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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.
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“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]
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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
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“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).”
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Insomnia disorder: State of the science and challenges for the future
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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
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