Sleep Deprivation in social phobia and generalized anxiety disorder

The effect of sleep deprivation and restriction on mood, emotion, and emotion regulation: three meta-analyses in one

STUDY OBJECTIVES

New theory and measurement approaches have facilitated nuanced investigation of how sleep loss impacts dimensions of affective functioning. To provide a quantitative summary of this literature, three conceptually related meta-analyses examined the effect of sleep restriction and sleep deprivation on mood, emotion, and emotion regulation across the lifespan (i.e. from early childhood to late adulthood).

METHODS

A total of 241 effect sizes from 64 studies were selected for inclusion, and multilevel meta-analytic techniques were used when applicable.

RESULTS

There was a moderate, positive effect of sleep loss on negative mood (g = 0.45), which was stronger for studies with younger samples, as well as a large, negative effect of sleep loss on positive mood (g = -0.94). For negative mood only, studies that used total sleep deprivation had larger effect sizes than studies that restricted sleep. After correcting for publication bias, a modest but significant negative effect for sleep loss on emotion (g = -0.11) was found; the valence of emotional stimuli did not change the direction of this effect, and type of sleep manipulation was also not a significant moderator. Finally, sleep restriction had a small, negative effect on adaptive emotion regulation (g = -0.32), but no significant impact on maladaptive emotion regulation (g = 0.14); all studies on adaptive emotion regulation were conducted with youth samples.

CONCLUSIONS

Sleep loss compromises optimal affective functioning, though the magnitude of effects varies across components. Findings underscore the importance of sleep for healthy affective outcomes.

Morin hydrate mitigates rapid eye movement sleep deprivation-induced neurobehavioural impairments and loss of viable neurons in the hippocampus of mice

Rapid eye movement sleep deprivation distorts the body's homeostasis and results in oxidative breakdown which may be responsible for a variety of neurological disorders. Some naturally occurring compounds of plant origin with antioxidant and neuroprotective properties are known to attenuate the detrimental effects of REM sleep deprivation. Morin hydrate, a flavonoid from Mulberry has demonstrated antioxidant and neuroprotective activities but its effect in sleep disturbed mice is unknown. The study was designed to explore the neuroprotective effect of Morin hydrate on 48 h. REM sleep deprivation-induced behavioural impairments and neuronal damage in mice. Mice were allotted into six treatment groups (n = 6): groups 1 and 2 received vehicle (10 ml/kg normal saline), groups 3-5 received Morin hydrate (5, 10, 20 mg/kg i.p) while group 6 received ginseng (25 mg/kg) which served as the reference drug. Treatment was performed daily for 5 days and animals were sleep-deprived on the last 48 h. Various behavioural tests (Elevated plus maze, Y-maze, locomotor activity) followed by oxidative parameters (malondialdehyde, nitric oxide, reduced glutathione) and histolopathological changes in the Cornu ammonis 1 (CA1) region of the hippocampus were assessed. Data were analysed using ANOVA at α_0.05. Morin hydrate (5, 10, 20 mg/kg) significantly enhanced memory performance, improves anxiolytic-like behaviour, reverses hyperlocomotion, restored depleted reduced glutathione, attenuated raised malondialdehyde and nitric oxide levels as compared to control animals and protects against loss of hippocampal neurons. Results of this present study suggest that Morin hydrate possess neuroprotective effects against sleep deprivation-induced behavioural impairments, oxidative stress and neuronal damage.

Cognitive behavioural therapy for anxiety disorders and insomnia: a commentary on future directions

Anxiety disorders and insomnia significantly impair daily functioning. Similar underlying mechanisms may account for the high comorbidity of both disorders, and respective treatments share pharmacological and behavioural features. This review suggests the utility of an integrated CBT approach in the treatment of generalized anxiety, post-traumatic stress, and panic disorders, and comorbid insomnia. Other anxiety disorders were not explored because current data are limited or inconsistent. A comprehensive, non-systematic review of the literature was conducted to evaluate the treatment of comorbid anxiety and insomnia disorders, and data reveal shared pharmacological and behavioural features of insomnia and anxiety disorders treatment. However, research demonstrates that CBT maintains successful treatment results longer than drug therapies. Despite similar treatment approaches, there is a paucity of research that explores integrated CBT approaches for comorbid anxiety and insomnia disorders. This review suggests that future research should assess the impact of combined therapeutic approaches on the simultaneous reduction of anxiety disorders, insomnia, and relapse rates.

Involvement of the α1-adrenoceptor in sleep-waking and sleep loss-induced anxiety behavior in zebrafish

Sleep is a universal phenomenon in vertebrates, and its loss affects various behaviors. Independent studies have reported that sleep loss increases anxiety; however, the detailed mechanism is unknown. Because sleep deprivation increases noradrenalin (NA), which modulates many behaviors and induces patho-physiological changes, this study utilized zebrafish as a model to investigate whether sleep loss-induced increased anxiety is modulated by NA. Continuous behavioral quiescence for at least 6s was considered to represent sleep in zebrafish; although some authors termed it as a sleep-like state, in this study we have termed it as sleep. The activity of fish that signified sleep-waking was recorded in light-dark, during continuous dark and light; the latter induced sleep loss in fish. The latency, number of entries, time spent and distance travelled in the light chamber were assessed in a light-dark box test to estimate the anxiety behavior of normal, sleep-deprived and prazosin (PRZ)-treated fish. Zebrafish showed increased waking during light and complete loss of sleep upon continuous exposure to light for 24h. PRZ significantly increased sleep in normal fish. Sleep-deprived fish showed an increased preference for dark (expression of increased anxiety), and this effect was prevented by PRZ, which increased sleep as well. Our findings suggest that sleep loss-induced anxiety-like behavior in zebrafish is likely to be mediated by NA's action on the α1-adrenoceptor.

Grooming analysis algorithm: use in the relationship between sleep deprivation and anxiety-like behavior

Increased anxiety is a classic effect of sleep deprivation. However, results regarding sleep deprivation-induced anxiety-like behavior are contradictory in rodent models. The grooming analysis algorithm is a method developed to examine anxiety-like behavior and stress in rodents, based on grooming characteristics and microstructure. This study evaluated the applicability of the grooming analysis algorithm to distinguish sleep-deprived and control rats in comparison to traditional grooming analysis. Forty-six animals were distributed into three groups: control (n=22), paradoxical sleep-deprived (96 h, n=10) and total sleep deprived (6 h, n=14). Immediately after the sleep deprivation protocol, grooming was evaluated using both the grooming analysis algorithm and traditional measures (grooming latency, frequency and duration). Results showed that both paradoxical sleep-deprived and total sleep-deprived groups displayed grooming in a fragmented framework when compared to control animals. Variables from the grooming analysis algorithm were successful in distinguishing sleep-deprived and normal sleep animals regarding anxiety-like behavior. The grooming analysis algorithm and traditional measures were strongly correlated. In conclusion, the grooming analysis algorithm is a reliable method to assess the relationship between anxiety-like behavior and sleep deprivation.

Relationship between sleep deprivation and anxiety: experimental research perspective

Sleep deprivation is a condition that is more and more observed in modern society bringing various neurobehavioral effects, being anxious states one of the main problems. Many studies have successfully demonstrated the relationship between sleep deprivation and anxiety in clinical research. As to basic experimentation, various models have been efficiently used in order to evaluate an anxious behavior. However, the same efficacy is not found on basic studies that deal with the relationship between paradoxical sleep and anxiety. The great majority of studies which approach this matter in animal models do not present results that may be applied to clinical practice and this is basically due to two reasons: inconsistency among results and lack of replicability as related to clinical studies. It has to be emphasized that the use of animal models is extremely useful, mainly under experimental conditions which cannot be ethically or plausibly be approached in human beings. So, the present theoretical assay tries to evaluate in a brief and critical manner the applicability of animal models in sleep deprivation under a translational perspective.

Co-occurrence of Insomnia and Anxiety Disorders: A Review of the Literature

Insomnia and anxiety disorders are highly prevalent and are associated with significant impairment and disability. There is evidence that insomnia and anxiety disorders commonly co-occur, in addition to both being highly comorbid with major depressive disorder. Thus, it is important for health care providers to be familiar with the literature in this area. Therefore, the purpose of this review was to examine the empirical literature on the co-occurrence of insomnia and anxiety disorders, as well as discuss the clinical and research implications of the findings. Studies were identified through PubMed and PsycINFO searches (1975-2007) and a bibliographic review of published articles. The results from this literature review suggest that certain anxiety disorders, such as panic disorder and generalized anxiety disorder, are clearly associated with symptoms of insomnia (eg, delayed sleep onset, restless sleep). Although there are some discrepancies in the literature, the findings suggest that individuals with posttraumatic stress disorder also experience significant sleep problems (eg, middle-of-the-night insomnia, poor sleep quality, nightmares), and the presence of such problems during the early posttrauma period predicts later development of the disorder. Few empirical studies examine sleep in other anxiety disorders, and the majority of studies on insomnia and anxiety disorders in general have not examined the effects of comorbid major depressive disorder, indicating a need for additional research. Overall, the findings highlight the importance of screening for and treating anxiety symptoms when a patient presents with symptoms of insomnia and vice versa. Clearly, treatment development work on interventions that address co-occurring insomnia and anxiety disorders is greatly needed.

Antidepressant response to partial sleep deprivation in unipolar depression is not related to state anxiety

One night of total or partial sleep deprivation (SD) produces a temporary remission in up to 60% of patients with major depression, yet mechanisms remain unclear. We investigated whether the antidepressant effects of SD are caused, even partially, by an improvement in anxiety. As part of a functional magnetic resonance imaging study, 19 unmedicated major depression patients and eight controls completed the Spielberger State/Trait Anxiety Inventory (STAI) (state version) at baseline and sleep-deprived scanning sessions. We found (1) greater anxiety in patients than controls; (2) no baseline or SD STAI difference between responders and nonresponders; (3) no STAI change with SD in any subject group; and (4) no significant correlation between any STAI and Hamilton Depression Rating Scale measures. Our findings did not provide support for an anxiolytic process associated with the antidepressant effects of SD.

The relationship between anxiety and sleep-wake behavior after stressor exposure in the rat

Disturbed sleep is a common subjective complaint among individuals diagnosed with anxiety disorders. In rodents, sleep is often recorded after exposure to various foot-shock paradigms designed to induce an anxiety state. Although differences in sleep-wake architecture are noted, the relationship to specific level of anxiety is often assumed or absent. Utilizing the elevated plus-maze (EPM) after exposure to escapable shock (ES), inescapable shock (IS) or fear conditioning (FC), resulting differences in sleep architecture were compared to an objective measure of anxiety. Male Wistar rats were implanted with EEG, EMG and hippocampal theta electrodes to record sleep-wake behavior. After recovery and recording of baseline sleep, rats were exposed to one of five manipulations: ES, IS, FC or control (CES or CIS; utilizing either chamber with no shock exposure). Shortly after experimental manipulation, the EPM was employed to quantify traditional and ethological measures of anxiety and polygraphic signs of sleep-wake behavior were recorded continuously for 6 h. Although no significance was observed in EPM measurements across groups, profound differences in sleep architecture were present. Individual correlation analysis revealed no differences in anxiety level and total percentage of time spent in sleep-wake states. These results indicate that differences in sleep architecture after foot-shock exposure may not be simply due to increased anxiety. Rather, individual anxiety may be exacerbated by disrupted sleep. To fully understand the relationship between anxiety and sleep-wake behavior, a more objective analysis of anxiety after stressor exposure is mandated.

Sleep and anxiety disorders

Sleep disturbances commonly are associated with anxiety disorders, in particular generalized anxiety disorder, panic disorder, and posttraumatic stress disorder. Sleep loss may exacerbate and contribute to relapse of these conditions. Core features of panic disorder and posttraumatic stress disorder occur in relation to sleep (sleep panic attacks or re-experiencing nightmares). Investigation of sleep in anxiety disorders provides clues to mechanisms of arousal regulation relevant to insomnia and pathologic anxiety. Established treatments for anxiety disorders and insomnia have many overlapping components; however, optimal sequencing and integration of the approaches remain under-investigated.

Sleep disturbance in anxiety disorders

Many patients suffering from the majority of anxiety disorders complain about their sleep by reporting difficulties in initiating and maintaining it. Polysomnographic studies have shown that, in comparison to normal subjects, the sleep of patients with panic disorder is characterized by longer sleep latency, increased time awake and reduced sleep efficiency. Sleep architecture is normal and there are no significant changes in REM sleep measures. Nocturnal panic attacks are non-REM-related events and occur without an obvious trigger in 18-45% of panic disorder patients. Regarding generalized anxiety disorder, the patients complain of 'trouble sleeping' in 60-70%, while polysomnography has shown increased sleep latency and decreased sleep continuity measures. The findings in REM sleep and sleep architecture generally do not show any aberration to exist. In patients with obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD), results from the sleep laboratory do not seem to support the subjective complaints of poor sleep. The early reports of shortened REM latency in OCD could not be replicated by recent studies. A dysregulation of the REM sleep control system has been reported for patients with PTSD. Finally, no significant differences were found in all sleep parameters between social phobia patients and controls.

Anxiogenic effect of sleep deprivation in the elevated plus-maze test in mice

RATIONALE

Several clinical studies demonstrate that the absence of periods of sleep is closely related to occurrence of anxiety symptoms. However, the basis of these interactions is poorly understood. Studies performed with animal models of sleep deprivation and anxiety would be helpful in the understanding of the mechanisms underlying this relationship, but some animal studies have not corroborated clinical data, reporting anxiolytic effects of sleep deprivation.

OBJECTIVES

The aim of the present study was to verify the effects of different protocols of sleep deprivation in mice tested in the elevated plus-maze and to assess the effect of chlordiazepoxide and clonidine.

METHODS

Three-month-old male mice were sleep-deprived for 24 or 72 h using the methods of single or multiple platforms in water tanks. Mice kept in their home cages were used as controls. Plus-maze behavior was observed immediately after the deprivation period.

RESULTS

Mice that were sleep-deprived for 72 h spent a lower percent time in the open arms of the apparatus than control animals. This sleep deprivation-induced anxiety-like behavior was unaffected by treatment with chlordiazepoxide (5.0 and 7.5 mg/kg IP), but reversed by an administration of 5 or 10 microg/kg IP clonidine.

CONCLUSION

The results indicate that under specific methodological conditions sleep deprivation causes an increase in anxiety-like behavior in mice exposed to the elevated plus-maze.