Chronic insomnia, REM sleep instability and emotional dysregulation: A pathway to anxiety and depression?

Abstract

The world-wide prevalence of insomnia disorder reaches up to 10% of the adult population. Women are more often afflicted than men, and insomnia disorder is a risk factor for somatic and mental illness, especially depression and anxiety disorders. Persistent hyperarousals at the cognitive, emotional, cortical and/or physiological levels are central to most theories regarding the pathophysiology of insomnia. Of the defining features of insomnia disorder, the discrepancy between minor objective polysomnographic alterations of sleep continuity and substantive subjective impairment in insomnia disorder remains enigmatic. Microstructural alterations, especially in rapid eye movement sleep ("rapid eye movement sleep instability"), might explain this mismatch between subjective and objective findings. As rapid eye movement sleep represents the most highly aroused brain state during sleep, it might be particularly prone to fragmentation in individuals with persistent hyperarousal. In consequence, mentation during rapid eye movement sleep may be toned more as conscious-like wake experience, reflecting pre-sleep concerns. It is suggested that this instability of rapid eye movement sleep is involved in the mismatch between subjective and objective measures of sleep in insomnia disorder. Furthermore, as rapid eye movement sleep has been linked in previous works to emotional processing, rapid eye movement sleep instability could play a central role in the close association between insomnia and depressive and anxiety disorders.

Keywords: anxiety; consciousness; depression; dreaming; insomnia; micro‐arousals; rapid eye movement sleep.

FIGURE 1

Polysomnographic (PSG) profiles of a good sleeper (upper panel; a) and a patient with insomnia (lower panel; b). The y‐axis displays arousal (micro‐arousals), wake and sleep stages (rapid eye movement [REM], stage N1, N2 and N3), as well as eye movements (EM). The x‐axis is the time axis.

FIGURE 2

Comprehensive model of chronic insomnia, rapid eye movement (REM) sleep instability, hyperarousal, dysfunctional emotion regulation, and anxiety and depression.