Sleep Reactivity as a Risk Factor for Psychopathology: A Review of Prospective Studies, Mechanisms, and Biological Correlates

Sleep reactivity is a trait predisposition to sleep disturbance after stress, which increases risk for psychopathology. We reviewed evidence for sleep reactivity as a risk factor for psychopathology and discuss the mechanisms and potential psychophysiology undergirding these relationships.

Sleep reactivity prospectively predicts acute stress disorder, posttraumatic stress disorder, depression, anxiety, and functional impairment across samples exposed to extreme stressors, including acute trauma survivors, individuals during the COVID-19 pandemic, and World Trade Center responders. These relationships are mediated by sleep disturbances and emotion dysregulation. Furthermore, sleep reactivity is associated with abnormalities across physiological systems involved in regulating stress and emotion.

Highly reactive sleepers face increased risk for mental disorders after stress, due in part to insomnia symptoms and emotion regulation difficulties. A reactive sleep system may reflect underlying deficits in physiological stress regulation. Sleep reactivity measures might facilitate early detection of individuals at risk of psychiatric conditions commonly downstream of chronic insomnia.