It is well established that during REM (Rapid Eye Movement) sleep, the brain processes emotions associated with stress and traumatic events. When significant traumatic exposures overwhelm this system or when REM sleep debt occurs, alterations arise that can result in posttraumatic stress disorder (PTSD), depression, and/or anxiety. A mathematical model is derived and calibrated to simulate this process. The model includes three independent variables: number of traumatic exposures, REM sleep debt (immediately before, during, and after traumatic exposure), and relative fitness related to aerobic exercise and cardiorespiratory fitness. The model was calibrated with laboratory REM sleep measurements and a known number of trauma expressions in a video. The number of memory intrusions was used to estimate relative risk of developing PTSD. After calibration, the model was applied to published data for military personnel on deployment. While exact inputs of REM debt and number of traumatic exposures are unknown for the military data, the mathematical model predicted results close to published relative risk for PTSD using reasonable estimates of these variables. Risks for depression and anxiety are often related to exposure to stress and trauma. Various data sources were used to calibrate and evaluate the benefits of aerobic exercise and the associated cardiorespiratory fitness on risks and treatment for mood, depression, PTSD, and anxiety. The model, supported by measured data in the literature, illustrates the importance of lifestyle choices early in life on health outcomes later in life.
References
[1]
Van Der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books.
[2]
Breslau, N., Kessler, R.C., Chilcoat, H.D., Schultz, L.R., Davis, G.C. and Andreski, P. (1998) Trauma and Posttraumatic Stress Disorder in the Community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626-632. https://doi.org/10.1001/archpsyc.55.7.626
[3]
James, E.L., Lau-Zhu, A., Clark, I.A., Visser, R.M., Hagenaars, M.A. and Holmes, E.A. (2016) The Trauma Film Paradigm as an Experimental Psychopathology Model of Psychological Trauma: Intrusive Memories and Beyond. Clinical Psychology Review, 47, 106-142. https://doi.org/10.1016/j.cpr.2016.04.010
[4]
Kessler, R.C. (1995) Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060. https://doi.org/10.1001/archpsyc.1995.03950240066012
[5]
Olff, M. (2017) Sex and Gender Differences in Post-Traumatic Stress Disorder: An Update. European journal of Psychotraumatology, 8, Article 1351204. https://doi.org/10.1080/20008198.2017.1351204
[6]
World Health Organization (2003) Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors. World Health Organization.
[7]
Osgood, J.M., Finan, P.H., Hinman, S.J., So, C.J. and Quartana, P.J. (2019) Combat Exposure, Post-Traumatic Stress Symptoms, and Health-Related Behaviors: The Role of Sleep Continuity and Duration. Sleep, 42, zsy257. https://doi.org/10.1093/sleep/zsy257
[8]
Olfati, M., Samea, F., Faghihroohi, S., Balajoo, S.M., Kuppers, V., Genon, S., Patil, K., Eickhoff, S.B. and Tahmasian, M. (2024) Prediction of Depressive Symptoms Severity Based on Sleep Quality, Anxiety, and Gray Matter Volume: A Generalizable Machine Learning Approach Across Three Datasets. Preprint. https://doi.org/10.1101/2023.08.09.23293887
[9]
Mellman, T.A., Bustamante, V., Fins, A.I., Pigeon, W.R. and Nolan, B. (2002) REM Sleep and the Early Development of Posttraumatic Stress Disorder. American Journal of Psychiatry, 159, 1696-1701. https://doi.org/10.1176/appi.ajp.159.10.1696
[10]
Rothbaum, B.O., Foa, E.B., Riggs, D.S., Murdock, T. and Walsh, W. (1992) A Prospective Examination of Post‐Traumatic Stress Disorder in Rape Victims. Journal of Traumatic Stress, 5, 455-475. https://doi.org/10.1002/jts.2490050309
[11]
Rosman, L., Sico, J.J., Lampert, R., Gaffey, A.E., Ramsey, C.M., Dziura, J., et al. (2019) Posttraumatic Stress Disorder and Risk for Stroke in Young and Middle-Aged Adults: A 13-Year Cohort Study. Stroke, 50, 2996-3003. https://doi.org/10.1161/strokeaha.119.026854
[12]
Brown, G.W. (2002) Social Roles, Context and Evolution in the Origins of Depression. Journal of Health and Social Behavior, 43, 255-276. https://doi.org/10.2307/3090203
[13]
Thurston, R.C., Jakubowski, K.P., Wu, M., Aizenstein, H.J., Chang, Y., Derby, C.A., et al. (2022) Sexual Assault and White Matter Hyperintensities among Midlife Women. Brain Imaging and Behavior, 16, 773-780. https://doi.org/10.1007/s11682-021-00536-2
[14]
Giese, A.-K., et al. (2020) White Matter Hyperintensity Burden in Acute Stroke Patients Differs by Ischemic Stroke Subtype. Neurology, 95, e79-e88.
[15]
Gregory, J.M. (2023) Mathematical Model for Stroke and White Matter Hyperintensities. Journal of Behavioral and Brain Science, 13, 66-94. https://doi.org/10.4236/jbbs.2023.134006
[16]
Tietjen, G.E. and Peterlin, B.L. (2011) Childhood Abuse and Migraine: Epidemiology, Sex Differences, and Potential Mechanisms. Headache: The Journal of Head and Face Pain, 51, 869-879. https://doi.org/10.1111/j.1526-4610.2011.01906.x
[17]
Teicher, M.H., Anderson, C.M., Ohashi, K., Khan, A., McGreenery, C.E., Bolger, E.A., et al. (2018) Differential Effects of Childhood Neglect and Abuse during Sensitive Exposure Periods on Male and Female Hippocampus. NeuroImage, 169, 443-452. https://doi.org/10.1016/j.neuroimage.2017.12.055
[18]
Teicher, M.H., Anderson, C.M. and Polcari, A. (2012) Childhood Maltreatment Is Associated with Reduced Volume in the Hippocampal Subfields CA3, Dentate Gyrus, and Subiculum. Proceedings of the National Academy of Sciences, 109, E563-E572. https://doi.org/10.1073/pnas.1115396109
[19]
Kornerup, H., Osler, M., Boysen, G., Barefoot, J., Schnohr, P. and Prescott, E. (2010) Major Life Events Increase the Risk of Stroke but Not of Myocardial Infarction: Results from the Copenhagen City Heart Study. European Journal of Cardiovascular Prevention and Rehabilitation, 17, 113-118. https://doi.org/10.1097/HJR.0b013e3283359c18
[20]
Ferree, N.K. and Cahill, L. (2009) Post-Event Spontaneous Intrusive Recollections and Strength of Memory for Emotional Events in Men and Women. Consciousness and Cognition, 18, 126-134. https://doi.org/10.1016/j.concog.2008.11.008
[21]
Pearson, D.G. (2012) Contextual Representations Increase Analogue Traumatic Intrusions: Evidence against a Dual-Representation Account of Peri-Traumatic Processing. Journal of Behavior Therapy and Experimental Psychiatry, 43, 1026-1031. https://doi.org/10.1016/j.jbtep.2012.04.002
[22]
Repantis, D., Wermuth, K., Tsamitros, N., Danker-Hopfe, H., Bublitz, J.C., Kühn, S., et al. (2020) REM Sleep in Acutely Traumatized Individuals and Interventions for the Secondary Prevention of Post-Traumatic Stress Disorder. European Journal of Psychotraumatology, 11, Article 1740492. https://doi.org/10.1080/20008198.2020.1740492
[23]
van Rijn, E., Eichenlaub, J.-B., Lewis, P.A., Walker, M.P., Gaskell, M.G., Malinowski, J.E., et al. (2015) The Dream-Lag Effect: Selective Processing of Personally Significant Events during Rapid Eye Movement Sleep, but Not during Slow Wave Sleep. Neurobiology of Learning and Memory, 122, 98-109. https://doi.org/10.1016/j.nlm.2015.01.009
[24]
Walker, M. (2017) Why WE Sleep: Unlocking the Power of Sleep and Dreams. Scribner.
[25]
Pace-Schott, E.F., Germain, A. and Milad, M.R. (2015) Sleep and REM Sleep Disturb-ance in the Pathophysiology of PTSD: the Role of Extinction Memory. Biology of Mood & Anxiety Disorders, 5, Article No. 3. https://doi.org/10.1186/s13587-015-0018-9
[26]
Ben Simon, E., Rossi, A., Harvey, A.G. and Walker, M.P. (2020) Overanxious and Underslept. Nature Human Behaviour, 4, 100-110. https://doi.org/10.1038/s41562-019-0754-8
[27]
Gregory, J.M. (2024) Modeling VO2max with Relative Fitness and BMI. Journal of Biosciences and Medicines, 12, 466-492. https://doi.org/10.4236/jbm.2024.1212037
[28]
Riggs, D.S., Rothbaum, B.O. and Foa, E.B. (1995) A Prospective Examination of Symptoms of Posttraumatic Stress Disorder in Victims of Nonsexual Assault. Journal of Interpersonal Violence, 10, 201-214. https://doi.org/10.1177/0886260595010002005
[29]
Sareen, J. (2014) Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment. The Canadian Journal of Psychiatry, 59, 460-467.
https://doi.org/10.1177/070674371405900902
[30]
Dement, W. (1960) The Effect of Dream Deprivation: The Need for a Certain Amount of Dreaming Each Night Is Suggested by Recent Experiments. Science, 131, 1705-1707. https://doi.org/10.1126/science.131.3415.1705
[31]
Seelig, A.D., Jacobson, I.G., Smith, B., Hooper, T.I., Boyko, E.J., Gackstetter, G.D., Gehrman, P., Macera, C.A. and Smith, T.C. (2010) Sleep Patterns Before, During, and After Deployment to Iraq and Afghanistan. Sleep, 33, 1615-1622. https://doi.org/10.1093/sleep/33.12.1615
[32]
Ross, R.J., Ball, W.A., Sullivan, K.A. and Caroff, S.N. (1989) Sleep Disturbance as the Hallmark of Posttraumatic Stress Disorder. American Journal of Psychiatry, 146, 697-707.
[33]
Alkalame, L., Ogden, J., Clark, J.W., Porcheret, K., Risbrough, V.B. and Drummond, S.P.A. (2024) The Relationship between REM Sleep Prior to Analog Trauma and Intrusive Memories. Sleep, 47, zsae203 https://doi.org/10.1093/sleep/zsae203
[34]
Gregory, J.M., Xie, X. and Mengel, S.A. (2004) SLEEP (Sleep Loss Effects on Everyday Performance) Model. Aviation, Space, and Environmental Medicine, 75, A125-A133.
[35]
Gehrman, P., Seelig, A.D., Jacobson, I.G., Boyko, E.J., Hooper, T.I., Gackstetter, G.D., et al. (2013) Predeployment Sleep Duration and Insomnia Symptoms as Risk Factors for New-Onset Mental Health Disorders Following Military Deployment. Sleep, 36, 1009-1018. https://doi.org/10.5665/sleep.2798
[36]
Kamimori, G.H., Karyekar, C.S., Otterstetter, R., Cox, D.S., Balkin, T.J., Belenky, G.L., et al. (2002) The Rate of Absorption and Relative Bioavailability of Caffeine Administered in Chewing Gum versus Capsules to Normal Healthy Volunteers. International Journal of Pharmaceutics, 234, 159-167. https://doi.org/10.1016/s0378-5173(01)00958-9
[37]
Kamimori, G.H., McLellan, T.M., Tate, C.M., Voss, D.M., Niro, P. and Lieberman, H.R. (2015) Caffeine Improves Reaction Time, Vigilance and Logical Reasoning during Extended Periods with Restricted Opportunities for Sleep. Psychopharmacology, 232, 2031-2042. https://doi.org/10.1007/s00213-014-3834-5
[38]
Franzen, P.L. and Buysse, D.J. (2008) Sleep Disturbances and Depression: Risk Relationships for Subsequent Depression and Therapeutic Implications. Dialogues in Clinical Neuroscience, 10, 473-481. https://doi.org/10.31887/dcns.2008.10.4/plfranzen
[39]
Boreham, I.D. and Schutte, N.S. (2023) The Relationship between Purpose in Life and Depression and Anxiety: A Meta‐Analysis. Journal of Clinical Psychology, 79, 2736-2767. https://doi.org/10.1002/jclp.23576
[40]
Kashdan, T.B. and McKnight, P.E. (2013) Commitment to a Purpose in Life: An Antidote to the Suffering by Individuals with Social Anxiety Disorder. Emotion, 13, 1150-1159. https://doi.org/10.1037/a0033278
[41]
Ratey, J.J. (2008) Spark: The Revolutionary New Science of Exercise and the Brain. Little, Brown and Company.
[42]
Dunn, A.L., Trivedi, M.H., Kampert, J.B., Clark, C.G. and Chambliss, H.O. (2005) Exercise Treatment for Depression: Efficacy and Dose Response. American Journal of Preventive Medicine, 28, 1-8. https://doi.org/10.1016/j.amepre.2004.09.003
[43]
Tanaka, H., Desouza, C.A., Jones, P.P., Stevenson, E.T., Davy, K.P. and Seals, D.R. (1997) Greater Rate of Decline in Maximal Aerobic Capacity with Age in Physically Active vs. Sedentary Healthy Women. Journal of Applied Physiology, 83, 1947-1953. https://doi.org/10.1152/jappl.1997.83.6.1947
[44]
Pimentel, A.E., Gentile, C.L., Tanaka, H., Seals, D.R. and Gates, P.E. (2003) Greater Rate of Decline in Maximal Aerobic Capacity with Age in Endurance-Trained than in Sedentary Men. Journal of Applied Physiology, 94, 2406-2413. https://doi.org/10.1152/japplphysiol.00774.2002
[45]
Wiklund, C.A., Lindwall, M., Ekblom, Ö., Nyberg, J., Åberg, M.I., Paulsson, S., et al. (2024) Change in Cardiorespiratory Fitness and Risk of Depression, Anxiety, and Cerebrovascular Disease. American Journal of Preventive Medicine, 67, 849-858. https://doi.org/10.1016/j.amepre.2024.07.012
[46]
Henriksson, P., Henriksson, H., Tynelius, P., Berglind, D., Lof, M., Lee, I., Shiro-ma, E.J. and Ortega, F.B. (2019) Fitness and Body Mass Index During Adolescence and Disability Later in Life: A Cohort Study. Annals of Internal Medicine, 170, 230-239.
[47]
Mizzi, A.L., McKinnon, M.C., Becker, S. (2022) The Impact of Aerobic Exercise on Mood Symptoms in Trauma-Exposed Young Adults: A Pilot Study. Frontiers in Behavioral Neuroscience, 16, Article 829571. https://doi.org/10.3389/fnbeh.2022.829571
[48]
Salk, R.H., Hyde, J.S. and Abramson, L.Y. (2017) Gender Differences in Depression in Representative National Samples: Meta-Analyses of Diagnoses and Symptoms. Psychological Bulletin, 143, 783-822. https://doi.org/10.1037/bul0000102
[49]
Gregory, J.M. (2022) WASO: Why Does It Increase with Age? Journal of Behavioral and Brain Science, 12, 164-176. https://doi.org/10.4236/jbbs.2022.124009
[50]
Hegberg, N.J., Hayes, J.P. and Hayes, S.M. (2019) Exercise Intervention in PTSD: A Narrative Review and Rationale for Implementation. Frontiers in Psychiatry, 10, Article 133. https://doi.org/10.3389/fpsyt.2019.00133
[51]
de Assis, M.A., de Mello, M.F., Scorza, F.A., Cadrobbi, M.P., Schooedl, A.F., da Silva, A.C., et al. (2008) Evaluation of Physical Activity Habits in Patients with Posttraumatic Stress Disorder. Clinics, 63, 473-478. https://doi.org/10.1590/s1807-59322008000400010
