Review Highlights Sleep-Emotion Research Gaps, Uses Process Model to Integrate Findings

Treating Co-Morbid Sleep Problems with Psychiatric Disorders
Dysfunctional sleep has been identified as a potential risk factor for emotional dysfunction and psychopathology.

A large body of research has shown that sleep problems often co-occur with psychiatric disorders such as depression, anxiety, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and substance use disorders.1 In fact, impaired sleep is one of the diagnostic criteria identified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for many of these conditions, and it can be both a risk factor for and a symptom of such disorders.2 Emotion regulation is one potential mechanism underlying the association between mental health and sleep.

“Given that the brain structures and neurochemicals involved in the regulation of emotion also govern sleep… an intimate relationship between these two domains of functioning is intuitive,” wrote the authors of a new review published in Sleep Medicine Reviews.3 Many of the studies investigating this link, however, have been limited by unclear definitions of concepts related to emotion and emotional processing, and few have focused on underlying processes that may alter emotional experiences.

Using an organizing framework based on the widely cited process model of emotion regulation, the authors aimed to integrate evidence regarding the influence of sleep on different components of emotional experiences in nonclinical populations. They first note the important distinction between emotion generation and emotion regulation: While the former occurs “when an individual encounters an emotion-eliciting stimulus, attends to and appraises that stimulus, and then generates an emotional response,” emotion regulation involves “actions that influence what emotions we have, when we have them, and how we have them,” explain the authors.

The model proposes 5 different strategies that take place at different time points as an emotional response is unfolding and may influence the course of an emotion:

  • Situation selection can determine whether a person encounters a situation in which emotion may be elicited, as through seeking out or avoiding situations associated with desired or undesired emotions.
  • Situation modification involves attempts to alter aspects of the current emotion-eliciting situation at its earliest point after it is already happening.
  • Attentional deployment “refers to the way individuals direct (or redirect) their attention toward or away from emotionally laden content,” both externally and internally, the authors explain. An example is the use of distraction, which directs attentional resources away from negative stimuli.
  • Cognitive change refers to strategies intended to change the meaning of a situation–such as reappraisal of it as less negative, for example–thereby altering the ensuing emotion.
  • Response modulation “involves direct alteration of experiential, behavioral, and/or physiological responses to an emotional stimulus and occurs after an emotion has been fully generated,” as reported in the review. This point in the process provides less opportunity and more effort to alter responses than the first 4 points. 

The authors review findings that support the influence of sleep on various strategies in the process model.  Previous studies suggest, for instance, that sleep deprivation may impair distraction ability and increase vigilance to negative stimuli, both of which could affect attentional deployment. They conclude that more experimental and longitudinal research is needed to explore the influence of sleep dysruption on emotional dysfunction and psychopathology.


1. National Alliance on Mental Illness. Mental Illnesses: Insomnia. Available at: Accessed July 26, 2016.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2013; 5th ed. Washington, DC.

3. Palmer CA, Alfano CA. Sleep and emotion regulation: an organizing, integrative review. Sleep Med Review. 2016; pii: S1087-0792(16)00004-6.

Related Articles