Insomnia: psychological and neurobiological aspects and non-pharmacological treatments

Abstract

The word insomnia may signify -both for patients and for many physicians, merely the difficulty in falling asleep and a disorder of sleep loss. However, besides the patient's experiencing difficulty in initiating or maintaining sleep and poor quality of sleep, even with adequate opportunity and time, he also faces daytime impairment: fatigue, decreased concentration, attention or memory, low academic productivity, functional or professional impairment, besides mood disturbances or irritability, greater work absenteeism, decreased motivation, energy or initiative, tendency to errors and accidents at work or while driving, tension and worries about sleep. Despite these many manifestations promoting nega tive consequences on quality of life, there is still little disse mination of the knowledge about the impact of insomnia on the body of the patient, as there are no longer any doubts as to homeostatic changes related to insomnia, including increased mortality 1 . Much is already known about the mechanisms of insomnia, with great scientific interest in identifying its neurobiological basis since the interaction between psychological states and metabolic and structural transformations of the nervous system is already widely accepted. As vast literature on insomnia approaches it in psychological, phy siological and neurobiological terms, in this article the rational basis of various concepts of insomnia are reviewed in order to better understand it.At the same time, the interventions available for non pharmacological treatment are presented along with the ABSTRACTInsomnia involves difficulty in falling asleep, maintaining sleep or having refreshing sleep. This review gathers the existing informations seeking to explain insomnia, including those that focus on psychological aspects and those considered neurobiological. Insomnia has been defined in psychological (cognitive components, such as worries and rumination, and behavioral aspects, such as classic conditioning) and physiological terms (increased metabolic rate, with increased muscle tone, heart rate and temperature). From the neurobiological point of view, there are two perspectives: one which proposes that insomnia occurs in association with a failure to inhibit wakefulness and another that considers hyperarousal as having an important role in the physiology of sleep. The non-pharmacological interventions developed to face different aspects of insomnia are presented.Keywords: insomnia, worry, attention-intention-effort pathway, hyperarousal, non-pharmacological treatment. RESUMOInsônia é um transtorno que envolve dificuldade em dormir, em manter-se dormindo ou em ter um sono restaurador. Esta revisão reúne informações que buscam explicar a insônia, incluindo aquelas que estudam os aspectos psicológicos e os neurobiológicos. A insônia tem sido definida em termos psicológicos (componentes cognitivos, tais como preocupações e ruminação e aspectos comportamentais, tais como o condicionamento clássico) e em termos fisiológicos (taxa metabólica aumentada, com tônus m...

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