The sleep response to stress: how sleep reactivity can help us prevent insomnia and promote resilience to trauma

Abstract

SummarySleep reactivity is a predisposition to sleep disturbance during environmental perturbations, pharmacological challenges, or stressful life events. Consequently, individuals with highly reactive sleep systems are prone to insomnia disorder after a stressor, engendering risk of psychopathology and potentially impeding recovery from traumatic stress. Thus, there is tremendous value in ameliorating sleep reactivity to foster a sleep system that is robust to stress exposure, ultimately preventing insomnia and its downstream consequences. We reviewed prospective evidence for sleep reactivity as a predisposition to insomnia since our last review on the topic in 2017. We also reviewed studies investigating pre‐trauma sleep reactivity as a predictor of adverse post‐traumatic sequelae, and clinical trials that reported the effect of behavioural treatments for insomnia on mitigating sleep reactivity. Most studies measured sleep reactivity via self‐report using the Ford Insomnia Response to Stress Test (FIRST), demonstrating high scores on this scale reliably indicate a sleep system with a lower capacity to tolerate stress. Nascent evidence suggests elevated sleep reactivity prior to trauma increases the risk of negative posttraumatic outcomes, namely acute stress disorder, depression, and post‐traumatic stress disorder. Lastly, sleep reactivity appears most responsive to behavioural insomnia interventions when delivered early during the acute phase of insomnia. Overall, the literature strongly supports sleep reactivity as a premorbid vulnerability to incident acute insomnia disorder when faced with an array of biopsychosocial stressors. The FIRST identifies individuals at risk of insomnia a priori, thereby guiding early interventions toward this vulnerable population to prevent insomnia and promote resilience to adversity.

Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms

“…While sleep reactivity is considered a trait-level predisposing factor for insomnia that remains stable over time, our data suggests it may also serve as a perpetuating factor. Recent research suggests sleep reactivity may be amenable to behavioral treatment [ 27 , 37 , 54 , 55 ], thus, this may be a useful target for preventative treatment. Additionally, sleep effort and cognitive arousal are modifiable perpetuating factors that can be influenced by cognitive behavioral therapy and mindfulness-based therapy for insomnia treatments [ 56–60 ].…”

“…Perpetuating factors (i.e. learned negative associations, behaviors, and cognitions that maintain poor sleep) play a much stronger role in maintaining persistent insomnia symptoms [ 14 , 26 , 27 ]. For example, high sleep effort and pre-sleep cognitive arousal are known to interfere with the normal autonomic process of falling asleep and increase the chronicity of insomnia [ 28 , 29 ].…”

“…For example, individuals with high trait sleep reactivity (i.e. a predisposition to experience sleep disturbance during or after a stressful event) are more likely to experience insomnia during a period of acute stress, with insomnia more likely to persist for these individuals if the stress becomes chronic [ 27 , 36 , 37 ]. Recently, other trait-level cognitive and psychological factors have been suggested to contribute to the development of sleep disturbances during periods of chronic stress [ 15 , 38 , 39 ].…”

GABALAGEN Alleviates Stress-Induced Sleep Disorder in Rats

“…Stress can have a significant, long -lasting negative impact on health including changes in behavior and sleep [8][9][10]. Sleep reactivity tends to cause sleep disturbances during environmental disturbances, pharmacological issues, or stressful life events [20]. As a result, individuals with highly responsive sleep systems are prone to insomnia disorders after stressors, pose a risk of psychopathology, and potentially hinder their recovery from traumatic stress [21][22][23][24][25][26][27].…”

The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

“…The patient reports, or the patient's parent or caregiver observes, one or more of the following: In this update we will not comment on aetiological and/or pathophysiological concepts of insomnia, as this would go far beyond the remit of this guideline. The interested reader is referred to recent work, much of which is part of the special insomnia issue of JSR (Dressle & Riemann, 2023;Espie, 2023;Fernandez & Perlis, 2023;Palagini et al, 2023;Reffi et al, 2023;Riemann et al, 2022;Tang et al, 2023;van Someren, 2021).…”