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Straus LD, ten Brink M, Sikka P, Srivastava R, Gross JJ, Colvonen PJ. The role of objective sleep in implicit and explicit affect regulation: A comprehensive review. Neurobiol Stress 2024; 31:100655. [PMID: 39036771 PMCID: PMC11260030 DOI: 10.1016/j.ynstr.2024.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Impairments in sleep and affect regulation are evident across a wide range of mental disorders. Understanding the sleep factors that relate to affect regulatory difficulties will inform mechanistic understanding and aid in treatment. Despite rising interest, some research challenges in this area include integrating across different clinical and non-clinical literatures investigating the role of sleep architecture (measured with polysomnography) and experimentally manipulated sleep, as well as integrating more explicit versus implicit affect regulation processes. In this comprehensive review, we use a unifying framework to examine sleep's relationship with implicit-automatic regulation and explicit-controlled regulation, both of which are relevant to mental health (e.g., PTSD and depression). Many studies of implicit-automatic regulation (e.g., fear extinction and safety learning) demonstrate the importance of sleep, and REM sleep specifically. Studies of explicit-controlled regulation (e.g., cognitive reappraisal and expressive suppression) are less consistent in their findings, with results differing depending on the type of affect regulation and/or way that sleep was measured or manipulated. There is a clear relationship between objective sleep and affect regulation processes. However, there is a need for 1) more studies focusing on sleep and explicit-controlled affect regulation; 2) replication with the same types of regulation strategies; 3) more studies experimentally manipulating sleep to examine its impact on affect regulation and vice versa in order to infer cause and effect; and 4) more studies looking at sleep's impact on next-day affect regulation (not just overnight change in affect reactivity).
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Affiliation(s)
- Laura D. Straus
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Maia ten Brink
- Department of Psychology, Stanford University, Stanford, CA, USA
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Pilleriin Sikka
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychology and Speech-Language Pathology, University of Turku, Finland
- Department of Cognitive Neuroscience and Philosophy, University of Skövde, Sweden
| | | | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Peter J. Colvonen
- San Diego VA Health Care System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
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2
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Cox RC, Ritchie HK, Knauer OA, Guerin MK, Stothard ER, Wright KP. Chronotype and Affective Response to Sleep Restriction and Subsequent Sleep Deprivation. J Biol Rhythms 2024; 39:35-48. [PMID: 37539684 PMCID: PMC10838359 DOI: 10.1177/07487304231188204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Prior research indicates that sleep restriction, sleep deprivation, and circadian misalignment diminish positive affect, whereas effects on negative affect are inconsistent. One potential factor that may influence an individual's affective response to sleep restriction, sleep deprivation, and circadian misalignment is chronotype. Later chronotypes generally report higher negative affect and lower positive affect under typical sleep conditions; however, there is mixed evidence for an influence of chronotype on affective responses to sleep restriction and sleep deprivation. The present study examined the effect of chronotype on positive and negative affect during sleep restriction and subsequent total sleep deprivation. Sixteen healthy adults (Mage = 28.2 years, SDage = 11.6 years) were classified as earlier or later chronotypes using multiple chronotype definitions: morningness-eveningness (MEQ), mid-sleep on free days corrected (MSFsc), habitual mid-sleep timing, dim light melatonin onset (DLMO), and phase relationship between DLMO and bedtime. Participants completed a 10-day protocol with one night of sleep restriction and subsequent 28 h total sleep deprivation. Affect was assessed hourly during scheduled wakefulness with the Positive and Negative Affect Schedule (PANAS). Data were analyzed with mixed-model analyses of variance (ANOVAs). During sleep restriction and subsequent sleep deprivation, positive affect decreased and negative affect increased. Across all chronotype measures, relatively later chronotypes demonstrated vulnerability to increased negative affect during sleep loss. The influence of chronotype on positive affect during sleep loss varied by chronotype measure. These findings suggest later chronotypes are more vulnerable to affective impairments during sleep loss and circadian misalignment, even when late chronotype is not extreme.
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Affiliation(s)
- Rebecca C. Cox
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Hannah K. Ritchie
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Oliver A. Knauer
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Molly K. Guerin
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Ellen R. Stothard
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
- Colorado Sleep Institute, Boulder, CO
| | - Kenneth P. Wright
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
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3
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Myers AM, Rech ME, Baran B, Palmer C, Mylonas D, Alfano CA. Sleep spindle activity is associated with state- and trait-based emotion in healthy school-aged children. Sleep Med 2024; 113:56-60. [PMID: 37984018 DOI: 10.1016/j.sleep.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND While connections between children's sleep and their daytime functioning are well established, less is known about the microstructural features of sleep that support emotional wellbeing. Investigating these relationships in healthy children may provide insight into adaptive emotional development. We therefore examined associations between non-rapid eye movement (N2) sleep spindles and both state- and trait-based measures of emotion. METHODS A sample of 30 children (7-11 years) without psychiatric disorders completed a baseline assessment, one night of at-home polysomnography (PSG), and an in-lab emotional state assessment the next day including self-reported arousal in response to affective images. Trait-based measures of anxiety and depression as well as savoring, a positive emotion regulatory strategy, were also completed. N2 sleep spindle parameters, including spindle density (number/min) and peak frequency in central regions, were detected using an automated algorithm. RESULTS Greater spindle density was significantly associated with decreased state-based emotional arousal towards negative affective images, and greater spindle peak frequency was associated with greater trait-based use of savoring. However, neither spindle parameter was associated with child anxiety or depressive symptoms. CONCLUSIONS Findings align with and expand on prior research to suggest that N2 sleep spindles support adaptive emotional functioning in school-aged children.
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Affiliation(s)
- Annika M Myers
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA
| | - Megan E Rech
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Cara Palmer
- Department of Psychology, Montana State University, A.J.M. Johnson Hall, Bozeman, MT, 59715, USA
| | - Dimitrios Mylonas
- Massachusetts General Hospital, Harvard Medical School, 275 Cambridge St., Boston, MA, 02114, USA
| | - Candice A Alfano
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA.
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Claussen AH, Dimitrov LV, Bhupalam S, Wheaton AG, Danielson ML. Short Sleep Duration: Children's Mental, Behavioral, and Developmental Disorders and Demographic, Neighborhood, and Family Context in a Nationally Representative Sample, 2016-2019. Prev Chronic Dis 2023; 20:E58. [PMID: 37441755 PMCID: PMC10364829 DOI: 10.5888/pcd20.220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Many children and adolescents experience insufficient sleep, which poses risks for their short- and long-term health and development. This study examined the concurrent associations of contextual factors, including child, demographic, neighborhood, and family factors, with short sleep duration. METHODS We combined data on children aged 3 to 17 years from the 2016-2019 National Survey of Children's Health (N = 112,925) to examine the association of parent-reported child short sleep duration (ages 3-5 y, <10 h; 6-12 y, <9 h; 13-17 y, <8 h) with mental, behavioral, and developmental disorders (MBDDs); selected physical health conditions; and demographic, neighborhood, and family factors. RESULTS Overall, 34.7% of children experienced short sleep duration. The prevalence was highest among children aged 6 to 12 years (37.5%); children from racial and ethnic minority groups, especially non-Hispanic Black children (50.0%); children from low-income households (44.9%); children with an MBDD (39.6%); children experiencing negative neighborhood factors (poor conditions and lack of safety, support, and amenities, 36.5%); and family factors such as inconsistent bedtime (57.3%), poor parental mental (47.5%) and physical health (46.0%), and adverse childhood experiences (44.1%). The associations between sleep and demographic, neighborhood, and family factors, and MBDD remained significant after controlling for all other factors. CONCLUSION This study identified several individual, family, and community factors that may contribute to children's short sleep duration and can be targeted to improve healthy development, particularly among children with an MBDD, from households with low socioeconomic status, or from racial and ethnic minority groups who are at increased risk for short sleep duration.
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Affiliation(s)
- Angelika H Claussen
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Centers for Disease Control and Prevention, 4770 Buford Hwy, S106-4, Atlanta, GA 30341-3717
| | - Lina V Dimitrov
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Sivapriya Bhupalam
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Anne G Wheaton
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, Georgia
| | - Melissa L Danielson
- Centers for Disease Control and Prevention, National Center on Birth Defects and Disabilities, Division of Human Development and Disability, Atlanta, Georgia
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Kim J, Park GR, Sutin AR. Adolescent sleep quality and quantity and educational attainment: a test of multiple mechanisms using sibling difference models. J Child Psychol Psychiatry 2022; 63:1644-1657. [PMID: 36016475 DOI: 10.1111/jcpp.13686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to determine whether and how sleep quality and quantity during adolescence are related to educational attainment in adulthood. This study also investigates whether this relationship varies by gender. METHODS Using data from the National Longitudinal Study of Adolescent to Adult Health, the present study employed a sibling fixed effect approach that takes into account unobserved family background factors such as genetics and social environments. Gender-stratified analyses were conducted to consider the potential gendered relationship between adolescent sleep and educational attainment. RESULTS Controlling for unobserved family-level heterogeneity attenuated the associations between adolescent sleep characteristics and educational attainment, albeit in different ways for boys and girls. Gender-stratified models suggest that, for boys, only the association between short sleep duration and educational attainment was robust to adjustment for sibling fixed effects. In contrast, for girls, among three sleep quality measures, only trouble falling or staying asleep remained significantly associated with educational attainment even after controlling for unobserved family heterogeneity. Sibling fixed effects estimates suggest that short sleep duration (6 or fewer hours per night) was negatively associated with years of schooling only among boys (b = -0.443), whereas trouble falling or staying asleep was associated with a reduction in years of schooling only among girls (b = -0.556). The mechanisms underlying the observed associations also differed by gender. For boys, the association between short sleep duration and educational attainment was partially explained by a combination of educational, social, and psychological factors. Only intermediate educational factors explained part of the association between trouble falling or staying asleep and educational attachment among girls. CONCLUSIONS The study's finding that the relationship between adolescent sleep characteristics and educational attainment and the mechanisms underlying this relationship differ by gender calls attention to the need for gender-specific interventions.
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Affiliation(s)
- Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea.,Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Gum-Ryeong Park
- Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada.,Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Angelina R Sutin
- College of Medicine, Florida State University, Tallahassee, FL, USA
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Alfano CA, Valentine M, Nogales JM, Kim J, Kim JS, Rigos P, McGlinchey EL, Ripple CH, Wolfson AR. How Are the Sleep Problems of Children in the US Foster Care System Addressed? J Dev Behav Pediatr 2022; 43:e525-e532. [PMID: 35507424 DOI: 10.1097/dbp.0000000000001090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps. METHODS Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well. RESULTS Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night. CONCLUSION Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.
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Affiliation(s)
| | | | | | - Jinu Kim
- Department of Psychology, University of Houston, Houston, TX
| | - Josephine S Kim
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ; and
| | - Priscilla Rigos
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ; and
| | | | | | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, MD
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Sundelin T, Holding BC. Trait Anxiety Does Not Predict the Anxiogenic Response to Sleep Deprivation. Front Behav Neurosci 2022; 16:880641. [PMID: 35910682 PMCID: PMC9332334 DOI: 10.3389/fnbeh.2022.880641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/16/2022] [Indexed: 11/21/2022] Open
Abstract
Sleep deprivation has in several studies been found to increase anxiety. However, the extent to which this anxiogenic effect depends on one’s underlying trait anxiety has not previously been determined. Using two separate sleep-loss experiments, the current research investigated whether trait anxiety (STAI-T) moderates the increase in state anxiety (STAI-S) following one night of total sleep loss (study 1, N = 182, age 25.3 ± 6.5, 103 women) and two nights of partial sleep restriction (study 2, N = 67, age 26.5 ± 7.4, 38 women). Both studies showed the expected anxiogenic effect of sleep loss, and a clear relationship between trait anxiety and state anxiety. However, the anxiogenic effect of sleep loss was not moderated by trait anxiety, as there was an equal impact regardless of trait anxiety level. These findings indicate that, although sleep loss is related to general anxiety as well as anxiety disorders, for a non-clinical sample the anxiogenic effect of short-term sleep loss is not affected by baseline levels of anxiety.
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Affiliation(s)
- Tina Sundelin
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Tina Sundelin,
| | - Benjamin C. Holding
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Sociology, University of Copenhagen, Copenhagen, Denmark
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Alfano CA, Kim J, Cifre AB, Palmer CA. Children's Emotional Expressivity After Sleep Restriction Forecasts Social Problems Years Later. AFFECTIVE SCIENCE 2022; 3:383-388. [PMID: 36046006 PMCID: PMC9382988 DOI: 10.1007/s42761-021-00078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/01/2021] [Indexed: 06/03/2023]
Abstract
Sleep patterns affect children's socioemotional functioning in ways that may predict long-term social problems. However, precise mechanisms through which these effects occur remain unexplored and thus unknown. Building on findings in adults, the current study examined whether changes in children's facial expressions of emotion after sleep restriction predict social problems concurrently and/or longitudinally. At time 1, 37 children (mean = 9.08 years, SD = 1.3) completed in-lab emotional assessments both when rested and after two nights of sleep restriction. Participants' parents provided reports of their child's social problems at time 1 and approximately 2 years later (time 2; mean = 11.26 years, SD = 1.6). Children who exhibited less positive facial expressions in response to positive images after sleep restriction evidenced greater social problems longitudinally, even when controlling for earlier social problems. Results suggest that inadequate sleep may undermine children's social functioning via alterations in emotional expression which may become more salient with age.
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Affiliation(s)
- Candice A. Alfano
- Department of Psychology, University of Houston, Houston, TX USA
- HEALTH Research Institute, University of Houston, Houston, TX USA
| | - Jinu Kim
- Department of Psychology, University of Houston, Houston, TX USA
| | - Anthony B. Cifre
- Department of Psychology, University of Houston, Houston, TX USA
| | - Cara A. Palmer
- Department of Psychology, Montana State University, Bozeman, MT USA
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Stahl ST, Insana SP, Martica H Hall, Buysse DJ. Pediatric Sleep Disturbances and Symptoms of Depression in Older Adults. Int J Aging Hum Dev 2022; 95:429-439. [PMID: 35124983 DOI: 10.1177/00914150221077950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the association between retrospectively reported sleep disturbances during childhood and adolescence and current symptoms of depression and anxiety in older adults. Participants included 116 older adults (M age = 68 years [SD = 6.4 years]) who completed a battery of sleep and psychological assessments. We tested two multivariate regression models using age, sex, race, physical illness burden, insomnia status, and pediatric sleep disturbances as correlates of depressive symptoms and anxiety symptoms. Pediatric sleep disturbances were significantly associated with greater depressive symptomatology (β = 0.247, p = .010), independent of current insomnia status. Medium effect sizes were reported. Our results suggest that pediatric sleep disturbances may be a biobehavioral signal for the development of poor emotional health across the lifespan. Future research should identify critical windows of development when sleep disturbances might be most impactful on emotional health trajectories.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Salvatore P Insana
- Department of Psychiatry, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Martica H Hall
- Department of Psychiatry, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, 6614University of Pittsburgh, Pittsburgh, PA, USA
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"Sleep is healthy for your body and brain." Use of student-centered photovoice to explore the translation of sleep promotion at school to sleep behavior at home. Sleep Health 2021; 7:588-595. [PMID: 34301526 DOI: 10.1016/j.sleh.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/01/2021] [Accepted: 05/08/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES Schools are an important setting to teach and reinforce positive health behaviors such as sleep, however, research that incorporates the student perspective of school-based sleep promotion initiatives is limited. This study explored student's perceptions of sleep behavior (how they understood and valued positive and negative sleep behaviors) and determined if and how students translate school-based sleep promotion to the home. METHODS Forty-five grade 4 and 5 children (aged 9-11 years) were purposefully sampled from 3 schools participating in the Alberta Project Promoting healthy Living for Everyone in schools (APPLE) in Edmonton, Canada. Using focused ethnography as the method and photovoice as a data generating strategy, qualitative in-depth information was generated through photo-taking and one-on-one interviews. Data were analyzed in an iterative, cyclical process using latent content analysis techniques. RESULTS Four themes related to students' perception of sleep behavior within the context of a school-based sleep promotion initiative were identified: sleep is "healthy for your body and brain," sleep habits are rooted in the home environment, school experiences shape positive sleep habits at home, and students translate sleep promotion home if they think it is useful or would be acceptable to the family. CONCLUSION AND IMPLICATIONS School-based sleep promotion interventions that are grounded in the comprehensive school health (CSH) approach hold promise for successfully shaping student sleep behavior. To promote health and academic success in children, future interventions should include home-school partnerships that address child sleep across multiple critical learning environments.
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Morales-Muñoz I, Durdurak BB, Bilgin A, Marwaha S, Winsper C. Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review. Nat Sci Sleep 2021; 13:2175-2202. [PMID: 34984039 PMCID: PMC8709557 DOI: 10.2147/nss.s311672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD. METHODS We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review. RESULTS The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD. CONCLUSION The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.
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Affiliation(s)
- Isabel Morales-Muñoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Buse Beril Durdurak
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Ayten Bilgin
- School of Psychology, University of Kent, Canterbury, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.,The Barberry National Centre for Mental Health, Birmingham and Solihull Mental Health Trust, Birmingham, UK
| | - Catherine Winsper
- Coventry and Warwickshire Partnership NHS Trust, Research and Innovation, Coventry, UK
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