| Insomnia disorder is the most common sleep disorder and the second prevalent mental disorder in the world.Its basic features include difficulty in falling asleep,difficulty in maintaining sleep,early awakening,short total sleep duration,and decreased daytime function because of bad sleep.Insomnia disorder is not only a risk factor for some physical diseases such as hypertension and stroke,but also has a detrimental impact on people’s cognition and emotion.A large number of previous studies have shown that sleep deprivation can lead to impaired cognitive reappraisal ability,which makes it impossible to down-regulate negative emotion and causes more serious emotional disorders.However,the vast majority of relevant studies focused on the impact of short-term sleep insufficiency or poor sleep quality such as sleep restriction,sleep deprivation and the inquiry into cognitive reappraisal ability has mainly focus on scale and behavioral research,so the results are extremely limited.Primary chronic insomnia patients refers to insomnia patients who suffer from insomnia for more than three months and the insomnia symptoms are not caused by other diseases.Therefore,further exploring the cognitive reappraisal ability of patients with chronic primary insomnia is of great significance for understanding the impact of chronic primary insomnia on emotion and thinking about how to treat insomnia.In order to explore the cognitive reappraisal ability and related brain imaging indicators of patients with long-term insomnia,we carried out the following three experimental studies.Study 1 is mainly about the differences between insomnia patients and healthy participants in sleep and emotion regulation from the behavioral data.Twenty insomnia participants in study 1 were recruited through the diagnosis of professional doctors,or the results of polysomnography(PSG)combined with the scales such as the Insomnia Severity Index(ISI).We also recruited thirty-two healthy participants whose gender and age were matched with the insomnia participants from communities.They were asked to complete sleep-related questionnaires,emotional regulation-related questionnaires,and affective disorder-related questionnaires.The results showed that in the respect of sleep,the sleep quality of long-term insomnia patients was significantly lower than that of healthy people,and the degree of insomnia was significantly higher than that of healthy people;in terms of the degree of hyperarousal,the degree of awakening of long-term insomnia patients tended to be higher than that of healthy people.In the aspect of emotion regulation ability,the Difficulties in Emotion Regulation Scale(DERS)of long-term insomnia patients is significantly higher than that of healthy people and one of the sub-dimension of the difficulty in emotion regulation scale: strategy use,also showed the ability to use emotion regulation strategies of chronic primary insomnia patients was significantly lower than that of healthy people.However,on the Emotional Regulation Questionnaire(ERQ),there was no significant difference between chronic primary insomnia patients and healthy people.In terms of emotional mental disorders,although all participants were required not to reach the level of clinical anxiety and depression in the selection,patients with longterm insomnia still showed a higher tendency to anxiety,which also reflected that longterm insomnia patients had more emotional regulation problems.However,in terms of depression scores,we did not find any difference in scores between the two groups.Study 2 followed James Gross’ emotion regulation task,focusing on the differences in behavior and brain activity between nineteen insomnia patients and twenty-eight healthy participants under a specific emotion regulation strategy(cognitive reappraisal).The experiment design was based on 2(insomnia patient group,healthy control group)×3(passively viewing of negative pictures,passively viewing of neutral pictures,and reappraisal of negative pictures),and the participants were required to complete the task of looking at the picture and scoring their inner feelings at that time.The behavioral data results showed that under the three experimental conditions,the participants showed different negative emotional feelings,and the interaction is marginally significant.However,we did not find a significant main effect by type of participants,i.e.there was no significant difference in negative emotional experience between people with chronic primary insomnia and healthy people under the same experimental condition.Brain imaging results showed that there was a significant difference in the brain activation of the cuneus under the conditions of reappraising negative emotional pictures via taking perspectives and passively viewing of negative pictures and there is a tendency that there is an interaction between the two groups of participants in the subgyrus of the temporal lobe,the inferior frontal gyrus(IFG)of the prefrontal cortex,and the para-hippocampal gyrus.Study 3 combined the resting state functional magnetic resonance imaging with the results of study 2 and the scale results of study 1.In this study,we further used resting state functional magnetic resonance imaging to verify whether there is a difference between insomnia patients and healthy participants in the functional connectivity between brain areas about cognitive reappraisal,that is,whether differences in cognitive reappraisal ability can be reproduced in the results of resting-state f MRI results,which is more stable because it does not need to consider the task format.In this study,we used 52 participants from Study 1(20 insomniacs and 32 healthy participants)and we used the results brain regions from Study 2(sub-gyrus of the temporal lobe,inferior frontal gyrus of the prefrontal cortex,and para-hippocampal gyrus)as the region of interest to find the functional connectivity of the whole brain,which were different in two groups of participants.Finally,we compared the obtained functional connectivity with the difficulty in emotional regulation scale in Study 1.The results showed that there is a trend that the functional connectivity in the inferior frontal gyrus,para-hippocampus and superior occipital gyrus,and para-hippocampus and inferior parietal lobule are different in two groups of participants.Also,in healthy controls,there is a significant negative correlation between the functional connectivity within the inferior frontal gyrus and the score of DERS,as well as the score of trait anxiety inventory.In addition,in chronic primary insomnia patients,functional connectivity between para-hippocampus and left superior occipital gyrus and functional connectivity between para-hippocampus and right superior occipital gyrus were significantly correlated with score of extreme factors of hyperarousal scale and ISI.In summary,consistent with previous research on cognitive reappraisal,our research results on scales also found that chronic primary insomnia patients have decreased cognitive reappraisal ability and emotional regulation ability.Our brain imaging results also show that the para-hippocampal gyrus,inferior frontal gyrus and parts of the temporal lobe are important brain regions for cognitive reappraisal.As a vital part of the amygdala,the para-hippocampal gyrus is a brain area which is related to emotion;the inferior frontal gyrus is an important part of the prefrontal cortex and plays an important role in controlling emotions;the temporal lobe is an intermediary brain region in the pathway from the amygdala to the prefrontal cortex,which relays signals from the prefrontal cortex to the amygdala for emotional regulation.The above results have deepened our understanding of the emotional regulation of insomnia patients,that is,patients with long-term insomnia have problems of decreased cognitive reappraisal ability and difficulty in down-regulating negative emotions due to lack of sleep and poor sleep quality for a long time,which was associated with the activity in the prefrontal cortex,para-hippocampal gyrus,and parts of the temporal lobe.This study also showed of the behavioral and neural mechanisms of emotional regulation problems in long-term insomnia patients,and provided theoretical knowledge for some emotional disorders like anxiety.At the same time,this study also provides theoretical support for the treatment of patients with long-term insomnia,that is,we should pay more attention to their problems in cognitive reappraisal and when treating them with the Cognitive Behavioral Therapy for Insomnia(CBT-I),it is also necessary to take the patient’s emotional factors into account. |
PDF Full Text Request