neuroimaging,
and subjective measurements need to be implemented.
Sleep assessment. This review provides the impression
that, especially, longitudinal studies evaluate subjective sleep
data more frequently than objective sleep data. Therefore,
objective data, such as actigraphy should additionally be
implemented in the research standard, due to the higher quality
of data93. However, the use of actigraphy in infants or toddlers
faces problems of appropriate algorithms94 to detect real night
awakenings and, therefore possibly making use of behavioral
sleep observation.
Variety of task characteristics and procedure
Stimuli presentation and sense activation. Additionally, it was
reported that there are differences in the presentation of the
stimulus (number, duration, rating-interval, and static image)62,66,67.
This alone also can have an impact on the emotional response.
To investigate the effect of these differences, experimental tasks
could vary in the time of stimuli presentation or in the duration
of the interval between stimuli. Additionally, there was evidence
that emotional response ratings are sensitive to the content
category of stimuli (neutral, negative, and positive). For precise
results, future studies should always report differences, as well as
missing difference in their subject’s responses towards neutral,
positive, or negative stimuli. Furthermore, the activation of an
additional sense during affect processes can also have an effect on
the responses to the stimuli66,67. Differences in affect responses
after stimulating different senses, and their sensitivity to sleep
loss or sleep parameters may be interesting to investigate in the
future. The relationships between different types of stimuli and
presentation appear important to take into account.
Individual condition before assessment. Neural activity in
response to emotional stimuli was affected by different sleep
conditions49, and there is evidence that speed of generation
of behavioral responses increased through enhanced cortical
activity51. As such, the individual condition of brain activity
could exert an additional effect on responses towards emotional
stimuli. The role of psychological constitution before assessment
seems to have an influential effect on the affect responses62,90.

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According to the finding from observational studies, the idea
arose that the implementation of positive, successful events can
enhance emotion regulation capacity during frustrating daily-life
situations after sleep loss has emerged62. As such, future research
aimed at these “mood manipulations” could give insight into the
biasing influence of temporal mood, as well as subject’s internal
factors as e.g. temperament65 on sensitivity to actual sleep loss
and affective responses and, additionally, help to identify factors
of resilience and better emotion regulation.
Sleep manipulation. In accordance with the results,
individuals vary in their reactivity to sleep or nap-deprivation,
and in their responses to different types of emotional measures.
It is indisputable that the schedules of sleep deprivation
alter in accordance with the subject’s age, but there were also
differences in scheduling of sleep deprivation and manipulation
within the group of toddlers53,62, school-aged children59, and
adolescents66,67. These factors suggest that the perceived
reactivity of sleep restriction on constructs of emotion
regulation cannot be explained by performance observation
or ratings alone; the procedure of sleep manipulation and the
amount of sleep deprivation could also affect the gradient of
reactivity. It is important to take into account the different
schedules and durations of sleep loss, as well as their dose
response costs on emotional processes.
Requirements for longitudinal research
Methodological demands. Longitudinal studies that
examine the role of sleep parameters in the context of affect
processes often limit the lack of assessment of affective
and sleep related constructions simultaneously76. Research
concerning the temporal development of the inter-relationship
of sleep and affect, as well as influencing conditions under
which sleep and affect regulation may develop into a negative
pattern is underrepresented. Additionally, changes in the
development of physiological responses to sleep deprivation in
the context of the processing of emotional stimuli in children
and adolescents should be considered in the future. The
methodological challenge when planning longitudinal research
contributes to the limited set of appropriate experimental tasks,
because such a task needs to develop with the participant’s age.
Therefore, within the scope of its variability of age-appropriate
images of the IAPS, it seems to be a good option in regards to
the affect stages, but in the scope of its increasing task demands,
the Balloons task95, especially, allows the implementation of the
same measure across a wide range of ages. Conducting such
demanding research may be important for the understanding of
the development of serious sleep, as well as affective problems
and their mutual association.
Longitudinal outcomes. To bring back Thompson’s
assumption, arguing that individuals construct their life-settings
whilst taking into account the expected emotional load24,43, it
is remarkable that none of the included studies was focused
on the long-term consequence of sleep problems in childhood
or adolescence for the later emotional load of their life-time
settings, burdens or responsibilities. As reported in many studies
there might be an association between healthy sleep early in life
on better later mental health, resilience or performance8,9,11,
early sleep could be expected to have impact on creation of the
life setting, but to what extent remains open for future research.
Evidence of this association could emphasize the importance of
detection and treatment of problematic sleep during childhood
and adolescence.
Vulnerability of gender to sleep and affect
Few studies have investigated the role of gender in
the subjective report of noticeable behavior problems and less
social competence82,84. The female gender was found to react
with more emotional reactivity to problematic sleep and loss
of sleep70,84. Possible reasons are for example gender related
differences in hormonal regulation96. Furthermore, adolescent
males are less willing to report and confess emotions such as
depressive mood in their self-report97. Explanations of these
findings were not investigated in the context of sleep and affect
studies. Therefore, care needs to be taken in the interpretation
of outcomes of this study and seen as hints towards differences,
which should be evaluated in upcoming research.
CONCLUSION
Sleep seems to be associated to each level of emotion
regulation processes. Sleep plays a role in the ongoing regulation
of emotional arousal from infancy to adolescence. Affect
processes in childhood and adolescents seems to be negatively
affected by sleep problems or sleep deprivation, whereas
prolonged sleep is a predictor for fewer behavioral problems,
less negative affect states and better affect regulation. Sleep
promotes sensory processing of emotional stimuli, and is most
obvious in neuroimaging and physiological measures. Sleep
deprivation impairs affect processing, with apparent results in
subjective and objective measurements of affective reactions
towards visual emotion eliciting stimuli. Observational studies
suggest that sleep enhances the duration and strength of positive
emotions towards successful events, as well as the ability for
emotional reasoning, behavioral response, and regulation.
In general, associations of sleep and levels of affect
in this review are restricted to young subjects. Furthermore, the
types of measurements, tasks and data analyses may also have
some influence on the results. Future studies should be based
on more diverse measurement of affect and sleep; they should
vary in their stimuli presentation and sense activation. Further,
they should implement mood manipulation to investigate
the mutual associations in some detail. The consideration
of gender differences in affect processes and sleep are also
important. Additionally, the role of different amounts of sleep
loss during sleep deprivation requires clarification. Detailed
and well-planned longitudinal research concerning temporal
development of sleep and affect is needed. Following from
the results, less sleep can be assumed to have a negative impact
on affect processes, and is associated with notable short- and
long-term psychological problems; therefore, understanding

Sleep Sci. 2022;15(4):490-514
508 Sleep and emotion regulation in young people
Practice points
• Sleep supports processing of emotional stimuli, obvious in physiological
and physiological measures.
• Sleep deprivation impairs affect processing, measured by subjective and
objective measurements of affective reactions towards visual and auditory
emotion eliciting stimuli.
• Longer sleep duration, as well as undisturbed instead of quite sleep
enhances the experience of positive emotions, as well as the capacity of
emotional reasoning, behavioral responding and regulation.
Key research agenda
• Include diverse measurements of affect and sleep, and examine the
presentation of stimuli and the activation of the senses.
• Be highly sensitive while choosing the methods of assessment and
manipulation of sleep and emotion regulation.
• Differences in results have to be interpreted with regard to the used
statistical analysis.
• Explicitly discriminate between assessment of emotion activation and
emotion regulation.
• Investigate the role of different amounts of sleep loss during sleep
deprivation on task performance, and involve the possible interference
between a constructed setting and emotional responses in the interpretation
of results.
• Assess the temporal development of sleep and emotion to clarify their
mutual association during childhood and adolescence.
• Investigate influencing conditions under which sleep and affect regulation
develop into a negative pattern.
• Implement and develop objective tests with age-appropriate and variable
task demands for longitudinal research.
• While utilizing report of others, pay attention to possible confounders.
• Identify confounding intra-individual factors of better emotion regulation.
• Acknowledge of gender as an influencing factor.
the relationships between affect processes and sleep is a central
assignment for future research.
Regarding the practical implications the results indicate
a direct relationship between sleep and emotional functioning
in a young population. Therefore, prevention and intervention
programs should increase sensitivity for sleep problems and its
recognition. Moreover, psychoeducation regarding sleep and its
positive and negative consequences among parents, children,
adolescents, and health care professionals might provide faster
recognition and a better opportunity for successful treatment
of sleep irregularities and therefore prevent chronification and
potential psychopathological consequences.
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