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Are Sleep Problems Symptoms or Causes of Emotional Disorders

sleeping like a dog
In a thought provoking article, Sleep study at Pitt is a researcher’s dream job, in the Pittsburgh Post-Gazette, the role of sleep in mental health is explored.

Some of the many interesting points from the interview of Dr. Anne Germain are:

  • “…there is growing evidence that sleep problems are actually the cause of many psychological and physical illnesses, rather than a side effect of them.”
  • “‘Whether we’re dealing with depression, anxiety or post-traumatic stress disorder, when we target sleep problems, we can have a significant improvement in people’s daytime functioning,’ she said.”
  • There are ” two effective therapies available to reduce or eliminate nightmares….
    One is an older high blood pressure medication called prazosin.
    [The other is] imagery rehearsal therapy, it provides ways for people to rewrite their nightmares into less threatening dreams, and it is effective in more than 90 percent of people who have tried it…”
  • And, of course, “the vast majority of people need between 6 1/2 and 8 hours of sleep a night to function well.”

No One Knowingly Errs

In the very first post on this blog, I wrote: "Actions based on anxiety are often regrettable."

That may be true, but someone experiencing intense anxiety or a panic attack feels under great pressure to do something, anything to relieve the anxiety and improve their situation.

Nevertheless, actions born from anxiety often have poor or unintended outcomes.

Those negative outcomes reinforce one’s feeling of being out of control, or of being inept, flawed. There is no sense of having a certain mastery or competence in the situation. In turn, those thoughts and emotions fuel further anxiety. There is now "objective" proof that the situation is overwhelming and threatening. The anxiety and panic is now grounded in hard evidence. This is the same situation I wrote about in "Anxiety, Self-Esteem and Self-Soothing."

Some recent studies shed a bit more light on this self-fulfilling prophecy.

The Rockefeller University posted "Stress disrupts human thinking, but the brain can bounce back" on January 27, 2009. In sum, they found that:

  • "A new neuroimaging study on stressed-out students suggests that male humans…don’t do their most agile thinking under stress."
  • "[stressed persons] had a harder time shifting their attention from one task to another than other healthy young men who were not under the gun."
  • In research on rats, the workers found further biological basis for poor performance under stress:
    "repeated stress on rats shriveled nerve cells of the medial prefrontal cortex, and that a shrunken prefrontal cortex is linked to slower performance on attention-shifting tasks."
  • However, there is good news as well. Within a month after the stress ends, the brain bounces back to its normal state and attention and performance returns to a person’s baseline level.

These findings are generally verified in another recent study: "Driving Under the Influence (of Stress): Regional Effects of 9/11 Attacks on Driving." "The authors found that there was an increase in the rate of traffic fatalities in the three months following the 9/11 attacks, but only in the Northeast, the region closest to the terrorist attack…" Further, there was "a 100 percentage point increase in the rate of drug- and alcohol-related fatal traffic accidents in the Northeast."

The authors theorize that "being close to the location of a traumatic event, such as the 9/11 attacks, may increase psychological stress, which may, in turn, impair one’s driving ability and thus lead to an increase in fatal traffic accidents."

Being under stress, whether from an upcoming test or a nearby terrorist attack, impairs a person’s ability to think, plan, perform. The consequences of choosing a course of action under stress and anxiety (for example, is it a good idea to drink alcohol if I know that I will have to drive later), can be severe. Doing poorly on a test or getting into a car crash can provide the illusory conclusions that I am not smart or I am a really bad person. With those beliefs, one is even more likely to become unduly anxious and underperform in the future.

But again notice the silver lining in the second study-traffic fatalities declined again three months after the stress of the 9/11 attack.

However, the effects of long-term stress or life-threatening events may not be so quickly reversed.

A study from the University of Wisconsin, published in the January 26, 2009 Proceedings of the National Academy of Sciences, looked at the immune systems of children who had lived in orphanages in Romania, Russia or China and were later adopted by American families. They found that, even after ten years of life in "stable, affluent, loving environments…their immune systems are compromised as well. In fact, they look just like the [more recently] physically abused kids."

"’Even though these children’s environments have changed, physiologically they’re still responding to stress. That can affect their learning and their behavior, and having a compromised immune system is going to affect these children’s health,’ says senior author Seth Pollak, a professor of psychology and pediatrics at UW-Madison."

Imagine, if you will, how easy then it would be for those children to form negative opinions about themselves and their abilities. They are ill more frequently than the children around them, have more difficulty making correct judgements. Their behaviors are not as well controlled as their peers’. They have more difficulty learning and in school. All this despite the apparent advantage of now living in "stable, affluent, loving environments." Who else to blame but themselves?

Let’s look at the sheerly biological side of this matter. In 2006, the Department of Neuroscience, Mount Sinai School of Medicine studied rats exposed to 21 days of restraint stress. [Readers interested in the effects of restraint stress on animals, in simpler language, are recommended to read Restraint and Handling of Wild and Domestic Animals By Murray E. Fowler] Mount Sinai’s study found significant impairment of the medial prefrontal cortex. "[N]early one-third of all axospinous synapses on apical dendrites of pyramidal neurons in medial PFC are lost following repeated stress…Dendritic atrophy and spine loss may be important cellular features of stress-related psychiatric disorders where the PFC is functionally impaired."

That’s a dense packet of jargon. Let’s break down those last two sentences a bit.

Click here for a look at the medial prefrontal cortex.

Now, why is the medial pre-frontal cortex important?

Here’s what Wikipedia says about that area of the brain:

"The most typical psychological term for functions carried out by the pre-frontal cortex area is executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social ‘control’ (the ability to suppress urges that, if not suppressed, could lead to socially-unacceptable outcomes)."

So the pre-frontal cortex assists in judgement, planning, decision-making (e.g., should I drink if I am going to have to drive home).

The dendrites bring information into the cells of the medial pre-frontal cortex. A loss of "nearly one-third" of these information carriers would have significant and negative impact on the ability to make judgements, plans, etc.

This same area of the brain has been implicated in Post-Traumatic Stress Disorder. In "Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD", the authors find that the "medial prefrontal cortex appears to be volumetrically smaller and is hyporesponsive during [PTSD] symptomatic states and the performance of emotional cognitive tasks in PTSD. Medial prefrontal cortex responsivity is inversely associated with PTSD symptom severity."

So, in both PTSD and situations of significant, chronic stress, there is long-term impairment of the medial prefrontal cortex. In turn, the afflicted person’s executive functioning (judgement, planning, decision-making, etc.) is worsened for lengthy periods of time.

It appears that shorter periods of lower grade stresses (e.g., an upcoming important test) produce briefer periods of poor executive functioning and less extensive impairment of the medial prefrontal cortex.

These studies can be used to make another point. We have seen that a stressed person has impaired executive functioning that stems at least in part from damage to the medial prefrontal cortex. Consequently, a stressed person will be cognitively, emotionally and behaviorally functioning at a lower level than their best capabilities. Therefore, these persons should be especially cautious before making and carrying out plans (even one as simple as whether or not to drive to a keg party). Equally important, their choices and behaviors have to be viewed in the context of being stressed and having a damaged prefrontal cortex.

With this knowledge in hand, a stressed, anxious or panic-stricken person can revise their opinions of themselves in a more objective fashion.

We would not judge how good a runner one was if the judgement was based on a 100 yard dash done when the person had the flu. All that can tell us is how they perform when significantly ill and impaired.

Forming your self-image and self-esteem on the evidence of beliefs, judgements and actions while stressed or suffering its after-effects is equally absurd.

Unfortunately, many people with anxiety, panic and other psychiatric disorders do exactly that. The net result is to generate further stress because of the internal self-criticisms and anxiety about their ability to function in the world. That, in turn, yields more impairment of the prefrontal cortex and consequently worsening executive functioning. A person’s self-image and self-esteem will then be in a graveyard spiral.

I will return to these studies and their implications in a later post about anxiety and self-image. For now I will leave you to ponder Socrates’ claim that "No one knowingly errs." Especially as it might apply to persons who are anxious, panicky, stressed and make invalid assumptions, poor judgements and mistakes in their actions.