Hyperarousal and insomnia: State of the science

Bonnet, Michael H.; Arand, Donna L.

doi:10.1016/j.smrv.2009.05.002

Cited by 731 publications

(496 citation statements)

References 81 publications

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“…resolving of emotional distress and whether hyperarousal, in fact, represents the resulting accumulation of this distress. Of note, hyperarousal is not only present across waking and sleep in people suffering from MDD (21) but is also of key importance in the pathophysiology of primary insomnia (6,(22)(23)(24) and a premorbid characteristic of people vulnerable to insomnia (5,25).…”

Section: Significancementioning

confidence: 99%

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Slow dissolving of emotional distress contributes to hyperarousal

Wassing

Benjamins

Dekker

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

141

121

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The mechanisms underlying hyperarousal, the key symptom of insomnia, have remained elusive, hampering cause-targeted treatment. Recently, restless rapid-eye-movement (REM) sleep emerged as a robust signature of sleep in insomnia. Given the role of REM sleep in emotion regulation, we hypothesized that restless REM sleep could interfere with the overnight resolution of emotional distress, thus contributing to accumulation of arousal. Participants (n = 1,199) completed questionnaires on insomnia severity, hyperarousal, self-conscious emotional distress, and thought-like nocturnal mentation that was validated to be a specific proxy for restless REM sleep (selective fragmentation: R = 0.57, P < 0.001; eye movement density: R = 0.46, P < 0.01) in 32 polysomnographically assessed participants. The experience of distress lasting overnight increased with insomnia severity (β = 0.29, P < 10 −23 ), whereas shortlasting distress did not (β = −0.02, P = 0.41). Insomnia severity was associated with hyperarousal (β = 0.47, P < 10 −63 ) and with the thought-like nocturnal mentation that is specifically associated with restless REM sleep (β = 0.31, P < 10 −26 ). Structural equation modeling showed that 62.4% of the association between these key characteristics of insomnia was mediated specifically by reduced overnight resolution of emotional distress. The model outperformed all alternative mediation pathways. The findings suggest that restless REM sleep reflects a process that interferes with the overnight resolution of distress. Its accumulation may promote the development of chronic hyperarousal, giving clinical relevance to the role of REM sleep in emotion regulation in insomnia, depression, and posttraumatic stress disorder.B oth insomnia and affective disorders are among the most prevalent and burdening health concerns facing our society. Targeted prevention of affective disorders in people at risk, as well as identification of mechanisms of conversion, could be the most viable approach to mitigate their increasing global burden (1). For the prevention of new-onset or recurrent affective disorder, insomnia may be the major risk factor that can be targeted best (2, 3). About 13% of people with insomnia develop major depression disorder (MDD) within a year (2). Moreover, remission rates after cognitive behavioral therapy are 21% lower for depressed patients with abnormal sleep compared with patients with relatively intact sleep (4). It therefore appears highly relevant to understand the mechanisms involved in the role of insomnia in disturbed emotion regulation (2). The present study addresses the roles of restless rapid-eye-movement (REM) sleep (5) and chronic physiological arousal (6), which are characteristic of both insomnia and MDD.Although sleep contributes to the more robust consolidation of emotional memories, relative to neutral memories (7, 8), their later recall is not associated with anywhere near the same magnitude of subjective emotional distress, autonomic arousal, and amygdala activation (7, 9-11). REM sleep p...

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Section: Significancementioning

confidence: 99%

“…It therefore appears highly relevant to understand the mechanisms involved in the role of insomnia in disturbed emotion regulation (2). The present study addresses the roles of restless rapid-eye-movement (REM) sleep (5) and chronic physiological arousal (6), which are characteristic of both insomnia and MDD.…”

mentioning

confidence: 99%

Slow dissolving of emotional distress contributes to hyperarousal

Wassing

Benjamins

Dekker

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

141

121

View full text Add to dashboard Cite

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“…She also suggests that oxytocin may have an etiological role in the development of psychiatric disorders, including depression, anxiety, and autism spectrum disorders, which are characterized by sleep disturbances (Hollander et al 2003;Panksepp 2006). Cortisol has been proposed as implicated in other sleep disorders, such as obstructive sleep apnea (Tomfohr et al 2012) and insomnia (Bonnet and Arand 2010). These biomarkers may thus be important for investigating the etiology and maintenance of these sleep disorders.…”

Section: Introductionmentioning

confidence: 99%

Association of salivary-assessed oxytocin and cortisol levels with time of night and sleep stage

et al. 2012

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There have been proposals for REM to have a function of emotional memory consolidation, and also for REM sleep to be involved in the promotion of attachment behaviour. The hormones cortisol and oxytocin, respectively, may be involved in these proposed REM sleep functions. However, there are conflicting reports on whether levels of cortisol differ between sleep stages when time since sleep onset (SSO) is controlled, and virtually no literature on whether levels of oxytocin differ between sleep stages. This study thus investigated the changes in levels of oxytocin (OT) and cortisol (CT) across the night, and whether these levels differ between REM and N2 sleep when time SSO is controlled. 20 participants (10 males, 10 females, mean age = 20.45, SD = 2.01) were awakened 10 min into REM and N2 sleep periods in the sleep laboratory and gave saliva samples which were assayed for OT and CT. Levels of OT were relatively constant across the night, whereas CT increased significantly. REM and N2 did not differ significantly neither for OT nor for CT. The study has implications for models of sleep-dependent memory consolidation that incorporate the late sleep increase in cortisol as a functional component of memory consolidation, and also for the medical diagnostic assaying of OT during sleep.

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“…onset, maintenance, and terminal), or factors that causes insomnia symptoms (e.g. daytime stress, anxiety, jetlag, and diet) [1], [2], [21]. Therefore, training sleep/wake detection models that are specified according to these categories based on a larger data set merits further exploration.…”

Section: Resultsmentioning

confidence: 99%

“…Many factors can lead to insomnia, such as increased age, hyperarousals, daytime stress events, and sympathetic activity during the night compared with healthy subjects [2], [3], [4]. Diagnosis of insomnia symptoms and objective assessment of sleep quality often rely on retrieving and analyzing nocturnal sleep-wake patterns [5], [6].…”

Section: Introductionmentioning

confidence: 99%