Chronic Insomnia and the Stress System

doi:10.1016/j.jsmc.2007.04.002

Sleep Medicine Clinics

Volume 2, Issue 2, June 2007, Pages 279-291

https://doi.org/10.1016/j.jsmc.2007.04.002 Get rights and content

In insomnia, which is a very common sleep disorder, objective sleep measures, EEG activity, physiologic findings, HPA axis activity, and inflammation markers suggest that it is not a state of sleep loss, but a disorder of hyperarousal present both during the night and the daytime. Several psychological and physiological factors contribute to the onset and perpetuation of insomnia, such as anxious-ruminative personality traits, stressful events, age-related sleep homeostasis weakening mechanisms, menopause, and biologic-genetic diathesis of CNS hyperarousal. The therapeutic approach in insomnia should be multidimensional, reducing the overall emotional and physiologic hyperarousal and its underlying factors present throughout the 24-hour sleep/wake period.

Section snippets

The role of emotional stress and psychiatric disorders

The emotional factors involved in the development and persistence of insomnia have been assessed in numerous studies investigating stressful life events, personality patterns, and psychiatric diagnoses.

Stressful life events are closely associated with the onset of chronic insomnia and are mediated by certain predisposing personality factors. Insomniacs, compared with controls, tend to be more discontent, both as children and as adults, have less satisfying interpersonal relations, and

Evaluation

Chronic insomnia is a difficult disorder to treat and the importance of a multidimensional evaluation that includes thorough sleep history, medical history, physical examination, and drug/substance use, as well as psychiatric assessment has been stressed for many years, although frequently overlooked in daily practice [20].

The data reviewed in the “etiologic factors and pathophysiologic models” section of this article call for an emphasis on elements of the evaluation that should be

Summary

Insomnia is considered to be the most common sleep disorder. Several different approaches suggest that insomnia is a state of 24-hour hyperarousal rather than sleep loss: insomniacs compared with normal sleepers are not sleepier during the day, have an increased level of high-frequency EEG rhythm during sleep, have elevated brain metabolism during sleep and decreased during wakefulness in functional neuroimaging studies, have similar cognitive function and performance, and also have a 24-hour

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Sleep is instrumental in safeguarding emotional well-being. While the susceptibility to both insomnia and anxiety has been demonstrated to involve intricate brain systems, the neuroimaging profile of chronic insomnia disorder with comorbid anxiety symptoms (CID-A) remains unexplored. Employing machine learning methodologies, this study aims to elucidate the distinct neural substrates underlying CID-A and to investigate whether these cerebral markers can prognosticate anxiety symptoms in patients with insomnia.
Functional magnetic resonance imaging (fMRI) data were procured from a relatively large cohort (dataset 1) comprised of 47 CID-A patients, 49 CID patients without anxiety (CID-NA), and 48 good sleeper controls (GSC). Aberrant cerebral functional alterations were assessed through functional connectivity strength (FCS) and resting-state functional connectivity (rsFC). Subsequently, Support Vector Regression (SVR) models were constructed to predict anxiety symptoms in CID patients based on neuroimaging features, which were validated utilizing an external cohort (dataset 2).
In comparison to CID-NA and GSC subjects, CID-A patients exhibited heightened FCS in the right dorsomedial prefrontal cortex (DMPFC), a central hub within the negative affective network. Moreover, the SVR models revealed that DMPFC-related rsFC/FCS features could be employed to predict anxiety symptoms in two independent cohorts of CID patients.
Modifications in brain functionality might vary across insomnia subtypes.
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Abnormal stress responses have been linked to the etiology of insomnia. We investigated the relationship between insomnia, stress, hypothalamic-pituitary-adrenal (HPA) axis activity, and autonomic nervous system (ANS) function in adolescence.
Forty-seven post-pubertal adolescents (16–20 years old, 28 female) with (N = 16; insomnia group) and without (N = 31; control group) DSM-5 insomnia symptoms were assessed for stress levels and stress reactivity and underwent a standardized stress protocol (Trier Social Stress Test (TSST)), after an overnight laboratory stay. Cortisol was measured upon awakening and 30-minutes later to calculate the cortisol awakening response (CAR). During the TSST, perceived stress, salivary cortisol (HPA activity), heart rate (HR) and blood pressure (BP) measures were collected.
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Results mostly show no group difference in physiological stress responses, although some interaction effects suggest a potential sex by insomnia interaction. Larger samples are needed to understand the physiological disturbances of insomnia in adolescence.
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Chronic Insomnia and the Stress System

Section snippets

The role of emotional stress and psychiatric disorders

Evaluation

Summary

Arch Gen Psychiatry

Chest

Sleep Medicine Reviews

J Psychiatr Res

Clin Cornerstone

Sleep Med Rev

Biol Psychiatry

Chest

Psychosomatics

Neurosci Lett

Metabolism

Sleep Med Rev

Neuroscience

Sleep Med

J Psychosom Res

Brain Behav Immun

Lancet

Selected symptoms of psychological distress

Insomnia and its treatment. Prevalence and correlates

Arch Gen Psychiatry

Risk factors associated with complaints of insomnia in a general adult population

Arch Intern Med

The natural history of insomnia and its relationship to respiratory symptoms

Arch Intern Med

Sleep complaints among elderly persons: an epidemiologic study of three communities

Sleep

National Center for Health Statistics. Third National Health and Nutrition Examination Survey, 1988–1994. NHANES III laboratory data file

Epidemiologic study of sleep disturbances and psychiatric disorders

JAMA

Prevalence, burden, and treatment of insomnia in primary care

Am J Psychiatry

Evaluation of severe insomnia in the general population: results of a European multinational survey

J Psychopharmacol

Diagnostic and statistical manual of mental disorders, text revision

Insomnia: psychological assessment and management

Evaluation and treatment of insomnia

Biopsychobehavioral correlates of insomnia II. Pattern specificity and consistency with the Minnesota Multiphasic Personality Inventory

Psychosomatic Med

Clinical diagnoses in 216 insomnia patients using the international classification of sleep disorders (ICSD), DSM-IV and ICD-10 categories: a report form the APA/NIMH DSM-IV trial

Sleep

Usefulness of polysomnographic studies in the differential diagnosis of insomnia

Int J Neurosci

Personality patterns in insomnia. Theoretical implications

Arch Gen Psychiatry

Sleep disorders: insomnia, sleepwalking, night terrors, nightmares and enuresis

Ann Inter Med

Insomnia, metabolic rate and sleep restoration

J Intern Med