<p>Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients’ Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives</p>

Abstract

Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.

Insomnia subtypes characterised by objective sleep duration and NREM spectral power and the effect of acute sleep restriction: an exploratory analysis

“…With the acute sleep restriction, we found insomnia SSDD and NSDD not only increased delta power but also showed improvements in several clinical outcomes, such as objective sleep e ciency, subjective sleep quality and sleep misperception. These ndings align with research showing that sleep restriction therapy improves both objective and subjective sleep in insomnia (Fernando III et al, 2013;Galbiati et al, 2019;Miller et al, 2018). Our results support the hypothesis that the impaired homeostatic sleep function in insomnia may be corrected using behavioural treatment, such as sleep restriction, to improve sleep quantity and quality (Cervena et al, 2004).…”

Polysomnographic Predictors of Treatment Response to Cognitive Behavioral Therapy for Insomnia in Participants With Co-morbid Insomnia and Sleep Apnea: Secondary Analysis of a Randomized Controlled Trial

“…Previous studies have investigated the effect of short objective sleep duration (i.e., total sleep time < 6 h) and objective sleep efficiency on treatment-response to CBTi in patients with insomnia ( Bathgate et al, 2017 ; Galbiati et al, 2019 ; Kalmbach et al, 2020 ). It has been postulated that insomnia patients with short objective sleep duration may experience an insomnia phenotype characterized by underlying biological mechanisms, rather than psychological/behavioral mechanisms that may be less responsive to CBTi ( Vgontzas et al, 2013 ).…”

Integrated Screening of Effective Anti-Insomnia Fractions of Zhi-Zi-Hou-Po Decoction via Drosophila melanogaster and Network Pharmacology Analysis of the Underlying Pharmacodynamic Material and Mechanism

“…Insomnia disorder (ID) is defined as a disorder of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. 5 , 6 , 13 The mechanism of insomnia is complicated, particularly concerning brain regions, function, and regulation of the sleep-wake process. Modern medicines deem that a variety of neurotransmitters participate in the regulation of the circadian rhythms, 2 such as γ-aminobutyric acid (GABA), which is well-known for improving sleep disturbances.…”