Sleep Disruption a Key Factor in Anxiety Disorders

Megan Brooks

July 05, 2013

A lack of sleep ramps up activity in brain regions involved in emotional regulation, and natural worriers seem most vulnerable to the negative effect of sleep loss, new research suggests

Using functional magnetic resonance imaging (fMRI), neuroscientists from the University of California, Berkeley, saw increased activity in the amygdala and insular cortex in healthy persons who were sleep deprived. The pattern they observed mirrors abnormal neural activity seen in anxiety disorders, the investigators note.

Furthermore, the study suggests that innate worriers — those who are naturally more anxious and therefore more likely to develop an anxiety disorder — are acutely vulnerable to the impact of sleep loss.

The findings suggest that "people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation," senior investigator Matthew Walker, PhD, professor of psychology and neuroscience at UC Berkeley, told Medscape Medical News.

The study was published in the June 26 issue of the Journal of Neuroscience.

Therapeutic Target

According to Dr. Walker, the study also suggests that people with generalized anxiety disorder, panic attacks, and posttraumatic stress disorder may benefit from sleep therapy.

"If sleep disruption is a key factor in anxiety disorders, as this study suggests, then it's a potentially treatable target," Dr. Walker said. "By restoring good quality sleep in people suffering from anxiety, we may be able to help ameliorate their excessive worry and disabling, fearful expectations," he added.

The study, conducted at at UC Berkeley's Sleep and Neuroimaging Laboratory, involved 18 healthy young adults with a wide range general anxiety levels, but none who met criteria for a clinical anxiety disorder.

After a good night's rest and again after a sleepless night, participants underwent fMRI while viewing images that were either neutral, disturbing, or that alternated between both.

To trigger anticipatory anxiety, the researchers primed the participants using 1 of 3 visual cues prior to each series of images. A large red minus sign signaled to participants that they were about to see a highly unpleasant image, such as a death scene. A yellow circle portended a neutral image, such as a basket on a table, and a white question mark indicated that either a grisly image or a bland, innocuous image was coming, designed to keep participants on edge.

When sleep-deprived and waiting in suspenseful anticipation for a neutral or disturbing image to appear, activity in the brain's emotional hubs — the amygdala and insular cortex — soared, particularly in people who were innately anxious to begin with.

Dr. Matthew Walker

This research, said Dr. Walker "illustrates how important sleep is to our mental health. It also emphasizes the intimate relationship between sleep and psychiatric disorders, both from a cause and a treatment perspective."

"It's been hard to tease out whether sleep loss is simply a byproduct of anxiety, or whether sleep disruption causes anxiety," lead investigator Andrea Goldstein, PhD, a UC Berkeley doctoral student in neuroscience, added in a statement.

"This study helps us understand that causal relationship more clearly."

Important Contribution

Commenting on the study for Medscape Medical News, Avi Sadeh, DSc, clinical psychologist and professor at the School of Psychological Sciences, Tel Aviv University in Israel, said it makes an "important contribution to the growing literature indicating that sleep deprivation leads to compromised emotion regulation and emotional information processing."

"Research in psychopathology suggests that heightened negative anticipation or increased vigilance to threat is an underlying characteristics in anxiety disorders," said Dr. Sadeh, who was not involved in the research.

"The current findings that sleep deprivation increases activation of 'emotional' brain areas during anticipation to emotional stimuli further suggest that sleep deprivation may indeed compromise emotion regulation or coping with emotional information. This line of research contributes to better understanding of the dynamic mechanisms underlying the strong links between sleep and psychopathology," he said.

The study was funded by the National Institute of Mental Health, part of the National Institutes of Health. The authors and Dr. Sadeh have disclosed no relevant financial relationships.

J Neurosci. 2013;33:10607-10615. Abstract

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