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Overanxious and underslept

Ben Simon, Eti, Rossi, Aubrey, Harvey, Allison G., Walker, Matthew P.·2019·Nature Human Behaviour

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Abstract

Are you feeling anxious? Did you sleep poorly last night? Sleep disruption is a recognized feature of all anxiety disorders. Here, we investigate the basic brain mechanisms underlying the anxiogenic impact of sleep loss. Additionally, we explore whether subtle, societally common reductions in sleep trigger elevated next-day anxiety. Finally, we examine what it is about sleep, physiologically, that provides such an overnight anxiety-reduction benefit. We demonstrate that the anxiogenic impact of sleep loss is linked to impaired medial prefrontal cortex activity and associated connectivity with extended limbic regions. In contrast, non-rapid eye movement (NREM) slow-wave oscillations offer an ameliorating, anxiolytic benefit on these brain networks following sleep. Of societal relevance, we establish that even modest night-to-night reductions in sleep across the population predict consequential day-to-day increases in anxiety. These findings help contribute to an emerging framework explaining the intimate link between sleep and anxiety and further highlight the prospect of non-rapid eye movement sleep as a therapeutic target for meaningfully reducing anxiety.

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Ye, X., Li, Y., Liu, Y., Zheng, Q., Lin, Z., Zeng, Y., Lin, Z., Zhu, T., Chen, X., Chen, L., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1289906 · Cited by 18
Developmental alcohol exposure is exhausting: Sleep and the enduring consequences of alcohol exposure during development
Wilson, D. A., Sullivan, R. M., Smiley, J. F., Saito, M., & Raineki, C. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105567 · Cited by 12
Analysis of Factors That Influenced the Mental Health Status of Public Health Workers During the COVID-19 Epidemic Based on Bayesian Networks: A Cross-Sectional Study
Peng, X., Pu, Y., Jiang, X., Zheng, Q., Gu, J., Zhou, H., & Deng, D. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.755347 · Cited by 12
The utility of wearable headband electroencephalography and pulse photoplethysmography to assess cortical and physiological arousal in individuals with stress‐related mental disorders
Blaskovich, B., Tarrasó, E. B., Pöhlchen, D., Manafis, A., Neumayer, H., Besedovsky, L., Brückl, T. M., BeCOME Working Group, Simor, P., Binder, F. P., et al. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14123 · Cited by 12
Adaptive consolidation of active inference: excitatory and inhibitory mechanisms for organizing feedforward and feedback memory systems in sleep
Tucker, D. M., Luu, P., & Friston, K. J. (2025) · Cerebral Cortex · doi:10.1093/cercor/bhaf122 · Cited by 15
Sleep Loss Influences the Interconnected Brain-Body Regulation of Cardiovascular Function in Humans
Krause, A. J., Vallat, R., Simon, E. B., & Walker, M. P. (2022) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001150 · Cited by 11
“Second, increases in MPFC connectivity with the amygdala were significantly and negatively related to increases in diastolic blood pressure (r(61) = −0.”
BackgroundSelf-citation
Disentangling Sleep's Role in Emotion processing
Sullivan, E. C., McCall, C., Henderson, L. M., & Cairney, S. A. (2025) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2025.109269 · Cited by 13
The Monday Effect Revisited: A Diary and Sleep Actigraphy Study
Elfering, A., Gerhardt, C., Pereira, D., Schenker, A., & Kottwitz, M. U. (2020) · Sleep and Vigilance · doi:10.1007/s41782-020-00105-5 · Cited by 10
COVID-somnia: Sleep disturbance among Indian nurses during COVID-19 pandemic
Kumar, M., Kumari, A., Rohilla, K. K., Dhawan, S., Singh, A., Sharma, N., Kriplani, N., Barari, N., & Soni, R. K. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_2113_21 · Cited by 10
“Disrupted sleep patterns and sleep quality have been associated with psychological symptoms such as anxiety, stress, and depression.[12] According to nurses’ reactions to the current pandemic, the most salient sources of stress were lack of sleep, anxiety, and safety concerns.”
Background
Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders
Perez, T. M., Glue, P., Adhia, D. B., Navid, M. S., Zeng, J., Dillingham, P., Smith, M., Niazi, I. K., Young, C. K., & De Ridder, D. (2022) · Trials · doi:10.1186/s13063-022-06863-z · Cited by 8
Disrupted Brain Functional Network Topology in Essential Tremor Patients With Poor Sleep Quality
Peng, J., Yang, J., Li, J., Lei, D., Li, N., Suo, X., Duan, L., Chen, C., Zeng, Y., Xi, J., et al. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.814745 · Cited by 9
The impact of pharmacotherapy for premenstrual dysphoric disorder on sleep
Meth, E. M. S., Nôga, D. A., Dubol, M., Xue, P., Poromaa, I. S., & Benedict, C. (2025) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2025.102069 · Cited by 10
“These include eating behavior [40 – 43], mood regulation [44, 45], social interactions [46,47], daytime cognitive performance [48, 49], and pain perception [50,51].”
The application of artificial intelligence in insomnia, anxiety, and depression: A bibliometric analysis
Lu, E., Zhang, D., Han, M., Wang, S., & He, L. (2025) · Digital Health · doi:10.1177/20552076251324456 · Cited by 10
Actigraphy monitoring in anxiety disorders: A mini-review of the literature
Pastre, M., & López‐Castromán, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.984878 · Cited by 9
“The anxiety symptoms that emerged in patients submitted to sleep deprivation were associated in functional MRI with an hypoactivity of the medial prefrontal cortex, involved in emotional control, and an hyperactivity in the amygdala and dorsal anterior cingulate cortex, responsible of the reactivity to negative emotio…”
Background
Prospective Bidirectional Relationship Between Sleep Duration and Posttraumatic Stress Disorder Symptoms After Suspected Acute Coronary Syndrome
Cornelius, T. M., Edmondson, D. E., Abdalla, M., Scott, A., Sedano, B. F., Hiti, D., Sullivan, A. M., Schwartz, J. E., Kronish, I. M., & Shechter, A. (2024) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001279 · Cited by 9
Rethinking the use of hypnotics for treatment of insomnia in the elderly
Kunz, D. (2021) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2021.1900116 · Cited by 9
“anxiety [20] and neurocognitive disorders [14–16] as it is long hypothesized for affective illnesses [8,21].”
Background
Distressing dreams in trauma survivors: using a sleep diary mobile app to reveal distressing dream characteristics and their relationship to symptoms and suicidal ideation in trauma-exposed adults
Richards, A. L., Santistevan, A. C., Kovnick, M. O., Orlova, P., Yack, L. M., Berg, E., Pracar, S., Metzler, T. J., Neylan, T. C., & Woodward, S. H. (2025) · SLEEP Advances · doi:10.1093/sleepadvances/zpae099 · Cited by 8
Restless nights, cold hearts: Poor sleep causally blunts empathy
Gordon‐Hecker, T., Choshen‐Hillel, S., Simon, E. B., Walker, M. P., Perry, A., & Gileles‐Hillel, A. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100548 · Cited by 9
Self-citation
Relationships Between Sleep Quality, Anxiety and Depression in University Students: Stable Trends over Time and a Pronounced Concern for Sleep Initiation
Whitehead, J. P., & Horton, C. L. (2025) · Brain Sciences · doi:10.3390/brainsci15111142 · Cited by 11
Expecting the Unexpected: Predicting Panic Attacks From Mood, Twitter, and Apple Watch Data
McGinnis, E. W., Loftness, B. C., Lunna, S., Berman, I., Bagdon, S., Lewis, G., Arnold, M., Danforth, C. M., Dodds, P. S., Price, M., et al. (2024) · IEEE Open Journal of Engineering in Medicine and Biology · doi:10.1109/ojemb.2024.3354208 · Cited by 14
The dynamic responses of mood and sleep physiology to chronic sleep restriction and subsequent recovery sleep
Jones, C. W., Larson, O., Basner, M., & Dinges, D. F. (2024) · SLEEP · doi:10.1093/sleep/zsae091 · Cited by 6
The effects of shared, depression-specific, and anxiety-specific internalizing symptoms on negative and neutral episodic memories following post-learning sleep
Niu, X., Utayde, M. F., Sanders, K. E. G., Cunningham, T. J., Zhang, G., Kensinger, E. A., & Payne, J. D. (2024) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-024-01209-5 · Cited by 8
“…sleep may provide robust passive protection against daytime interferences (Casillas & Clark, 2000), especially during SWS where slow oscillatory activities may offer ameliorating benefits on anxious thoughts and cognitive disruptions (Ben Simon et al., 2020; Chellappa & Aeschbach, 2022).”
Quantitative association of cerebral blood flow, relaxation times and proton density in young and middle-aged primary insomnia patients: A prospective study using three-dimensional arterial spin labeling and synthetic magnetic resonance imaging
Luo, X., Li, Q.-X., Shen, L., Zhou, X., Zou, F., Tang, W., & Guo, R. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1099911 · Cited by 7
COVID-19 Fear, Sleep Quality, Anxiety and Depression: A Moderated Mediation Model
Ho, T. T. Q. (2023) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-023-00533-1 · Cited by 7
“The link between CV-19 F and anxiety (Erbiçer et al., 2021; Gao et al., 2020; Meller et al., 2022) as well as between sleep quality and anxiety (Ben Simon et al., 2020; Diaz et al., 2022; Sun et al., 2018) were documented separately.”
Background
Gray matter volume alterations in de novo Parkinson's disease: A mediational role in the interplay between sleep quality and anxiety
He, G., Huang, X., Sun, H.-H., Xing, Y., Gu, S., Ren, J., Liu, W., & Lu, M. (2024) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.14867 · Cited by 7
“30 Although our study was constrained by a modest sample size, the observed GMV changes in the FG and ITG are noteworthy and consistent with the anticipated neuroanatomical patterns in A-PD.”
BackgroundInfluential
Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation
Zagaria, A., & Ballesio, A. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.09.020 · Cited by 11
Deep Learning Automatic Sleep Staging Method Based on Multidimensional Sleep Data
Yang, J., Meng, Y., Cheng, Q., Li, H., Cai, W., & Wang, T. (2024) · IEEE Access · doi:10.1109/access.2024.3496721 · Cited by 7
Investigation of Sleep Disorders and Related Influencing Factors Among the Elderly in Southeast Coastal Regions of China: A Cross-Sectional Survey Analysis
Chen, Y., Su, F., Xiang, H., & Xia, J. (2025) · Clinical Interventions in Aging · doi:10.2147/cia.s482763 · Cited by 7
Sleep fails to depotentiate amygdala-reactivity to negative emotional stimuli in youth with elevated symptoms of anxiety
Sollenberger, N. A., Kimbler, A., Cummings, L. R., Pettit, J. W., Hayes, T., Patriarca, G. C., Vázquez, A. L., Shumway, P., Yegüez, C. E., Rey, Y., et al. (2023) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-023-01066-8 · Cited by 7
Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations
Sheaves, B., Cropley, V. L., Moseley, P., Woodruff, P. W. R., Punton, G., Speth, C., Speth, J., Meerlo, P., & Brederoo, S. G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf107 · Cited by 6
“51 Hence, the loss of functional connectivity of the prefrontal cortex following sleep disruption may be the neurological under-pinning of negative affect that was shown to mediate the relationship between sleep loss and hallucinations (as reported at the psychological level).”
Sympathetic Neural Control in Humans with Anxiety‐Related Disorders
Bigalke, J. A., & Carter, J. R. (2021) · Comprehensive physiology · doi:10.1002/j.2040-4603.2022.tb00206.x · Cited by 6
“Importantly, anxiety has been shown to exacerbate the impact of sleep deprivation on neural functioning (18, 120, 251), indicating a distinct susceptibility of anxious populations to the negative impact of poor sleep.”
Tired of war: Changes in the sleep of the Israeli civilian population in the wake of the Israel-Hamas war
Zak, U., Choshen‐Hillel, S., Hochner, H., & Gileles‐Hillel, A. (2025) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2025.100596 · Cited by 6
Prevalence and correlates of sleep quality in the Chinese college students with migraine: a cross-sectional study
Zhao, J., Cen, Y., Yang, J., Liu, C., Li, Y., Ren, Z., Xiao, Y., He, J., Jing, L., Zhong, Y., et al. (2022) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2022.1037103 · Cited by 6
Self-reported suboptimal sleep and receipt of sleep assessment and treatment among persons with and without a mental health condition in Australia: a cross sectional study
Metse, A. P., Fehily, C. M. C., Clinton‐McHarg, T., Wynne, O., Lawn, S., Wiggers, J. H., & Bowman, J. (2021) · BMC Public Health · doi:10.1186/s12889-021-10504-6 · Cited by 6
A theoretical perspective on the role of sleep in borderline personality disorder: From causative factor to treatment target
van Trigt, S., van der Zweerde, T., Someren, E. J. W. V., van Straten, A., & van Marle, H. J. F. (2025) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2025.102089 · Cited by 9

Authors: Ben Simon, E., Rossi, A., Harvey, A. G., & Walker, M. P.
Affiliations: University of California, Berkeley (US)
Corresponding author: Walker, Matthew P.
ORCID: Ben Simon, Eti
Harvey, Allison G.
Walker, Matthew P.
Venue: Nature Human Behaviour
Publisher: Springer Science and Business Media LLC
Published: 2019-11-04
Volume: 4
Issue: 1
Pages: 100-110
ISSN: 2397-3374 (ISSN-L)
DOI: 10.1038/s41562-019-0754-8
OpenAlex: W2987569059
Cited by: 177
References: 96
Citations by year: 2026: 24 · 2025: 32 · 2024: 30 · 2023: 19 · 2022: 23 · 2021: 33 · 2020: 14 · 2019: 2
FWCI: 10.47
Type: journal article
Language: en
Update notices: correction (2020-11-30)
Open access: closed
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Nature Human Behaviour (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Funders: National Institute on Aging (RF1AG054019, R01AG015019, R01AG031164)
National Institute of Mental Health (R01MH093537)
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
Keywords: sleep deprivation, anxiety, medial prefrontal cortex, limbic system
MeSH terms: Adult, Amygdala, Anxiety, Anxiety Disorders, Electroencephalography, Female, Humans, Limbic System, Magnetic Resonance Imaging, Male, Nerve Net, Sleep Deprivation, Sleep Stages, Prefrontal Cortex, Young Adult, Functional Neuroimaging

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