Review ArticlePoor sleep as a potential causal factor in aggression and violence
Introduction
It is well known that sleep loss can have serious detrimental effects on cognitive performance. For example, sleep deprivation reduces sustained attention, executive functioning, and memory [1], [2]. Moreover, sleep loss may also affect emotional function [3], and chronically disrupted sleep may even sensitize individuals to mood disorders [4], [5]. However, relatively little attention has been paid to the effects of sleep loss on other areas of affective functioning. Yet, many people have the experience that disturbed sleep is accompanied by emotional instability expressed, for instance, by a greater irritability and short-temperedness. In most people this will not result in physical outbursts of aggression. However, this may be different in vulnerable individuals, such as psychiatric patients, who often experience serious sleep problems. For example, about 80% of patients suffering from a depressive disorder experience sleep problems [6], and sleep disturbances are found in 30–80% of schizophrenic patients [7]. Similar numbers may apply to forensic psychiatric patients, but published data are lacking. Forensic psychiatric hospitals treat patients who have committed (violent) offences but have diminished responsibility due to a mental disorder. The most important treatment goal for this specific group of patients is to reduce the risk of (violent) recidivism. Based on clinical observations in forensic psychiatry, we have the impression that poor sleep may contribute to the loss of emotional control, including the regulation of aggression. If sleep problems are a potential risk factor for hostile and (reactive) aggressive behavior, treating sleep disturbances and promoting good sleep in mentally disordered offenders may be beneficial in crime-preventing treatment programs. Therefore, in this paper we present an overview of existing literature concerning the relationship between sleep and aggression/hostility.
Section snippets
Methods
A literature search was performed in PubMed and Ovid with the following search terms: sleep, sleep disturbances, sleep problems, sleep deprivation, sleep architecture, aggression and aggressive behavior. The search terms were used in different combinations. Cross-references were checked for relevant papers. We included studies that covered sleep and its effects on aggression, anger, and irritability.
With regards to the interpretation of relevant studies, it is important to bear in mind that
Childhood populations
In addition to the more obvious consequences – such as sleepiness, inattention, and poor cognitive performance and anxiety – poor sleep in children and adolescents appears to be associated with aggression and conduct problems [8], [9]. In a large group of 2- to 3-year-old children the number of night time awakenings was positively correlated with parent-rated aggressive behavior [10]. Parent-reported sleep problems in 3- to 4-year-old twins correlated positively with conduct problems, anxiety,
Correlations
The correlation between disturbed or short sleep and disturbed control of aggression could be even stronger in subjects with a high anger-trait as part of their character. A condition in which aggression and angriness are core symptoms and can be considered part of the subject’s character is antisocial personality disorder (ASPD). Individuals with ASPD probably suffer from sleep problems comparable to other psychiatric patients. In fact, in a group of Turkish male military subjects diagnosed
Effects of treatment of sleep problems
An interesting case report describes two boys (six and eight years old), both admitted to a psychiatric unit for increasingly aggressive and violent behavior towards peers and family members [36]. During admission, they were diagnosed with obstructive sleep apnea syndrome (OSAS), which in children is most often due to enlarged tonsils. After adenotonsillectomy, both children had, as expected, a significant reduction in their apneic episodes. More importantly, prominent reductions both in the
Animal studies
Various experimental studies in rats suggest that sleep deprivation may increase aggression: rats subjected to enforced wakefulness by placing them together on top of a rotating drum surrounded by water, died after 3–14 days, not directly from sleep loss per se, but from fighting [43]. These rats became so hyper-reactive that even slight physical contacts precipitated vicious, aggressive behavior. This behavior was not always directed against the actual offender, and occasionally several
Prefrontal cortical functioning
One hypothesis on the relationship between poor sleep and aggression is that sleep deprivation results in poor prefrontal cortical (PFC) functioning. When PFC functioning is reduced, the ability to anticipate, delay, and initiate behavioral responses based on cognitive and social context declines [69]. That sleep deprivation affects the PFC is supported by the finding that sleep deprivation as short as 24 h leads to significant declines in PFC metabolic activity [70]. In addition, after sleep
Individual vulnerability
It is possible that certain individuals are more susceptible to the emotional consequences of poor sleep. For example, individual differences in emotional intelligence predict the influence of sleep deprivation on written responses to cartoons displaying frustrating situations [62]. This could indicate that individuals with low emotional intelligence are more vulnerable to the negative effects of sleep deprivation on mental functioning. Speculatively, individuals with poor prefrontal
Conclusions
Clinical and anecdotal observations in forensic psychiatric patients suggest that sleep loss is a potential risk factor for impulsive, reactive aggression. The larger part of the reviewed literature concerning the relationship between poor sleep and emotional regulation supports this hypothesis. Yet, most studies measured correlations and, thus, did not provide information on causality: poor sleep may affect aggressiveness or aggressiveness may produce sleep problems. Another option is that
Conflict of Interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.12.006.
References (98)
- et al.
Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies
J Affect Disord
(2011) - et al.
Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity
Sleep Med Rev
(2008) The neurocognitive effects of sleep disruption in children and adolescents
Child Adolesc Psychiatr Clin N Am
(2009)Sleeplessness and aggression in youth
J Adolesc Health
(2006)- et al.
Etiologies of associations between childhood sleep and behavioral problems in a large twin sample
J Am Acad Child Adolesc Psychiatry
(2004) - et al.
Association between sleep patterns and daytime functioning in children with insomnia: the contribution of parent-reported frequency of night waking and wake time after sleep onset
Sleep Med
(2010) - et al.
Conduct problems and symptoms of sleep disorders in children
J Am Acad Child Adolesc Psychiatry
(2003) - et al.
Aggressive behavior, bullying, snoring, and sleepiness in schoolchildren
Sleep Med
(2011) Behavioral and psychological correlates of a difference in chronic sleep duration
Biol Psychol
(1977)- et al.
Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students
J Psychosom Res
(1997)
Relationship between trait-anger and sleep disturbances in middle-aged men and women
J Psychosom Res
Sleep patterns and predictors of disturbed sleep in a large population of college students
J Adolesc Health
The relationship between sleeping problems and aggression, anger, and impulsivity in a population of juvenile and young offenders
J Adolesc Health
Sleep architecture in homicidal women with antisocial personality disorder – a preliminary study
Psychiatry Res
EEG sleep “abnormalities” in preadolescent boys with a diagnosis of conduct disorder
J Am Acad Child Psychiatry
Reduced aggression in two inpatient children with the treatment of their sleep disorder
J Am Acad Child Adolesc Psychiatry
Long-term changes in behavior after adenotonsillectomy for obstructive sleep apnea syndrome in children
Otolaryngol Head Neck Surg
Experimental sleep fragmentation and sleep deprivation in rats increases exploration in an open field test of anxiety while increasing plasma corticosterone levels
Behav Brain Res
The effects of deprivation of rapid eye movement (REM) sleep on maze learning and aggression in the albino rat
J Psychiatr Res
REM sleep deprivation increases aggressiveness in male rats
Physiol Behav
Increased aggression after rapid eye movement sleep deprivation in Wistar rats is not influenced by reduction of dimensions of enclosure
Behav Neural Biol
Effects of sleep disruption on rat dentate granule cell LTP in vivo
Brain Res Bull
Behavioural sensitization to repeated sleep deprivation in a mice model of mania
Behav Brain Res
Social stress induces high intensity sleep in rats
Neurosci Lett
A social conflict increases EEG slow-wave activity during subsequent sleep
Physiol Behav
Effects of social stimuli on sleep in mice: non-rapid-eye-movement (NREM) sleep is promoted by aggressive interaction but not by sexual interaction
Brain Res
Effects of sleep deprivation and exercise on cognitive, motor performance and mood
Physiol Behav
Sustained sleep restriction reduces emotional and physical well-being
Pain
The effects of sleep deprivation on symptoms of psychopathology in healthy adults
Sleep Med
Sleep deprivation adversely affects interpersonal responses to frustration
Pers Indiv Differ
Effects of sleep deprivation on impulsive behaviors in men and women
Physiol Behav
Sleep deprivation lowers inhibition and enhances impulsivity to negative stimuli
Behav Brain Res
Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills
Sleep Med
Aggression-interactions of serotonin and testosterone in healthy men and women
Behav Brain Res
Serotonin control of sleep–wake behavior
Sleep Med Rev
Serotonin and the sleep/wake cycle: special emphasis on microdialysis studies
Prog Neurobiol
Neuroendocrinology of coping styles: towards understanding the biology of individual variation
Front Neuroendocrinol
Sleep and the hypothalamo–pituitary–adrenocortical system
Sleep Med Rev
Sleep, the hypothalamic–pituitary–adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders
Endocrinol Metab Clin North Am
Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis
Psychiatry Res: Neuroimaging
The role of sleep in learning and memory
Science
Cognitive consequences of sleep and sleep loss
Sleep Med
Overnight therapy? The role of sleep in emotional brain processing
Psychol Bull
Sleep and psychiatry
Dialogues Clin Neurosci
Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics
CNS Drugs
The relation between common sleep problems and emotional and behavioral problems among 2- and 3-year-olds in the context of known risk factors for psychopathology
J Sleep Res
Sleep and behavior problems among preschoolers
J Dev Behav Pediatr
Concurrent associations among sleep problems, indicators of inadequate sleep, psychopathology, and shared risk factors in a population-based sample of healthy Ontario children
J Pediatr Psychol
Sleep problems, tiredness, and psychological symptoms among healthy adolescents
J Pediatr Psychol
Cited by (291)
Short-term high temperature may increase the incidence risk of collective conflicts: A case-crossover study in the Greater Middle East
2024, Science of the Total Environment