The Pathophysiology of Insomnia

Levenson, Jessica C.; Kay, Daniel B.; Buysse, Daniel J.

doi:10.1378/chest.14-1617

Cited by 280 publications

(193 citation statements)

References 128 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“…It still needs to be clarified what is the extent of overlap between insomnia that develops in this context and insomnia that develops in the context of other life events. As previously published by our group, women with perimenopausal insomnia are more neurotic and have higher levels of subclinical depression, and have increased REM sleep beta EEG power compared with controls (Baker et al, 2015; Sassoon et al, 2014), similar to findings for insomnia in other populations (Levenson et al, 2015; Riemann et al, 2015; van de Laar et al, 2010). Data presented here suggest that a stress challenge reveals underlying differences in responsivity in both the autonomic and central nervous systems in perimenopausal women with insomnia that are not apparent under baseline conditions.…”

Section: Discussionsupporting

confidence: 88%

“…Stress exposure at baseline is a significant predictor of insomnia one year later, particularly in individuals with high sleep reactivity (more likely to have difficulty sleeping in stressful situations, such as before an important meeting the following day), an effect mediated by the extent of cognitive intrusion elicited by the stress exposure (Drake et al, 2014). Insomnia that develops in response to stress could be related to underlying levels of chronic hyperarousal (Bonnet and Arand, 2003), a core feature of the hyperarousal model of insomnia, indexed by increased heart rate, presleep cognitive arousal, sympathetic activity, and brain activation (reviewed in (Levenson et al, 2015; Riemann et al, 2015). While individuals with insomnia in the general population may not necessarily experience more frequent stressful life events, they perceive the impact of these events more negatively and consider their lives to be more stressful compared with good sleepers, with the pathway between daily stress and poor sleep being mediated by high levels of pre-sleep arousal (Morin et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Acute stress alters autonomic modulation during sleep in women approaching menopause

Zambotti

Sugarbaker

Trinder

et al. 2016

Psychoneuroendocrinology

View full text Add to dashboard Cite

Hot flashes, hormones, and psychosocial factors contribute to insomnia risk in the context of the menopausal transition. Stress is a well-recognized factor implicated in the pathophysiology of insomnia; however the impact of stress on sleep and sleep-related processes in perimenopausal women remains largely unknown. We investigated the effect of an acute experimental stress (impending Trier Social Stress Task in the morning) on presleep measures of cortisol and autonomic arousal in perimenopausal women with and without insomnia that developed in the context of the menopausal transition. In addition, we assessed the macro- and micro-structure of sleep and autonomic functioning during sleep. Following adaptation to the laboratory, twenty two women with (age: 50.4 ± 3.2 y) and eighteen women without (age: 48.5±2.3 y) insomnia had two randomized in-lab overnight recordings: baseline and stress nights. Anticipation of the task resulted in higher pre-sleep salivary cortisol levels and perceived tension, faster heart rate and lower vagal activity, based on heart rate variability measures, in both groups of women. The effect of the stress manipulation on the autonomic nervous system extended into the first four hours of the night in both groups. However, vagal tone recovered four-six hours into the stress night in controls but not in the insomnia group. Sleep macrostructure was largely unaltered by the stress, apart from a delayed latency to REM sleep in both groups. Quantitative analysis of non-rapid eye movement sleep microstructure revealed greater electroencephalographic (EEG) power in the beta1 range (15-≤23Hz), reflecting greater EEG arousal during sleep, on the stress night compared to baseline, in the insomnia group. Hot flash frequency remained similar on both nights for both groups. These results show that presleep stress impacts autonomic nervous system functioning before and during sleep in perimenopausal women with and without insomnia. Findings also indicate that women with insomnia had increased EEG arousal and lacked recovery in vagal activity across the stress night suggesting a greater sensitivity to stress in this group.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Acute stress alters autonomic modulation during sleep in women approaching menopause

Zambotti

Sugarbaker

Trinder

et al. 2016

Psychoneuroendocrinology

View full text Add to dashboard Cite

show abstract

“…In addition, we found no evidence that interpersonal distress, lower-level executive functioning, distress associated psychical health, nor benzodiazepine use might explain the association between insomnia and suicidal behavior. Thus, there is a need to explore other behavioral and biological mechanisms through which insomnia may increase the risk for suicide including dysfunction in cognitive domains (i.e., autobiographical memory, problem solving, and working memory)(reviewed in Fortier-Brochu et a., 2012) and neural circuitries, including brain regions (i.e., prefrontal cortex, cingulate cortex, precuneus, and medial temporal cortex)(reviewed in Levenson et al, 2015) associated with insomnia.…”

Section: Discussionmentioning

confidence: 99%

Insomnia is associated with suicide attempt in middle-aged and older adults with depression

Kay

Dombrovski

Buysse

et al. 2015

Int. Psychogeriatr.

Self Cite

View full text Add to dashboard Cite

Background Insomnia increases in prevalence with age, is strongly associated with depression, and has been identified as a risk factor for suicide in several studies. The aim of this study was to determine whether insomnia severity varies between those who have attempted suicide (n = 72), those who only contemplate suicide (n = 28), and those who are depressed but have no suicidal ideation or attempt history (n = 35). Methods Participants were middle-aged and older adults (Age 44–87, M = 66 years) with depression. Insomnia severity was measured as the sum of the early, middle, and late insomnia items from the Hamilton Rating Scale for Depression. General linear models examined relations between group status as the independent variable and insomnia severity as the dependent variable. Results The suicide attempt group suffered from more severe insomnia than the suicidal ideation and non-suicidal depressed groups (p < .05). Differences remained after adjusting for potential confounders including demographics, cognitive ability, alcohol dependence in the past month, severity of depressed mood, anxiety, and physical health burden. Moreover, greater insomnia severity in the suicide attempt group could not be explained by interpersonal difficulties, executive functioning, benzodiazepine use, or by the presence of post-traumatic stress disorder. Conclusion Our results suggest that insomnia may be more strongly associated with suicidal behavior than with the presence of suicidal thoughts alone. Accordingly, insomnia is a potential treatment target for reducing suicide risk in middle-aged and older adults.

show abstract

“…Early work hypothesized that insomnia was an internalization of emotional arousal [81–85] and recent research has focused on two lines of inquiry: cognitive arousal and increased somatic/physiological arousal. The theory of cognitive arousal hypothesizes that increased cognitive activity (thinking and worrying while trying to fall asleep) prevents the initiation of the sleep process [82, 84, 85]. The theory of physiological arousal posits that there is greater activation of the sympathetic nervous system in patients with insomnia compared to good sleepers [86].…”

Section: What Are the Hypotheses For The High Prevalence Of Insomniamentioning

confidence: 99%

Sleep in Children with Autism Spectrum Disorder

Souders

Zavodny

Eriksen

et al. 2017

Curr Psychiatry Rep

201

143

View full text Add to dashboard Cite

The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.

show abstract

The Pathophysiology of Insomnia

Cited by 280 publications

References 128 publications

Acute stress alters autonomic modulation during sleep in women approaching menopause

Acute stress alters autonomic modulation during sleep in women approaching menopause

Insomnia is associated with suicide attempt in middle-aged and older adults with depression

Sleep in Children with Autism Spectrum Disorder

Contact Info

Product

Resources

About