Sleep and Emotion

Question 1

What is The case of Randy (Ross, 1965)

Answer 1

• 1964: Prolonged wakefulness of a 17-year-old boy named Randy Gardner, in an attempt to break the world record for prolonged wakefulness
• Remained awake for 11 days and was subjected to a series of tests every 6 hours
• By the 3rd day he developed mood changes and from the 4th day, he became irritable and uncooperative
• By the 9th day, he regularly did not finish his sentences, showed fragmented thoughts and suffered from blurred vision

Question 2

Sleep and Emotion:
1- what is found in terms of consistency for studies involving sleep deprivation
2- what does emotion involve?
3- what varies across studies?
4- what does bad sleep affect?
5- examples
6- disrupted sleep is both a symptom and a risk factor for ____

Answer 2

1- A great deal of inconsistency in findings from studies involving sleep deprivation
2- Emotion involves several components
3- Also the methodological approaches vary across studies
4- Common knowledge that bad sleep affects our mood the next day – crankiness in children is very obvious, mood swings etc
5- Grumpiness, short-tempered etc
6- Disrupted sleep is both a symptom and a risk factor for various mental health conditions

Question 3

Effects of Sleep Deprivation on Performance: A meta-analysis by Pilcher and Huffcutt 1996

Answer 3

• A substantial difference across three dependent measures: cognitive performance, motor performance and mood
• The mean level of functioning in SD-participants was comparable to that of only the 9th percentile of those non-SD
• Cognitive performance was more affected by SD than motor performance but Mood was much more affected than either cognitive or motor performance
• Mood was much worse (over 3SD) in those SD, than those non-SD

Question 4

Pilcher and Huffcutt 1996

Answer 4

Distribution of people who are sleep deprived and nonsleep deprived. Both groups are behaving in a different way.

The average person in the deprived group is functioning at the tail end of the people who are non deprived

Sum- mood is affected by lack of sleep

Question 5

Sleep and Aggression

What have correlational studies found about non-aggressive vs aggressive populations

Answer 5

In non-aggressive populations:
Several studies found a correlation between self-reported sleep difficulties and feelings of anger, hostile tendencies and aggressive behaviour

In aggressive populations:
a) incarcerated offenders: shorter sleep has been associated with greater hostility
b) forensic psychiatric patients: association between poor sleep quality and increased aggression

Question 6

SD and Aggression in Animal Studies:
Licklider and Bunch (1946) study and findings

Answer 6

Investigated the physiological effects of long-term selective rapid-eye movement (REM) sleep deprivation and found quite striking effects on aggression

Rats died after 3-14 days due to fighting with each other; even the slightest physical contact led to a vicious fight, not only targeting the offender but also innocent bystanders

Question 7

A bidirectional relationship between anger and sleep?

Answer 7

• Perhaps angry or hostile traits may predispose individuals to sleep problems
• Studies in individuals with traits of antisocial personality disorder, characterized by irritability, hostility, aggressive behaviour, impulsivity, lack of remorse and deceptive acts, find that 58-80% suffer from poor sleep quality (Kamphuis et al 2013; Semiz et al 2008)

Question 8

A systematic Review and Meta-analysis of studies on Sleep Quality and Aggression (Van Veen et al 2021)

Answer 8

• Included subjective and objective measures of sleep quality and multiple measures of aggression: externalizing behaviour, anger, hostility and irritability
• Overall data from 74 studies were used, a total of 58,154 children, adolescents and adults
• First systematic evaluation of studies in this area
• Poor sleep was associated with higher aggression in 80.8% of studies

Question 9

Overall Correlation Estimate of Sleep Quality and Aggression

Van Veen et al 2021

Answer 9

• A consistent association between poor sleep quality and measures of aggression in general and in clinical populations
• Both qualitative and quantitative data supported this association
• Greater vulnerability in those with psychological or medical conditions
• increased likelihood of those who are sleep deprived to show increased irritability, hostility, externalising behaviour, anger, aggression control, aggression composite, aggressive behaviour

Question 10

Studies in Sleep and Mood in Adolescents
- What did the National Sleep Foundation poll (US) report?
- wakefulness and sleep disturbances in adolescence?
- what is sleep disturbance a precursor for?
- what do sleep issues seem to affect?

Answer 10

• National Sleep Foundation poll (US) reported that more than 87% of US high school students get less than the recommended hours of sleep (Krueger & Friedman, 2009)
• Adolescents spent more wakefulness in bed (take longer to fall asleep) and more wakefulness during the night, and reported more sleep disturbances
• Data suggest that sleep disturbance is a precursor for the development of depression
• sleep issues seem (eg sleep quality) to predispose people and set the grounds for mental health conditions eg depression

Question 11

Sleep Duration and Mood in Adolescents Systematic Review and Meta-Analysis (Short et al 2020)

study and findings

Answer 11

• 74 studies, including 361,505 adolescents were used
• Results indicated that less sleep was associated with a 55% increase in the likelihood of mood deficits
• Positive mood showed the largest relationship with sleep duration followed by anger, depression, negative affect and anxiety
• This effect was true across all geographical regions although the effect size was different (greater for North America compared to Europe, Australia, New Zealand and Asia

Question 12

What did findings from Short et al 2020 find the strongest impact on?

Answer 12

Positive affect

Question 13

Short et al 2020 results and implications

Answer 13

Short sleep duration:
- doubled the odds of adolescents experiencing reduced positive affect
- Increased the odds of anger by 83%
- Increased the odds of depressed mood by 62%
- Increased the odds for negative affect by 60%
- Increased the odds for anxiety by 41%

• Consistent with Shen et al (2018) who examined association between sleep duration and mood in 4,582 adolescents and found that sleep loss and mood association was stronger for happiness and positive affect than for negative affect
• Anhedonia is a core symptom of Major Depressive Disorder (the other being depressed mood)

Things that were pleasurable before are not pleasurable anymore

Question 14

Sleep Loss in Medical Residents: Zohar et al 2005

Method

Answer 14

• Investigated the relationship between sleep loss and emotional reactivity in medical residents. Hypothesized that this will be influenced by sleep loss effects on cognitive-energy resources in light of goal-disruptive ( interfering with something they wanted to do at the time/ interfere with ability to do work) and goal-enhancing events
• 78 medical residents, 26-39 years old, with shifts that varied (up to 32h each time)
• Measured sleep-wake cycles with actigraphy for 5-7days, every 6 months for the first 2y of residency
• Received 3 phone calls that reminded them to complete a questionnaire
• Sleep loss intensified negative emotions and fatigue following daytime goal-disruptive events whereas positive emotion was blunted following goal-enhancing events

Question 15

Sleep Loss in Medical Residents: Zohar et al 2005

Results

Answer 15

Affect:

a) NA: when something disruptive was happening, those that are sleep deprived are experiencing greater NA compared to the well slept people

b) PA: with enhancing events, people are helping out and getting good equipment, those who had good sleep were benefiting/ demonstrating greater positive affect when having help but low sleep didn’t show much improvement.

PA based on this study is taken away if they don’t sleep properly because they don’t have enhancement - PA was blunted because of their lack of sleep

Fatigue:

a) started off the same but looking at the levels of fatigue after a disruptive event, those who didn’t sleep well showed a much greater fatigue response (fatigue levels higher)

b) even with enhancing events, those who have low sleep continue to exhibit greater levels of fatigue

Question 16

Major Depression
1- sleep disturbances in ____ were noted since ancient times
2- what did Emil Kraeplin (1909) note?
3- what is depression characterised by?

Answer 16

1- Sleep disturbances in melancholia were noted since ancient times, by Plato and Hippocrates
2- Emil Kraeplin (1909) noted that various disorders are associated with sleep disturbances
3- Depression is characterized by changes in sleep and arousal most likely a predisposing factor

Question 17

Sleep in Psychiatric Conditions Baglioni et al 2016

Background

Answer 17

• Meta-analysis with studies from 1992-2015 (English, Italian, Spanish, French, German).
• In most mental health conditions, the balance between arousal and de-arousal is disturbed
• Insomnia, the most prevalent sleep continuity disorder is highly comorbid with mental and somatic conditions and needs to be better understood
• Comorbidity is the rule and not the exception in mental health conditions and this complicates the process

Question 18

Sleep in Psychiatric Conditions Baglioni et al 2016

Method

Answer 18

Grouped 11 sleep variables in three main domains:

1) Sleep continuity (when we go to sleep are we able to maintain sleep): defined by higher sleep efficiency (time in bed vs time asleep), shorter sleep onset latency (time to get to sleep), and reduced number of awakenings

2) Sleep depth: defined by shorter duration of NREM 1 sleep, and longer duration of NREM 2 and SWS

3) REM pressure: defined by shorter REM latency, increased REM density (how much eyes blink in REM), and longer duration of REM sleep.

Question 19

Sleep in Psychiatric Conditions Baglioni et al 2016

Findings

Answer 19

• Depression was associated with the most severe changes in sleep continuity, sleep depth and increased REM pressure
  – Longer REM duration
  – Shortened REM latency
  – Prolonged 1st REM episode
• Other studies find increased REM density in depression (indicating a high number of rapid eye movements)
• Benca et al 1992 – Meta-analysis which included first night PSG, found differences in those with depression:

– Shortened REM latency (observed more frequently than in any other disorder)
– Increased REM density (found exclusively in affective disorders)
– Reduced time in SWS

• sleep continuity was affected the most- high significance for MDD
• decrease in sleep depth for major depression and an increase in REM pressure
• for anxiety disorders there was a significant impact of sleep continuity (arousals ect.) but this was mostly due to ptsd. So sleep continuity is affected for anxiety disorders more than sleep depth and REM pressure.
• Schizophrenia was also highly significant- sever impact on sleep continuity and a little bit on sleep depth.

Question 20

Subgroup Analyses in Baglioni et al 2016: Gender and Age in Depression

Answer 20

• Men: sleep continuity, depth and REM pressure were altered compared to controls, they spent less time asleep and more time awake
• Women: only sleep continuity was disrupted (important because usually women complain more about their sleep compared to men)
• In younger age groups only marginally worse continuity in sleep

– studies seem to suggest that depressive symptoms may be less severe in younger groups, so it may be the best time to intervene and prevent deterioration

Question 21

Conceptual Model
For the relationship between depression and poor sleep, suggested by Lovato & Gradisar, 2014

Answer 21

Puberty:
- decreased SWS
- decreased total sleep time
- circadian delay
- evening arousal
|
Poor sleep:
- increased SOL (arousal)
- increased WASO (arousal)
- decreased self-reported sleep quality
|
Ruminating
|
Depression >(=) 5 symptoms
- increased irritable mood
- decreased motivation
- increased fatigue/ decreased energy
- decreased concentration
- insomnia

Question 22

Anxiety:
1- what is anxiety characterised by?
2- What is worry often accompanied by?
3- rumination?
4- what are people with insomnia more likely to do?
5- what are high levels of worry associated with?

Answer 22

1- Anxiety is characterised by worry about perceived threats
2- Worry is often accompanied by maladaptive thoughts, that are often repetitive and intrusive
3- Rumination (repetitive thoughts that are not productive) intensifies negative affect and is associated with longer sleep onset latency
4- People with insomnia are 10 times more likely to attribute their insomnia to cognitive factors such as worrying, planning, difficulty of controlling thoughts etc
5- High levels of worry are associated with elevated sympathetic system activation during wakefulness and sleep

Question 23

Worry and Sleep
1- what do college students with high levels of worry report?
2- what are adults with work-related worry more likely to have?
3- what is worrying about sleepiness related to?

Answer 23

1- College students with high levels of worry report shorter sleep durations
2- Adults with work-related worry are more likely to have poor sleep quality
3- Worrying about sleeplessness is related to self-reported sleep disturbances including shorter sleep, longer sleep onset latency and more time awake after sleep onset

Question 24

Findings for Anxiety Disorders: Baglioni et al 2016

Answer 24

• Majority of the studies included on anxiety focused on PTSD (13/21 studies)
• Anxiety disorders were found to have reduced SWS duration (not reported in the previous meta-analysis by Benca et al 1992)
• PTSD was found to be linked with all measures of sleep continuity, sleep depth and sleep pressure

Question 25

Summary: 1- what is sleep deprivation associated with? 2- having changes in several aspects of sleep can be experienced by..... 3- lack of sleep seems to be predisposing people to conditions such as....

Answer 25

1- Sleep deprivation is associated with increased expression of aggression 1- Sleep deprivation is associated with decreases in positive emotions and increases in negative emotions 2- People suffering from mental health conditions experience changes in several aspects of their sleep 3- Lack of sleep seems to be predisposing people to conditions such as major depression, anxiety etc.

Question 26

Sleep Deprivation and Emotion Recognition: Van der Helm, Gujar and Walker, 2010 procedure and sum of results

Answer 26

Procedure: - Task to recognize correctly facial expressions of angry, sad and happy faces raging from neutral to highly expressive - sleep deprived condition: 30 hours of sleep deprivation on night 1, then have test 1, then sleep on night 2, then have test 2 - sleep control condition: sleep on night 1, then test 1, then sleep on night 2, then test 2 Results overview: - In the TSD there was significant blunting in recognition of angry and happy faces in the moderate range and not the extreme. No change in the ability to recognize emotions for sad faces. - These deficits were ameliorated once they recovered their sleep

Question 27

Sleep Deprivation and Emotion Recognition: Van der Helm, Gujar and Walker, 2010 Results

Answer 27

**Control Group:** - No significant difference between test 1 and test 2 when they had to recognise emotional expressions on images. All emotions merged- no difference - No difference in happy, angry, sad **Sleep-Deprived Group:** - tested once after sleep deprived (Test 1) and then tested again when they could sleep (Test 2) - For all emotions- there was a difference in their recognition - There was decreased capacity to recognise happy emotions with moderate intensity when they were sleep deprived. - Angry- when they were sleep deprived vs after sleep recovery there was a difference - No difference in sad (but we have more than 3 emotions)

Question 28

Killgore et al 2017

Answer 28

- Emotion Hexagon Test comprised of 150 trials - 6 emotions used: happiness, anger, sadness, disgust, fear, surprise - Recognition of the basic emotions under BL, SD (one night) and Recovery conditions - They manipulated and created a composite 2 emotions that would vary from one to the other. - Showed to sleep deprived and control people and the recognition of this was measured after baseline conditions or after one night of sleep deprivation.

Question 29

Killgore et al 2017 Results

Answer 29

Sleep deprivation was associated with a significant decline in the % correct responses for faces with dominant expressions of happiness or sadness When people were sleep deprived they were worse in identifying happiness in peoples faces. There was a decrease in ability to detects sadness in peoples faces.

Question 30

Emphathy 1- what is it 2- what are the 2 separate systems for empathy 3- brain areas involved in this function

Answer 30

(not one of the 6 basic emotions) 1- Ability to share emotions and understand other people’s thoughts, desires and feelings 2- Two separate systems for empathy: — an **emotional system** that supports our ability to empathize emotionally (eg. baby starts crying because baby next to them is crying) — a **cognitive system** that involves cognitive understanding of other’s perspective (theory of mind) 3- ACC (dorsal and anterior middle part), supplementary motor area and the insular cortex bilaterally

Question 31

SD and Emotional Empathy (EE): Guadagni et al 2014 Method

Answer 31

- 37 healthy volunteers assigned to three groups: -- SD group (one night without sleep) -- Sleep group (tested before and after sleep) -- Day group (did the task twice during the day (am/pm) - Task: Modified version of the *Multifaceted Empathy Test* (MET, Dziobek et al 2008) which is used to assess direct and indirect emotional empathy (depicting people in positive, neutral and negative scenes) -- *”how strong is the emotion you feel about this person?”* – direct EE -- *”how calm/aroused does this picture make you feel?”*- indirect EE -- *”how would you judge this image?” –* valence judgment

Question 32

Measures of direct and indirect emotional empathy: Guadagni et al 2014

Answer 32

Emotional empathy direct: Day- highest mean scores Night- also high mean scores Sleep deprived- lower scores Emotional empathy indirect: Day- highest mean scores Night- also high mean scores Sleep deprived- lower scores Sum: Those that were sleep deprived performed worse than those that were not sleep deprived in both conditions. This is important when we think about our daily interactions with people. If we are not sleep deprived we might not be able to know the feelings of the person next to us (who could be sleep deprived).

Question 33

Key takeaway from study by Goldstein-Piekarski et al 2015 looking at sleep deprivation and social threat

Answer 33

Sleep deprivation impairs the ability to discriminate emotional face stimuli **Those sleep-deprived judged more faces as threatening than those who slept**

Question 34

Sleep Deprivation and Emotional Response (Yoo, et al., 2007) study and results

Answer 34

- Effects of 35h of SD on emotional responses in healthy volunteers using fMRI - After the night, the participants performed an emotional stimulus-viewing task, involving the presentation of 100 pics ranging from emotionally neutral to extremely aversive - The SD group showed **significantly greater amygdala activation** in response to the negative pictures compared to the control group and no differences for neutral pictures - Also, the SD group had a **significantly weaker connectivity between the amygdala and the medial PFC** and a **greater connectivity from the Amy to autonomic-activating centers in the brainstem including the locus coeruleus (LC)** - Sleep may be necessary to ‘reset’ the correct brain reactivity to next-day emotional challenges - greater activation in amygdala in sleep deprived group - those who slept/ were rested seemed to have greater activity in frontal lobes - control group had greater connectivity between mPFC and amygdala compared to sleep deprived group who had greater activation in LC and mid brain

Question 35

Sleep Dept (SD), mood and diminished AMY-PFC connectivity: Motomura et al 2017

Answer 35

- Healthy young adult men (N=18) - 2-day SD resulted in sig increases in sleepiness (SSS) and state anxiety (STAI-S) - Greater connectivity between the AMY and mPFC was found in the control group compared to the SD group

Question 36

Goldstein and Walker 2014: Results

Answer 36

- An amplified response of the limbic system to the negative emotional stimuli under sleep deprivation conditions - This increase in AMY activity is associated with a loss of functional connectivity between the mPFC in the SD group, suggesting a failure of top-down regulation - Thus, a night of sleep may ‘reset’ the correct brain reactivity to the emotional challenges of the next day by maintaining functional integrity of this mPFC-AMY circuit - those who are sleep deprived are responding more to images as theire amygdala is lighting up - In the control group there was a communication between mPFC (inhibitory-controlling activation of amygdala and silencing it) and amygdala

Question 37

Sleep as an Overnight Therapy? 1- what may the sleep-deprived brain suffer a mismatch between? 2- what is REM sleep involved in? 3- what does sleep facilitate? 4- what can sleep modify? 5- what does sleep deprivation therefore do?

Answer 37

1- The sleep-deprived brain may suffer a mismatch between too much subcortical reactivity and an impaired higher-order pre-frontal functioning 2- Sleep and in particular REM sleep is involved in conditioned fear responses, helps to consolidate fear memories, allowing for better discrimination between threatening and non-threatening stimuli in the future 3- Sleep, (especially REM sleep) also facilitates the extinction of a conditioned fear via a top-down PFC inhibition of the amygdala 4- Also, there is evidence that sleep modifies the expression of fear depending on the context and contextual cues (Menz et al 2013; Pace-Schott et al 2009) 5- Sleep deprivation impairs these processes whereas sleep following exposure therapy facilitates recovery (Kleim et al 2013) he says pfc is not acting to inhibit amygdala which can set us up for deviations in emotional behaviour so the way we react/ process/ behave to emotions highlights importance of rem sleep in dealing with our emotions/ emotionally charged experiences

Question 38

REM sleep and Mood (Cartwright RD et al 1998)

Answer 38

- Participants filled out a mood scale - The second night they were awakened several times in each REM episode and were asked to report what they had been experiencing - Dreams contained more negative affect and less positive affect *early* in the night with the negative ones decreasing and the positive ones increasing, and this was not found when there was no negative mood before sleep - Concluded that depressive mood correlates with negative dream content and that the modulatory function of REM sleep dreaming appears when a negative mood is moderate early at night- more SWS, later in night get REM sleep seemed that rem was doing something to deal with negative emotions so we wake up refreshed

Question 39

REM Emotional Homeostasis Hypothesis: What are the 2 main benefits from REM sleep

Answer 39

1) Function of REM sleep ***after*** an emotional experience - Resolving strong emotions associated with challenging memories - Lack of sleep the first night after exposure to aversive stimuli is associated with long-term effects 2) A role of REM sleep ***before*** an emotional experience - Calibrating the sensitivity and specificity of the brain’s response to emotional events - REM sleep primes key areas of the brain to react appropriately to affective experiences

Question 40

Sleep as overnight therapy (SFSR model- sleep to forget and sleep to remember) Goldstein and Walker, 2014

Answer 40

When we are awake we are going about doing our business so our hippocampus is interacting with our amygdala and cortex. When we are awake our neurochemistry is reflected by increases in our adrenergic system and polynergic system. When we are asleep, something happens with the chemistry of REM sleep. When we are entering REM, there is absence of neurodrenaline where as our ACH is up. So when we are asleep and enter rem the drop in noradrenaline is reducing the activity of the amygdala and is allowing our PFC to communicate with the hippocampus and amygdala and to basically reduce the activation of the amygdala in the end and the emotional response. When we wake up these emotional responses are not blunted (weakened) because of the processes during the night and because the mPFC is inhibiting the activity of the amygdala. Overtime when dealing with emotional events: every time we go to bed we go to sleep and go into rem sleep, our emotionally charged experiences are being processed during rem but the emotional charge is gradually being stripped away. With every subsequent sleep, proposal goes that emotion is stripped away and at the end we are able to deal with emotional experience by maintaining memory of event without having arousal that is associated with that event. sum- so overnight the emotions that were originally associated with that memory is stripped away

Question 41

Recalibration During REM sleep: what is found in sleep rested conditions?

Answer 41

**sleep rested** conditions: Noradrenaline induces PFC engagement through alpha-2 receptor which enables inhibition of the amygdala as well as enhance sensitivity to stimuli due to differences in the phasic vs tonic inhibition Communication of pfc with amygdala and this is inhibitory communication. Pfc is inhibiting amygdala, amygdala is recieving input from LC to pay attention to things. When LC is secreting normal levels of noradrenaline and the normal levels of noradrenaline are acting through the alpha 2 receptor to stimulate the pfc and come down to the amygdala to reduce the activity of the amygdala. If we are not over aroused, there should be a decent discrimination between what is considered to be normal versus a stimulus that requires us to respond with increased arousal. Sum- When we are sleep rested, there is proper activation of the LC, the pfc is acting properly to inhibit the amygdala. There is discrimination of firing of LC so we can react in a specific stimulus because there is enough discrimination of signal to noise ratio. We can discriminate between threatening and non threatening stimulus because everything is working properly if we are not asleep.

Question 42

Recalibration During REM sleep: what is found in sleep deprived conditions?

Answer 42

**SD**: High tonic activity in LC which increase binding to the alpha-1 receptor which is inhibitory causing PFC disengagement and disinhibition of the amygdala and non-discriminant response to stimuli If we are sleep deprived there is higher increase of LC, communicating with amygdala and pfc. There is a lot of adrenaline release which activates alpha 2 AND alpha 1 which leads to inhibition of pfc. (disinhibiting amygdala even more- even more exaggerated response to a stimulus. we start to miss this differentiation between what is actually threatening vs a neutral event). SO we have an impaired discrimination between a neutral stimulus and a threatening stimulus

Question 43

Difference between tonic firing and phasic firing?

Answer 43

**tonic firing**- normal firing of neurons which is happening all the time **phasic firing**- in response to specific stimulus

Question 44

Sleep and PTSD 1- what is PTSD associated with? 2- what has found to be a predictor of PTSD symptom development in war veterans 3- what do PTSD patients also show?

Answer 44

1- PTSD is associated with decreased time spent in REM sleep and REM-sleep changes such as fragmentation of REM sleep and increases in sympathetic tone of the ANS (increased adrenergic activity) 2- Having insomnia before deployment has been found to be a predictor of PTSD symptom development in war veterans 3- PTSD patients also show exaggerated locus coeruleus activity during REM sleep compared to controls (instead of quiescence) and increased noradrenaline concentrations in urine during the night (instead of a drop in levels)

Question 45

Sleep and PTSD: 1- what do PTSD sufferers do? 2- what does having such nightmares predict? 3- what does this take a toll on? 4- what is there in PTSD? 5- what did Mellman et al 1995 find?

Answer 45

1- PTSD sufferers replay the actual trauma memory often every night 2- Having such nightmares is predictive of who goes on to develop PTSD and is associated with more severe and more chronic symptoms of PTSD 3- This takes a toll on other functions that are dependent on REM sleep such as softening of emotional responses, integration of new memories with older memories, extracting the gist, network exploration etc 4- In PTSD there is hyperarousal that prevents noradrenaline shutdown and prevents REM sleep and failure to integrate the traumatic event 5- Mellman et al 1995: NA dropped by 75% in healthy participants whereas it increased by 25% in those with PTSD

Question 46

Sleep and PTSD: PTSD without treatment vs PTSD with treatment

Answer 46

Failure to remove the emotional component of an event may lead to repeated efforts until this is achieved, evident in recurrent nightmares REm- overactivity of LC. Attempt to reactivate everything and remove emotional component but because adrenaline is not reduced, its a failed attempt to remove emotional component **PTSD without treatment:** - Wake memory encoding: increased amygdala communicate which communicates with the hippocampus and the pfc. Increased adrenergic activity and cholinergic activity - REM neural reactivation: there is continued activation, noradrenaline doesn’t really go down, the amygdala continues to be highly active and it doesn’t really allow the processing to take place because the pfc cannot really inhibit the amygdala and hippocampus - Wake memory recollection: memory is still there, mpfc is not able to inhibit the amygdala **PTSD with treatment:** example where prazosin is given which reduces sympathetic arousal activation, noradrenaline, blood pressure, heart rate. This is lifting the problem, allowing the LC to be quiet and allowing the pfc to act and inhibit arousal from the amygdala and perhaps allowing the patients to deal with these emotionally charged emotions and finally be able to move on.