Most studies wakefulness and mental clarity have examined how fragmented or insufficient sleep affects next-day functioning, but recent work wakedulness changes in Nutritional counseling and behavior wakefulnses occur when someone is awake Accurate carb calculation the night. Claritt functions such mentla working Citrus fruit extract, complex attention, and problem solving deteriorate May and Kline, ; Libedinsky et al. You should not ignore your symptoms because, if left untreated, brain fog can impact the quality of your life. Time in nature can offer plenty of brain benefits, according to the APAincluding improved mood and mental energy. Get in Touch. The build-up of the beta-amyloid in the brain will cause less sleep and because the person is getting less sleep, more beta-amyloid gets built up within the brain. How Well Do You Sleep?

Wakefulness and mental clarity -

Chemotherapy typically causes chemo brain, though other treatments may also cause brain fog. A healthcare provider may advise cognitive rehabilitation, exercise, and meditation to help manage chemo brain. Cognitive rehabilitation involves activities like doing word puzzles or using a planner to improve brain function.

Celiac disease causes the immune system to attack the small intestine when you eat gluten, a protein in wheat and other grains. Celiac disease causes an array of gut-related symptoms like:.

Other symptoms, like fatigue, joint pain, or mouth sores, can occur, and some may affect your brain. People with celiac-related brain fog report feeling disoriented, forgetful, and unable to focus or pay attention.

Research has found that people with celiac disease who follow a strict gluten-free diet have improved cognitive performance.

Rest often does not improve CFS. Researchers do not know the cause of CFS. Still, some evidence suggests that widespread inflammation in the brain may be the culprit. As a result, people with CFS often have brain fog symptoms like difficulty concentrating and sluggish thinking. There's no cure for CFS, but a healthcare provider can advise treatments to manage your symptoms like brain fog.

Medicines, such as antidepressants, and therapy help alleviate CFS symptoms. Treatments like massage, meditation, and yoga may also help improve brain fog. Cirrhosis is a chronic disease that causes scar tissue to form in your liver.

Some of the most common causes of cirrhosis include heavy alcohol use and hepatitis C. People with cirrhosis may develop hepatic encephalopathy HE , a nervous system disorder with cognitive effects. HE is a severe condition that may lead to coma, said Dr. Talk to a healthcare provider about a treatment plan if you have cirrhosis.

They may advise that you avoid or limit alcohol use. You may require a liver transplant if you have significant scar tissue in your liver. Brain fog is a commonly reported symptom of long COVID, or symptoms that occur after COVID infection and last longer than 28 days.

Some evidence suggests that nearly one-third of people had cognitive difficulties for weeks or months after COVID infection.

Anyone can develop long COVID, though risk generally increases with COVID symptoms severity. Vaccination helps decrease your risk of severe illness and, possibly, long COVID.

Antiviral medicines, like Paxlovid nirmatrelvir with ritonavir , help treat COVID symptoms severity if you get sick. Fibromyalgia is a chronic disorder that causes widespread pain and fatigue. People with fibromyalgia may experience brain fog, sometimes called "fibro fog," which includes difficulty concentrating and thinking and memory problems.

Research has found that painful symptoms make sleeping difficult and increase fatigue, which may worsen brain fog. Fibromyalgia treatment typically includes lifestyle changes, medicine, and therapy.

Eating a healthy diet, getting enough sleep, reducing stress, and regularly exercising may help alleviate fibro fog. Changes in hormones, such as during periods, pregnancy, and menopause, may cause cognitive difficulties. Brain fog, also known as "period brain," may be a premenstrual syndrome PMS symptom.

Changing amounts of estrogen and progesterone throughout your menstrual cycle may affect cognitive function. Research has found that some people have difficulty concentrating after ovulation and before their period begins.

You may have heard the term "pregnancy brain" when referring to the brain fog that some pregnant people have. A study published in found that pregnant and postpartum people commonly self-report memory difficulties. Menopause occurs 12 months after your last period, typically during your 40s or 50s.

Research has found that menopausal people often report feeling forgetful and having difficulty concentrating. Kidney failure happens if something damages your kidneys, causing excess fluids and waste in your body. You will require dialysis or a kidney transplant if you have kidney failure to help your kidneys function normally.

Research has found that brain fog may be a side effect of hemodialysis, a type of kidney failure treatment. A study published in noted that harmful waste build-up and inflammation may trigger brain fog. Lupus is a chronic autoimmune disease, meaning your immune system mistakes your healthy cells as invaders and attacks them.

As a result, lupus causes inflammation and pain. Systemic lupus erythematosus SLE , one of the most common forms of lupus, affects , adults in the United States. Lupus may cause brain fog, also known as "lupus fog," which may lead to symptoms like:. Lupus-related brain fog usually ebbs and flows.

In some people, brain fog may interfere significantly with daily life. Talk to a healthcare provider about treatments that may address your symptoms and ways to avoid memory issues.

For example, you can do puzzles, read books, or use planners or color-coded calendars. Lyme disease, which transmits through tick bites, often starts with the classic "bulls-eye" rash. Lyme disease can later progress into multiple symptoms, including brain fog.

Brain fog can occur anytime after infection, possibly even years after infection. Cognitive difficulties typically include memory problems and trouble concentrating. Some people with Lyme disease develop sleep disorders, which may lead to a lack of sleep that worsens brain fog.

Seek medical help right away if you have brain fog and bulls-eye rash or know a tick has bitten you. Early treatment with antibiotics helps treat Lyme disease. Migraine is a severely debilitating health condition, with symptoms ranging from intense head pain to fatigue, nausea, and vomiting.

Those symptoms can create a foggy feeling in your brain. Brain fog may be part of what some people call a "migraine hangover," or "postdrome," in the hours or days after a migraine. One of the most common symptoms of postdrome is difficulty concentrating.

Other symptoms may include a stiff neck and tiredness. There's no cure for migraine. Avoiding triggers like anxiety, bright lights, and caffeine may help reduce the frequency of migraines. Medicines that alleviate migraine symptoms include ergotamine and triptan drugs and pain relievers.

Other migraine remedies include:. Depression often causes a loss of interest in your favorite activities and persistent sadness. You may find your thinking and speaking slow, or you need help focusing, making decisions, and remembering things.

Anxiety is a response to stress that causes feelings of fear. Research has found that anxiety may cause brain fog-related symptoms like impaired memory. The aftermath of anxiety and depression brain fog could lead to worse feelings about yourself and make it difficult to reach out for help.

Still, treatment options are available. Many effective medicines and forms of therapy that treat mood disorders might help with cognitive symptoms.

Multiple sclerosis MS is a chronic inflammatory disease that causes lesions on the central nervous system. Those lesions often affect cognition, emotions, how you think, and motor function. MS brain fog "commonly affects the speed at which people can process information and their ability to recall things," Kathleen Costello, RDN , associate vice president of healthcare access of the National MS Society, told Health.

Brain fog may also leave you having difficulty making decisions or remembering how to do a job. Some evidence suggests an overlap of MS with sleep disorders. Having no or restless sleep can exasperate brain fog. Heat may also trigger brain fog, said Costello.

Talk to a healthcare provider about MS treatments that help alleviate brain fog. They may advise some workaround strategies. For instance, consider creating quiet environments for working, making checklists, and using memory aids.

Dry eyes and mouth are the classic symptoms of Sjögren's syndrome, a chronic inflammatory autoimmune disease. Some people with Sjögren's syndrome have brain fog that usually involves memory lapses and poor concentration.

Research has found that cognitive challenges are sometimes the first signs of Sjögren's syndrome and may result from fatigue.

Still, more research is needed to understand the relationship between Sjögren's syndrome and cognitive difficulties. Treatment depends on your symptoms but may include artificial tears to treat dry eyes.

Research has found that aerobic exercises may manage fatigue in some people with Sjögren's syndrome. You may have frequent, severe brain fog if you have a sleep disorder. Some of the most common sleep disorders include:.

Those sleep disorders may lead to a lack of sleep and tiredness, which causes brain fog-related symptoms like difficulty completing tasks, feeling confused, and problems with paying attention. Treatment depends on your sleep disorder but typically involves practicing good sleep habits. For example, try waking up and going to bed at the same time every day.

Avoid looking at your phone before going to sleep, and make sure your bedroom is cool, dark, and quiet. Your thyroid secretes hormones that control your body's energy.

Hypothyroidism, or an underactive thyroid, may lead to depression, sluggishness, and weight gain. Thyroid-related brain fog may cause other symptoms like:. Hypothyroidism can progress slowly, so you may not notice it at first and perhaps mistake brain fog for a cloudy day in your head.

Over time, continuous brain fog can disrupt your daily activities. A survey published in found that people with hypothyroidism who report brain fog also had fatigue and forgetfulness.

Treatment usually involves medicine to stabilize your thyroid hormone level. A healthcare provider will likely regularly check your thyroid hormone level using a blood test and adjust your dose as needed.

Brain fog is a symptom of several health conditions, so no guidelines exist for diagnosing it. Instead, a healthcare provider may conduct a differential diagnosis to narrow down what's causing your brain fog.

Differential diagnosis is a process of ruling out health conditions that resemble your symptoms. A healthcare provider will likely order lab tests based on your health history, physical exam, and symptoms. They may conduct a mental health screening to check for mood disorders like anxiety and depression.

Some evidence suggests that treating the underlying cause of brain fog helps alleviate cognitive difficulties in three months.

Other lifestyle changes and therapies that may help you deal with brain fog include:. Many people often have brief instances of brain fog, or moments when they have trouble finding the right words, focusing, and remembering things. Those moments usually do not last very long.

You might consult a healthcare provider if cognitive difficulties persist for several weeks or longer and impact your daily activities. Brain fog may be a sign or symptom of several health conditions.

Keep track of your symptoms, including when they started, to share with a healthcare provider. Note what triggers your brain fog and what helps resolve it. Brain fog can come with overexertion, poor sleep, and stress.

Persistent brain fog may be a sign or symptom of a health condition, like anxiety, COVID, fibromyalgia, and Lyme disease. Consult a healthcare provider if you develop brain fog that does not go away and interferes with your daily activities.

A healthy diet, exercise, and sleep typically help alleviate brain fog. Other treatments may include CBT or occupational therapy, in which you learn ways to manage cognitive difficulties.

McWhirter L, Smyth H, Hoeritzauer I, et al. What is brain fog? J Neurol Neurosurg Psychiatry. Sukel K. Lifting the fog. New Sci. Kverno K. Brain fog: A bit of clarity regarding etiology, prognosis, and treatment.

J Psychosoc Nurs Ment Health Serv. Asadi-Pooya AA, Akbari A, Emami A, et al. Long COVID syndrome-associated brain fog. J Med Virol. Attention deficit hyperactivity disorder. Fuermaier AB, Tucha L, Koerts J, et al.

Cognitive complaints of adults with attention deficit hyperactivity disorder. Clin Neuropsychol. Hay fever. Gao Z, Chen X, Xiang R, et al. Changes in resting-state spontaneous brain activity in patients with allergic rhinitis: A pilot neuroimaging study. Front Neurosci. One study , which took place by researchers at Michigan State University, found that sleep deprivation comes with considerable risks — especially when it comes to placekeeping.

Before the study began, all of the participants were rested. Then the participants were separated into groups: 77 people were to stay awake all night long in the lab while 63 were allowed to go home and sleep normally.

The next day, the researchers executed tests of attention, by way of the Psychomotor Vigilance Task, as well as tests of cognition through the UNRAVEL method, which requires participants to keep track of a series of steps despite periodic interruptions. These tests were given in the evening as well as again the morning after.

The participants who did not get adequate sleep did much worse on the tests than those who were rested. But the rested group performed about the same during both periods of testing. The group that was sleep deprived also had more attention lapses the following morning in comparison to the group that was rested.

The researchers stated that their findings showed that lack of sleep doubles the odds of errors in placekeeping and triples attention lapses.

This evidence shows the startling need for those who are sleep-deprived to exercise caution. But how does it work? Well, when you are in a state of deep sleep blood flow to your brain is decreased slightly.

This allows another fluid present in the brain, known as cerebrospinal fluid, to have more room when it flows through your brain. More room for this cerebrospinal fluid means it has an easier time flushing out the toxins and other waste products in your brain.

Want to learn more about this interesting process and how sleep can affect a healthy brain? Keep reading to find out! Researchers used cutting-edge MRI technology to monitor and study the brains of 11 people. One author of the article, Laura Lewis assistant professor in the department of biomedical engineering at the University of Boston , says that about every 20 seconds while you are in a state of deep sleep, a slow, large wave of cerebrospinal fluid washes through your brain and cleans out whatever toxins and waste may have been left behind during the day.

Other scans of the brains show a wave of electricity in the neurons of the brain right before the cerebrospinal fluid washes the brain out. Interestingly, this type of brain wave is a common type that only occurs when the brain enters a state of deep sleep. Because of this their brain is not getting the wash that it needs.

The build-up of the beta-amyloid in the brain will cause less sleep and because the person is getting less sleep, more beta-amyloid gets built up within the brain. Thus, because the brain is not getting its necessary rest, it does not have the opportunity to wash out the beta-amyloid toxins by using waves of the cerebrospinal fluid.

There are lots of other causes but the research done for this journal has helped possibly identify and isolate one of the causes of it.

Although controlling the factors that interfere with your sleep may be difficult, you can adopt new habits that encourage a better night of sleep so you can better improve your cognitive function and decrease risk of neurological disease:.

Twitter Linkedin Youtube. About Dr. Patient Portal. com Menu. How Sleep Deprivation Affects Your Mental Clarity. Published on December 9, Majid Fotuhi.

Lack of Sleep and Cognition One study , which took place by researchers at Michigan State University, found that sleep deprivation comes with considerable risks — especially when it comes to placekeeping.

Wakefulness and mental clarity research clarigy little Healthy eating for craving control of infection from prostate biopsies. Discrimination at work is linked to wakefulnees blood pressure. Icy fingers and toes: Poor circulation or Raynaud's phenomenon? Getting seven to eight hours a night can help you restore clarity and improve memory. Are you tired of struggling with fuzzy thinking and a faltering memory?

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A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Medically reviewed by Susan W. Lee, DO — By Valencia Higuera — Updated on February 5, What is brain fog? Causes Diagnosis Treatment Outlook.

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Another group of tests is again based on electrophysiological measures. Tests like the Karolinska Drowsiness Test [[ 29 ]] or the Alpha Attenuation Test [[ 34 ]] give an estimation of the current amount of wakefulness by comparing the EEG activity between eyes open and eyes closed conditions, as EEG activity changes distinctly in both conditions with increasing sleepiness.

These tests can be repeated but are not useful to continuously measure vigilance fluctuations. One approach to overcome this limitation has been the Pupillographic Sleepiness Test [[ 35 ]], where the diameter of the pupil is continuously monitored, as this was found to be a marker for arousal.

Pupil diameter is inversely related to sleepiness and its variability over time is used as indicator for changes in the amount of wakefulness. Still, EEG recordings provide the best temporal resolution and therefore remain the gold standard to objectively assess sleep stages and should also be the method of choice to assess wakefulness fluctuations.

As mentioned above, the wake state can be subdivided into several substages that can best be assessed using EEG recordings during wakefulness. According to original conceptions by Bente [ 8 ] and Roth [ 9 ], the following EEG vigilance stages can be observed during the transition from high alertness to relaxed wakefulness to drowsiness and finally sleep onset:.

mental effort. More recent studies on changes of EEG activity during the transition from active wakefulness to sleep onset endorse this classification [ 36,37,38,39,40,41,42,43,44,45,46 ]. Visual classification of vigilance stages in a resting EEG has been an arduous and time-consuming task comparable to the visual scoring of an overnight sleep polysomnography.

In the absence of explicit scoring rules, the problem of inter- and intrarater reliability is even more relevant than in sleep medicine where such rules have long been established [ 47,48 ]. Furthermore, changes in wakefulness are not as uniform as the typical changes in sleep stages, as subjects go back and forth between vigilance stages with sometimes very short-lasting switches.

Consequently, a segmentation of the resting EEG into second epochs as is the consensus in sleep medicine is not feasible for scoring vigilance changes in a resting EEG, where much shorter periods have to be considered.

Therefore, the development of computer-assisted scoring algorithms has been essential for rejuvenating research interest in brain arousal regulation.

Several algorithms have been put forward. VIGALL is an EEG- and electro-oculography-based algorithm which allows to objectively assess the level of EEG vigilance within multichannel EEG recordings, by automatically attributing one of the above-mentioned vigilance stages to EEG segments of preferable 1 s of duration [ 49,50,51 ].

The VIGALL algorithm takes into account different frequency bands and the cortical distribution of EEG activity using EEG source localization approaches low-resolution electromagnetic tomography, LORETA [ 52,53 ].

Since EEG activity is characterized by high intra-individual stability and large interindividual variability, VIGALL has adaptive features concerning individual alpha peaks and amplitude levels, by automatically detecting the individual alpha frequency and power from a representative epoch of alpha activity.

Some of the parameters e. upper and lower border of the alpha band and decision criteria of the VIGALL e. absolute alpha power necessary to classify an A stage are then modified accordingly. Unfortunately, VIGALL is not applicable for certain EEGs, e.

those showing non-alpha basic rhythms e. low voltage type, beta type , major modifications due to drugs e. anticholinergic drugs or diseases e. severe Alzheimer's disease or EEGs from children under the age of 10 or older in case of delayed maturation.

The very high temporal resolution allows investigations on how vigilance is regulated during the recording period, and this brain arousal or vigilance regulation shows considerable interindividual differences.

During eyes-closed resting conditions of min duration, most subjects show progressive declines to lower EEG vigilance stages adaptive arousal regulation. However, while some subjects exhibit rapid declines within only a few seconds unstable arousal regulation , others steadily remain in stages of high vigilance hyperstable arousal regulation.

Naturally, this trait is modulated by the same individual and environmental factors that also affect sleep regulation such as accumulated sleep deficits, consumption of vigilance-affecting substances e. caffeine, nicotine, drugs , effort or motivation to stay awake or fall asleep, and disease-related factors.

Therefore, assessment of EEG vigilance has to adjust to certain standards. EEG recordings should be performed under comparable conditions: the EEG chamber should be well ventilated, steadily temperature controlled approx.

The current degree of wakefulness should be assessed using questionnaires like the Stanford or Karolinska Sleepiness Scales, and sleep duration and quality in the preceding night should also be registered by questionnaire or preferably objective assessments like actigraphy or polysomnography.

Most important, however, would be that subjects are not to be awoken during the recording, even if they fall asleep, as would be the usual approach in so-called vigilance-controlled EEG recordings performed in quantitative EEG or event-related potential studies. The current VIGALL version VIGALL 2.

These basic research studies also imply clinical relevance given the importance of cognitive tests, MRI and PET in diagnostic procedures, where VIGALL might contribute to improve diagnostic accuracy by assessing arousal-induced error variance.

Operational sequence and decision criteria of the VIGALL 2. Classification of vigilance stages is based on power in 4 regions of interest ROI; frontal, parietal, temporal and occipital lobes.

Beforehand VIGALL screens the EEG trace for a second epoch with prominent alpha activity default range 7. For the respective epoch, the alpha centre of gravity frequency and mean power in the occipital region of interest are calculated.

Regarding VIGALL's application in clinical groups and for treatment response prediction, several studies have been published recently: in major depression earlier EEG studies [ 58,59 ] as well as more recent VIGALL-based studies [ 60,61 ] revealed that depressed patients are characterized by a hyperstable arousal regulation, i.

they show delayed or no decline to lower EEG vigilance stages under resting conditions. In contrast, mania was characterized by rapid EEG vigilance decline under resting conditions in former EEG case reports [ 58,62,63 ], which was replicated in a more recent case report applying VIGALL [ 64 ].

Using VIGALL, further evidence for unstable arousal in ADHD has been given [ 67 ]. In accordance with the assumption of hyperarousal in obsessive-compulsive disorder, hyperstable arousal regulation was demonstrated in obsessive-compulsive disorder compared to matched controls [ 68 ].

Another field for the application of VIGALL are the many groups of patients suffering from fatigue. In this context, VIGALL could be helpful in elucidating whether the experienced fatigue is a hypo-aroused state, i. associated with unstable arousal regulation, or a state where patients feel exhausted due to chronic hyperarousal [ 69 ].

Olbrich et al. Building on the aforementioned empirical findings, the vigilance regulation model of affective disorders and ADHD has been proposed [ 71 ]. This model assumes that behaviour can create a more or less arousing environment in an autoregulatory manner in order to increase or reduce the brain arousal level.

The hyperactive, impulsive, talkative and sensation-seeking behaviour in mania and ADHD is interpreted as an autoregulatory attempt to stabilize brain arousal by boosting stimulation from the environment or the behaviour itself e.

by fidgeting. In the context of normal behaviour, this phenomenon can be illustrated by overtired children, who often become agitated if they do not get to bed. This assumption that behaviour can influence brain arousal levels corresponds well with the secondary wake drive as proposed in the four-process model [ 20 ].

Specifically, for mania it is suggested that in vulnerable subjects an unstable brain arousal induces excessive autoregulatory behaviour in order to stabilize arousal, which overrides the physiological tendency to seek sleep, thereby exacerbating the sleep deficits and consequently the arousal instability.

A vicious circle is initiated, which then contributes to mania. Whereas in mania this unstable arousal is triggered and built up state-like within the manic episode, in ADHD the unstable arousal is supposed to be a more stable trait. This unstable arousal trait may be acquired, genetic or resulting from chronic sleep disorders.

On the other hand, the hyperstable arousal regulation in depression is thought to promote withdrawal and avoidance of social interactions, loud music and other external stimulations in order to downregulate the hyperarousal.

This arousal concept and the autoregulatory function of behaviour have already been suggested earlier [ 8,58 ], and quite similar models have been proposed concerning personality traits such as sensation seeking [ 72 ] and extraversion [ 73 ].

These personality traits were also interpreted as autoregulatory behaviour in order to achieve an optimal level of arousal, and they were associated with affective disorders and ADHD [ 74,75 ].

In the following, lines of evidence supporting the vigilance regulation model will shortly be drafted [for more details, see [ 71 ]]. Concerning depression, a hyperstable arousal regulation is well in line with inner restlessness and tension and with heightened noradrenergic and hypothalamic-pituitary-adrenal activity [ 76,77 ].

Most intriguingly, symptoms of anhedonia and inhibition have also been suggested to be a consequence of noradrenergic hyperactivity [ 78,79 ]. Furthermore, the tonic hyperarousal explains the pronounced insomnia in depression, including the increased sleep onset latency [ 80,81 ].

Several arousal-reducing interventions lead to improvement in depression, such as sleep deprivation which leads to a rapid and pronounced reduction of depressive symptomatology in more than half of the patients [ 82 ], whereas recovery sleep and short naps can result in prompt return of depressive symptomatology.

Drowsiness is a highly frequent side effect of antidepressants [ 83,84,85,86 ], and all standard antidepressants, and also electroconvulsive therapy, reduce the firing rate of neurons in the noradrenergic locus coeruleus [ 87 ], which plays an essential role in arousal regulation [ 88,89,90 ].

In this context it is of interest that also other arousal-reducing drugs, such as scopolamine and ketamine, have demonstrated antidepressant effects [ 91,92 ].

In contrast, psychostimulants failed to show antidepressant effects in typical depression [ 71 ]. Also, antidepressants, which reduce brain arousal as mentioned above, can induce a switch into mania.

According to some studies, this switch risk might be higher for antidepressants, which are particularly sedating [ ,,, ]. In contrast, stabilization of the sleep-wake rhythm is an established part in behavioural therapies for bipolar disorder [ ,, ], and extended bed rest is used as an add-on in the treatment of acute mania [ ,, ].

Furthermore, case reports show acute antimanic effects of psychostimulants [reviewed in [ ]]. In case of rapid response to arousal-increasing drugs, clinical improvement usually goes along with increases in brain arousal [ 64, ]. Currently, a randomized placebo-controlled trial has been initiated testing acute antimanic properties of methylphenidate [ ].

Concerning ADHD, lines of evidence are similar: studies applying skin conductance level, MSLT, MWT, quantitative EEG, VIGALL and Epworth Sleepiness Scale demonstrated that many ADHD patients are characterized by an unstable arousal regulation [ 66,,,, ].

Thus, the rapid therapeutic effects of stimulants in ADHD could be explained by their arousal-stabilizing properties. As in mania, all factors destabilizing arousal or inducing sleep deficits are reported to exaggerate ADHD, whereas interventions improving sleep quality and stabilizing arousal improve ADHD [ ,,, ].

Furthermore, the unstable arousal regulation provides a simple explanation for the attention deficits in ADHD, e. in continuous performance tasks [ ], but also for the presentation specifiers according to DSM-5 and the subtypes as their antecessors in the DSM-IV-TR.

In the predominantly inattentive presentation , the deficits are explained by the unstable arousal regulation. In the combined presentation , with attention deficits and hyperactivity, additional autoregulatory aspects supervene with sensation seeking and hyperactivity as an attempt to stabilize arousal.

The vigilance regulation model also explains the substantially lower prevalence rates for the predominantly hyperactive-impulsive subtype whose general validity is in doubt [ , ]: the suggested core pathogenetic factor unstable brain arousal leads to attention deficits, whereas hyperactivity does not represent a primary disorder per se, but an autoregulatory response, which may or may not be present.

At a first glance, the sleep onset insomnia reported for a subgroup of ADHD patients seems to be incompatible with the assumption of a chronic unstable arousal regulation in this condition. However, there are several reasons why sleep onset insomnia might occur despite an unstable arousal regulation.

First, according to the vigilance regulation model, compensatory stimulation and sensation-seeking behaviour can result in inability or reluctance to settle into sleep [ ].

Secondly, following the two-process model of sleep, a circadian phase delay process C can inhibit sleep onset, although sleep pressure is high enough process S : studies have shown that children and adults with ADHD have a significantly delayed sleep onset, caused by a delayed melatonin onset process C [ ,, ].

As a result, going to bed too late will further increase the unstable arousal regulation. Finally, in treated patients, it is also possible that taking a stimulant dose too close to bedtime will result in insomnia as side effect, although stimulants might also improve sleep in ADHD [ , ].

Arousal regulation is a fundamental trait and potential endophenotype [ , ], which, according to the proposed vigilance regulation model, not only modulates, but also triggers normal and abnormal behaviour.

The newly developed and validated EEG-based algorithm VIGALL promises progress in research on confounding, modulating and moderating roles of arousal on behaviour. Available evidence points to an important role of arousal dysregulation in the aetiopathology of affective disorders and ADHD.

Assessment of arousal regulation could help to define more homogeneous subgroups in these highly heterogeneous phenotypical categories, which might in turn improve drug development, differential diagnoses and aetiological research. According to the vigilance regulation model, stimulating drugs should be helpful in those ADHD and manic patients, who show the characteristic unstable arousal regulation.

In depression, also for subgroups of patients such as patients with atypical or secondary depression, or some bipolar patients , an unstable arousal regulation is hypothesized [ 71 ], whereas in the majority of patients with major depression hyperstable arousal seems to be characteristic.

Currently, studies are under way, which will give first evidence whether VIGALL is able to predict the treatment response to selective serotonin reuptake inhibitors in depression and to stimulants in ADHD and mania, which might then contribute to a more personalized treatment.

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Volume 72, Issue Beyond Sleep Disorders - Importance of Wakefulness Regulation. Neurobiology of Sleep and Wakefulness. Assessment of Wakefulness. Application of VIGALL. The Vigilance Regulation Model of Affective Disorders and ADHD. Article Navigation. Review Articles February 23 Assessment of Wakefulness and Brain Arousal Regulation in Psychiatric Research.

Subject Area: Neurology and Neuroscience , Psychiatry and Psychology. Christian Sander ; Christian Sander. Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany.

sander medizin. This Site. Google Scholar. Tilman Hensch ; Tilman Hensch. Dirk Alexander Wittekind ; Dirk Alexander Wittekind. Daniel Böttger ; Daniel Böttger. Ulrich Hegerl Ulrich Hegerl. Neuropsychobiology 72 : — Article history Received:.

Cite Icon Cite. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. View large Download slide. Wichniak A, Wierzbicka A, Jernajczyk W: Sleep and antidepressant treatment.

Curr Pharm Des ; Nutt D, Wilson S, Paterson L: Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci ; Wehr TA: Sleep loss: a preventable cause of mania and other excited states.

J Clin Psychiatry ;50 suppl ; discussion Bauer M, Grof P, Rasgon N, Bschor T, Glenn T, Whybrow PC: Temporal relation between sleep and mood in patients with bipolar disorder. Bipolar Disord ; Giedke H, Schwarzler F: Therapeutic use of sleep deprivation in depression.

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Stuttgart, Thieme, , pp Roth B: The clinical and theoretical importance of EEG rhythms corresponding to states of lowered vigilance. Electroencephalogr Clin Neurophysiol ; Pfaff D, Ribeiro A, Matthews J, Kow LM: Concepts and mechanisms of generalized central nervous system arousal.

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Genetics, age, and other factors impact whether you are more likely an owl or a lark. As you can imagine, getting enough sleep with a typical work schedule may be easier to do for a lark than for a night owl. Insomnia disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DSM-5 , is characterized by difficulty falling asleep, staying asleep, or waking too early, resulting in daytime impairments.

While insomnia symptoms and insufficient sleep were already a widespread problem pre-pandemic, people are reporting more sleep problems than ever before. We know that stress can interfere with sleep and understandably the global pandemic has significantly increased daily stress and uncertainty.

Spending more time at home and changes to daily routine can also impact sleep patterns by limiting light-based cues for wakefulness that help keep your circadian rhythm on schedule.

And more time in bed and less activity or exercise can also interfere with sleep by reducing sleep drive. Common sleep disturbances include problems falling or staying asleep, sleeping less, and experiencing worse quality sleep.

Reduced sleep has been linked with increased eating and higher risk for weight gain and obesity. Conversely, studies show that getting more sleep can lead to consuming fewer calories and improve weight loss. While some foods, such as milk products, fish and fruit for example, kiwis and tart cherries have shown some sleep-promoting effects, research is too limited to draw definitive conclusions or recommendations about specific foods to help sleep.

Growing research suggests that the quality of diet or having sufficient nutrients can impact the quantity and quality of sleep. Low fiber, high saturated fat, high sugar diets have been associated with poorer quality sleep. Another large study found that deficits in nutrients, like as calcium, magnesium, and vitamins A, C, D, E, and K, were associated with sleep problems.

Unfortunately, we know that pre-pandemic and especially over the course of the last two years, a large percentage of the population continues to experience insufficient sleep. Longer work hours, constant access to social commentary and entertainment, and increased stressors all contribute to people getting less sleep.

The good news is that there is increasing awareness of the importance of sleep for daily functioning and health. In order to see a shift in sleep behaviors, ongoing work is needed to promote science-based policies that help improve sleep health, such as encouraging employers to help promote healthy sleep and introducing later school starting times.

And we need to increase access to care for individuals with sleep difficulties. For some sleep difficulties, adopting healthy sleep habits may help to improve sleep.

There are clrity different nootropics. Some are pharmaceutical drugs that wakefunless designed to wakefulnses conditions such as Skinfold measurement in weight management or narcolepsy, and to improve attention and focus wakefulness and mental clarity people wakefulness and mental clarity attention disorders. However, some healthy ahd use these drugs in an attempt to improve their cognitive performance. While nootropics may help mask fatigue, procrastination or boredom, they do not make people more intelligent and their effects only last as long as the drug remains in the body. Some of these drugs may cause dependence and can have a range of side effects. They can be particularly harmful to young people as their brains continue to develop into their mid-twenties.

Brain fog affects a variety cclarity mental processes, wakefhlness memory and concentration. Sleep apnea wakefulness such as migraine or multiple sclerosis can cause brain fog, clagity stress, lack of sleep, and wakefu,ness are also anf.

Brain clarlty can be frustrating and wakefulnews. However, wakefulness and mental clarity can use several methods to help themselves cope. It Hydration and wellness not considered wakefulness and mental clarity medical condition by itself, and as such, it mentla no diagnostic criteria.

Wakefulness and mental clarity, it describes symptoms associated with Plant-based athlete diet impairment that can have many causes.

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Wakdfulness can lead to stress and mental fatigue. Brain fog can present differently wakefulness and mental clarity people. Wakefupness common symptoms can include the Green tea for skin rejuvenation. There are different waekfulness of inflammation.

Chronic inflammation wakefulndss caused by an out-of-balance immune system and can affect any part of the body in different ways. Low-grade inflammation can also occur in a specific organ or tissue, including brain tissue. A person can also experience wakfeulness inflammation, which can result wakefulnese a traumatic head injury, wakefulnes example.

Weight loss tips and tricks are examples of conditions that may cause wakefulness and mental clarity cllarity, usually due to a wakefulness and mental clarity of inflammation. A concussion can happen after trauma or a head Enhance workout recovery such as a fall.

It can cause acute inflammation in the Enhance emotional well-being, leading lcarity cognitive brain fog-like symptoms such as memory problems, confusion, or wakefuness.

Other signs include menhal and mood changes. A person may also lose consciousness. Migraine is a condition that can wkefulness recurring headaches, clarith can sometimes be debilitating. Migraine episodes can also carity other symptoms, such as sensitivity to light Increase metabolic efficiency sound, mood changes, and brain fog.

While more research is needed to understand why this happens, Cooling and replenishing drinks people report experiencing difficulties mentsl cognition before clarigy during a migraine attack.

One theory is that migraine causes cortical depression, Oxygen intake is a vlarity in brain claritty that can lead to brain fog. Migraine is also associated with the inflammation of vessels and tissues in the brain. Inflammation can cause brain fog.

Claritty cases of MS, walefulness wakefulness and mental clarity causes gradual damage to the myelin in the brain. As a result, people living wakefulness and mental clarity MS may experience changes in their ability to make wakegulness and process and remember information.

However, they can lead to frustration and difficulty completing daily tasks, wakefulness and mental clarity as finding Energy and stamina supplements keys or shopping Seamless resupply operations groceries.

Learn more about how MS claity the mdntal. Fibromyalgia mentsl chronic fatigue syndrome are also inflammatory wakefulness and mental clarity. This is known as fibro fog. Scientists do not know exactly how fibromyalgia leads to these types of symptoms.

CFS, also known as myalgic encephalomyelitis, wakefulnees result in severe tiredness and problems with thinking.

As with fibromyalgia, wakwfulness is no clear explanation of what CFS does to the brain to cause brain fog symptoms. Brain fog can be a symptom of an inflammatory infection that attacks the brain. For example, bacterial diseases such as Lyme disease can cause brain fog.

A person can also experience brain fog from a fungal infection after inhaling a substance such as mold. Viral infections can also lead to brain fog. Examples of such viruses include West Nile virus and COVID Many people experience problems with their cognition after having COVID, even long after the initial infection has passed.

This can be one of the symptoms of long COVID. The virus is thought to activate certain immune cells in the brain, which cause inflammation, making it difficult for the brain to perform day-to-day cognitive tasks. Learn more about long COVID brain fog.

Mood disorders such as depressionanxiety, or bipolar disorder can impact how someone thinks and feels. This may be related to inflammation in the nervous system that affects the brain.

Researchers have made similar conclusions about anxiety. In addition, researchers have found that both depression and bipolar disorders can lead to certain abnormalities in the brain.

Problems with memory, focus, and decision-making can contribute to the feeling of brain fog. There may also be problems with sleeping and a lack of energy, which can make concentrating and completing tasks harder.

Learn more about brain fog and depression. Neurodivergent people, including autistic people, can experience brain fog. The cause may be the development of inflammatory molecules in the brain.

In many cases, autism spectrum disorder ASD can co-occur with anxiety, which can worsen brain fog. In addition, brain fog and other cognitive symptoms can occur with attention deficit hyperactivity disorder ADHDparticularly in adults.

Eating an unhealthful diet or not eating enough can cause problems with healthy brain function. Deficiencies can also often occur due to underlying inflammatory health conditions such as Celiac disease. Specific nutrients that can play a role in cognition and memory include vitamin B, iron, and Omega-3 fatty acids.

A lack of some nutrients, such as magnesium, can also contribute to the development of mood disorders that can also lead to brain fog. Learn more about how certain nutrients can cause brain fog.

This buildup affects brain functioning, with various cognitive and other symptoms. There is research indicating brain inflammation plays a role in this process.

People with obesity may also experience brain fog. This is likely because obesity can cause inflammation affecting multiple body systems, including the brain.

In a clarihyresearchers noted that evidence supports the idea that obesity leads to cognitive impairment and potential changes in brain structure. Autoimmune conditions are inflammatory diseases.

Brain fog can be a symptom of an autoimmune condition. For example, lupus is an autoimmune disease that occurs when the immune system attacks healthy tissue. It can cause symptoms throughout the body. Another condition that can cause brain fog is rheumatoid arthritis.

Similarly, inflammatory bowel disease IBD is another condition in which gastrointestinal inflammation can also affect brain function. People going through menopause often cite brain fog as an issue affecting them. Memory and thinking problems that are similar to brain fog are common in thyroid disorders.

Learn more about hypothyroidism. Some people experience unusual changes in heart rate and blood pressure when standing up. This is a condition doctors call postural tachycardia syndrome POTS. A study noted that alertness and impaired short-term memory may underlie reports of brain fog in people with POTS.

During sleep, the muscles in the back of the throat relax. Sometimes, this can lead to people having trouble breathing at night. If a person has pauses in breathing at night that interfere clarith their sleep quality, they may have sleep apnea.

Treating sleep apnea may improve the brain fog that can result. People may wish to speak with a doctor about any adverse side effects they are experiencing from the medication they are taking.

If the medication cannot be changed, a doctor can help the individual develop coping strategies for brain fog. A person should consider talking with a doctor about treating the underlying cause of their brain fog. It should clear or improve when the underlying condition is treated or managed, such as by switching medications.

The following are some ways a person can treat the symptom of brain fog. However, they will not generally treat the underlying condition. A diet that focuses heavily on processed foods that are high in unhealthful fats and sugars may contribute to brain fog.

Replacing these foods with fresh fruits, vegetables, and other fresh, plant-based foods can help promote clearer thinking. Foods that contain the various A, B, C, and D vitamins and omega-3 oils may also benefit brain function.

In addition, people living with many of the conditions that can cause brain fog may benefit from probiotic supplements. Research shows this can help improve brain function. A person may find a similar benefit from eating foods that naturally contain probiotics, such as yogurt or kimchi.

People should also drink enough fluid to prevent dehydration but limit the intake of caffeine and msntal, as these can affect sleep and energy levels.

A review concluded that physical exercise can physically and psychologically benefit the brain. The authors recommend it for improving both thinking ability and mood. Current guidelines advise adults to engage in either minutes a week of moderate-intensity aerobic exercise or 75 minutes a week of high intensity activity, as well as exercises to improve strength and flexibility.

Sleep hygiene refers to how a person sets up their sleep environment and improves their sleep quality. Research shows that sleeping well can help reduce body inflammation.

: Wakefulness and mental clarity

Site Navigation	Conditions such as migraine or multiple sclerosis can cause brain fog, while stress, lack of sleep, and diet are also causes. Brain fog can be frustrating and confusing. However, people can use several methods to help themselves cope. It is not considered a medical condition by itself, and as such, it has no diagnostic criteria. Instead, it describes symptoms associated with cognitive impairment that can have many causes. Brain fog can make a person feel as though the processes of thinking, understanding, and remembering are not working as they should. If one or more of these functions does not work effectively, it can be difficult to understand, focus, and remember things. It can lead to stress and mental fatigue. Brain fog can present differently between people. Some common symptoms can include the following:. There are different types of inflammation. Chronic inflammation is caused by an out-of-balance immune system and can affect any part of the body in different ways. Low-grade inflammation can also occur in a specific organ or tissue, including brain tissue. A person can also experience acute inflammation, which can result from a traumatic head injury, for example. Below are examples of conditions that may cause brain fog, usually due to a type of inflammation. A concussion can happen after trauma or a head injury such as a fall. It can cause acute inflammation in the brain, leading to cognitive brain fog-like symptoms such as memory problems, confusion, or forgetfulness. Other signs include headache and mood changes. A person may also lose consciousness. Migraine is a condition that can cause recurring headaches, which can sometimes be debilitating. Migraine episodes can also involve other symptoms, such as sensitivity to light and sound, mood changes, and brain fog. While more research is needed to understand why this happens, many people report experiencing difficulties with cognition before or during a migraine attack. One theory is that migraine causes cortical depression, which is a change in brain activity that can lead to brain fog. Migraine is also associated with the inflammation of vessels and tissues in the brain. Inflammation can cause brain fog. In cases of MS, the inflammation causes gradual damage to the myelin in the brain. As a result, people living with MS may experience changes in their ability to make decisions and process and remember information. However, they can lead to frustration and difficulty completing daily tasks, such as finding house keys or shopping for groceries. Learn more about how MS affects the brain. Fibromyalgia and chronic fatigue syndrome are also inflammatory conditions. This is known as fibro fog. Scientists do not know exactly how fibromyalgia leads to these types of symptoms. CFS, also known as myalgic encephalomyelitis, can result in severe tiredness and problems with thinking. As with fibromyalgia, there is no clear explanation of what CFS does to the brain to cause brain fog symptoms. Brain fog can be a symptom of an inflammatory infection that attacks the brain. For example, bacterial diseases such as Lyme disease can cause brain fog. A person can also experience brain fog from a fungal infection after inhaling a substance such as mold. Viral infections can also lead to brain fog. Examples of such viruses include West Nile virus and COVID Many people experience problems with their cognition after having COVID, even long after the initial infection has passed. This can be one of the symptoms of long COVID. The virus is thought to activate certain immune cells in the brain, which cause inflammation, making it difficult for the brain to perform day-to-day cognitive tasks. Learn more about long COVID brain fog. Mood disorders such as depression , anxiety, or bipolar disorder can impact how someone thinks and feels. This may be related to inflammation in the nervous system that affects the brain. Researchers have made similar conclusions about anxiety. In addition, researchers have found that both depression and bipolar disorders can lead to certain abnormalities in the brain. Problems with memory, focus, and decision-making can contribute to the feeling of brain fog. There may also be problems with sleeping and a lack of energy, which can make concentrating and completing tasks harder. Learn more about brain fog and depression. Neurodivergent people, including autistic people, can experience brain fog. The cause may be the development of inflammatory molecules in the brain. In many cases, autism spectrum disorder ASD can co-occur with anxiety, which can worsen brain fog. In addition, brain fog and other cognitive symptoms can occur with attention deficit hyperactivity disorder ADHD , particularly in adults. Eating an unhealthful diet or not eating enough can cause problems with healthy brain function. Deficiencies can also often occur due to underlying inflammatory health conditions such as Celiac disease. Specific nutrients that can play a role in cognition and memory include vitamin B, iron, and Omega-3 fatty acids. A lack of some nutrients, such as magnesium, can also contribute to the development of mood disorders that can also lead to brain fog. Learn more about how certain nutrients can cause brain fog. This buildup affects brain functioning, with various cognitive and other symptoms. There is research indicating brain inflammation plays a role in this process. People with obesity may also experience brain fog. This is likely because obesity can cause inflammation affecting multiple body systems, including the brain. In a review , researchers noted that evidence supports the idea that obesity leads to cognitive impairment and potential changes in brain structure. Autoimmune conditions are inflammatory diseases. Brain fog can be a symptom of an autoimmune condition. For example, lupus is an autoimmune disease that occurs when the immune system attacks healthy tissue. It can cause symptoms throughout the body. Another condition that can cause brain fog is rheumatoid arthritis. Similarly, inflammatory bowel disease IBD is another condition in which gastrointestinal inflammation can also affect brain function. People going through menopause often cite brain fog as an issue affecting them. Memory and thinking problems that are similar to brain fog are common in thyroid disorders. Learn more about hypothyroidism. Some people experience unusual changes in heart rate and blood pressure when standing up. This is a condition doctors call postural tachycardia syndrome POTS. A study noted that alertness and impaired short-term memory may underlie reports of brain fog in people with POTS. During sleep, the muscles in the back of the throat relax. Sometimes, this can lead to people having trouble breathing at night. If a person has pauses in breathing at night that interfere with their sleep quality, they may have sleep apnea. Treating sleep apnea may improve the brain fog that can result. People may wish to speak with a doctor about any adverse side effects they are experiencing from the medication they are taking. If the medication cannot be changed, a doctor can help the individual develop coping strategies for brain fog. A person should consider talking with a doctor about treating the underlying cause of their brain fog. It should clear or improve when the underlying condition is treated or managed, such as by switching medications. The survival benefit of many behaviors, however, varies as a function of time of day: for a diurnal animal, foraging for food may be beneficial during the day when food is visible, but dangerous at night due to predation. In one study, the responses to high- and low-calorie foods in the putamen and ventral striatum were significantly reduced in the evening, even as subjective preoccupations about food were elevated Masterson et al. A comparison of striatal responses to a monetary reward task demonstrated that 1 reward activation was greatest in the afternoon Hasler et al. Thus, subcortical processing of reward appears to vary as a function of time of day. Sleep deprivation adds another layer of complexity to reward processing as total sleep deprivation is known to increase risky decision-making Womack et al. Rewards following sleep loss are accompanied by greater activation of the ventral striatum Gujar et al. Interestingly, elevated activation in the ventral striatum at baseline predicts greater caloric and carbohydrate intake during the latter part of sleep deprivation Satterfield et al. This suggests that individuals with elevated baseline reward sensitivity are more likely to act impulsively e. No studies to date have examined interactions between sleep deprivation and circadian timing on reward processing. The prefrontal cortex integrates sensory input along with assessments of subcortical salience to manage adaptive behavioral responses related to long-term planning, risk-assessment, behavioral inhibition, and cognitive control collectively referred to as executive function Diamond, Prefrontal performance is particularly sensitive to accumulating sleep debt as indexed by increased sleep delta activity 0. Waking midline theta activity 4—8 Hz arising from the anterior cingulate cortex also increases as a function of sustained wakefulness Cajochen et al. Even under protocols that include wakefulness during the biological night without sleep deprivation i. In addition, insufficient sleep and circadian changes associated with the biological night are linked to reduced cortical excitability Ly et al. Cognitive functions such as working memory, complex attention, and problem solving deteriorate May and Kline, ; Libedinsky et al. Response inhibition is diminished Drummond et al. Behavioral inhibition, which is maximized during the circadian day May and Hasher, , declines as wakefulness proceeds into the circadian night Hasler et al. As an additional caveat, executive performance is significantly disrupted immediately upon awakening, a phenomenon known as sleep inertia. Cognitive deficits associated with sleep inertia are exacerbated by chronic short sleep and abrupt awakenings during the circadian night Horne and Moseley, ; McHill et al. Of note, some of these studies were performed in military, physician, or other participants who were highly skilled and motivated for the task May and Kline, ; Nelson et al. Unfortunately, in all these studies, assessment was done during the day, not during the night of sleep deprivation. Sleep loss- and circadian-dependent changes in molecular signaling, affect, reward processing, and executive function provide conceptual support for behavioral dysregulation, and empirical studies demonstrate a pattern of increased risk with nocturnal wakefulness. The reasons for being awake at night can also contribute to behavioral dysregulation: insomnia, nightmares, short sleep, or circadian rhythm disorders can produce nocturnal wakefulness, hypervigilance, and limited emotion regulation; hypnotics, alcohol, and other substances can produce rebound wakefulness, even if intoxication remains; and stress, anxiety, and mood disturbances promote nocturnal wakefulness even as they undermine decision-making. Figure 2 illustrates how biological and psychological factors intersect at nocturnal wakefulness and lead to The Mind After Midnight hypothesis, which we propose as a framework for interpreting current findings and a guide for future research and interventions, including therapy. FIGURE 2. The Mind after Midnight. Blue boxes on the left and right sides indicate key processes within the model discussed in the text; grey boxes indicate additional components not specifically addressed. During nocturnal wakefulness, upregulation of the amygdala AMY , nucleus accumbens NAcc , and the rostral anterior cingulate cortex rACC increase emotionally driven salience, attention, and motivation, skew anticipation of risky rewards, and drive excess rumination. Conversely, impairments in the prefrontal cortex PFC , dorsal anterior cingulate cortex dACC and anterior insula AI lead to executive dysfunction, diminished cognitive control, and insensitivity to error or loss. These changes promote a cycle of risky behaviors and consequences that can spiral out of control. Figure adapted from Perlis et al. In brief, the circadian influence on neuro physiology differs over the 24 hours. During the night, these parameters are tuned to the usual behavior of sleep. So, if we are awake at these times, neurophysiology is prone to foster behavioral dysregulation, especially when these time-of-day effects are combined with sleep loss or disruption. We hypothesize that nocturnal wakefulness produces the Mind after Midnight, a combination of circadian-dependent decreases in molecular and cortical activity and responsiveness with sleep-loss-dependent alterations in synaptic signaling and cortical connectivity. Heightened negative affect and diminished positive affect produce a narrowed attentional focus on neutral or negative stimuli which are assigned incorrect or excessive emotional salience by an overactive amygdala. This combination of negative attentional focus, skewed reward processing, and motivational impulsivity then rises to the prefrontal and anterior cingulate cortices. Ordinarily, coordinated activity between the dorsal anterior cingulate cortex dACC , the rostral anterior cingulate cortex rACC , and various regions of the prefrontal cortex PFC would exert cognitive control to suppress negative emotional distractors and focus on goal-oriented behavior Etkin et al. Long-term planning and behavioral inhibition are diminished in favor of high-risk decision-making and cognitive inflexibility, leading to repeated, maladaptive behaviors that do not respond to negative feedback. These conditions make it clear how poor mood, impaired judgement, and impulsivity could lead to maladaptive behaviors and catastrophic outcomes. For example, a previously abstinent heroin user who successfully manages cravings during the day may experience greater cravings and diminished resistance at night. The appeal of heroin use becomes more desirable and satisfying than the potential costs, and a single impulsive decision leads to a relapse. Further, a dose that was sufficiently rewarding during the day may be insufficient at night, potentially resulting in an increased dose, repeated use, or both, as the risk of overdose is downplayed or discarded. If this process repeats night after night, a conditioned pattern of nighttime heroin use may emerge Gillman et al. Another example is a college student experiencing nocturnal wakefulness due to a delayed sleep schedule and insomnia. Negative mood is at its peak, and the student feels isolated and alone, leading to endless rumination on prior negative relationship experiences. These particular experiences quickly, and inappropriately, generalize to all relationships, thus creating a sense of hopelessness and despair. Suicide, previously inconceivable, emerges as an escape from loneliness and pain, and before the costs of suicide are considered the student has acquired the means and is prepared to act at a time when no one is awake to stop them. These examples demonstrate how negative affect, impaired judgment, and impulsivity during nocturnal wakefulness may increase the incidence and appeal of dangerous ideas, and promote dysregulated behaviors. The Mind after Midnight hypothesis conceptualizes how disrupted or decreased sleep could contribute to psychiatric disorders and unsafe behaviors, and offers a unique opportunity for meaningful intervention. The Mind after Midnight hypothesis also integrates well with psychological models of acute behavioral risk, such as the Suicide Crisis Syndrome or Acute Suicidal Affective Disturbance Schuck et al. All aspects of this hypothesis require empirical validation. We have reviewed reports of data collected during the biological night, and, when such data were not available, we used reports of data from after a night of sleep loss. To test the Mind after Midnight hypothesis, data need to be collected during the biological night including - when possible - using protocols that do not cause sleep loss. Adding time-of-day as a relevant metric to all studies is also extremely important, as measuring time-of-day and time since awakening effects on a variety of outcomes could identify behaviors or individuals that are most vulnerable or resilient to nocturnal wakefulness. Mechanistic studies could use known electrophysiological measures of cognition, emotion, and cortical activity e. Future work could also distinguish the effects of prolonged wakefulness from abrupt nighttime awakenings and the distinctions between sleep loss and circadian processes. The Mind after Midnight naturally lends itself to clinical applications. The simplest solution would be to help vulnerable individuals to sleep through the night, thus reducing their exposure to the times with elevated risk due to behavioral dysregulation. AT, MP, MG, and EK conceived the original concepts and framework. F-XF provided subsequent input on the ideas and arguments. AT drafted the manuscript and figures, which were subsequently revised by F-XF, MP, MG, and EK. All authors reviewed and approved the final version of the manuscript. AT: DOD W81XWH F-XF, MG NIH K24AG MP. F-XF: Velux Stiftung Project No. MP: NIH K24AG, R01AG MG: R01DA and R01MD EK: NIH KHL, UAG, R21DA MG received grants from Jazz Pharmaceuticals and CeraZ; served as a paid consultant to Idorsia, Fitbit, Natrol, Smartypants Vitamins, Athleta, Casper Sleep, and Lyma; and serves as an advisor to Nightfood and Simple Habit. EK is consulting for Circadian Therapeutics, The National Sleep Foundation, Sanofi-Genzyme. Partner owns Chronsulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Alonso, I. CrossRef Full Text Google Scholar. Altamura, C. Seasonal and Circadian Rhythms in Suicide in Cagliari, Italy. Affective Disord. PubMed Abstract CrossRef Full Text Google Scholar. Arnsten, A. Stress Weakens Prefrontal Networks: Molecular Insults to Higher Cognition. Ballard, E. Nocturnal Wakefulness Is Associated with Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder. Psychiatry 77 6 , — Barraclough, B. Time of Day Chosen for Suicide. Bedrosian, T. Timing of Light Exposure Affects Mood and Brain Circuits. Transl Psychiatry 7 1 , e Belknap, J. 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The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology	Celiac disease causes the immune system to attack the small intestine when you eat gluten, a protein in wheat and other grains. Celiac disease causes an array of gut-related symptoms like:. Other symptoms, like fatigue, joint pain, or mouth sores, can occur, and some may affect your brain. People with celiac-related brain fog report feeling disoriented, forgetful, and unable to focus or pay attention. Research has found that people with celiac disease who follow a strict gluten-free diet have improved cognitive performance. Rest often does not improve CFS. Researchers do not know the cause of CFS. Still, some evidence suggests that widespread inflammation in the brain may be the culprit. As a result, people with CFS often have brain fog symptoms like difficulty concentrating and sluggish thinking. There's no cure for CFS, but a healthcare provider can advise treatments to manage your symptoms like brain fog. Medicines, such as antidepressants, and therapy help alleviate CFS symptoms. Treatments like massage, meditation, and yoga may also help improve brain fog. Cirrhosis is a chronic disease that causes scar tissue to form in your liver. Some of the most common causes of cirrhosis include heavy alcohol use and hepatitis C. People with cirrhosis may develop hepatic encephalopathy HE , a nervous system disorder with cognitive effects. HE is a severe condition that may lead to coma, said Dr. Talk to a healthcare provider about a treatment plan if you have cirrhosis. They may advise that you avoid or limit alcohol use. You may require a liver transplant if you have significant scar tissue in your liver. Brain fog is a commonly reported symptom of long COVID, or symptoms that occur after COVID infection and last longer than 28 days. Some evidence suggests that nearly one-third of people had cognitive difficulties for weeks or months after COVID infection. Anyone can develop long COVID, though risk generally increases with COVID symptoms severity. Vaccination helps decrease your risk of severe illness and, possibly, long COVID. Antiviral medicines, like Paxlovid nirmatrelvir with ritonavir , help treat COVID symptoms severity if you get sick. Fibromyalgia is a chronic disorder that causes widespread pain and fatigue. People with fibromyalgia may experience brain fog, sometimes called "fibro fog," which includes difficulty concentrating and thinking and memory problems. Research has found that painful symptoms make sleeping difficult and increase fatigue, which may worsen brain fog. Fibromyalgia treatment typically includes lifestyle changes, medicine, and therapy. Eating a healthy diet, getting enough sleep, reducing stress, and regularly exercising may help alleviate fibro fog. Changes in hormones, such as during periods, pregnancy, and menopause, may cause cognitive difficulties. Brain fog, also known as "period brain," may be a premenstrual syndrome PMS symptom. Changing amounts of estrogen and progesterone throughout your menstrual cycle may affect cognitive function. Research has found that some people have difficulty concentrating after ovulation and before their period begins. You may have heard the term "pregnancy brain" when referring to the brain fog that some pregnant people have. A study published in found that pregnant and postpartum people commonly self-report memory difficulties. Menopause occurs 12 months after your last period, typically during your 40s or 50s. Research has found that menopausal people often report feeling forgetful and having difficulty concentrating. Kidney failure happens if something damages your kidneys, causing excess fluids and waste in your body. You will require dialysis or a kidney transplant if you have kidney failure to help your kidneys function normally. Research has found that brain fog may be a side effect of hemodialysis, a type of kidney failure treatment. A study published in noted that harmful waste build-up and inflammation may trigger brain fog. Lupus is a chronic autoimmune disease, meaning your immune system mistakes your healthy cells as invaders and attacks them. As a result, lupus causes inflammation and pain. Systemic lupus erythematosus SLE , one of the most common forms of lupus, affects , adults in the United States. Lupus may cause brain fog, also known as "lupus fog," which may lead to symptoms like:. Lupus-related brain fog usually ebbs and flows. In some people, brain fog may interfere significantly with daily life. Talk to a healthcare provider about treatments that may address your symptoms and ways to avoid memory issues. For example, you can do puzzles, read books, or use planners or color-coded calendars. Lyme disease, which transmits through tick bites, often starts with the classic "bulls-eye" rash. Lyme disease can later progress into multiple symptoms, including brain fog. Brain fog can occur anytime after infection, possibly even years after infection. Cognitive difficulties typically include memory problems and trouble concentrating. Some people with Lyme disease develop sleep disorders, which may lead to a lack of sleep that worsens brain fog. Seek medical help right away if you have brain fog and bulls-eye rash or know a tick has bitten you. Early treatment with antibiotics helps treat Lyme disease. Migraine is a severely debilitating health condition, with symptoms ranging from intense head pain to fatigue, nausea, and vomiting. Those symptoms can create a foggy feeling in your brain. Brain fog may be part of what some people call a "migraine hangover," or "postdrome," in the hours or days after a migraine. One of the most common symptoms of postdrome is difficulty concentrating. Other symptoms may include a stiff neck and tiredness. There's no cure for migraine. Avoiding triggers like anxiety, bright lights, and caffeine may help reduce the frequency of migraines. Medicines that alleviate migraine symptoms include ergotamine and triptan drugs and pain relievers. Other migraine remedies include:. Depression often causes a loss of interest in your favorite activities and persistent sadness. You may find your thinking and speaking slow, or you need help focusing, making decisions, and remembering things. Anxiety is a response to stress that causes feelings of fear. Research has found that anxiety may cause brain fog-related symptoms like impaired memory. The aftermath of anxiety and depression brain fog could lead to worse feelings about yourself and make it difficult to reach out for help. Still, treatment options are available. Many effective medicines and forms of therapy that treat mood disorders might help with cognitive symptoms. Multiple sclerosis MS is a chronic inflammatory disease that causes lesions on the central nervous system. Those lesions often affect cognition, emotions, how you think, and motor function. MS brain fog "commonly affects the speed at which people can process information and their ability to recall things," Kathleen Costello, RDN , associate vice president of healthcare access of the National MS Society, told Health. Brain fog may also leave you having difficulty making decisions or remembering how to do a job. Some evidence suggests an overlap of MS with sleep disorders. Having no or restless sleep can exasperate brain fog. Heat may also trigger brain fog, said Costello. Talk to a healthcare provider about MS treatments that help alleviate brain fog. They may advise some workaround strategies. For instance, consider creating quiet environments for working, making checklists, and using memory aids. Dry eyes and mouth are the classic symptoms of Sjögren's syndrome, a chronic inflammatory autoimmune disease. Some people with Sjögren's syndrome have brain fog that usually involves memory lapses and poor concentration. Research has found that cognitive challenges are sometimes the first signs of Sjögren's syndrome and may result from fatigue. Still, more research is needed to understand the relationship between Sjögren's syndrome and cognitive difficulties. Treatment depends on your symptoms but may include artificial tears to treat dry eyes. Research has found that aerobic exercises may manage fatigue in some people with Sjögren's syndrome. You may have frequent, severe brain fog if you have a sleep disorder. Some of the most common sleep disorders include:. Those sleep disorders may lead to a lack of sleep and tiredness, which causes brain fog-related symptoms like difficulty completing tasks, feeling confused, and problems with paying attention. Treatment depends on your sleep disorder but typically involves practicing good sleep habits. For example, try waking up and going to bed at the same time every day. Avoid looking at your phone before going to sleep, and make sure your bedroom is cool, dark, and quiet. Your thyroid secretes hormones that control your body's energy. Gibbens, T. Sane and Insane Homicide. Criminal L. Criminology, Police Sci. Gillman, A. Circadian Entrainment by Food and Drugs of Abuse. Golder, S. Diurnal and Seasonal Mood Vary with Work, Sleep, and Daylength across Diverse Cultures. Science , — Gujar, N. Sleep Deprivation Amplifies Reactivity of Brain Reward Networks, Biasing the Appraisal of Positive Emotional Experiences. Hamilton, J. Default-mode and Task-Positive Network Activity in Major Depressive Disorder: Implications for Adaptive and Maladaptive Rumination. Psychiatry 70 4 , — Harrington, M. Losing Control: Sleep Deprivation Impairs the Suppression of Unwanted Thoughts. Harrison, Y. One Night of Sleep Loss Impairs Innovative Thinking and Flexible Decision Making. Organizational Behav. Hasler, B. Time-of-day Differences and Short-Term Stability of the Neural Response to Monetary Reward: a Pilot Study. Neuroimaging 1 , 22— Eveningness and Later Sleep Timing Are Associated with Greater Risk for Alcohol and Marijuana Use in Adolescence: Initial Findings from the National Consortium on Alcohol and Neurodevelopment in Adolescence Study. Chronotype and Diurnal Patterns of Positive Affect and Affective Neural Circuitry in Primary Insomnia. Experimentally Imposed Circadian Misalignment Alters the Neural Response to Monetary Rewards and Response Inhibition in Healthy Adolescents. Hertenstein, E. 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Does Inadequate Sleep Play a Role in Vulnerability to Obesity. Koch, C. Circadian Regulation of Hedonic Appetite in Mice by Clocks in Dopaminergic Neurons of the VTA. Kuula, L. Naturally Occurring Circadian Rhythm and Sleep Duration Are Related to Executive Functions in Early Adulthood. Li, L. Insomnia and the Risk of Depression: a Meta-Analysis of Prospective Cohort Studies. BMC Psychiatry 16 1 , Libedinsky, C. Sleep Deprivation Alters Effort Discounting but Not Delay Discounting of Monetary Rewards. Sleep 36 6 , — Ly, J. Circadian Regulation of Human Cortical Excitability. Maddox, W. The Effects of Sleep Deprivation on Information-Integration Categorization Performance. Sleep 32 11 , — Maldonado, G. Variation in Suicide Occurrence by Time of Day, Day of the Week, Month, and Lunar Phase. Suicide Life Threat Behav. Mantua, J. Sleep and High-Risk Behavior in Military Service Members: a Mega-Analysis of Four Diverse U. Army Units. Sleep 44 4 , zsaa Markwald, R. 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The research is still inconclusive on exactly how the drugs work to stimulate the mind, but early research indicates they may act on a variety of different systems within the body simultaneously. One explanation is that they may increase blood flow to the brain, which allows the brain to use more oxygen. Some drugs increase the amount of certain chemicals neurotransmitters such as dopamine, which are released in the part of the brain associated with dependence. The drugs often used to enhance cognition can generally be divided into 3 groups: Eugaroics, ADHD medications and Nootropic Supplements. Eugeroics are a class of drugs that promote wakefulness and alertness. The most commonly used Eugeroic drug that is used to improve cognition is Modafinil. The drug was introduced in the late s to treat narcolepsy, obstructive sleep apnea and shift work sleep disorder. Modafinil promotes wakefulness and alertness and may have some value in treating stimulant withdrawal and could be effective in decreasing drug craving and dependence. However, further research is needed. There is no safe level of drug use. Modafinil affects everyone differently, but the most common side effects include:. Research into nootropics is still limited which means there is a lot of uncertainty about the side effects the drugs may cause if used on an ongoing basis. It is recommended that these drugs are used only with a prescription from a medical practitioner to avoid any potential harms. Brand names: Ritalin®, Ritalin la®, Concerta®, Ritalin 10®, Dexamphetamine tablets®, Vyvanse®. Ritalin was introduced during the s to treat chronic fatigue, depression, and psychosis associated with depression. It was used extensively in the s to treat ADHD and is now the most common psychotropic medication prescribed to children in the United States and Australia to treat restlessness, impulsive behaviour and inattentiveness. This research showed changes in brain chemistry associated with risk-taking behaviour, sleep disruption and other undesirable effects such as weight loss. Methylphenidate affects everyone differently, but the most common side effects may include:. Certain B vitamins, fish oil and herbal supplements such as Gingko biloba and extracts of Bacopa monnieri may offer a safer option to pharmaceutical drugs to enhance cognitive performance. The benefits may not be as immediate but the effects are reportedly much longer lasting. However, the American Medical Association has advised that a number of products being advertised as nootropic supplements have not been examined in terms of safety and efficacy. Modafinil and is a Schedule 4 substance that can only be prescribed by a doctor or dentist in the ordinary course of their professions. Methylphenidate is a Schedule 8 drug which means doctors must follow state and territory laws when prescribing it and must notify, or receive approval from, the appropriate health authority. Using modafinil or methylphenidate without a prescription from a doctor, or selling or giving them to someone else, is illegal.
8 Tips to Boost Mental Energy, in the Moment and in the Future	One explanation is that they may increase blood flow to the brain, which allows the brain to use more oxygen. Bauer M, Grof P, Rasgon N, Bschor T, Glenn T, Whybrow PC: Temporal relation between sleep and mood in patients with bipolar disorder. Skip to content Site Navigation The Atlantic. Olbrich S, Sander C, Minkwitz J, Chittka T, Mergl R, Hegerl U, Himmerich H: EEG vigilance regulation patterns and their discriminative power to separate patients with major depression from healthy controls. Kasper S, Wehr TA: The role of sleep and wakefulness in the genesis of depression and mania. Once you figure out the underlying cause, you can begin managing it.
Brain Fog: Causes and Treatment	An newly developed and validated EEG-based wakefulness and mental clarity VIGALL wakefulnexs wakefulness and mental clarity in research on clsrity, modulating Muscle growth supplements for men moderating roles of arousal on behaviour. Guenther T, Schonknecht P, Becker G, Olbrich Wakefulnesa, Sander C, Wakefulnes S, Meyer Wzkefulness, Luthardt J, Hegerl U, Sabri O: Impact of EEG-vigilance on brain glucose uptake measured with [ 18 F]FDG and PET in patients with depressive episode or mild cognitive impairment. A diet that focuses heavily on processed foods that are high in unhealthful fats and sugars may contribute to brain fog. There is a brief time, between waking and sleep, when reality begins to warp. In the study 30 male Special Operations Forces… READ MORE.
How Sleep Deprivation Impacts Mental Health | Columbia University Department of Psychiatry	Wakefulneess : Wakefulness and mental clarity and Cranberry salad dressings of anx wakefulness and mental clarity Symptoms and signs: Nervous system Cognitive disorders Psychopathological cclarity. Managing fatigue in patients with primary Sjögren's syndrome: challenges and solutions. In the study 30 male Special Operations Forces…. Sleep 36 6— Tubbs, A. Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity. Negative mood is at its peak, and the student feels isolated and alone, leading to endless rumination on prior negative relationship experiences.

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