Insomnia—perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia

Feige, Bernd; Nanovska, Svetoslava; Baglioni, Chiara; Bier, Benedict; Cabrera, Laura Y.; Diemers, Sarah; Quellmalz, Maximilian; Siegel, Markus; Xeni, Ireni; Szentkirályi, András; Doerr, John Peter; Riemann, Dieter

doi:10.1093/sleep/zsy032

Cited by 53 publications

(92 citation statements)

References 65 publications

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“…Notably, sleep physiology research shows that insomniacs have fragmented REM sleep (Feige et al., , ; Riemann et al., ), and a recent study showed that a pre‐sleep negative affect induction task increased the number of awakenings during REM sleep (Vandekerckhove & Cluydts, ). Subjective reports are consistent with these sleep physiology findings, such that insomniacs report REM sleep mentation as more wake‐like and emotionally negative than good sleepers (Feige et al., ). Riemann's team presented these findings in the context of highlighting REM instability (i.e.…”

Section: The Neurobiology Of Sleep Reactivitymentioning

confidence: 64%

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

Kalmbach

Anderson

Drake

2018

Journal of Sleep Research

330

224

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Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.

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Section: The Neurobiology Of Sleep Reactivitymentioning

confidence: 64%

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

Kalmbach

Anderson

Drake

2018

Journal of Sleep Research

330

224

View full text Add to dashboard Cite

show abstract

“…Cell body-specific striatal lesions of the rostral striatum induce profound sleep fragmentation, which is highly characteristic of insomnia 45,49 . As discussed more extensively in the Supplementary Note, fragmented REM sleep is highly characteristic of insomnia and related to the ongoing thought-like mental content that makes patients with insomnia underestimate sleep duration [50][51][52] .…”

Section: Discussionmentioning

confidence: 99%

Genome-wide analysis of insomnia in 1,331,010 individuals identifies new risk loci and functional pathways

et al. 2019

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“…EEG microstate analysis may serve as a valuable paradigm for future investigations on nocturnal mentation in ID. Previous studies have shown that insomnia severity is associated with the frequency of thought-like nocturnal mentation ( 57 ) which might be experienced as wakefulness ( 58 ). It is still unclear, however, whether (and how) distinct nocturnal thought content contributes differentially to the experience of insomnia ( 59 , 60 ).…”

Section: Discussionmentioning

confidence: 99%

EEG Microstates Indicate Heightened Somatic Awareness in Insomnia: Toward Objective Assessment of Subjective Mental Content

et al. 2018

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People with Insomnia Disorder (ID) not only experience abundant nocturnal mentation, but also report altered spontaneous mental content during daytime wakefulness, such as an increase in bodily experiences (heightened somatic awareness). Previous studies have shown that resting-state EEG can be temporally partitioned into quasi-stable microstates, and that these microstates form a small number of canonical classes that are consistent across people. Furthermore, the microstate classes have been associated with individual differences in resting mental content including somatic awareness. To address the hypothesis that altered resting mental content in ID would be reflected in an altered representation of the corresponding EEG microstates, we analyzed resting-state high-density EEG of 32 people with ID and 32 age- and sex-matched controls assessed during 5-min eyes-closed wakefulness. Using data-driven topographical k-means clustering, we found that 5 microstate classes optimally explained the EEG scalp voltage map sequences across participants. For each microstate class, 3 dynamic features were obtained: mean duration, frequency of occurrence, and proportional coverage time. People with ID had a shorter mean duration of class C microstates, and more frequent occurrence of class D microstates. The finding is consistent with previously established associations of these microstate properties with somatic awareness, and increased somatic awareness in ID. EEG microstate assessment could provide objective markers of subjective experience dimensions in studies on consciousness during the transition between wake and sleep, when self-report is not possible because it would interfere with the very process under study. Addressing somatic awareness may benefit psychotherapeutic treatment of insomnia.

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Insomnia—perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia

Cited by 53 publications

References 65 publications

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

Genome-wide analysis of insomnia in 1,331,010 individuals identifies new risk loci and functional pathways

EEG Microstates Indicate Heightened Somatic Awareness in Insomnia: Toward Objective Assessment of Subjective Mental Content

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