Cognitive-Emotional Hyperarousal as a Premorbid Characteristic of Individuals Vulnerable to Insomnia

Fernández-Mendoza, Julio; Vela‐Bueno, Antonio; Vgontzas, Alexandros N.; Ramos-Platón, María José; Olavarrieta-Bernardino, Sara; Bixler, Edward O.; Cruz-Troca, Juan José De la

doi:10.1097/psy.0b013e3181d75319

Cited by 202 publications

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“…These findings reveal important associations between key characteristics of both insomnia and depression (5,6,(21)(22)(23)(24)(25). Although the present study focused on insomnia, the role of restless REM sleep in emotion regulation appears highly relevant to other realms of psychiatry.…”

Section: Discussionmentioning

confidence: 90%

“…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.

145

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: Discussionmentioning

confidence: 90%

Section: Significancementioning

confidence: 99%

Slow dissolving of emotional distress contributes to hyperarousal

Wassing

Benjamins

Dekker

et al. 2016

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

145

121

View full text Add to dashboard Cite

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“…In addition, the highest associations were with frequent nocturnal awakenings and sleep latency [35]. Recent studies with college students (good sleepers) suggest that cognitive-emotional hyperarousal is a premorbid characteristic of people vulnerable for stress-related insomnia [37,38]. Azevedo et al [37] analyzed both sexes separately and found that female pre-sleep cognitive arousal, predisposition to arousal (arousability), perceived academic stress, and sleep loss due to worries were all associated with sleep disruption related to stress/transient insomnia.…”

Section: Discussionmentioning

confidence: 99%

Don't worry, sleep well: predictors of sleep loss over worry

Marques

Gomes

Ferreira

et al. 2016

Sleep Biol. Rhythms

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declare that they have no conflict of interest. AbstractIn this study, our aim was to explore the relationship between sleep quality/quantity, chronotype, pre-sleep arousal, arousability, stress, coping, neuroticism, extraversion, mood/affect, perceived health and sleep loss due to worry in college students. A total of 713 students (mean age=19.29±1.256 years) completed a set of questionnaires that assessed sleep loss over worry (item from the General Health Questionnaire), other sleep-wake aspects (e.g., habitual sleep duration, sleep needs, sleep depth, subjective sleep quality, sleep latency, night awakenings, daytime sleepiness, sleep flexibility, sleep reactivity to stress), pre-sleep arousal (cognitive/somatic arousal), arousability, coping, neuroticism, extraversion, perceived physical/mental health, academic stress, and positive/negative affect. Sleep disturbance due to worry was reported by 40.6% of females and 19.2% of male students. It was significantly correlated with perceived health and the majority of sleep-wake variables. Almost all correlations between the psychological traits under study and sleep loss over worry were significant. Results from the stepwise regression analyses, however, showed that only cognitive arousal (β=.353; p<.001), perceived academic stress (β=.129; p<.01), arousability (β=.127; p<.01), worry tendency (β =.153; p<.001), gender (β =.118; p<.01), and perceived physical health (β=-.093; p<.01) were significant predictors of sleep loss over worry.Together, these variables accounted for 40.3% of the total variance in sleep disturbance due to worry. Our findings suggest that cognitive arousal, academic stress, arousability, tendency to worry, gender and perceived physical health may be important determinants of sleep loss over worry. These results may have important implications for prevention and intervention to improve sleep quality in young adults.

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“…Several personality and psychological characteristics are recognized as putative predisposing traits of insomnia, including a ruminative personality, 1 high neuroticism, 2 high depression, 2,3 anxiety introversion, and arousability. 2,4 Another predisposing factor of insomnia, which has gained attention in the literature, is a traitlike vulnerability to stress-related insomnia termed sleep reactivity.…”

Section: Introductionmentioning

confidence: 99%

Temporal Stability of the Ford Insomnia Response to Stress Test (FIRST)

Jarrin

Chen

Ivers

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: The Ford Insomnia Response to Stress Test (FIRST) is a self-report tool that measures sleep reactivity (i.e., vulnerability to experience situational insomnia under stressful conditions). Sleep reactivity has been termed a "trait-like" vulnerability; however, evidence of its long-term stability is lacking. The main objective of the current psychometric study was to investigate the temporal stability of the FIRST over two 6-mo intervals in a populationbased sample of adults with and without insomnia. The temporal stability of the FIRST was also compared with the temporal stability of other scales associated with insomnia (trait-anxiety, arousability). Methods: Participants included 1,122 adults (mean age = 49.9 y, standard deviation = 14.8; 38.8% male) presenting with an insomnia syndrome (n = 159), insomnia symptoms (n = 152), or good sleep (n = 811). Participants completed the FIRST, the State-Trait Anxiety Inventory (trait-anxiety), and the Arousal Predisposition Scale (arousability) on three different occasions: baseline and at 6-and 12-mo follow-up. Intraclass correlation coefficients (ICCs) were computed for all scales (baseline to 6 mo and 6 to 12 mo). Results: The FIRST yielded strong temporal stability from baseline to 6 mo among those with insomnia syndrome (ICC = 0.81), symptoms (ICC = 0.78), and good sleep (ICC = 0.81). Similar results were observed for 6 to 12 mo among those with insomnia syndrome (ICC = 0.74), insomnia symptoms (ICC = 0.82), and good sleep (ICC = 0.84). The stability of the FIRST was not comparable with the stability of trait-anxiety, but was somewhat comparable with the stability of arousability. Conclusions: Overall, the FIRST is a temporally reliable stable scale over 6-mo intervals. Future research is needed to corroborate the stability and trait-like measures of sleep reactivity with physiological, behavioural and personality measures.

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Cognitive-Emotional Hyperarousal as a Premorbid Characteristic of Individuals Vulnerable to Insomnia

Cited by 202 publications

References 40 publications

Slow dissolving of emotional distress contributes to hyperarousal

Slow dissolving of emotional distress contributes to hyperarousal

Don't worry, sleep well: predictors of sleep loss over worry

Temporal Stability of the Ford Insomnia Response to Stress Test (FIRST)

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