The DOI matches its Crossref record; 54 of the 56 references it cites were found in a registry or an index.
Slow dissolving of emotional distress contributes to hyperarousal
Open accessAbstract
The mechanisms underlying hyperarousal, the key symptom of insomnia, have remained elusive, hampering cause-targeted treatment. Recently, restless rapid-eye-movement (REM) sleep emerged as a robust signature of sleep in insomnia. Given the role of REM sleep in emotion regulation, we hypothesized that restless REM sleep could interfere with the overnight resolution of emotional distress, thus contributing to accumulation of arousal. Participants (n = 1,199) completed questionnaires on insomnia severity, hyperarousal, self-conscious emotional distress, and thought-like nocturnal mentation that was validated to be a specific proxy for restless REM sleep (selective fragmentation: R = 0.57, P < 0.001; eye movement density: R = 0.46, P < 0.01) in 32 polysomnographically assessed participants. The experience of distress lasting overnight increased with insomnia severity (β = 0.29, P < 10(-23)), whereas short-lasting distress did not (β = -0.02, P = 0.41). Insomnia severity was associated with hyperarousal (β = 0.47, P < 10(-63)) and with the thought-like nocturnal mentation that is specifically associated with restless REM sleep (β = 0.31, P < 10(-26)). Structural equation modeling showed that 62.4% of the association between these key characteristics of insomnia was mediated specifically by reduced overnight resolution of emotional distress. The model outperformed all alternative mediation pathways. The findings suggest that restless REM sleep reflects a process that interferes with the overnight resolution of distress. Its accumulation may promote the development of chronic hyperarousal, giving clinical relevance to the role of REM sleep in emotion regulation in insomnia, depression, and posttraumatic stress disorder.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Restless or fragmented REM sleep interferes with the process of distress resolution thereby contributing to a state of chronic hyperarousal, which is a primary symptom of insomnia [114,115].”
From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [115]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772
Applied Multivariate Statistics for the Social Sciences
Stevens, J. P. (2012) · Routledge eBooks · doi:10.4324/9780203843130 · Cited by 10,652
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972
Hobson, J. A. (1969) · Electroencephalography and Clinical Neurophysiology · doi:10.1016/0013-4694(69)90021-2 · Cited by 5,215
Assessing the impact of life changes: Development of the Life Experiences Survey.
Sarason, I. G., Johnson, J. H., & Siegel, J. M. (1978) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.46.5.932 · Cited by 2,788
Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., Lombardo, C., & Riemann, D. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.01.011 · Cited by 2,779
Self-citationEEG Arousals: Scoring Rules and Examples
(1992) · SLEEP · doi:10.1093/sleep/15.2.173 · Cited by 2,138
The hyperarousal model of insomnia: A review of the concept and its evidence
Riemann, D., Spiegelhalder, K., Feige, B., Voderholzer, U., Berger, M., Perlis, M., & Nissen, C. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.04.002 · Cited by 1,789 · cited 1×
“Because hyperarousal resembles a state of chronic distress, the present study sought indirect support for the possibility that restless REM sleep interferes with the proper overnight resolving of distress after an emotional experience, and thus contributes to its accumulation into a state of chronic hyperarousal in in…”
ResultSelf-citationThe human emotional brain without sleep—a prefrontal amygdala disconnect
Yoo, S.-S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007) · Current Biology · doi:10.1016/j.cub.2007.08.007 · Cited by 1,303
Self-citationHyperarousal and insomnia: state of the science
Bonnet, M. H., & Arand, D. L. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.05.002 · Cited by 914
Manber, R., Edinger, J. D., Gress, J. L., Pedro-Salcedo, M. G. S., Kuo, T. F., & Kalista, T. (2008) · Sleep · doi:10.1093/sleep/31.4.489 · Cited by 868
Functional Neuroimaging Evidence for Hyperarousal in Insomnia
Nofzinger, E. A., Buysse, D. J., Germain, A., Price, J. C., Miewald, J. M., & Kupfer, D. J. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.11.2126 · Cited by 752
Sleep disturbances as the hallmark of PTSD: where are we now?
Germain, A. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12040432 · Cited by 634
A manual of Standardized Terminology
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 632
Nielsen, T. A. (2000) · Behavioral and Brain Sciences · doi:10.1017/s0140525x0000399x · Cited by 521
Physiological stress reactivity and recovery: Conceptual siblings separated at birth?
Linden, W., Earle, T. L., Gerin, W., & Christenfeld, N. J. S. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(96)00240-1 · Cited by 418
REM sleep and the early development of posttraumatic stress disorder
Mellman, T. A., Bustamante, V., Fins, A. I., Pigeon, W. R., & Nolan, B. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.10.1696 · Cited by 414 · cited 5×
“For example, in sexually abused youth, shame contributes to risk of depression (27) and the maintenance of PTSD symptoms, including hyperarousal (28).”
BackgroundInfluentialStuewig, J. B., & McCloskey, L. A. (2005) · Child Maltreatment · doi:10.1177/1077559505279308 · Cited by 402
The Persistence of Shame Following Sexual Abuse: A Longitudinal Look at Risk and Recovery
Feiring, C., & Taska, L. S. (2005) · Child Maltreatment · doi:10.1177/1077559505276686 · Cited by 393
Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies
Baglioni, C., Regen, W., Teghen, A., Spiegelhalder, K., Feige, B., Nissen, C., & Riemann, D. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.04.001 · Cited by 386
Self-citationREM sleep depotentiates amygdala activity to previous emotional experiences
van der Helm, E., Yao, J., Dutt, S., Rao, V., Saletin, J. M., & Walker, M. P. (2011) · Current Biology · doi:10.1016/j.cub.2011.10.052 · Cited by 379 · cited 1×
“Furthermore, high-frequency electroencephalographic activity during REM sleep, an index of fragmented REM sleep, hinders resolution of emotional distress (10).”
BackgroundSelf-citationPreventing Depression: A Global Priority
Cuijpers, P., Beekman, A. T. F., & Reynolds, C. F. (2012) · JAMA · doi:10.1001/jama.2012.271 · Cited by 368
The emotional brain and sleep: An intimate relationship
Vandekerckhove, M., & Cluydts, R. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2010.01.002 · Cited by 350
A role for REM sleep in recalibrating the sensitivity of the human brain to specific emotions
Gujar, N., McDonald, S. A., Nishida, M., & Walker, M. P. (2011) · Cerebral Cortex · doi:10.1093/cercor/bhq064 · Cited by 276
Self-citationSleep-related hippocampo-cortical interplay during emotional memory recollection
Sterpenich, V., Albouy, G., Boly, M., Vandewalle, G., Darsaud, A., Balteau, E., Dang-Vu, T. T., Desseilles, M., D'Argembeau, A., Gais, S., et al. (2007) · PLoS Biology · doi:10.1371/journal.pbio.0050282 · Cited by 265 · cited 1×
“Although sleep contributes to the more robust consolidation of emotional memories, relative to neutral memories (7, 8), their later recall is not associated with anywhere near the same magnitude of subjective emotional distress, autonomic arousal, and amygdala activation (7, 9–11).”
BackgroundREM Sleep Instability – A New Pathway for Insomnia?
Riemann, D. W., Spiegelhalder, K., Nissen, C., Hirscher, V., Baglioni, C., & Feige, B. (2012) · Pharmacopsychiatry · doi:10.1055/s-0031-1299721 · Cited by 254
Self-citationCognitive-Emotional Hyperarousal as a Premorbid Characteristic of Individuals Vulnerable to Insomnia
Fernández-Mendoza, J., Vela-Bueno, A., Vgontzas, A. N., Ramos-Platón, M. J., Olavarrieta-Bernardino, S., Bixler, E. O., & De la Cruz-Troca, J. J. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181d75319 · Cited by 234
FEIGE, B., AL‐SHAJLAWI, A., NISSEN, C., VODERHOLZER, U., HORNYAK, M., SPIEGELHALDER, K., KLOEPFER, C., PERLIS, M., & RIEMANN, D. (2008) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00651.x · Cited by 211
Self-citationApplied Multivariate Statistics for the Social Sciences
Carlson, J. E., & Stevens, J. L. (1988) · Journal of Educational Statistics · doi:10.2307/1164712 · Cited by 202
Brosschot, J. F. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.01.004 · Cited by 197
Reliability and Stability of a Dream Recall Frequency Scale
Schredl, M. (2004) · Perceptual and Motor Skills · doi:10.2466/pms.98.3c.1422-1426 · Cited by 177
Thase, M. E., Buysse, D. J., Frank, E., Cherry, C. R., Cornes, C. L., Mallinger, A. G., & Kupfer, D. J. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.4.502 · Cited by 157
Spoormaker, V. I., Schröter, M. S., Andrade, K. C., Dresler, M., Kiem, S. A., Goya‐Maldonado, R., Wetter, T. C., Holsboer, F., Sämann, P. G., & Czisch, M. (2012) · Human Brain Mapping · doi:10.1002/hbm.21369 · Cited by 153
Affective Instability: Toward an Integration of Neuroscience and Psychological Perspectives
Koenigsberg, H. W. (2010) · Journal of Personality Disorders · doi:10.1521/pedi.2010.24.1.60 · Cited by 146
Dream recall and dream recall failure: an arousal-retrieval model
Koulack, D., & Goodenough, D. R. (1976) · Psychological Bulletin · doi:10.1037/0033-2909.83.5.975 · Cited by 145
Enhanced emotional reactivity after selective REM sleep deprivation in humans: an fMRI study
Rosales-Lagarde, A., Armony, J. L., del Río‐Portilla, Y., Trejo‐Martínez, D., Conde, R., & Corsi‐Cabrera, M. (2012) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2012.00025 · Cited by 143
Dreaming: cognitive processes during cortical activation and high afferent thresholds
Antrobus, J. (1991) · Psychological Review · doi:10.1037/0033-295x.98.1.96 · Cited by 134
Testing the Reliability and Validity of DSM-IV-TR and ICSD-2 Insomnia Diagnoses
Edinger, J. D. (2011) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2011.64 · Cited by 130
Wagner, U., Kashyap, N., Diekelmann, S., & Jan Born, A. (2007) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2007.01.004 · Cited by 123
Dreaming and insomnia: Dream recall and dream content of patients with insomnia
SCHREDL, M., SCHÄFER, G., WEBER, B., & HEUSER, I. (1998) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1998.00113.x · Cited by 113
Napping promotes inter-session habituation to emotional stimuli
Pace-Schott, E. F., Shepherd, E., Spencer, R. M. C., Marcello, M., Tucker, M., Propper, R. E., & Stickgold, R. (2011) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2010.10.006 · Cited by 109
REM architecture changes in bipolar and unipolar depression
Duncan, W. C., Pettigrew, K. D., & Gillin, J. C. (1979) · American Journal of Psychiatry · doi:10.1176/ajp.136.11.1424 · Cited by 101
Self-reported hyperarousal traits among insomnia patients.
Pavlova, M., Berg, O., Gleason, R., Walker, F., Roberts, S., & Regestein, Q. (2001) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(01)00189-1 · Cited by 92
Sleeping Worries Away or Worrying Away Sleep? Physiological Evidence on Sleep-Emotion Interactions
Talamini, L. M., Bringmann, L. F., de Boer, M., & Hofman, W. F. (2013) · PLoS ONE · doi:10.1371/journal.pone.0062480 · Cited by 80
Self-citationSHAME-FOCUSED COPING: AN EMPIRICAL STUDY OF THE COMPASS OF SHAME
Elison, J., Pulos, S. M., & Lennon, R. (2006) · Social Behavior and Personality An International Journal · doi:10.2224/sbp.2006.34.2.161 · Cited by 74
van Es, S. M., Kaptein, A. A., Bezemer, P. D., Nagelkerke, A. F., Colland, V. T., & Bouter, L. M. (2002) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00195-1 · Cited by 47
REM and NREM Sleep Mentation Differences: A Question of Story Structure?
Nielsen, T., Kuiken, D., Hoffmann, R. F., & Moffitt, A. R. (2001) · Sleep and Hypnosis · Cited by 41
Does Physiological Hyperarousal Enhance Error Rates among Insomnia Sufferers?
Edinger, J. D., Means, M. K., & Krystal, A. D. (2013) · SLEEP · doi:10.5665/sleep.2882 · Cited by 36
Disturbed Dreaming in Medical Conditions
Nielsen, T. (2005) · Elsevier eBooks · doi:10.1016/b0-72-160797-7/50085-9 · Cited by 19
The Conscience and Self-Conscious Emotions in Adolescence: An integrative approach
Schalkwijk, F. W. (2014) · Cited by 15
Self-citation[Spontaneous awakening and dreams of patients with psychophysiologic sleep disorders].
Ermann, M., Peichl, J., Pohl, H., Schneider, M. M., & Winkelmann, Y. (1993) · PubMed · Cited by 8
Changes in Cognitive Asymmetries from Waking to REM and Nrem Sleep
Casagrande, M., Bertini, M., & Testa, P. (1995) · Brain and Cognition · doi:10.1006/brcg.1995.1275 · Cited by 3
Research works printed but not linked: 3
- EA Nofzinger, , A comparison of regional cerebral metabolism across waking and NREM sleep between primary insomnia and major depression. Sleep 28, A232–A233 (2005).
- M Ermann, J Peichl, H Pohl, MM Schneider, Y Winkelmann, Spontanerwachen und Träumen bei Patienten mit psychovegetativen Schlafstörungen. Psychother Psychosom Med Psychol 43, 333–340, German. (1993).
- J Edinger, , The Duke Structured Interview Schedule for DSM-IV-TR and International Classification of Sleep Disorders. ICSD-2 Sleep Disorder Diagnoses (Duke University Medical Center, 2nd Ed (ICSD-2), Durham, NC, 2004).
Cited by
Sorted by citations
Jansen, P. R., Watanabe, K., Stringer, S., Skene, N., Bryois, J., Hammerschlag, A. R., de Leeuw, C., Benjamins, J. S., Muñoz‐Manchado, A. B., Nagel, M., et al. (2019) · Nature Genetics · doi:10.1038/s41588-018-0333-3 · Cited by 869
Self-citationKalmbach, D. A., Anderson, J. R., & Drake, C. L. (2018) · Journal of Sleep Research · doi:10.1111/jsr.12710 · Cited by 620
“Indeed, recent evidence suggests that REM instability reflects interference of overnight resolution of stress, the accumulation of which may contribute to chronic hyperarousal (Wassing et al., 2016).”
BackgroundBrain mechanisms of insomnia: new perspectives on causes and consequences
Someren, E. J. W. V. (2020) · Physiological Reviews · doi:10.1152/physrev.00046.2019 · Cited by 578
Blake, M. J., Trinder, J. A., & Allen, N. B. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.05.006 · Cited by 477
Insomnia disorder: State of the science and challenges for the future
Riemann, D. W., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., et al. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13604 · Cited by 398
Self-citation
Metadata
- Authors
- Wassing, R., Benjamins, J. S., Dekker, K., Moens, S., Spiegelhalder, K., Feige, B., Riemann, D., van der Sluis, S., Van Der Werf, Y. D., Talamini, L. M., Walker, M. P., Schalkwijk, F., & Van Someren, E. J. W.
- Affiliations
- Netherlands Institute for Neuroscience (NL)
- University Medical Center Freiburg (DE)
- Department of Clinical Genetics, Complex Trait Genetics Section, Vrije Universiteit Medical Center, 1081 HV, Amsterdam, The Netherlands;
- Department of Anatomy and Neurosciences, Vrije Universiteit Medical Center, 1007 MB, Amsterdam, The Netherlands;
- University of Amsterdam (NL)
- University of California, Berkeley (US)
- Institute for Psychotherapy, 1076 AP, Amsterdam, The Netherlands;
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, 1105 BA, Amsterdam, The Netherlands;
- ORCID
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2016-02-08
- Volume
- 113
- Issue
- 9
- Pages
- 2538-2543
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC4780629
- OpenAlex
- W2254421629
- Cited by
- 174
- References
- 56
- Citations by year
- 2026: 18 · 2025: 16 · 2024: 16 · 2023: 20 · 2022: 13 · 2021: 23 · 2020: 20 · 2019: 20 · 2018: 14 · 2017: 9 · 2016: 5
- FWCI
- 22.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- KNAW Research Portal (The Royal Netherlands Academy of Arts and Sciences) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (16.561.0001, 453.07.001)
- Fundação Bial (253/2012)
- EC | European Research Council (AdG-2014-671084)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Health Sciences › Medicine › Clinical Neurology › Restless Legs Syndrome Research
- Keywords
- insomnia, hyperarousal, emotional distress, REM sleep fragmentation, emotion regulation, mediation, polysomnography
- MeSH terms
- Adult, Aged, Emotions, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Stress, Psychological, Polysomnography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
