Sleep and anxiety: From mechanisms to interventions

Chellappa, Sarah L.; Aeschbach, Daniel

doi:10.1016/j.smrv.2021.101583

Cited by 511Sleep and related disordersSleep and Wakefulness ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Sleep and anxiety: From mechanisms to interventions

Chellappa, Sarah L., Aeschbach, Daniel·2022·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2021.101583

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Abstract

Anxiety is the most common mental health problem worldwide. Epidemiological studies show that sleep disturbances, particularly insomnia, affect ∼50% of individuals with anxiety, and that insufficient sleep can instigate or further exacerbate it. This review outlines brain mechanisms underlying sleep and anxiety, by addressing recent human functional/structural imaging studies on brain networks underlying the anxiogenic impact of sleep loss, and the beneficial effect of sleep on these brain networks. We discuss recent developments from human molecular imaging studies that highlight the role of specific brain neurotransmitter mechanisms, such as the adenosinergic receptor system, on anxiety, arousal, and sleep. This review further discusses frontline sleep interventions aimed at enhancing sleep in individuals experiencing anxiety, such as nonbenzodiazepines/antidepressants, lifestyle and sleep interventions and cognitive behavioral therapy for insomnia. Notwithstanding therapeutic success, up to ∼30% of individuals with anxiety can be nonresponsive to frontline treatments. Thus, we address novel non-invasive brain stimulation techniques that can enhance electroencephalographic slow waves, and might help alleviate sleep and anxiety symptoms. Collectively, these findings contribute to an emerging biological framework that elucidates the interrelationship between sleep and anxiety, and highlight the prospect of slow wave sleep as a potential therapeutic target for reducing anxiety.

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Pre-sleep anxiety amplifies threat monitoring and hyperarousal, thereby delaying sleep initiation.
“Cognitive models of insomnia and emerging data linking circadian factors to affective dysregulation suggest how pre-sleep anxiety amplifies threat monitoring and hyperarousal, thereby delaying sleep initiation [3,4].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [3]
Sleep onset anxiety is often accompanied by mental distress and physical tension, further compounding sleep difficulty.
“The condition is often accompanied by mental distress and physical tension, further compounding sleep difficulty [3].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [3]
Sleep onset anxiety functions as a transdiagnostic symptom cluster that increases vulnerability to insomnia rather than constituting a standalone disorder.
“Sleep onset anxiety, a heightened state of worry and cognitive arousal occurring during the transition to sleep, functions as a transdiagnostic symptom cluster that increases vulnerability to insomnia rather than constituting a standalone disorder [3].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [3]
Sleep onset anxiety commonly occurs with generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD).
“Sleep onset anxiety commonly occurs with generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD) [3].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [3]

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Sleep, insomnia and mental health
Palagini, L., Hertenstein, E., Riemann, D. W., & Nissen, C. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13628 · Cited by 360 · see citing works
Adenosine, caffeine, and sleep–wake regulation: state of the science and perspectives
Reichert, C. F., Deboer, T., & Landolt, H. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13597 · Cited by 183 · see citing works
“The functional connectivity within these networks is altered in certain patients with anxiety disorders and insomnia (Chellappa & Aeschbach, 2022).”
Background
Long-term use of benzodiazepines in chronic insomnia: a European perspective
Soyka, M., Wild, I., Caulet, B., Leontiou, C., Lugoboni, F., & Hajak, G. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1212028 · Cited by 104 · see citing works
“It is known that insomnia affects around half of individuals with anxiety (97), so by using these drugs, physicians may be attempting to address both insomnia and anxiety, despite their not being licensed for insomnia, and the products being licensed for short-term relief only in the treatment of anxiety due to concer…”
Background
Insomnia, anxiety and related disorders: a systematic review on clinical and therapeutic perspective with potential mechanisms underlying their complex link
Palagini, L., Miniati, M., Caruso, V., Alfi, G., Geoffroy, P. A., Domschke, K., Riemann, D., Gemignani, A., & Pini, S. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.103936 · Cited by 82 · see citing works
The relationship between physical activity and sleep disorders in adolescents: a chain-mediated model of anxiety and mobile phone dependence
Xiao, T., Pan, M., Xiao, X., & Liu, Y. (2024) · BMC Psychology · doi:10.1186/s40359-024-02237-z · Cited by 73 · see citing works
A comprehensive examination of mental health in patients with head and neck cancer: systematic review and meta-analysis
Jiménez-Labaig, P., Aymerich, C., Braña, I., Rullan, A., Cacicedo, J., Torres, M. Á. G., Harrington, K. J., & Catalán, A. (2024) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkae031 · Cited by 67 · see citing works
Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: A systematic review and meta-analysis of observational studies
Bourke, M., Wang, H., McNaughton, S. A., Thomas, G., Firth, J., Trott, M., & Cairney, J. (2025) · Clinical Psychology Review · doi:10.1016/j.cpr.2025.102585 · Cited by 65 · see citing works
Associations between 24-h movement behaviors and indicators of mental health and well-being across the lifespan: a systematic review
Groves, C. I., Huong, C., Porter, C. D., Summerville, B., Swafford, I., Witham, B., Hayward, M., KWAN, M. Y. W., & Brown, D. M. Y. (2024) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-024-00048-6 · Cited by 59 · see citing works
A neural circuit associated with anxiety‐like behaviors induced by chronic inflammatory pain and the anxiolytic effects of electroacupuncture
Wu, Z., Shen, Z., Xu, Y., Chen, S., Xiao, S., Ye, J., Zhang, H., Ma, X., Zhu, Y., Zhu, X., et al. (2023) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.14520 · Cited by 46 · see citing works
Automated Detection of Neurological and Mental Health Disorders Using EEG Signals and Artificial Intelligence: A Systematic Review
Uyanık, H., Şengür, A., Salvi, M., Tan, R., Tan, J. H., & Acharya, U. R. (2025) · Wiley Interdisciplinary Reviews Data Mining and Knowledge Discovery · doi:10.1002/widm.70002 · Cited by 49 · see citing works
“…Disorder (MDD) (Fava and Kendler 2000), Bipolar Disorder (Grande et al. 2016), Bipolar Depression (Malhi et al. 2003), Bipolar Mania (Li, Yuan et al. 2023), Anxiety (Saxena and Krug 2013; Chellappa and Aeschbach 2022), Anhedonia (Serretti 2023) and Stress (Cohen et al. 2007) are considered.”
Screening the effective components of Suanzaoren decoction on the treatment of chronic restraint stress induced anxiety-like mice by integrated chinmedomics and network pharmacology
Yan, Y., Li, J., Zhang, Y., Wang, H., Qin, X., Zhai, K., & Du, C. (2023) · Phytomedicine · doi:10.1016/j.phymed.2023.154853 · Cited by 45 · see citing works
The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety
Huang, M. T., Liu, K., Liang, C., Wang, Y., & Guo, Z. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-04161-0 · Cited by 44 · see citing works
“And the appearance of anxiety may be associated with specific brain neurotransmitter mechanisms [71].”
Background
The influence of sleep on fear extinction in trauma-related disorders
Pace-Schott, E. F., Seo, J., & Bottary, R. M. (2022) · Neurobiology of Stress · doi:10.1016/j.ynstr.2022.100500 · Cited by 45 · see citing works
Postpartum Insomnia and Poor Sleep Quality Are Longitudinally Predictive of Postpartum Mood Symptoms
Okun, M. L., & Lac, A. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001234 · Cited by 41 · see citing works
“It is well known that insomnia is a primary symptom of depression and anxiety (80,81), that insomnia is a prodromal symptom for mood disorders (40,82), and that persistent or reemergence of insomnia is an indicator for relapse and recurrence (83).”
Background
Academic Burden and Emotional Problems Among Adolescents: A Longitudinal Mediation Analysis
Wang, J., Wang, Z., Yang, Y., Wang, T., Lin, H., Zhang, W., Chen, X., & Fu, C. (2025) · Journal of Adolescence · doi:10.1002/jad.12471 · Cited by 40 · see citing works
“Epidemiological studies reported that sleep disturbances, particularly insomnia, affected 50% of people with anxiety, and that insufficient sleep instigated or further exacerbated anxiety symptoms (Chellappa and Aeschbach 2022).”
Clinical usefulness of dual orexin receptor antagonism beyond insomnia: Neurological and psychiatric comorbidities
Carpi, M., Palagini, L., Fernandes, M., Calvello, C., Geoffroy, P. A., Miniati, M., Pini, S., Gemignani, A., Mercuri, N. B., & Liguori, C. (2023) · Neuropharmacology · doi:10.1016/j.neuropharm.2023.109815 · Cited by 40 · see citing works
“Furthermore, comorbid insomnia is an indicator of increased morbidity and low responsiveness to treatment and was shown to be related to the severity of worry, fear, and hypervigilance (Chellappa and Aeschbach, 2022; Palagini et al., 2022).”
Background
Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study
Jackson, C., Stewart, I. D., Plekhanova, T., Cunningham, P. S., Hazel, A. L., Al-Sheklly, B., Aul, R., Bolton, C. E., Chalder, T., Chalmers, J. D., et al. (2023) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(23)00124-8 · Cited by 35 · see citing works
“16,17 Furthermore, epidemiological studies have suggested that sleep disturbance is associated with respiratory disease, which can cause dyspnoea.”
Background
Comorbidities and Risk Factors Associated With Insomnia in the Elderly Population
Mookerjee, N., Schmalbach, N. K., Antinori, G., Thampi, S., Windle-Puente, D., Gilligan, A., Huy, H., Andrews, M., Sun, A., Gandhi, R., et al. (2023) · Journal of Primary Care & Community Health · doi:10.1177/21501319231168721 · Cited by 34 · see citing works
Relationship between sleep and serum inflammatory factors in patients with major depressive disorder
Yang, Y., Gu, K., Meng, C., Li, J., Qiao, L., Zhou, X., Yan, D., Li, D., Pei, C., Lu, Y., et al. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115528 · Cited by 36 · see citing works
Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications
Maniaci, A., Via, L. L., Pecorino, B., Chiofalo, B., Scibilia, G., Lavalle, S., & Scollo, P. (2024) · Neurology International · doi:10.3390/neurolint16030039 · Cited by 33 · see citing works
“Moreover, the psychological impact of OSA, including chronic fatigue and the stress of coping with a sleep disorder, can also weigh heavily on mental well-being, potentially triggering feelings of inadequacy or frustration that can spiral into more severe mood disorders [38].”
Background
Deficits in brain default mode network connectivity mediate the relationship between poor sleep quality and anxiety severity
Shen, Z., Yang, X., She, T., Zhao, G., Dou, Z., Luo, Y., Lin, W., Dang, W., & Yu, S. (2023) · SLEEP · doi:10.1093/sleep/zsad296 · Cited by 35 · see citing works
Relationship of Sleep Disorder with Neurodegenerative and Psychiatric Diseases: An Updated Review
Xiao, X., Rui, Y., Jin, Y., & Chen, M. (2023) · Neurochemical Research · doi:10.1007/s11064-023-04086-5 · Cited by 35 · see citing works
“Anxiety is a common psychiatric disorder characterized by persistent feelings of fear and worry [71 ].”
The impact of screen time changes on anxiety during the COVID-19 pandemic: sleep and physical activity as mediators
Chen, Q., Dai, W., Li, G., & Ma, N. (2022) · Sleep and Biological Rhythms · doi:10.1007/s41105-022-00398-1 · Cited by 36 · see citing works
“The sleep loss can result in an abnormal top-down prefrontal control of emotional regulation, thereby directly affecting responses to negative emotions [55].”
Background
Restraint stress induced anxiety and sleep in mice
Xu, Y., Liu, G., Ji, Z.-Z., Li, Y.-Y., Wang, Y., Wu, X., Liu, J.-L., Ma, D.-X., Zhong, M., Gao, C., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1090420 · Cited by 30 · see citing works
Effectiveness of app-based cognitive behavioral therapy for insomnia on preventing major depressive disorder in youth with insomnia and subclinical depression: A randomized clinical trial
Chen, S., Que, J., Chan, N. Y., Shi, L., Li, S. X., Chan, J. W. Y., Huang, W., Chen, X., Tsang, C. C., Ho, Y. L., et al. (2025) · PLoS Medicine · doi:10.1371/journal.pmed.1004510 · Cited by 30 · see citing works
“In contrast to the long-term effects of app-based CBT-I on insomnia, its anxiolytic effect observed at post-intervention did not sustain at follow-ups, despite the close relationship between insomnia and anxiety [39].”
From the gut to the brain, mechanisms and clinical applications of γ-aminobutyric acid (GABA) on the treatment of anxiety and insomnia
Jiang, C., Chen, Y., & Sun, T. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1570173 · Cited by 31 · see citing works
“Conversely, anxiety disorders disrupt sleep architecture by reducing slow-wave sleep and increase nocturnal awakenings through noradrenergic hyperactivity in the locus coeruleus (Chellappa and Aeschbach, 2022; Gong et al., 2021).”
Uncovering the effects and mechanisms of tea and its components on depression, anxiety, and sleep disorders: A comprehensive review
Han, Z., Wang, L., Zhu, H., Tu, Y., He, P., & Li, B. (2024) · Food Research International · doi:10.1016/j.foodres.2024.115191 · Cited by 27 · see citing works
Sleep disturbances in generalized anxiety Disorder: The central role of insomnia
Xue, Y., Wang, W.-D., Liu, Y., Wang, J., & Walters, A. S. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106545 · Cited by 32 · see citing works
The prevalence and associated factors of prenatal depression and anxiety in twin pregnancy: a cross-sectional study in Chongqing, China
Zhou, Y., Huang, J., Baker, P. N., Liao, B., & Yu, X. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-05203-y · Cited by 25 · see citing works
“Long-term sleep disturbance can lead to circadian rhythm disorder, affect the autonomic nervous system and limbic system (which is involved in mediating emotion), worsen mood vulnerability and instigate or exacerbate anxiety symptoms [48].”
Background
Effects of Neuroticism on Differences in Symptom Structure of Life Satisfaction and Depression-Anxiety among College Students: A Network Analysis
Tang, Q., He, X., Zhang, L., Liu, X., Tao, Y., & Liu, G. (2023) · Behavioral Sciences · doi:10.3390/bs13080641 · Cited by 26 · see citing works
“As for the relationship between sleep, depression, and anxiety, sleep problems are identified as common symptoms of both depression [72,73] and anxiety [74,75].”
Background
Sleep and the recovery from stress
Yu, X., Nollet, M., Franks, N. P., & Wisden, W. (2025) · Neuron · doi:10.1016/j.neuron.2025.04.028 · Cited by 27 · see citing works
The Association between Circadian Syndrome and Frailty in US adults: a cross-sectional study of NHANES Data from 2007 to 2018
Sun, L., Huo, X., Jia, S., & Chen, X. (2024) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02745-3 · Cited by 24 · see citing works
“About 50% of patients with sleep disorders, especially insomnia, suffer from anxiety, which can be triggered or exacerbated by sleep deprivation [35] .”
Background
Ethological computational psychiatry: Challenges and opportunities
Monosov, I. E., Zimmermann, J., Frank, M. J., Mathis, M. W., & Baker, J. T. (2024) · Current Opinion in Neurobiology · doi:10.1016/j.conb.2024.102881 · Cited by 21 · see citing works
“For example, in generalized anxiety disorders and other mental health disorders patients often have disruptions of sleep, and their behavior, decision making, and other activities may be particularly mal-adaptive within the context of a sleepless night [16].”
Exploring the mechanism of Suanzaoren decoction in treatment of insomnia based on network pharmacology and molecular docking
Wang, S., Yan, Z., & Hu, X. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1145532 · Cited by 23 · see citing works
“Long-term insomnia can also induce anxiety, depression, and other mental disorders (Hertenstein et al., 2019; Chellappa and Aeschbach, 2022).”
Background
The relationship between autoimmune thyroid disease, thyroid nodules and sleep traits: a Mendelian randomization study
Wang, S., Wang, K., Chen, X., & Lin, S. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1325538 · Cited by 24 · see citing works
“…Autoimmune hypothyroidism as the exposures, we excluded several SNPs (rs568999, rs2160232, rs9271500, rs10995256) that were associated with anxiety and in ﬂ ammatory bowel disease, as previous studies have suggested a link between anxiety, in ﬂ ammatory bowel disease, and sleep disorders (34 – 37).”
Result
The impact of sleep deprivation on the functional connectivity of visual-related brain regions
Weng, X., Wen, K., Guo, J., Zhang, P., Zhang, Y., Cao, Q., Han, Q., & Xu, F. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.11.026 · Cited by 21 · see citing works
GabaAergic sedative prospection of sclareol-linalool co-treatment: An antagonistic intervention through in vivo and in silico studies
Islam, M. T., Hasan, M. S. A., Ferdous, J., Mia, E., Yana, N. T., Ansari, I. A., Ansari, S. A., Islam, M. A., & Coutinho, H. D. M. (2024) · Neuroscience Letters · doi:10.1016/j.neulet.2024.138060 · Cited by 21 · see citing works
Food insecurity and insomnia‐related symptoms among adults from low‐ and middle‐income countries
Jacob, L., Smith, L., Kostev, K., Oh, H. Y., Gyasi, R. M., Sánchez, G. F. L., Song, T., Tully, M. A., Haro, J. M., Yon, D. K., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13852 · Cited by 21 · see citing works
“…relationships with sleep disturbances, which may involve hypermetabolism of multiple brain regions (e.g., locus coeruleus, limbic system, and thalamus), dopaminergic hypoactivity, and changes in the strength of binding of γ-aminobutyric acid (GABA) receptors (Chellappa & Aeschbach, 2022).”
Background
“Close your eyes and relax”: the role of hypnosis in reducing anxiety, and its implications for the prevention of cardiovascular diseases
Leo, D. G., Keller, S. S., & Proietti, R. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1411835 · Cited by 21 · see citing works
Anxiolytic-like effect of succinic acid: A possible GABAergic intervention
Mia, M. N., Smrity, S. Z., Bappi, M. H., Kamli, H. M., Islam, T., Prottay, A. A. S., Akbor, M. S., Latif, M. A., Islam, S., Bhakta, K., et al. (2023) · Food Bioscience · doi:10.1016/j.fbio.2023.103044 · Cited by 20 · see citing works
Perils of the nighttime: Impact of behavioral timing and preference on mental health in 73,888 community-dwelling adults
Lok, R., Weed, L., Winer, J. R., & Zeitzer, J. M. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115956 · Cited by 21 · see citing works
Impact of rumination on sleep quality among patients with non‑alcoholic fatty liver disease: a moderated mediation model of anxiety symptoms and resilience
Chang, X., Guo, C., Heng, Z., & Liu, L. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04572-8 · Cited by 24 · see citing works
“Anxiety and sleep are intricately connected through a self-reinforcing feedback loop [32].”
Background
Unraveling the complex interplay between insomnia, anxiety, and brain networks
Mao, T., Guo, B., & Rao, H. (2024) · SLEEP · doi:10.1093/sleep/zsad330 · Cited by 19 · see citing works
“CID frequently coexists with anxiety, the predominant category of mental disorders characterized by excessive fear, anxiety, or avoidance of perceived threats [8, 9].”
Background
Glycyrrhizic acid treatment ameliorates anxiety-like behaviour via GLT1 and Per1/2-dependent pathways
Ma, S., Chong, Y., Zhang, R., Quan, W., Gui, J., Li, L., Wang, J., Miao, S., Shi, X., Zhao, M., et al. (2024) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2024.118013 · Cited by 19 · see citing works
The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology
Gilgoff, R., Mengelkoch, S., Elbers, J. M., Kotz, K. J., Radin, A. S., Pasumarthi, I., Murthy, R., Sindher, S., Harris, N. B., & Slavich, G. M. (2024) · Stress · doi:10.1080/10253890.2024.2327333 · Cited by 21 · see citing works
“…(a) levels of neurotransmitters such as orexin, catecholamines, gamma amino-butyric acid (GABA), glutamate, acetylcholine, serotonin, adenosine (chellappa & Aeschbach, 2022; linnstaedt et al., 2019), and melatonin (caumo et al., 2019); (b) markers of oxidative stress such as F2 isoprostane…”
Background
Sleep, insomnia and anxiety–Bidirectional mechanisms and chances for intervention
Riemann, D. W. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101584 · Cited by 19 · see citing works
Transcutaneous Auricular Vagus Nerve Stimulation Modulating the Brain Topological Architecture of Functional Network in Major Depressive Disorder: An fMRI Study
Guo, Z., Liao, D., Chen, L., Wang, C., Qu, M., Lv, X., Fang, J., & Liu, C. (2024) · Brain Sciences · doi:10.3390/brainsci14090945 · Cited by 19 · see citing works
“These approaches have been widely utilized to investigate the underlying neural mechanism of insomnia [20], MDD [21], and the treatment efficiency of taVNS [3,8].”
Distinct functional brain abnormalities in insomnia disorder and obstructive sleep apnea
Duan, W., Liu, X., Ping, L., Jin, S., Yu, H., Dong, M., Xu, F., Li, N., Li, Y., Xu, Y., et al. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01485-7 · Cited by 18 · see citing works
Morning blue light treatment improves sleep complaints, symptom severity, and retention of fear extinction memory in post-traumatic stress disorder
Vanuk, J. R., Pace-Schott, E. F., Bullock, A., Esbit, S., Dailey, N. S., & Killgore, W. D. S. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.886816 · Cited by 19 · see citing works
Endogenous circadian rhythms in mood and well-being
Scheer, F. A. J. L., & Chellappa, S. L. (2023) · Sleep Health · doi:10.1016/j.sleh.2023.07.012 · Cited by 17 · see citing works
Self-citation
A cohort study comparing the effects of medical cannabis for anxiety patients with and without comorbid sleep disturbance
Murphy, M., Erridge, S., Holvey, C., Coomber, R., Rucker, J., & Sodergren, M. H. (2023) · Neuropsychopharmacology Reports · doi:10.1002/npr2.12407 · Cited by 17 · see citing works
“19 The complex origin of GAD, its comorbidity with other psychiatric conditions, and its impact on brain circuitry make a best-fit treatment difficult to identify.”
Background
Extracellular vesicles ameliorates sleep deprivation induced anxiety-like behavior and cognitive impairment in mice
Lin, Y., Kang, Z.-M., Su, C., Li, S., & Xie, W. (2024) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2024.101207 · Cited by 18 · see citing works
“9 The reciprocal in ﬂ uence between sleep-wake regulation and emotional processing, mediated by intricate neural networks, under-scores the intricate nature of this correlation.”
Background
Relationships among anxiety, psychological resilience, and physical activity in university students: variable-centred and person-centred perspectives
Yuan, Y., Yang, J., Huang, W., Hu, C., Zhang, W., & Chen, B. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1694344 · Cited by 20 · see citing works
Aberrant individual large-scale functional network connectivity and topology in chronic insomnia disorder with and without depression
Chen, M., Shao, H., Wang, L., Ma, J., Chen, J., Li, J., Zhong, J., Zhu, B., Bi, B., Chen, K., et al. (2024) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2024.111158 · Cited by 19 · see citing works
Meta-narrative review: the impact of music therapy on sleep and future research directions
Gou, Q., Li, M., Wang, X., Yuan, X., Yang, M., Li, J., Wang, B., Yang, D., Ren, X., Yang, M., et al. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2024.1433592 · Cited by 18 · see citing works
Association Between Dietary Fiber Intake and Sleep Disorders: Based on the NHANES Database
Chen, Y., Zhao, Z., Ding, W., Zhou, Z., & Xiao, M. (2024) · Brain and Behavior · doi:10.1002/brb3.70123 · Cited by 15 · see citing works
Disordered Eating Behaviors, Perceived Stress and Insomnia During Academic Exams: A Study Among University Students
Strete, E. G., Cincu, M.-G., & Sălcudean, A. (2025) · Medicina · doi:10.3390/medicina61071226 · Cited by 17 · see citing works
Electroencephalography connectome changes in chronic insomnia disorder are correlated with neurochemical signatures
Yu, L., Peng, W. J., Lin, W., Luo, Y., Hu, D., Zhao, G., Xu, H., Dou, Z., Zhang, Q., Hong, X., et al. (2024) · SLEEP · doi:10.1093/sleep/zsae080 · Cited by 16 · see citing works
Sleep and mental health among Chinese adolescents: the chain-mediating role of physical health perception and school adjustment
Li, L., Zhang, Y., Fan, M., & Cao, B. (2024) · BMC Psychology · doi:10.1186/s40359-024-01719-4 · Cited by 19 · see citing works
“…to the evidence from animal models and/or pharmacological work, a plethora of neurotransmitter and neuromodula-tor systems orchestrates sleep and emotional regulation, including but not limited to norepinephrine, acetylcholine, γ-aminobutyric acid (GABA), dopamine, glutamate, serotonin [17, 18].”
Background
The Hidden Dangers of Sedentary Living: Insights into Molecular, Cellular, and Systemic Mechanisms
Diniz, D. G., Bento‐Torres, J., da Costa, V. O., Carvalho, J. P. R., Tomás, A. M., de Oliveira, T. C. G., Soares, F. C., de Macedo, L. D. E. D., Jardim, N. Y. V., Bento-Torres, N. V. O., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms251910757 · Cited by 17 · see citing works
Social support and anxiety, a moderated mediating model
Yang, L., Wang, N., Li, D., Zhao, X., Wen, M., Zhang, Y., & Liu, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-14336-x · Cited by 21 · see citing works
Status and Determinants of Symptoms of Anxiety and Depression among Food Delivery Drivers in Shanghai, China
Peng, Y., Shao, Y., Li, Z., Cai, R., Bo, X., Qian, C., Chu, Q., Jiang, C., & Shi, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013189 · Cited by 15 · see citing works
“Consistent with previous studies [40,41], sleep quality influenced both the anxiety and the depression dimensions, and people who experienced anxiety and depression were also more likely to lose sleep [14].”
Result
Impact of Medical School on the Relationship between Nutritional Knowledge and Sleep Quality—A Longitudinal Study of Students at Wroclaw Medical University in Poland
Kosendiak, A. A., Adamczak, B. B., Kuźnik, Z., & Makles, S. (2024) · Nutrients · doi:10.3390/nu16020278 · Cited by 18 · see citing works
“Studies have shown that anxiety and stress may contribute to the exacerbation of overall sleep quality, shortened sleep duration, and increased reliance on sleeping medication [67].”
Background
Prevalence, Severity, and Predictors of Insomnia in Advanced Colorectal Cancer
Wong, A. K. Y., Wang, D. T., Marco, D. J. T., Le, B. H. C., & Philip, J. A. M. (2023) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2023.05.020 · Cited by 15 · see citing works
Sleep health among sexual and gender minority people in the United States: A scoping review
Leonard, S. I., Castiblanco, M. R., Chang, A., Belloir, J. A., Caceres, B. A., Bruzzese, J., & Jackman, K. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2024.12.033 · Cited by 14 · see citing works
Smartphone addiction and sleep quality in the physical activity-anxiety link: a mediation-moderation model
Qin, X., Liu, L., Yan, Y., Guo, X., Yang, N., & Li, L. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1512812 · Cited by 14 · see citing works
“This deterioration in sleep quality subsequently exacerbates anxiety levels, thereby creating a detrimental cycle (88).”
The brain in chronic insomnia and anxiety disorder: a combined structural and functional fMRI study
Xu, M., Li, B., Wang, S., Chen, C., Liu, Z., Ji, Y., Liu, K., & Niu, Y. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1364713 · Cited by 15 · see citing works
“For instance, individuals with both disorders may exhibit abnormal levels of neurotransmitters such as 5-hydroxytryptamine (5, 6), g - aminobutyric acid (7) and dopamine (8), which maintain a state of hyperarousal and stress (9).”
Background
The relationship between physical activity and anxiety in college students: exploring the mediating role of lifestyle habits and dietary nutrition
Sun, D., Zhu, X., & Bao, Z. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1296154 · Cited by 13 · see citing works
The altered hypothalamic network functional connectivity in chronic insomnia disorder and regulation effect of acupuncture: a randomized controlled neuroimaging study
Peng, W., Xu, H., Zhang, C., Hu, Y., & Yu, S. (2024) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-024-04703-y · Cited by 13 · see citing works
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Authors: Chellappa, S. L., & Aeschbach, D.
Affiliations: University of Cologne (DE)
University of Bonn (DE)
Corresponding author: Chellappa, Sarah L.
ORCID: Chellappa, Sarah L.
Aeschbach, Daniel
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2022-02
Volume: 61
Pages: 101583
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2021.101583
OpenAlex: W4200462974
Cited by: 509
References: 158
Citations by year: 2026: 111 · 2025: 170 · 2024: 135 · 2023: 71 · 2022: 21 · 2021: 1
FWCI: 9.43
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
elib (German Aerospace Center) (acceptedVersion)
ePrints Soton (University of Southampton) (submittedVersion)
Funders: Alexander von Humboldt Foundation
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: sleep, anxiety, insomnia, sleep deprivation, brain networks, arousal, cognitive behavioral therapy for insomnia, non-benzodiazepine hypnotics, antidepressants, lifestyle intervention, non-invasive brain stimulation, slow-wave sleep, sleep interventions
MeSH terms: Anxiety, Anxiety Disorders, Humans, Sleep Initiation and Maintenance Disorders, Sleep, Cognitive Behavioral Therapy

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Sleep and anxiety: From mechanisms to interventions

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