1
|
Yu L, Yang L, Xu H, Zhao G, Dou Z, Luo Y, Yang J, Zhang Q, Yu S. Inhibitory Deficits of Insomnia Disorder: A Meta-Analysis on Event Related Potentials in Auditory Oddball Task. Behav Sleep Med 2024; 22:100-114. [PMID: 36994479 DOI: 10.1080/15402002.2023.2192499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite numerous studies on auditory event-related potentials (ERPs) in insomnia disorder (ID), the results are inconsistent across different ERP components (e.g. N1, P2, P3, and N350), types of auditory stimuli (e.g. standard and deviant), and stages of sleep (e.g. wakefulness, NREM sleep, and REM sleep). In light of this variability, we conducted a systematic meta-analysis of previous auditory ERP studies in ID to provide a quantitative review of the existing literature. METHODS Relevant literatures were searched on the Embase, PubMed/MEDLINE, PsycINFO and Cochrane Library. A total of 12 studies comprising 497 participants were finally included in this meta-analysis. The study protocol was registered with PROSPERO under the registration number CRD42022308348. RESULTS We found that patients with ID have significantly decreased N1 (Hedges' g = 0.34, 95%CI [0.04, 0.65]) and P3 (Hedges'g = -1.21, 95%CI [-2.37, -0.06]) amplitudes during wakefulness. In addition, decreases in P2 (Hedges'g = -0.57, 95%CI [-0.96, -0.17]) amplitude during wakefulness and N350 (Hedges' g = 0.73, 95%CI [0.36, 1.09]) amplitude during NREM. CONCLUSIONS This meta-analysis represents the first systematic investigation of ERP features across different stages of sleep in individuals with ID. Our results suggest that in patients with insomnia, the absence or deficiency of arousal inhibition during the nighttime sleep initiation or maintenance process may interfere with the normal process of sleep.
Collapse
Affiliation(s)
- Liyong Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lu Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Xu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guangli Zhao
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zeyang Dou
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yucai Luo
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Zhang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Siyi Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
2
|
Reid MJ, Quigg M, Finan PH. Sleep-EEG in comorbid pain and insomnia: implications for the treatment of pain disorders. Pain Rep 2023; 8:e1101. [PMID: 37899939 PMCID: PMC10599985 DOI: 10.1097/pr9.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Patients with chronic pain experience a high prevalence of comorbid insomnia, which is associated with functional impairment. Recent advances in sleep electroencephalography (sleep-EEG) may clarify the mechanisms that link sleep and chronic pain. In this clinical update, we outline current advancements in sleep-EEG assessments for pain and provide research recommendations. Results Promising preliminary work suggests that sleep-EEG spectral bands, particularly beta, gamma, alpha, and delta power, may create candidate neurophysiological signatures of pain, and macro-architectural parameters (e.g., total sleep time, arousals, and sleep continuity) may facilitate EEG-derived sleep phenotyping and may enable future stratification in the treatment of pain. Conclusion Integration of measures obtained through sleep-EEG represent feasible and scalable approaches that could be adopted in the future. We provide research recommendations to progress the field towards a deeper understanding of their utility and potential future applications in clinical practice.
Collapse
Affiliation(s)
- Matthew J. Reid
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Quigg
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patrick H. Finan
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
3
|
Stephan AM, Siclari F. Reconsidering sleep perception in insomnia: from misperception to mismeasurement. J Sleep Res 2023; 32:e14028. [PMID: 37678561 DOI: 10.1111/jsr.14028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
So-called 'sleep misperception' refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of sleep. It is unknown whether this subjective-objective mismatch truly reflects an abnormal perception of sleep, or whether it results from the inability of standard sleep recording techniques to capture 'wake-like' brain activity patterns that could account for feeling awake during sleep. Here, we systematically reviewed studies reporting sleep macro- and microstructural, metabolic, and mental correlates of sleep (mis)perception. Our findings suggest that most individuals tend to accurately estimate their sleep duration measured with polysomnography (PSG). In good sleepers, feeling awake during sleep is the rule at sleep onset, remains frequent in the first non-rapid eye movement sleep cycle and almost never occurs in rapid eye movement (REM) sleep. In contrast, there are patients with insomnia who consistently underestimate their sleep duration, regardless of how long they sleep. Unlike good sleepers, they continue to feel awake after the first sleep cycle and importantly, during REM sleep. Their mental activity during sleep is also more thought-like. Initial studies based on standard PSG parameters largely failed to show consistent differences in sleep macrostructure between these patients and controls. However, recent studies assessing sleep with more refined techniques have revealed that these patients show metabolic and microstructural electroencephalography changes that likely reflect a shift towards greater cortical activation during sleep and correlate with feeling awake. We discuss the significance of these correlates and conclude with open questions and possible ways to address them.
Collapse
Affiliation(s)
- Aurélie M Stephan
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Francesca Siclari
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| |
Collapse
|
4
|
Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
Collapse
Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
5
|
Dressle RJ, Riemann D. Hyperarousal in insomnia disorder: Current evidence and potential mechanisms. J Sleep Res 2023; 32:e13928. [PMID: 37183177 DOI: 10.1111/jsr.13928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/16/2023]
Abstract
Insomnia disorder is among the most frequent mental disorders, making research on its aetiology and pathophysiology particularly important. A unifying element of many aetiological and pathophysiological models is that they support or even centre on the role of some form of hyperarousal. In this theoretical review, we aim to summarise the current evidence on hyperarousal in insomnia. Hyperarousal is discussed as a state of relatively increased arousal in physiological, cortical and cognitive-emotional domains. Regarding physiological hyperarousal, there is no conclusive evidence for the involvement of autonomous variables such as heart rate and heart rate variability, whereas recent evidence points to a pathophysiological role of neuroendocrine variables. In addition, current literature supports a central involvement of cortical arousal, that is, high-frequency electroencephalographic activity. An increasingly important focus in the literature is on the role of other microstructural sleep parameters, especially the existence of microarousals during sleep. Beyond that, a broad range of evidence exists supporting the role of cognitive-emotional hyperarousal in the form of insomnia-related thought and worries, and their concomitant emotional symptoms. Besides being a state marker of insomnia, hyperarousal is considered crucial for the predisposition to insomnia and for the development of comorbid mental disorders. Thus, beyond presenting evidence from cross-sectional studies on markers of hyperarousal in insomnia, hypotheses about the mechanisms of hyperarousal are presented. Nevertheless, longitudinal studies are needed to further elucidate the mechanism of hyperarousal throughout the course of the disorder, and future studies should also focus on similarities and differences in hyperarousal across different diagnostic entities.
Collapse
Affiliation(s)
- Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Center for Basics in NeuroModulation (NeuroModulBasics), University of Freiburg, Freiburg, Germany
| |
Collapse
|
6
|
Altena E, Ellis J, Camart N, Guichard K, Bastien C. Mechanisms of cognitive behavioural therapy for insomnia. J Sleep Res 2023; 32:e13860. [PMID: 36866434 DOI: 10.1111/jsr.13860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
Although much is known now about behavioural, cognitive and physiological consequences of insomnia, little is known about changes after cognitive behavioural therapy for insomnia on these particular factors. We here report baseline findings on each of these factors in insomnia, after which we address findings on their changes after cognitive behavioural therapy. Sleep restriction remains the strongest determinant of insomnia treatment success. Cognitive interventions addressing dysfunctional beliefs and attitudes about sleep, sleep-related selective attention, worry and rumination further drive effectiveness of cognitive behavioural therapy for insomnia. Future studies should focus on physiological changes after cognitive behavioural therapy for insomnia, such as changes in hyperarousal and brain activity, as literature on these changes is sparse. We introduce a detailed clinical research agenda on how to address this topic.
Collapse
Affiliation(s)
| | - Jason Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | - Nathalie Camart
- UR CLIPSYD, UFR SPSE, Département de psychologie, Université Paris Nanterre, Nanterre, France
- Cabinet Pôle Psy République, Bordeaux, France
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
| | - Kelly Guichard
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
- CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | - Célyne Bastien
- Ecole de Psychologie, Université Laval, Québec, Québec, Canada
| |
Collapse
|
7
|
Bastien CH, Cote KA. Insomnia: A magnifying glass to measure hyperarousal in REM. Sleep 2021; 44:6331313. [PMID: 34329476 DOI: 10.1093/sleep/zsab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Célyne H Bastien
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre de Recherche CERVO, Québec, QC, Canada
| | - Kimberly A Cote
- Psychology Department, Brock University, St. Catharines, ON, Canada
| |
Collapse
|
8
|
Feige B, Baglioni C, Boehm P, Heinrich A, Trumm S, Benz F, Nissen C, Domschke K, Frase L, Riemann D. Event-related potentials in insomnia reflect altered perception of sleep. Sleep 2021; 44:6290313. [PMID: 34059920 DOI: 10.1093/sleep/zsab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
STUDY OBJECTIVES Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more sensitive to inevitably occurring internal or external stimuli during the night, causing brief sleep disruptions then perceived as wake time. METHODS Auditory event-related potentials (ERP) to low intensity (50 dB SPL) synthesized guitar tones played continuously throughout two nights of polysomnographically registered sleep were obtained in fifty patients with insomnia disorder (ID, without comorbidities) and 50 age- and sex- matched good sleeper controls (GSC) for each sleep stage and NREM/REM cycle. Phasic and tonic REM were treated as separate stages. Latencies and amplitudes of components P1, N1 and P2 were measured and analyzed by multivariate repeated-measures ANCOVA including effects of group, night, cycle and age. RESULTS ID showed reduced P2 amplitudes relative to GSC specifically in phasic REM sleep. The same reduction also correlated with the amount of sleep misperception across groups. Independent component analysis showed a frontal negativity to contribute most to this group difference. CONCLUSIONS The present finding can be interpreted as increased mismatch negativity (MMN) in ID, reflecting automated detection of change in the auditory system and a concomitant orienting response. Specifically phasic REM sleep appears to be vulnerable to sensory afferences in ID patients, possibly contributing to the perception of being awake.
Collapse
Affiliation(s)
- Bernd Feige
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Chiara Baglioni
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Philipp Boehm
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Anna Heinrich
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Samuel Trumm
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Fee Benz
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Domschke
- Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany.,Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Center for Basics in NeuroModulation (NeuroModulBasics), Breisacherstraße, Freiburg, Germany
| | - Lukas Frase
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Dieter Riemann
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| |
Collapse
|
9
|
Howlett RDM, Lustig KA, MacDonald KJ, Cote KA. Hyperarousal Is Associated with Socioemotional Processing in Individuals with Insomnia Symptoms and Good Sleepers. Brain Sci 2020; 10:brainsci10020112. [PMID: 32093215 PMCID: PMC7071480 DOI: 10.3390/brainsci10020112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Despite complaints of difficulties in waking socioemotional functioning by individuals with insomnia, only a few studies have investigated emotion processing performance in this group. Additionally, the role of sleep in socioemotional processing has not been investigated extensively nor using quantitative measures of sleep. Individuals with insomnia symptoms (n = 14) and healthy good sleepers (n = 15) completed two nights of at-home polysomnography, followed by an afternoon of in-lab performance testing on tasks measuring the processing of emotional facial expressions. The insomnia group self-reported less total sleep time, but no other group differences in sleep or task performance were observed. Greater beta EEG power throughout the night was associated with higher intensity ratings of happy, fearful and sad faces for individuals with insomnia, yet blunted sensitivity and lower accuracy for good sleepers. Thus, the presence of hyperarousal differentially impacted socioemotional processing of faces in individuals with insomnia symptoms and good sleepers.
Collapse
Affiliation(s)
| | | | | | - Kimberly A. Cote
- Correspondence: ; Tel.: +1-905-688-5550 (ext. 4806); Fax: +1-905-688-6922
| |
Collapse
|
10
|
Peter-Derex L. Patologie del sonno. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
11
|
Muscarella C, Mairesse O, Hughes G, Neu D, Van den Bussche E. Recruitment dynamics of cognitive control in insomnia. Sleep 2019; 42:5352976. [DOI: 10.1093/sleep/zsz039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/19/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Charlotte Muscarella
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
- Brain & Cognition, KU Leuven, Leuven, Belgium
| | - Olivier Mairesse
- Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium
- Sleep Laboratory & Unit for Chronobiology U78, Brugmann University Hospital, Brussels, Belgium
- Department LIFE, Royal Military Academy, Brussels, Belgium
| | - Gethin Hughes
- Department of Psychology, University of Essex, Colchester, UK
| | - Daniel Neu
- Sleep Laboratory & Unit for Chronobiology U78, Brugmann University Hospital, Brussels, Belgium
- UNI Neuroscience Institute, ULB312 Faculty of Medicine, and ULB388 Faculty of Motor Sciences, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
- Center for the Study of Sleep Disorders, Delta Hospital and Edith Cavell Polyclinic, Neuroscience Pole and Department of Internal Medicine, CHIREC, Brussels, Belgium
| | | |
Collapse
|
12
|
Castelnovo A, Ferri R, Punjabi NM, Castronovo V, Garbazza C, Zucconi M, Ferini-Strambi L, Manconi M. The paradox of paradoxical insomnia: A theoretical review towards a unifying evidence-based definition. Sleep Med Rev 2018; 44:70-82. [PMID: 30731262 DOI: 10.1016/j.smrv.2018.12.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023]
Abstract
Paradoxical insomnia is one of the most intriguing yet challenging subtypes of insomnia. Despite being recognized for a long time by the international community, it is still unclear whether this entity really exists, which are its features and boundaries. Much of the debate is fuelled by the lack of a consensus on its precise definition. To help filling some of the existing gaps, a systematic review of the literature was conducted, through which 19 different quantitative definitions were obtained. These definitions were then applied to two distinct datasets. The first consisted of 200 chronic primary insomnia patients, diagnosed according to the DSM-IV-TR criteria. The second consisted of 200 age- and sex-matched healthy persons without insomnia. For each dataset, available data from the objective sleep parameters and their subjective estimation were imported and analysed in MATLAB. Depending on the definition used, the prevalence of paradoxical insomnia ranged from 8 to 66%, while agreement between different definitions ranged from -0.19 to 0.9 (using Cohen's kappa coefficient). Based on the results garnered, necessary features for a quantitative definition of paradoxical insomnia were identified. Several open questions remain, such as whether there is a minimum number of hours a patient should sleep to fulfill the criteria for a diagnosis of paradoxical insomnia, and whether sleep latency can be used in the definition along with total sleep time. We conclude by advocating continued study of paradoxical insomnia and sleep state misperception and by providing specific directions for future research. STATEMENT OF SIGNIFICANCE: The current understanding of paradoxical insomnia and, more broadly, of sleep state misperception, is greatly hampered by the lack of agreement on a quantitative and evidence-base measure of the discrepancy between subjective and objective sleep evaluation. The current study provides a critical analysis about the strength and the limitations of the available definitions, using both a data-driven and a theory-driven approach. The overarching goal is to motivate a rigorous discussion involving the main experts of the field, to build a consensus, and develop an evidence-based measure of sleep state misperception and/or of paradoxical insomnia.
Collapse
Affiliation(s)
- Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.
| | | | - Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vincenza Castronovo
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland; Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy.
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors. RECENT FINDINGS Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities. SUMMARY Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.
Collapse
|
14
|
Feige B, Nanovska S, Baglioni C, Bier B, Cabrera L, Diemers S, Quellmalz M, Siegel M, Xeni I, Szentkiralyi A, Doerr JP, Riemann D. Insomnia—perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia. Sleep 2018; 41:4845543. [DOI: 10.1093/sleep/zsy032] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedict Bier
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laura Cabrera
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah Diemers
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Quellmalz
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Siegel
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ireni Xeni
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andras Szentkiralyi
- Institute for Epidemiology and Social Medicine, University of Münster, Germany
| | - John-Peter Doerr
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
15
|
Role of Sleep Aids and Wake-Promoting Agents During Cognitive Behavior Therapy for Insomnia. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
The insomnia with short sleep duration phenotype: an update on it's importance for health and prevention. Curr Opin Psychiatry 2017; 30:56-63. [PMID: 27764017 DOI: 10.1097/yco.0000000000000292] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It was first proposed in the late 1990s that objective markers of sleep disturbance could serve as an index of the biological severity of insomnia. In 2013, a heuristic model of two insomnia phenotypes based on objective sleep duration was proposed. Herein, we review the studies conducted in the past 3 years on the insomnia with short sleep duration phenotype and its implications for a clinical research agenda. RECENT FINDINGS Studies have shown that insomnia with objective short sleep duration is associated with physiologic hyperarousal and cardiometabolic and neurocognitive morbidity, whereas insomnia with normal sleep duration is not. Both insomnia phenotypes are associated with psychiatric morbidity albeit through different psychobiological mechanisms. Novel recent studies have included occupational outcomes, developmental approaches, at-home objective sleep testing, diagnostic accuracy measures, and response to cognitive-behavioral treatment. SUMMARY Accumulating evidence in the past years has continued to support that insomnia with short sleep duration is a more severe phenotype of the disorder associated with physiologic changes, significant morbidity and mortality and, potentially, a differential response to treatment.
Collapse
|
17
|
Wei Y, Ramautar JR, Colombo MA, Stoffers D, Gómez-Herrero G, van der Meijden WP, te Lindert BH, van der Werf YD, Van Someren EJ. I Keep a Close Watch on This Heart of Mine: Increased Interoception in Insomnia. Sleep 2016; 39:2113-2124. [PMID: 27634787 PMCID: PMC5103799 DOI: 10.5665/sleep.6308] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/23/2016] [Indexed: 01/04/2023] Open
Abstract
STUDY OBJECTIVES Whereas both insomnia and altered interoception are core symptoms in affective disorders, their neural mechanisms remain insufficiently understood and have not previously been linked. Insomnia Disorder (ID) is characterized by sensory hypersensitivity during wakefulness and sleep. Previous studies on sensory processing in ID addressed external stimuli only, but not interoception. Interoceptive sensitivity can be studied quantitatively by measuring the cerebral cortical response to one's heartbeat (heartbeat-evoked potential, HEP). We here investigated whether insomnia is associated with increased interoceptive sensitivity as indexed by the HEP amplitude. METHODS Sixty-four participants aged 21-70 years were recruited through www.sleepregistry.nl including 32 people suffering from ID and 32 age- and sex-matched controls without sleep complaints. HEPs were obtained from resting-state high-density electroencephalography (HD-EEG) recorded during evening wakeful rest in eyes-open (EO) and eyes-closed (EC) conditions of 5-minute duration each. Significance of group differences in HEP amplitude and their topographical distribution over the scalp were assessed by means of cluster-based permutation tests. RESULTS In particular during EC, and to a lesser extent during EO, people with ID had a larger amplitude late HEP component than controls at frontal electrodes 376-500 ms after the R-wave peak. Source localization suggested increased neural activity time-locked to heartbeats in people with ID mainly in anterior cingulate/medial frontal cortices. CONCLUSIONS People with insomnia show insufficient adaptation of their brain responses to the ever-present heartbeats. Abnormalities in the neural circuits involved in interoceptive awareness including the salience network may be of key importance to the pathophysiology of insomnia.
Collapse
Affiliation(s)
- Yishul Wei
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Jennifer R. Ramautar
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Michele A. Colombo
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Bernstein Center Freiburg and Faculty of Biology, University of Freiburg, Freiburg, Germany
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel (UPK), Basel, Switzerland
| | - Diederick Stoffers
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Germán Gómez-Herrero
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Wisse P. van der Meijden
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Bart H.W. te Lindert
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Ysbrand D. van der Werf
- Department of Emotion and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Eus J.W. Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), VU University and Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Pérusse AD, De Koninck J, Pedneault-Drolet M, Ellis JG, Bastien CH. REM dream activity of insomnia sufferers: a systematic comparison with good sleepers. Sleep Med 2016; 20:147-54. [DOI: 10.1016/j.sleep.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022]
|
19
|
Corsi-Cabrera M, Rojas-Ramos OA, del Río-Portilla Y. Waking EEG signs of non-restoring sleep in primary insomnia patients. Clin Neurophysiol 2015; 127:1813-21. [PMID: 26675627 DOI: 10.1016/j.clinph.2015.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/17/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Subjective feelings of insufficient and non-restorative sleep are core symptoms of primary insomnia. Sleep has a restorative effect on next-day waking EEG activity, whereas sleep loss has non-restorative effects in good sleepers. We proposed to explore waking EEG activity in primary insomniacs the evening before, and the morning after, a night of sleep, in order to detect signs of morning hyper-arousal and non-restoring sleep that might explain the subjective feelings despite the absence of objective signs in polysomnography. METHOD Pre-sleep (10 pm) and post-sleep (10 am) waking EEG activity was analyzed in 10 non-medicated primary insomniacs and matched control subjects. Beta and Gamma absolute power and EEG temporal coupling were obtained. Participants also evaluated subjective sleep quantity and quality. RESULTS Insomnia patients evaluated their sleep as non-restorative and insufficient. Compared to pre-sleep, during post-sleep control subjects exhibited significantly decreased Beta and Gamma power and reduced synchronization among anterior and posterior regions, consistent with restoring effects of sleep. Insomnia patients showed no beneficial effects of sleep on these EEG parameters. CONCLUSION Insomniacs are hyper-aroused during morning wakefulness and they do not benefit from preceding sleep. SIGNIFICANCE Our study adds new knowledge to our understanding of the physiopathology of insomnia.
Collapse
Affiliation(s)
- María Corsi-Cabrera
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico.
| | - Olga A Rojas-Ramos
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico; Departament of Psychophysiology, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico
| | - Yolanda del Río-Portilla
- Sleep Laboratory, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico; Departament of Psychophysiology, Facultad de Psicología, Universidad Nacional Autónoma de México, Av. Universidad 3004, D.F. México 04510, Mexico
| |
Collapse
|
20
|
Ceklic T, Bastien CH. Information processing during NREM sleep and sleep quality in insomnia. Int J Psychophysiol 2015; 98:460-9. [PMID: 26506477 DOI: 10.1016/j.ijpsycho.2015.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022]
Abstract
Insomnia sufferers (INS) are cortically hyperaroused during sleep, which seems to translate into altered information processing during nighttime. While information processing, as measured by event-related potentials (ERPs), during wake appears to be associated with sleep quality of the preceding night, the existence of such an association during nighttime has never been investigated. This study aims to investigate nighttime information processing among good sleepers (GS) and INS while considering concomitant sleep quality. Following a multistep clinical evaluation, INS and GS participants underwent 4 consecutive nights of PSG recordings in the sleep laboratory. Thirty nine GS (mean age 34.56±9.02) and twenty nine INS (mean age 43.03±9.12) were included in the study. ERPs (N1, P2, N350) were recorded all night on Night 4 (oddball paradigm) during NREM sleep. Regardless of sleep quality, INS presented a larger N350 amplitude during SWS (p=0.042) while GS showed a larger N350 amplitude during late-night stage 2 sleep (p=0.004). Regardless of diagnosis, those who slept objectively well showed a smaller N350 amplitude (p=0.020) while those who slept subjectively well showed a smaller P2 (p<0.001) and N350 amplitude (p=0.006). Also, those who reported an objectively bad night as good showed smaller P2 (p< 0.001) and N350 (p=0.010) amplitudes. Information processing seems to be associated with concomitant subjective and objective sleep quality for both GS and INS. However, INS show an alteration in information processing during sleep, especially for inhibition processes, regardless of their sleep quality.
Collapse
Affiliation(s)
- Tijana Ceklic
- School of Psychology, Laval University, Quebec, Canada; Institut Universitaire en Santé Mentale de Quebec, Quebec, Canada
| | - Célyne H Bastien
- School of Psychology, Laval University, Quebec, Canada; Institut Universitaire en Santé Mentale de Quebec, Quebec, Canada.
| |
Collapse
|
21
|
Pérusse AD, Pedneault-Drolet M, Rancourt C, Turcotte I, St-Jean G, Bastien CH. REM sleep as a potential indicator of hyperarousal in psychophysiological and paradoxical insomnia sufferers. Int J Psychophysiol 2015; 95:372-8. [PMID: 25596383 DOI: 10.1016/j.ijpsycho.2015.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 11/30/2014] [Accepted: 01/09/2015] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVES The objective was to study REM sleep macrostructure and microstructure as potential indicators of hyperarousal in insomnia by comparing good sleepers (GS) and insomnia sufferers (INS) (subdivided into psychophysiological "PSY-I" and paradoxical "PARA-I"). DESIGN Cross-sectional comparisons of GS, PSY-I and PARA-I. SETTING Participants slept for 4 consecutive nights in the laboratory where PSG was recorded. Nights 2 and 3 were combined to compare REM sleep between groups. PARTICIPANTS Thirty-nine PSY-I, 27 PARA-I and 47 GS completed the study, comprising home questionnaires, clinical interviews and night PSG recordings. All participants were aged between 25 and 55 and met inclusion criteria for either PSY-I, PARA-I or GS. INTERVENTIONS N/A MEASUREMENTS AND RESULTS Results showed no between group differences on REM sleep macrostructure. As for REM sleep microstructure, PSY-I had an increased number of wake intrusions compared to PARA-I (p=.03). Subjective SE, TST and TWT were significantly correlated with the duration of REM sleep (REMD; p≤.002) and with the proportion of REM sleep for PARA-I (p≤.06). CONCLUSIONS REM sleep macrostructure does not seem to be an adequate indicator of hyperarousal in insomnia. However, the number of wake intrusions in REM could be used to differentiate PSY-I from PARA-I and could reflect the heightened arousal of the former group. Relationships between REM sleep duration and proportion could be linked to dream imagery activity, especially in PARA-I. Further investigations are needed to identify variables that could reflect hyperarousal and differentiate insomnia types.
Collapse
Affiliation(s)
- Alexandra D Pérusse
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| | - Maude Pedneault-Drolet
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| | - Christine Rancourt
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| | - Isabelle Turcotte
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| | - Geneviève St-Jean
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| | - Célyne H Bastien
- École de psychologie, 2325 rue des Bibliothèques, Université Laval, Québec, QC, G1V 0A6, Canada; Laboratoire de sommeil et potentiels évoqués cognitifs, 2525 chemin de la Canardière, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, QC,G1J 2G2, Canada.
| |
Collapse
|
22
|
Gupta R, Zalai D, Spence DW, BaHammam AS, Ramasubramanian C, Monti JM, Pandi-Perumal SR. When insomnia is not just insomnia: the deeper correlates of disturbed sleep with reference to DSM-5. Asian J Psychiatr 2014; 12:23-30. [PMID: 25441304 DOI: 10.1016/j.ajp.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 08/24/2014] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
Abstract
Recent scientific evidences have brought a paradigm shift in our approach towards the concepts of insomnia and its management. The differentiation between primary and secondary insomnia was proved more hypothetical than actual and based upon the current evidences insomnia subtypes described in earlier system have been lumped into one-insomnia disorder. Research in this field suggests that insomnia occurring during psychiatric or medical disorders has a bidirectional and interactive relationship with and coexisting medical and psychiatric illnesses. The new approach looks to coexist psychiatric or medical disorders as comorbid conditions and hence specifies two coexisting conditions. Therefore, the management and treatment plans should address both the conditions. A number of sleep disorders may present with insomnia like symptoms and these disorders should be treated efficiently in order to alleviate insomnia symptoms. In such cases, a thorough history from the patient and his/her bed-partner is warranted. Moreover, some patients may need polysomnography or other diagnostic tests like actigraphy to confirm the diagnosis of the underlying sleep disorder. DSM-5 classification system of sleep–wake disorders has several advantages, e.g., it has seen insomnia across different dimensions to make it clinically more useful; it focuses on the assessment of severity and guides the mental health professional when to refer a patient of insomnia to a sleep specialist; lastly, it may encourage the psychiatrists to opt for sleep medicine as a career.
Collapse
Affiliation(s)
- Ravi Gupta
- Department of Psychiatry & Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Dehradun 248140, India.
| | | | | | | | | | | | | |
Collapse
|
23
|
Bastien C, Ceklic T, St-Hilaire P, Desmarais F, Pérusse A, Lefrançois J, Pedneault-Drolet M. Insomnia and sleep misperception. ACTA ACUST UNITED AC 2014; 62:241-51. [DOI: 10.1016/j.patbio.2014.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
|
24
|
Abstract
In contrast to the association of insomnia with mental health, its association with physical health has remained largely unexplored until recently. Based on findings that insomnia with objective short sleep duration is associated with activation of both limbs of the stress system and other indices of physiological hyperarousal, which should adversely affect physical and mental health, we have recently demonstrated that this insomnia phenotype is associated with a significant risk of cardiometabolic and neurocognitive morbidity and mortality. In contrast, insomnia with normal sleep duration is associated with sleep misperception and cognitive-emotional arousal, but not with signs of physiological hyperarousal or cardiometabolic or neurocognitive morbidity. Interestingly, both insomnia phenotypes are associated with mental health, although most likely through different pathophysiological mechanisms. We propose that objective measures of sleep duration may become part of the routine evaluation and diagnosis of insomnia, and that these two insomnia phenotypes may respond differentially to biological versus psychological treatments.
Collapse
Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, 500 University Drive H073, Hershey, PA, 17033, USA,
| | | |
Collapse
|
25
|
Vgontzas AN, Fernandez-Mendoza J. Insomnia with Short Sleep Duration: Nosological, Diagnostic, and Treatment Implications. Sleep Med Clin 2013; 8:309-322. [PMID: 24072989 PMCID: PMC3780422 DOI: 10.1016/j.jsmc.2013.04.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The diagnosis of insomnia is based solely on subjective complaints. This has contributed to the low reliability and validity of the current nosology of insomnia as well as to its lack of firm association with clinically relevant outcomes such as cardiometabolic and neurocognitive morbidity. We review evidence that insomnia with objective short sleep duration is associated with physiological hyperarousal, higher risk for hypertension, diabetes, neurocognitive impairment, and mortality as well as with a persistent course. It also appears that objective short sleep duration in poor sleepers is a biological marker of genetic predisposition to chronic insomnia. In contrast, insomnia with objective normal sleep duration is associated with cognitive-emotional and cortical arousal and sleep misperception but not with signs of physiological hyperarousal or medical complications. Thus, short sleep duration in insomnia may be a reliable marker of the biological severity and medical impact of the disorder. We propose that (a) objective measures of sleep be included in the diagnosis of insomnia and its subtypes, (b) objective measures of sleep obtained in the home environment of the patient would become part of the routine assessment and diagnosis of insomnia in a clinician's office setting, and (c) insomnia with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.
Collapse
Affiliation(s)
- Alexandros N Vgontzas
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | | |
Collapse
|
26
|
St-Jean G, Turcotte I, Pérusse AD, Bastien CH. REM and NREM power spectral analysis on two consecutive nights in psychophysiological and paradoxical insomnia sufferers. Int J Psychophysiol 2013; 89:181-94. [DOI: 10.1016/j.ijpsycho.2013.06.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/15/2022]
|