Poor Sleep, Poor Emotion Regulation: A Meta-Analysis on the Association Between Insomnia and Impaired Emotion Regulation Examining the Effect of Moderating Factors

A growing body of evidence indicates an association between insomnia and impaired emotion dysregulation, yet with divergent results. In this meta-analysis, we provide a global-aggregated estimate of the insomnia-impaired ER relationship quantitatively. We searched PubMed, Scopus, Web of Science, and PsycINFO databases and systematically retrieved and reviewed 57 studies. Two separate sets of analyses were performed to extract the effect sizes of correlational and group-comparison records independently. Overall, the analyses demonstrated noticeable estimates of the link between insomnia and impaired ER for both correlational (Fisher’s z=0.29, p<0.001) and group-comparison studies (Hedges’ g=0.71, p<0.01). Moderator analyses on correlational studies indicated that the insomnia-impaired ER association varies in terms of severity (Fisher’s z=0.33, p<0.001) and presence (Fisher’s z=0.11, p<0.01) of insomnia symptoms. Moreover, across different aspects of impaired ER, insomnia is associated with difficulties in ER (Fisher’s z=0.39, p<0.001) and maladaptive ER strategies (Fisher’s z=0.3, p<0.001), but not with adaptive ER strategies (p=0.59). In addition, results of focal analyses on the effect sizes grouped by sub-domains of ER difficulties, including emotional clarity and acceptance, ability to control impulsive behavior and to engage in goal-directed behavior, ability to access the appropriate strategy, as well as ER strategies, including rumination, suppression, and reappraisal were significant (p<0.05). The findings of this quantitative meta-analysis indicate a robust link between insomnia and impaired ER. Further studies are needed to identify the underpinning neurophysiological mechanisms of this association and design individual treatments, which is crucial for precision psychiatry.