Copyright ©The Author(s) 2021.
World J Psychiatr. Feb 19, 2021; 11(2): 27-34
Published online Feb 19, 2021. doi: 10.5498/wjp.v11.i2.27
Table 1 Hypothetical mechanisms by which traumatic exposure may affect sleep
Biological perspectivePhysiological arousal (increased activity of the amygdala, and decreased activity of the medial prefrontal cortex) hinders sleep onset
Safety and attachmentFeeling that one needs to be continuously alert and on guard instead of sleeping
Emotional memory and affectAlterations in nightmare rates, severity, and comorbidity reflect the influence of both affect load and distress
Threat simulation theoryThreat simulation in the course of dreaming reenacts the cognitive mechanisms needed for adequate threat perception and threat avoidance
Emotional regulation modelIndividuals exposed to trauma continue to be hyper-alert to defend themselves against real or imagined hazards, such as through distressing dreaming that replays the traumatic experience during sleep
Hyperarousal-based theoryUnder a hyper-arousal state, trauma survivors show an increased level of awareness and a sensitized response to the external world
Anxiety buffer disruption assumptionFear can increase the likelihood of gathering traumatic cues in the cognitive world, resulting in intrusive thoughts
Depressive-like pathophysiologyElevated plasma cortisol levels near sleep onset, increased sleep latency, and significant dysregulation in REM sleep patterns
Cognitive hyperactivationExcessive worry, rumination, and negative attributions contribute to the hyperarousal interfering with sleep