Insomnia causes, consequences, and therapeutics: An overview

Abstract

There is growing interest in insomnia both from the perspective of recent advances in clinical management as well as research aimed at elucidating its pathophysiology. This theoretical overview of insomnia describes the negative impact, etiological considerations, and pharmacological and behavioral treatments for the disorder, with an emphasis on areas receiving increased research attention. Insomnia, the most prevalent sleep disorder, affects 10-15% of the general population. In population-based studies severe insomnia has been shown to last for a median of 4 years. In addition, insomnia has a significant negative impact on an individual's work, physical, and social performance as well as overall quality of life. Furthermore, the economic cost of insomnia related to lost productivity, work-related accidents, absenteeism, and health-care costs are enormous. There is increasing evidence linking the precipitation of insomnia to stress, and converging evidence from cognitive, endocrine, neurological, and behavioral domains provide clear evidence for hyper-arousal in insomnia. However, there remains no consensus regarding the specific etiological mechanisms of this disorder. Although the pathophysiology of primary insomnia remains an enigma, numerous treatments both pharmacological and behavioral have been developed and found to be efficacious in controlled studies. Despite the wide availability of pharmacological treatments and increased knowledge of behavioral interventions, the vast majority of individuals with insomnia do not appear to be receiving adequate treatment. The inadequate treatment of insomnia leads to several important and under-recognized consequences including subsequent development of psychiatric disease and increased substance use.

Stress-related sleep disturbance and polysomnographic response to caffeine

“…These findings suggest why multiple stressors across an array of categories such as medical or psychiatric disease and psychosocial stress may trigger chronic insomnia in some individuals but not others [31][32][33]. As the current data and other research [25] has suggested, there are specific individual differences responsible for the sleep-response to stress [7,20] and these differences may be markedly important in terms of the longitudinal development of insomnia [21].…”

“…Although there are a number of well established options available for insomnia treatment [7], data regarding the etiology of this disorder remain sparse. However, there is an increasing body of literature regarding the psychological and physiological differences between insomniacs and good sleepers.…”

Association between sleep‐disordered breathing, sleep–wake pattern, and cognitive impairment among patients with chronic heart failure

“…22 The Minimal Insomnia Symptom Scale (MISS) consists of three items focusing on difficulties initiating sleep, difficulties maintaining sleep, and non-restorative sleep. 23,24 The patients grade their difficulties on a scale ranging from no problems (0), to very great problems (4). Using a summation score, insomnia can be subgrouped as no insomnia (0 -3), subclinical insomnia (4 -6), moderate insomnia (7 -9), and severe insomnia (10)(11)(12).…”

Repercussões imunológicas dos distúrbios do sono: o eixo hipotálamo-pituitária-adrenal como fator modulador

“…Stress is considered one of the major triggering factors of insomnia, inasmuch as epidemiologic studies report that primary insomnia patients attribute the onset of the disorder to some stressful event. [43][44][45] Chronic internalization of feelings may cause a psychological and physiological arousal, leading, ultimately, to insomnia. Some authors propose that increased activity of the HPA axis produces sleep fragmentation, which, in turn, elevates circulating levels of cortisol, 46 whereas others 43 believe in the existence of a mechanism of cortical hyperarousal in insomniac patients triggered by emotional, cognitive and physiological components.…”

“…[43][44][45] Chronic internalization of feelings may cause a psychological and physiological arousal, leading, ultimately, to insomnia. Some authors propose that increased activity of the HPA axis produces sleep fragmentation, which, in turn, elevates circulating levels of cortisol, 46 whereas others 43 believe in the existence of a mechanism of cortical hyperarousal in insomniac patients triggered by emotional, cognitive and physiological components. Therefore, the hyperactivity exacerbates vigilance and impacts negatively on sleep, thus forming a vicious circle in which difficulty to sleep becomes the stressful factor itself.…”