Exploration of changes in the brain response to sleep-related pictures after cognitive–behavioral therapy for psychophysiological insomnia

Abstract

Psychophysiological insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional magnetic resonance imaging (fMRI). BOLD changes after CBT-I in patients were also examined. PI patients showed higher BOLD activation to SS in the precentral, prefrontal, fusiform, and posterior cingulate cortices before CBT-I. The increased responses to SS were reduced after CBT-I. The increased response to SS in the precentral cortex was associated with longer wake time after sleep onset (WASO), and its reduction after CBT-I was associated with improvements in WASO. Clinical improvements after CBT-I were correlated with BOLD reduction in the right insula and left paracentral cortex in response to SS. PI showed hyper-responses to SS in the precentral cortex, prefrontal cortex, and default mode network and these brain hyper-responses were normalized after CBT-I. CBT-I may exert its treatment effects on PI by reducing hyper-responses to SS in the precentral cortex and insula.

A lack of consistent brain alterations in insomnia disorder: An activation likelihood estimation meta-analysis

“…Paradigm diversity of tasks performed in fMRI experiments in ID include a working memory task, a spatial working memory, letter or category fluency task, a tower of London task, emotional task, and passive viewing tasks (emotional, sleep-related and neutral pictures) (34)(35)(36)(37)(38)(39). The number of experiments with similar tasks was not sufficient to conduct sub-analyses for specific cognitive domains.…”

“…PET studies revealed an altered neural metabolism in the general arousal system including the ascending reticular activating system and hypothalamus, in the emotion-regulating system including the hippocampus, amygdala and ACC, and in the cognitive system including the prefrontal cortex (32,33). Task-based fMRI studies suggested abnormal activation in various regions including the amygdala, temporal lobe, and frontostriatal networks including the caudate nucleus and inferior frontal gyrus (34)(35)(36)(37)(38)(39). Rs-fMRI studies reported abnormal connectivity patterns in ID (40-46) e.g.…”

“…Our screening process yielded 19 studies consisting of 6 task-based fMRI, 8 rs-fMRI, 3 VBM, and 2 PET publications comprising 404 patients with ID and 395 good sleepers (27,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) (Table 1, S1). Recorded data includes the first author's name, year of publication, age, gender, number of subjects, scanning modality, and the peak coordinates (x,y,z) in Talairach (57) or Montreal neurological institute (MNI) (58) stereotactic space.…”

The Instant Spontaneous Neuronal Activity Modulation of Transcutaneous Auricular Vagus Nerve Stimulation on Patients With Primary Insomnia

“…Under normal physiological conditions, the neurological activity of DMN gradually decreases after falling asleep, whereas the DMN of PI patients is still active (Horovitz et al, 2009;Sämann et al, 2011). DMN in insomnia also showed hyper-responses to arousal to sleep-related stimuli of psychophysiological insomnia, and the effective cognitive behavioral therapy (CBT) could reduce the hyper-responses (Kim et al, 2017). Introspection of PI patients can excite DMN, which in turn affects patients' sleep (Marques et al, 2015).…”

Brain response to sleep-related attentional bias after cognitive-behavioral therapy in individuals with insomnia symptoms

“…However, there is a lack of Editorial Brain response to sleep-related attentional bias after cognitivebehavioral therapy in individuals with insomnia symptoms Xiao Nie 1 , Xi-Jian Dai longitudinal study to explore the brain responses to sleeprelated stimuli before and after the CBT for individuals with chronic insomnia symptoms. Recently, Kim et al using a longitudinal data aimed to explore the changes in brain activities in response to visual sleep-related stimuli and neutral stimuli in 14 drug-free psychophysiological insomnia before and after the CBT for insomnia (CBT-I) (20). In their study, psychophysiological insomnia showed higher brain responses to sleeprelated stimuli in several brain areas before the CBT, including the prefrontal lobe, precentral gyrus, fusiform gyrus, and posterior cingulate cortices, whereas these increased responses in brain areas were reduced after the CBT.…”