During the biological night, cognitive capacity and mood regulation are diminished and “reason sleeps” ( Perlis et al., 2016b), probably due to both intrinsic sleep loss and circadian rhythm influences. Disrupted sleep increases the risk for incident and worsening psychiatric illness ( Pigeon et al., 2012 Li et al., 2016 Hertenstein et al., 2019 Zhang et al., 2019 Freeman et al., 2020), and this risk may partially derive from nocturnal wakefulness, which we define as being awake during the circadian or biological night. Based on this evidence, we propose the Mind after Midnight hypothesis in which attentional biases, negative affect, altered reward processing, and prefrontal disinhibition interact to promote behavioral dysregulation and psychiatric disorders.Ĭircadian rhythms influence human physiology and behavior, promoting wakefulness and cognition during the day and reducing cortical activity for sleep at night. This review summarizes the evidence for day-night alterations in maladaptive behaviors, including suicide, violent crime, and substance use, and examines how mood, reward processing, and executive function differ during nocturnal wakefulness. Most studies to-date have examined how fragmented or insufficient sleep affects next-day functioning, but recent work highlights changes in cognition and behavior that occur when someone is awake during the night. Conversely, disrupted sleep involving significant nocturnal wakefulness leads to cognitive and behavioral dysregulation. Sufficient sleep with minimal interruption during the circadian/biological night supports daytime cognition and emotional regulation.
4Department of Neurology, Division of Sleep Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.3Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Tubbs 1 †, Fabian-Xosé Fernandez 2 †, Michael A.
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