Michael Breus Blog: Insomnia Impairs Emotional Regulation

by Michael Breus Ph.D., Clinical Psychologist and Board Certified Sleep Specialist

Insomnia Impairs Emotional Regulation

The relationship between disordered sleep and emotional health is an intricate one, as each can influence the other for better and worse.

Stress and worry, as well as mental illnesses such as depression and anxiety can interfere with sleep. And an abundance of research indicates that people who experience disrupted sleep, including obstructive sleep apnea and insomnia, are at dramatically elevated risk for depression and other psychiatric disorders.

Insomnia is an important risk factor for depression, and has also been linked to a sharply increased risk of suicide among people who suffer from depression. Despite all that we know about this complicated relationship, scientists are still working to understand the underlying mechanics and root causes of sleep disorders and mood disorders when both are present.

A new study provides some important new information about how disrupted, insufficient sleep may contribute to the onset of emotional difficulties as well as the development of depression and other psychiatric problems.

Researchers at the University of Pittsburgh School of Medicine investigated emotional responses in the brains of people with insomnia and found dysfunctional activity in an area of the brain that regulates and processes emotions. Their findings may provide an explanation for the mechanism by which disrupted sleep influences depression and other psychiatric conditions.

Researchers included 44 adults in their study. Of these, 14 had chronic insomnia, and no other primary psychiatric disorders. The remaining 30 participants were people who had no insomnia and who slept well. All of the study subjects participated in the same exercise, a task involving voluntary emotional regulation.

First, participants were shown a series of images containing both negative and neutral emotional content. They were asked to view the series of images passively, without trying to control or influence their emotional responses.

When they were shown the images a second time, participants were asked to decrease their emotional response using a voluntary emotional regulation technique called cognitive reappraisal. 

Cognitive reappraisal involves the deliberate attempt to change one's emotional response to a stimulus.

In this case, participants were asked to intentionally decrease their negative emotional responses to the images shown to them. Researchers' analysis showed: 

A distinct difference in the brain activity of those with insomnia compared to those with normal sleep patterns.

Specifically, researchers found a dramatic difference in the activity of the amygdala, a cluster of neurons within the temporal lobe that plays a critical role in processing and regulating emotion.

Amygdala activity was significantly greater for those with insomnia during the period when they were asked to decrease their negative responses to images using cognitive reappraisal, compared to those without the sleep disorder.

There was no significant difference between insomnia and non-insomnia participants during their passive viewing of the images.

Previous research has shown that cognitive reappraisal decreases amygdala activity.

These results, which show the opposite, suggest that insomnia may impair the brain's ability to successfully process negative emotions, a finding that could help to explain the mechanics of how sleep contributes to depression and other psychiatric disorders.

Other recent research has demonstrated evidence of neural changes and emotional regulation difficulties among people with disordered, insufficient sleep: 

The ability to accurately judge emotion in human faces is compromised by sleep deprivation, according to research conducted at the University of California, Berkeley. Researchers measured the ability to read emotions in faces by people who were sleep deprived in a laboratory setting, and found significant impairment to their assessment of certain emotions, including anger and sadness. The impairment was particularly significant among women. The decrease in this ability was alleviated after a night of recovery sleep.

Researchers in the United Kingdom examined how sleep deprivation affects inhibition and impulse control. They found a night of sleep deprivation lowered inhibition and increased impulsivity to negative stimuli.

In responding to a series of images categorized as pleasant, neutral, or unpleasant, people who were sleep deprived perceived the neutral images more negatively than those who were not sleep deprived. Those who were sleep deprived also demonstrated more negative moods.

Sleep deprived patients were more highly reactive to both negative and positive stimuli, showing greater levels of activity in the limbic regions of the brain, where much of the work of emotional regulation and processing occurs.

The latest research findings add to the growing body of scientific knowledge indicating that sleep problems cause dysfunction in the brain that may contribute to emotional difficulties and psychiatric conditions.

This is an exciting and important area of research, as scientists continue to explore the biological roots of both sleep disorders and psychiatric disorders.

All of us who've experienced insufficient, disrupted sleep know first-hand how being sleep deprived can negatively affect our emotional equilibrium.

When we're tired, we're more likely to be short-tempered, impatient, and moody.
Research such as this brings us closer to understanding the mechanics that may underlie a broad range of emotional disturbance and dysfunction.

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Eleanor Longden: "The Voices In My Head"

By Lloyd  I. Sederer, M.D., Huffingtonpost blog

Paul Klee, Angelus Novus, oil transfer and watercolor on paper, 1920

Damage is not destiny. That is Eleanor Longden's lived experience and the message delivered in her warm, poignant and illuminating talk.

She casts a striking figure, statuesque in the beam of the lights with her long, golden blond hair and crystal clear blue eyes, telling a story about psychosis -- her own. I watched, mesmerized, and saw both her confidence and her fragility as she revealed how what started as benign voices commenting on her behavior escalated to sinister, accusatory and demoralizing demons. She was told she had schizophrenia, a severe and persistent mental illness. Like many people in a psychotic state she was given medication that -- while generally necessary -- left her feeling more "drugged and discarded" than having assisted her in overcoming a serious illness.

Longden speaks with eloquence about how each color of voice (e.g., angry, shaming, guilty, abusive) represented an aspect of herself that she had tried to bury but they had not died.

Longden, already a media journalist, deteriorated. Her capacity to work and her self-respect drained slowly over two years of progressive symptoms and illness. She tells us she was hospitalized, more than once, but she did not give up. She would not be victim to her condition but rather become a survivor of it. The turning point, as she describes it, was catalyzed by three things: her search for meaning, not going it alone, and finding hope.

Her search for meaning began with the perspective that the voices were ways by which her inner emotions, long buried, found a route for expression. They were not to be fought but rather understood. Longden speaks with eloquence about how each color of voice (e.g., angry, shaming, guilty, abusive) represented an aspect of herself that she had tried to bury but they had not died. She remarks that the loudest of the voices called for the greatest of respect because their amplitude was a measure of their need for recognition and response. As she reframed the voices, viewed them through a lens of metaphor, she could work with them, set limits on them, and appreciate the trauma that, for her, was instrumental to their genesis.

Not going it alone, a message fundamental to all human pain -- mental and physical -- was another adaptive path Longden found. She especially credits her mother who stood by her despite the catastrophe her life had become. She tells doctors and other clinicians that her doctor steadily held to a conviction that recovery is possible and that too made a deep impression that helped her keep going during what must have been many a dark moment. She urges others to become a survivor, to find others like yourself who face similar feelings, experiences and struggles and not go it alone.

Hope is the other essential ingredient to her story, and to her recovery. She urges her listeners to ask "What happened to you, not what's wrong." Wrong is antithetical to recovery; it is destructive of hope. Hope can emerge when a person can see that what is happening to them, in the form of symptoms or illness, has an element of a survival strategy, a "... sane strategy for insane situations." Hope, I have learned in my work, is the essence that separates the winners from the losers, the survivors from the casualties, the leaders from the followers. Longden is a winner, a survivor and now she is also a leader.

Among her activities in her reconstructed world is Intervoice -- "The International Hearing Voices Network." Check out their website: It is not only for people hearing voices -- and there are millions who do; it is also for families, friends and those seeking inspiration.

Trauma is ubiquitous in human experience. Sometimes voices emerge in its wake. Or there may be nightmares, self-abuse, alcohol and drug dependence, and many other forms of suffering. What Eleanor Longden shows us is that damage need not be the final word, that damage need not be destiny.

Dr. Sederer's new book for families who have a member with a mental illness, The Family Guide to Mental Health Care, published by WW Norton, is now available, as is his even newer book (with Jay Neugeboren and Michael Friedman), The Diagnostic Manual of Mishegas.

Once Again, Neuroplasticity and Learning

Realize Your Mind's Intrinsic Power

By Marie Pasinski, M.D.

Holding a human brain for the first time was a powerful moment. Cradling the fragile organ in my hands, I had this overwhelming realization that every thought, every emotion, every experience and every dream this person ever had was coded within. As a neurologist, my awe for this miraculous structure intensifies with every new breakthrough in neuroscience and each personal triumph that I encounter. Eleanor Longden's talk, "The Voices in My Head" is a testament to the intrinsic power of the human brain and its ability to redesign itself.

Only recently have we begun to understand that thoughts are structurally encoded within the brain. Every time you think a specific thought, certain pathways of neurons fire up. With repetition, these pathways are strengthened. The more often you think a specific thought, the stronger that particular pathway becomes. Over time, you develop habitual thought patterns because it's more convenient for the brain to send ideas down a well paved highway rather than a cobble side street. This is how mental habits are formed, both good and bad. When we think in novel ways, new thought pathways are forged in the brain. In this way, the brain you have at this very moment is a result of how your brain has been molded over time.

We now understand that from depression and anxiety disorders to cognitive dysfunction, psychosis, substance abuse and eating disorders, the brain has been physically altered to an unhealthy state.

Regardless of age, your brain has the ability to make new neurons and redesign neural pathways throughout your life. This process called "neuroplasticity", has been a revelation in neuroscience and has transformed the way we perceive mental illness. We now understand that from depression and anxiety disorders to cognitive dysfunction, psychosis, substance abuse and eating disorders, the brain has been physically altered to an unhealthy state. Although we have just begun to scratch the surface in understanding these complex changes, recent discoveries in this area are truly remarkable.

Ground-breaking research shows that both depression and chronic stress are associated with diminished neuroplasticity. In other words, the production of new neurons markedly decreases in these conditions. Meanwhile other studies show that antidepressants, the medications used to treat depression, such as SSRIs and tricyclics, actually boost the production of new neurons. This may explain why exercise, which has been shown to increase the birth of new neurons and enhance neuroplasticity may be helpful in reversing depression and treating anxiety.

It's important to know that many factors and numerous medical conditions affect our thoughts, emotions and behavior. For example, sleep disorders, thyroid dysfunction, metabolic abnormalities, vitamin deficiencies and medication side effects are common conditions that can masquerade as mental illness. This is why it's so vital to see your doctor if you do notice a change in your thinking or mood. Once other contributing medical causes have been eliminated or treated, it's essential to realize that thought, emotion and behavior have a physical, chemical and biologic, basis within the brain. All the thoughts and experiences you have had throughout your life combined with your unique genetic makeup determine your brain's structure and function.

Although you cannot change your past experiences or your genetics, you can foster a mentally healthier brain. From this day forward, you can tap into the power of neuroplasticity. It begins by taking charge of your thoughts and realizing that you can choose to think and feel differently. Over time, like Eleanor Longden, you can redesign the infrastructure of your brain. That's the beauty and the miracle of her story. Nothing will have a greater impact on the quality of your life than discovering your brain's intrinsic power.

Recollections of the Swindle Family

Swindle, swindle, everywhere,
Every shape and size;
Take the swindle out of a man,
And you’ve nothing left but lies.

Philanthropy is made to cover a fraud,
Charity keeps humbugs in tow;
And we’re swindled at home, swindled abroad,
And swindled wherever we go.

For the world is full of humbugs
Managed by dishonest men;
One moves on, another comes,
And we’re swindled again and again.

—Apoth E. Cary, “Recollections of the Swindle Family”

Momento Mori

From yee Wiki: Momento mori

Popular belief says the phrase originated in ancient Rome: as a Roman general was parading through the streets during a victory triumph, standing behind him was his slave, tasked with reminding the general that, although at his peak today, tomorrow he could fall, or — more likely — be brought down. 

The servant is thought to have conveyed this with the warning, "Memento mori."

It is further possible that the servant may have instead advised, "Respice post te! Hominem te esse memento! Memento mori!": "Look behind you! Remember that you are but a man! Remember that you'll die!", as noted by Tertullian in his Apologeticus.

The Honest Truth About Dishonesty: How We Lie to Everyone--Especially Ourselves

Here's my latest non-fiction read, and as usual, Dan Ariely has written an highly entertaining and insightful book on an important topic of behavioral economics. 

An interesting side note is, my first print hard cover edition has a promotional blurb written by author Jonah Lehrer, who was soon disgraced as a literary fudger himself in a publishing scandal, after he was taken to school by his journalistic peers when it was revealed that for some strange (dishonest) reason Lehrer totally fabricated the Bob Dylan quotes jn his book on creativity, Imagine. 

Further investigation then revealed Lehrer fudged many of his non-fiction scientific quotes in nearly all of his previous works -- oh, the humanity. 

I'll have to research to see what, if anything, Dan Ariely has to say about the dishonesty of all that. I note that the Lehrer quote was deleted for the Amazon copy on the later paperback edition below...

Here's the painfully ironic Jonah Lehrer book blurb quote:

"In this endlessly fascinating book, Dan Ariely proves that dishonesty is everywhere: we are all bad apples. It's an uncomfortable message, but the implications are huge -- and nobody understands this better than Ariely. If you care about the truth, read this book." -- Jonah Lehrer, author of How We Decide and Imagine

Jonah Lehrer, author of Imagine.

The Honest Truth About Dishonesty: How We Lie to Everyone--Especially Ourselves by Dan Ariely

Dan Ariely, behavioral economist and the New York Times bestselling author ofThe Upside of Irrationality and Predictably Irrational, examines the contradictory forces that drive us to cheat and keep us honest, in this groundbreaking look at the way we behave: The (Honest) Truth About Dishonesty.
From ticket-fixing in our police departments to test-score scandals in our schools, from our elected leaders’ extra-marital affairs to the Ponzi schemes undermining our economy, cheating and dishonesty are ubiquitous parts of our national news cycle—and inescapable parts of the human condition.
Drawing on original experiments and research, in the vein of Freakonomics, The Tipping Point, and Survival of the Sickest, Ariely reveals—honestly—what motivates these irrational, but entirely human, behaviors.

Editorial Reviews

“Ariely raises the bar for everyone. In the increasingly crowded field of popular cognitive science and behavioral economics, he writes with an unusual combination of verve and sagacity.” (Washington Post)

“I thought [Ariely’s] book was an outstanding encapsulation of the good hearted and easygoing moral climate of the age.” (David Brooks, the New York Times)
“The best-selling author’s creativity is evident throughout. . . . A lively tour through the impulses that cause many of us to cheat, the book offers especially keen insights into the ways in which we cut corners while still thinking of ourselves as moral people.” (Time.com)

“Captivating and astute. . . . In his characteristic spry, cheerful style, Ariely delves deep into the conundrum of human (dis)honesty in the hopes of discovering ways to help us control our behavior and improve our outcomes.” (Publishers Weekly)

“Dan Ariely ingeniously and delightfully teases out how people balance truthfulness with cheating to create a reality out of wishful-blindness reality. You’ll develop a deeper understanding of your own personal ethics—and those of everybody you know.” (Mehmet Oz, MD; Vice-Chair and Professor of Surgery at Columbia University and host ofThe Dr. Oz Show)

“Anyone who lies should read this book. And those who claim not to tell lies are liars. So they sould read this book too. This is a fascinating, learned, and funny book that will make you a better person.” (A.J. Jacobs, author of The Year of Living Biblically and Drop Dead Healthy)

“I was shocked at how prevalent mild cheating was and how much more harmful it can be, cumulatively, compared to outright fraud. This is Dan Ariely’s most interesting and most useful book.” (Nassim Nicholas Taleb, author of The Black Swan)

“Through a remarkable series of experiments, Ariely presents a convincing case. . . . Required reading for politicians and Wall Street executives.” (Booklist)

The New York Times bestselling author of Predictably Irrational and The Upside of Irrationality returns with a thought-provoking work that challenges our preconceptions about dishonesty and urges us to take an honest look at ourselves.

Does the chance of getting caught affect how likely we are to cheat?

How do companies pave the way for dishonesty?

Does collaboration make us more or less honest?

Does religion improve our honesty?

Most of us think of ourselves as honest, but, in fact, we all cheat. From Washington to Wall Street, the classroom to the workplace, unethical behavior is everywhere. None of us is immune, whether it's a white lie to head off trouble or padding our expense reports. In The (Honest) Truth About Dishonesty, award-winning, bestselling author Dan Ariely shows why some things are easier to lie about than others; how getting caught matters less than we think in whether we cheat; and how business practices pave the way for unethical behavior, both intentionally and unintentionally. 

Ariely explores how unethical behavior works in the personal, professional, and political worlds, and how it affects all of us, even as we think of ourselves as having high moral standards. But all is not lost. Ariely also identifies what keeps us honest, pointing the way for achieving higher ethics in our everyday lives.

With compelling personal and academic findings, The (Honest) Truth About Dishonesty will change the way we see ourselves, our actions, and others.

Behaviorial Economics researcher and best-selling author Dan Ariely.

In the News: Cocaine "Rapidly Changes the Brain"

By James Gallagher, BBC News

Taking cocaine can change the structure of the brain within hours in what could be the first steps of drug addiction, according to US researchers.

Animal tests, reported in the journal Nature Neuroscience, showed new structures linked to learning and memory began to grow soon after the drug was taken.

Mice with the most brain changes showed a greater preference for cocaine.

Experts described it as the brain "learning addiction."

The team at University of California, Berkeley and UC San Francisco looked for tiny protrusions from brain cells called dendritic spines. They are heavily implicated in memory formation.

“This study gives us a solid understanding of how addiction occurs - it shows us how addiction is learned by the brain."

In the experiments, the mice were allowed to explore freely two very different chambers - each with a different smell and surface texture.

Once they had picked a favorite they were injected with cocaine in the other chamber.

A type of laser microscopy was used to look inside the brains of living mice to hunt for the dendritic spines.

More new spines were produced when the mice were injected with cocaine than with water, suggesting new memories being formed around drug use.

The difference could be detected two hours after the first dose.

Researcher Linda Wilbrecht, assistant professor of psychology and neuroscience at UC Berkeley, said: "Our images provide clear evidence that cocaine induces rapid gains in new spines, and the more spines the mice gain, the more they show they learned about the drug.

"This gives us a possible mechanism for how drug use fuels further drug-seeking behavior.

"These drug-induced changes in the brain may explain how drug-related cues come to dominate decision making in a human drug user."

Commenting on the research, Dr Gerome Breen, from the Institute of Psychiatry at King's College London, told the BBC: "Dendritic spine development is particularly important in learning and memory.

"This study gives us a solid understanding of how addiction occurs - it shows us how addiction is learned by the brain.

"But it is not immediately apparent how useful this would be in developing a therapy."

Prediction: r.e. Health Insurance Rates, Being Obese Will Become the New Smoking

BMI is a sub-par measure of your heath, experts say

By Lance Tillson, National Monitor

Two obesity researchers from the University of Pennsylvania are trying to discredit the Body Mass Index (BMI), which is a widely used measure of a person’s health. They make their case in a perspective article published in the journal Science.

However, their passion for defaming the BMI isn’t shared by everyone in the scientific community. In fact, the Centers for Disease Control and Prevention (CDC) notes that the BMI affords a “reliable indicator” of fat for a lot of individuals and is suitable for the purpose of spotting weight categories that may result in health problems.

“Obesity has increased worldwide; is a major risk factor for diabetes, cardiovascular disease, cancer, sleep apnea, nonalcoholic fatty liver disease, osteoarthritis, and other ailments; and has been associated with disability, mortality, and enormous health costs,” the authors argue in a summary of their perspective article. “Despite these clear adverse consequences of obesity, some studies have suggested that obesity as defined by [BMI] improves survival under certain conditions.”

Although several studies have revealed an increase in mortality in obese people, recent studies have indicated that obesity safeguards against death from all causes as well as death because of chronic disease. The “obesity-mortality” paradox implying a helpful influence of obesity is extremely controversial.

As noted by LiveScience, the researchers believe that the problem arises from the fact that the BMI is a terrible measure of an individual’s health. For instance, the BMI fails to take into consideration fat, and where that fat is located on the body. While abdominal fat may raise the risk of a number of chronic illnesses, peripheral fat may be safer.

“There is an urgent need for accurate, practical and affordable tools to measure fat and skeletal muscle, and biomarkers that can better predict the risks of diseases and mortality,” said Dr. Rexford Ahima, Professor of Medicine and Director of the Obesity Unit in the Institute for Diabetes, Obesity and Metabolism, in a Penn news release.

“Advances to improve the measurement of obesity and related factors will help determine the optimal weight for an individual, taking into account factors such as age, sex, genetics, fitness, pre-existing diseases, as well novel blood markers and metabolic parameters altered by obesity.”

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