Shortened sleep fuels inflammatory responses to marital conflict: Emotion regulation matters
Introduction
Sufficient sleep is critical for maintaining health and well-being. Short sleep is implicated in premature mortality as well as cardiovascular disease, cancer, obesity, and diabetes (Cappuccio et al., 2011, Cappuccio et al., 2010). In fact, an expert consensus panel recommended 7–9 h of sleep each night to preserve health in adulthood (Consensus Conference et al., 2015).
Short sleep upregulates inflammatory signaling, a key pathway to many chronic conditions. For example, just one night of 4 h sleep deprivation was sufficient to increase messenger RNA transcription and stimulated monocyte production of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α, Irwin et al., 2006), as well as nuclear factor-κB (NF-κB) activation (Irwin et al., 2008). Similarly, restricting sleep to 6 h per night for one week resulted in heightened resting plasma IL-6 and TNF-α (Vgontzas et al., 2004), suggesting that the inflammatory effects of minor sleep debt may accumulate rapidly across days. On the other hand, a meta-analysis did not find effects for experimental sleep deprivation or subjective sleep duration on IL-6, indicating that short sleep alone may not increase inflammation (Irwin et al., 2016).
Nevertheless, short sleep duration may independently exacerbate inflammatory responses to stressors. Experimentally sleep-deprived people mount exaggerated sympathetic responses to stressful tasks compared to well-rested people (Liu et al., 2015, O’Leary et al., 2015). Because sympathetic activation heightens inflammation (Pongratz and Straub, 2014), increased inflammatory responsiveness may follow short sleep in daily life as well. Inflammatory sensitization to psychosocial stressors may reflect a novel path from short sleep to chronic illness, as inflammatory responses can contribute to long-term health risks beyond the effects of resting inflammation (Pace et al., 2006).
For couples, sleep problems can provoke hostility (Gordon and Chen, 2014, Hasler and Troxel, 2010). In a diary study, men reported more problematic interactions with their wives after a night of disturbed sleep (Hasler and Troxel, 2010). Likewise, couples who slept poorly over 14 nights reported more daily marital conflict than those who slept better (Gordon and Chen, 2014). Poorer sleep quality also increased negative affect and reduced positive affect during a marital problem discussion (Gordon and Chen, 2014). Moreover, just one partner’s poor sleep affected not only his or her own mood and empathic accuracy (i.e. the ability to interpret the other partner’s emotions) but also impacted the partner’s affect and accuracy (Gordon and Chen, 2014). Consistent with sleep quality’s effects on couples, people who were sleep-deprived for 36 h were less sociable in a decision-making game with an anonymous partner, and they were less likely to trust their teammate (Anderson and Dickinson, 2010). Thus, shortened sleep also sets the stage for soured social interactions.
Emotion regulation strategies are the behaviors we use to manage and change our emotions. Common strategies include emotion expression (conveying feelings with words and nonverbal gestures) and cognitive reappraisal, i.e., thinking about an upsetting situation from a different perspective. These regulation strategies play a role in the aftermath of sleep loss, but whether short sleep disturbs emotion regulation is unclear. On the one hand, short sleep may increase both inflammation and interpersonal conflict by disrupting emotion regulation. For instance, total sleep deprivation reduced neural communication between emotion-relevant brain regions, resulting in poorer discrimination of emotion cues (Simon et al., 2015, Yoo et al., 2007). Emotion expression may also suffer with shortened sleep: following sleep deprivation, people were less facially expressive and used more negative emotion words and fewer positive words than after a full night of sleep (McGlinchey et al., 2011, Minkel et al., 2011). On the other hand, some studies suggest that a person’s emotion regulation strategies remain unchanged after sleep loss and, therefore, protect against its negative consequences. For example, after sleep restriction, people who frequently used cognitive reappraisal paid less attention to negative-emotion faces than did infrequent reappraisers (Cote et al., 2015). Because regulation strategies directly affect interpersonal communication, conflict, and intimacy between partners (Laurenceau et al., 2005), the question of whether they are reduced by or buffer the effects of short sleep is important; the two hypotheses have not been tested together in a single sample.
Sleep is dyadic for many adults: 70% share a bed with their significant other (National Sleep Foundation, 2013). Nevertheless, there is a surprising dearth of studies on short sleep and inflammation in couples. Having a bed partner impacts sleep quantity and quality (Troxel et al., 2007), and beyond the effects of their own sleep problems, people whose partners slept poorly reported poorer health and well-being (Strawbridge et al., 2004). Inflammatory changes may account for this trend: partners’ short sleep may serve to boost one another’s next-day inflammation and heighten inflammatory responses to conflict, a novel mechanism of short sleep’s health effects. Given that partners’ poor sleep has also led to increases in negative mood and lower empathic accuracy (Gordon and Chen, 2014), it is important to examine whether short sleep translates to more hostile, less warm behavior during conflict. Furthermore, both partners’ emotion regulation use during conflict may modulate the effects of sleep on inflammation.
The first objective of our study was to examine the effects of husbands’ and wives’ self-reported recent sleep duration on both partners’ inflammation and inflammatory reactivity to marital conflict, a potent stressor. We hypothesized that those with shorter recent sleep would have higher morning inflammation and inflammatory reactivity to conflict than people who had slept more, assessed via stimulated IL-6 and TNF-α. We also predicted that people whose partners had slept less would have higher next-morning and post-conflict inflammation, above and beyond the effects of their own sleep duration. Our second objective was to test the effects of both partners’ short sleep on their behavior and emotion regulation during conflict. We hypothesized that both partners’ short sleep would relate to more negative and less positive behavior during conflict. Finally, we tested emotion expression and cognitive reappraisal strategies both as outcomes of sleep and buffers of the sleep-inflammation tie, expecting that more expression and reappraisal would relate to lower post-conflict inflammation or would attenuate short sleep’s effects on post-conflict inflammation.
Section snippets
Participants
Couples were recruited for a parent study of immune responses to high-fat meals (Kiecolt-Glaser et al., 2015b). An initial online screen and follow-up in-person screen determined eligibility. Couples married fewer than 3 years and those who had sensory impairments that would interfere with study completion were excluded. Couples were not considered if either partner had a chronic health problem including anemia or diabetes (HbA1c > 6.5), smoked, abused substances, or used prescription medication
Results
According to zero-order correlations, partners’ recent sleep duration were modestly related to each other but not redundant (r = 0.233, p = 0.003). Those who reported fewer hours of sleep in the prior two nights also experienced more sleep problems in the past month, as measured by the PSQI (r = −0.439, p < 0.0001). Partners’ past-month sleep problems were not significantly correlated with each other (r = 0.020, p = 0.78).
Discussion
People who slept fewer hours in the past two nights had higher inflammatory responses following marital conflict than those who slept more, despite the fact that baseline inflammation levels did not differ. Couples’ recent sleep also related to their marital problem discussion: when both partners had slept less, they behaved more negatively and less positively during conflict. However, they were protected from short sleep’s behavioral effects if one of the partners had sufficient sleep in the
Acknowledgements
This work was supported in part by NIH grants R21 CA158868, UL1TR001070, K05 CA172296, and T32 DE014320, as well as a Pelotonia Postdoctoral Fellowship from the Ohio State University Comprehensive Cancer Center and American Cancer Society Postdoctoral Fellowship Grant 121911-PF-12-040-01-CPPB.
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