Overanxious and underslept

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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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Fig. 1: Experimental design and behavioural results.
Fig. 2: fMRI results of the In-laboratory study.
Fig. 3: mPFC activity in relation to anxiety.
Fig. 4: Sleep-rested physiology in relation to next-day anxiety.

Data availability

The data that support the findings of this study are available from the corresponding authors upon request.


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The authors thank R. Mak-McCully for valuable assistance with data analysis, and the ISEF foundation for their continuous support. This work was supported by NIH (nos. R01AG031164, R01AG054019, RF1AG054019 and R01MH093537 to M.P.W). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

E.B.S and M.P.W. conceived and designed the study. E.B.S and A.R. collected the data. E.B.S, A.R. and M.P.W. analysed the data. E.B.S, A.G.H and M.P.W wrote the paper.

Correspondence to Eti Ben Simon or Matthew P. Walker.

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The authors declare no competing interests.

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Peer review information Primary handling editor: Mary Elizabeth Sutherland.

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Extended data

Extended Data Fig. 1 Sleep rested physiology in relation to next-day anxiety (PSG replication study).

(a), Anxiety association in relation to REM and non-REM sleep stages (left panel). Time spent in deep NREM sleep (NREM3) was associated with a significant reduction in next-day anxiety (right scatter plot). (b), Power in the Delta band (SWA, 0.8-4.6 Hz) during NREM sleep (left panel) was associated with lower morning anxiety (right scatter plot), most pronounced for posterior derivations (circled by a dashed line). Dashed grey lines denote zero crossing.

Extended Data Fig. 2 STAI item values (In-lab Study).

Item values for in-lab STAI-state questionnaire (mean ± SD, higher values indicate greater anxiety).

Extended Data Fig. 3 STAI item values (Online Studies).

Item values for the online short STAI-state questionnaire (day 1; mean ± SD, higher values indicate greater anxiety).

Extended Data Fig. 4 BAI item values (Online Study 2).

Item values for Beck Anxiety Inventory (day1; mean ± SD, higher values indicate greater anxiety).

Extended Data Fig. 5 Sleep Characteristics (In-lab Study).

Polysomnography sleep characteristics for the sleep-rested night (Mean ± SD). WASO, wake after sleep onset; NREM, non rapid-eye-movement sleep; SWS, slow-wave sleep (SWS, NREM stages 3 and 4); REM, rapid-eye-movement sleep.

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Supplementary Information

Supplementary Tables 1–3, Supplementary Notes 1–4 and Supplementary References.

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Ben Simon, E., Rossi, A., Harvey, A.G. et al. Overanxious and underslept. Nat Hum Behav (2019) doi:10.1038/s41562-019-0754-8

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