Physiological Basis of Insomnia
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Forty years of psychophysiological research have shown that patients with primary insomnia have elevated levels of physiological arousal as indicated by a wide range of variables including brain and whole-body metabolic measures, cardiac measures, and hormone and endocrine measures. Current research has attempted to refine our understanding of the relationship between physiological arousal, poor EEG sleep, psychological status, and subjective report of insomnia. Experimentally induced chronic physiological arousal in normal adults produces mood and personality changes seen in insomnia patients and therefore provides a model of how chronic insomnia could develop in physiologically susceptible individuals. Studies showing that poor sleep, as found in insomnia patients, by itself does not produce the arousal, mood, and personality characteristics found in clinical insomnia and imply that (1) the symptoms produced by chronic physiological arousal are not mediated by the poor sleep itself and (2) the symptom complex associated with psychophysiological insomnia is not really a sleep disorder but rather an arousal disorder. Finally, the importance of physiological arousal as the harbinger of insomnia has been enhanced by the finding that normal adults with no reported sleep disorder who were found to have EEG-defined situational insomnia also had elevated heart rate and cardiac spectral activity – an indication of predisposition to the later development of insomnia. In total, such studies show the primary importance of physiological activation as the harbinger of both the poor sleep and subjective dysphoria that characterize primary insomnia.
KeywordsInsomnia Physiology Metabolic rate Heart rate Sympathetic nervous system
Supported by the Dayton Department of Veterans Affairs Medical Center, Wright State University School of Medicine, and the Sleep-Wake Disorders Research Institute.
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