# Motivation and emotion/Book/2014/Sleep deprivation and emotion

* Multimedia presentation (5 min)

## Overview

"Without sleep, we all become tall two-year-olds." (Jensen, 2002, Dirt Farmer).}}
Everyone experiences sleep problems occasionally due to stress or other compounding factors. Generally, this is a normal but temporary part of life. However, if sleep deprivation becomes a regular occurrence, it negatively impacts on the physical, mental and emotional health of the individual. The aim of this chapter is to describe the effects of sleep deprivation on our emotional health and well-being and how the lack of sleep is intricately linked into our physical and mental health. Importantly, gaining a better understanding of how this impacts on our mood states in everyday living. In doing so this chapter will delve into biological and cognitive theories to explain what is emotion and what causes it? What is the difference between emotion and mood? How does sleep deprivation affect the sleep-wake cycle? Lastly, what sort of treatments are available to insomnia sufferers[grammar?].

## What is sleep deprivation and how does it effect our emotions?

Cognitive and behavioural symptoms of sleep deprivation:
* Fatigue, lethargy, and lack of motivation
* Moodiness and irritability
* Inability to cope with stress
* Reduced creativity and problem -solving skills
* Concentration and memory problems
* Impaired motor skills
* Difficulty making decisions
Box 1
Sleep is not simply a state of rest for the mind and body or a lack of experiencing consciousness, but it is an dynamic process in which some brain regions are as active during sleep as they are during the wake cycle (Dahl & Lewin, 2002). Sleep deprivation is a condition of inadequate qualitative or quantitative sleep that may subsequently manifest in a variety of compromised cognitive and behavioural states (Box 1). It can occur voluntarily or it may be linked to sleep disorders such as insomnia, snoring, depression and many other mental illnesses.
| Age Groups | Sleep Needs |
| Newborns (0-2 months) | 12-18 hours |
| Infants (3-11 months) | 14-15 hours |
| Toddlers (1-3 years) | 12-14 hours |
| Preschoolers (3-5 years) | 11-13 hours |
| School-age children (5-10 years) | 10-11 hours |
| Adolescents (10-17 years) | 8.5-9.25 hours |
| Adults, including elderly | 7-9 hours |
Table 1 Adapted from "How Much Sleep Do We Really Need?"
National Sleep Foundation n.d. Retrieved 21 October 2014
A healthy amount of sleep allows for many restorative processes and adaptive benefits to occur in the human body and mind. For example, children and adolescents generally require more sleep than adults to facilitate growth and maturation processes as shown in Table 1 (Dahl & Lewin, 2002). Mounting evidence indicates that inadequate sleep may contribute to negative effects on brain maturation and its control on behaviour, emotion and attention (Dahl & Lewin, 2002).
Furthermore, healthy brain development requires qualitative sleep for successful synaptic plasticity to occur, which is critical for learning and the consolidation of emotional memory processing (Wang, Grone, Colas, Applelbaum & Mourrain, 2011; Walker & Van Der Helm, 2009), and subjectively everyone has experienced the difference between a good and bad nights sleep and its effects on our social and emotional functions as well as our mood regulation (Goldstein & Walker, 2014). Many recent studies have demonstrated the intimate and causal relationship that exists between the brain and the importance of sleep in processing emotional regulation (Deliens, Gilson & Peigneux, 2014; Guadagni, Burles, Ferrara & Iaria, 2014; Gruber, 2014; Mauss, Troy & LeBourgeois, 2013; Vandekerckove & Cluydts, 2010; Walker & Van Der Helm, 2009).
Indeed, research conducted using functional magnetic resonance imaging (fMRI) has verified the effects of emotional dysregulation following sleep deprivation (Goldstein & Walker, 2014). The results indicated that after a period of sleep deprivation, a substantial increase of reactivity in the amygdala occurred while an associated decrease in functional connectivity within regions of the medial pre-frontal cortex (mPFC) also occurred (Goldstein & Walker, 2014). The mPFC influences top-down processing of the amygdala, which is necessary for emotional processing (Goldstein & Walker, 2014).[Provide more detail]

## What is an emotion and why do we have them?

Emotions are defined as episodic, short lived, biologically based patterns of perception, experience related, physiological, action and communication oriented that occur in response to specific physical and social challenges and opportunities (Levinson, 1999).
Although it has been argued that emotions serve no useful function and seemingly cause us to behave irrationally, illogically and impair our cognitive processes, theorists have argued that emotions serve as important adaptive functions that regulate the individual’s relationship to the external environment (Gross, 1999; Keltner & Gross, 1999)[grammar?].
The question of whether emotions are useless and dysfunctional or adaptive and functional may rely on whether we are capable of emotional self-regulation or whether we happen to be regulated by our emotion (Gross, 1999). Biological theories hold that emotions are governed by sub-cortical brain structures and pathways and are therefore considered to be largely involuntary responses while cognitive theories hold that emotions are generated by thoughts, beliefs and may therefore be derived through voluntary control (Reeves, 2009). The two main emotional theories focus on cognitive mechanisms such as appraisal, attributions and construals that emphasise how personal meaning is generated (Lazarus, 1991), and a biological/evolutionary perspective that recognises that emotions have evolved and adapted to deal with fundamental life situations and tasks,as a loosely organised hierarchical arrangement of an emotion-activation system (Izard, 1993).
Test yourself

### Biological perspective theory

The biological theory emanates from the James-Lange theory of emotion. This theory specified that different emotions produce distinguishable patterns of bodily activity, such as anger producing an increase in blood pressure (Reeve, 2009). Furthermore, modern research has established that physiological arousal regulates emotion but does not necessarily cause it. Instead emotions mobilise the automatic nervous system (ANS) to support adaptive behaviours such as the fight or flight response (Reeve, 2009).
According to Izard (1993), a multisystem model for emotion activation consists of neural, sensorimotor, motivational and cognitive systems. In particular, all emotional activation must involve a neural system but neural systems can still activate emotions independently of the other three activation systems (Izard, 1993). Brain structures such as the amygdala and specific neurotransmitters are associated with the activation of a negative pattern of emotions in people who experience depression and anxiety while the limbic system and its associated dopamine pathways support a positive affect (Izard, 1993; Reeve, 2009).
Each system activates emotions differently. In the sensorimotor system, an afferant feedback signal from muscle activity triggers emotions. While in the motivational system drive states, such as pain, activate emotions, and in the cognitive system emotions are activated by appraisal and attribution processes (Izard, 1993). Izard argues that this biological perspective is based on a loosely organized hierarchical system of emotional activators from the simplest level (i.e., neural level, which is always necessary and sufficient to activate emotions) to the highest level (i.e., cognitive level, which involves a more complex processing of inference and attribution to activate emotions).

### Cognitive perspective theory

Lazarus (1999), states that the key role in emotion is demonstrated by a cognitive appraisal, which is an evaluation that depends on motivation and personal meaning. Although cognition is a necessary condition of emotion, the functional relationship between cognition and emotion are bidirectional (Lazarus 1991). Emotions, such as anger or disappointment, are not activated by the automatic nervous system (ANS), but from a cognitive, social or even cultural perspective (Lazarus, 1991). However, once the emotion occurs it sets the stage for the next appraisal and emotion. For example, we may feel ashamed by the expression of angry behaviour, because we appraise it as an unwarranted personal lapse and subsequently, anger could be said to have generated the shame resulting in a bidirectional effect (Lazarus, 1991)[grammar?].
There are also individual differences in the appraisal-emotion relationship with certain primary relationships being stronger than non-primary relationships (Nezlek & Vansteelandt, 2008). Instead of appraisals and emotion being associated with a one-on-one relationship, research has shown that emotions can be associated with different appraisal profiles, and that appraisals can elicit different types of emotions, because individuals may differ on the interpretation on what specific emotional experiences mean to them (Nezlek & Vansteelandt, 2008). One individual may feel angry because of strong feelings related to blaming others, whereas another individual may experience other blame less central to the experience of anger (Nezlek & Vansteelandt, 2008). The appraisal theory of emotion includes a primary and secondary process.
Test yourself

## Defining emotional regulation

Emotional regulation refers to the way in which the individual influences which emotion they have, when they have them, and how they experience and express these emotions (Gross, 1999). It is an attempt at self-control that occurs during an emotional episode and it manages the core affect (neurophysiological state) of the feelings that are evident in moods and emotions and draws on self perceptions categorised through previous emotional meta-experience (Russell, 2003).

### The difference between emotion and mood

There are three main differences between emotion and mood[factual?]:
* They arise from different antecedents.
* They have different action-specificity.
* They have a different time-course.
Emotions arise from significant life situations connected to our well-being while moods have ill-defined or unknown causes. Emotions tend to influence our behaviour and result in direct action, whereas moods tend to influence cognition and direct thinking. Emotions are short lived, perhaps lasting as little as a few seconds to a few minutes while moods occur as lasting mental events that may endure for hours or even days (Beedie, Terry, & Lane, 2005; Reeve, 2009).
Moods are known to fluctuate throughout the day. Perhaps you woke up grumpy or on the ‘wrong side of the bed’, but as the day progresses your mood tends to improve based on your emotional experience. Mood exists as two distinct entities; a positive affect state and a negative affect state or sometimes referred to as a good or bad mood. Individuals can experience these states consecutively or at the same time as they operate independently of each other (Reeves, 2009). Research has shown that individuals who experience sleep deprivation experience both an increase in negative affect and a reduction in positive affect and this is associated with behaviour and mood problems and a weakened ability to regulate emotions (Baum et al., 2014).

## Understanding the sleep cycle and its effect on emotions

Our perceived well-being largely depends on our current mood, which is determined by both a psychological and physical state. Our cognitive state can also be linked to the circadian rhythms in the sleep cycle (Birchler-Pedross et al., 2009). Sleep studies have shown how manipulation of the sleep-wake cycle dramatically changes mood suggesting that a homeostatic circadian rhythm is critical for mood regulation (Birchler-Pedross et al., 2009).
There are two main types of sleep: Non REM (NREM) sleep - [grammar?] comprises of three stages of sleep, each deeper than the last, REM (rapid eye movement) sleep is the stage where most of the active dreaming occurs. During the night, sleep follows a predictable pattern cycling back and forth between NREM and REM to form a complete cycle with each cycle lasting approximately 90 minutes, repeating between four to six times. Deep sleep is the most important stage occuring in stage 3 NREM as this is the time the body uses to repair itself and to build up energy for the next day. However, REM sleep is important for consolidation of learning and memory processes, forming neural connections, strengthening memory, replenishing neurotransmitters and chemicals like serotonin and dopamine to assist in mood regulation.

## What can be done about the effects of sleep deprivation?

Individuals who suffer from insomnia are frequently found to have a comorbid diagnosis of depression, anxiety and/or physical pain (Ebben & Narizhnaya, 2012). This comorbid relationship makes it unclear as to whether insomnia is independently related to depression and anxiety or whether it is one of the symptoms (Ebben & Narizhnaya, 2012). However, several studies have shown a bilateral effect between insomnia and depression that results in a reduction of depressive symptoms when targeting treatments towards reducing insomnia (Ebben & Narizhnaya, 2012).
Insomnia is characterised as having physical, cognitive and emotion arousal that interferes with the sleep cycle (Ebben & Narizhnaya, 2012), while other research ascertained predisposing genetic components and personality traits as determining how large a stressor will be necessary for the development of insomnia (Ebben & Narizhnaya, 2012).
Insomnia or sleep deprivation is also significantly linked to psychiatric and physical illnesses (Ebben & Narizhnaya, 2012), and there is a considerable amount of symptom overlap between mood dysregulation and attention-deficit/hyperactivity disorder (ADHD), pediatric bipolar disorder (PBD), and oppositional defiant disorder (ODD) (Heiler, Legenbauer, Borgen, Jensch, & Holtmann, 2011).

### Cognitive behavioural treatments

Cognitive behavioural therapy for insomnia (CBT-I) have been found to be most successful in the long-term treatment of insomnia because they address causal factors as opposed to treating just the symptoms (Ebben & Narizhnaya, 2012). However, a combination of the various techniques is generally more effective than a single treatment. The following is a brief summary of the available cognitive behavioural treatment options listed in Eben & Narizhayna, (2012 ) special feature on CBT options for insomnia:
| Stimulus control | The aim is to teach the patient to associate the bedroom and night time routine solely with sleep. All negative stimuli are removed and the new environment builds a new association, which facilitates sleep. |
| Sleep Restriction Therapy | This technique initially restricts the patients sleep time. The patient must adhere to a sleep log and may feel tired at the beginning of treatment due to sleep loss. However, sleep quality rapidly begins to improve and patients generally report continued improvement in the following 12 months. |
| Progressive Muscle Relaxation | The patient is trained to tense and relax muscles and to develop an awareness of the changing experience of tension. In some cases visualization of relaxing imagery is used to focus when in bed. |
| Cognitive Therapy | This therapy directly targets negative cognitive beliefs about sleep that induce emotional arousal and anxiety at bedtime. The patient completes a Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS) and their faulty beliefs and sleep attitudes are identified and addressed by the clinician using reassurance techniques while challenging patient’s irrational beliefs. |
| Sleep Hygiene | Involves establishing specific rules to improve sleep quality. For example, regular sleep and wake times, limit sleep time, no napping, no clock in the bedroom, and avoidance of caffeine and alcohol. |
| Biofeedback | This is similar to progressive muscle relaxation but incorporates monitoring of the patients physiological activity with an electronic or computerized system to teach the patient when to increase and decrease muscle tension, brain wave frequency and limb temperature. |
| Paradoxical Intention | During this treatment the patient is instructed to purposely stay awake during the night while in bed. This acts to relive the stress of trying to sleep, and the patient naturally falls asleep. |
| Intensive Sleep Training | This treatment was developed to improve stimulus-control therapy by accelerating sleep onset and the ability to gain control over sleep through sleep deprivation. The patient undergoes an intensive 28-hour monitoring and training of their physiological activity using electrodes in a sleep laboratory. |
| Physical Activity | This therapy is effective because exercise reduces presleep anxiety and improves sleep quality, and decreases sleep onset latency. Patients participate in aerobic exercise, monitor their sleep patterns and use sleep logs. |

### Medication

Sedative medication is the most common treatment for insomnia because of its ease and practicality of usage (Ebben & Narizhnaya, 2012). Although these medications maybe consumed safely in the short term, there is concern about the side effects of long term use, such as developing dependence and drug tolerance that can lead to the need to consume larger dosages (Ebben & Narizhnaya, 2012). The main drawback of the use of medication is that it does not resolve the underlying issue and if its use is suspended the symptoms generally resume (Ebben & Narizhnaya, 2012).

## Conclusion

The aim of this chapter was to give the reader a better understanding of how sleep deprivation impacts on emotion. We covered the importance of sleep in the healthy development for psychological and biological wellbeing . We discussed the significance of cognitive and biological theories associated with emotion and the differences we experience between emotions and moods. Lastly, we looked at the negative impact sleep deprivation has on our minds and bodies and the sorts of psychological therapies available to counter act the effects of insomnia.