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The Nature of Insomnia

Published online by Cambridge University Press:  07 November 2014

Thomas Roth
Thomas Roth*
Affiliation:
Dr. Roth is director of the Sleep Disorders and Research Center at Henry Ford Health System in Detroit, and clinical professor of psychiatry at the, University of Michigan School of Medicine in Ann Arbor
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Abstract

Insomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.

In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

Type
Research Article
Information
CNS Spectrums , Volume 12 , Issue S10 , 2007 , pp. 3 - 5
Copyright
Copyright © Cambridge University Press 2007

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References

1.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
2. American Academy of Sleep Medicine. Available at: http://www.aasmnet.org. Accessed May 30, 2007.Google Scholar
3.Edinger, JD, Bonnet, MH, Bootzin, RR, et al.Derivation of Research Diagnostic Criteria for Insomnia: Report of an American Academy of Sleep Medicine Workgroup. Sleep. 2004;27:1567–1596.CrossRefGoogle Scholar
4.Leshner, A. National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13–15, 2005. Sleep. 2005;28:1049–1057.Google Scholar
5. US Department of Health and Human Services: National Institutes of Health. Available at: www.nih.gov. Accessed June 20, 2007.Google Scholar
6.Foley, D, Ancoli-Israel, S, Britz, P, Walsh, J. Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502.CrossRefGoogle ScholarPubMed
7.Fava, M, McCall, WV, Krystal, A, et al.Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biol Psychiatry. 2006;59(11):1052–1060.CrossRefGoogle ScholarPubMed
8.Nofzinger, EA, Buysse, DJ, Germain, A, Price, JC, Miewald, JM, Kupfer, DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry. 2004;161(11):2126–2128.CrossRefGoogle ScholarPubMed
9.Bonnet, MH, Arand, DL. 24-Hour metabolic rate in insomniacs and matched normal sleepers. Sleep. 1995;18(7):581–588.CrossRefGoogle ScholarPubMed
10.Bonnet, MH, Arand, DL. Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med. 1998;60(5):610–615.CrossRefGoogle ScholarPubMed
11.Perlis, ML, Smith, MT, Andrews, PJ, Orff, H, Giles, DE. Beta/gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls. Sleep. 2001;24:110–117.CrossRefGoogle ScholarPubMed
12.Lushington, K, Dawson, D, Lack, L. Core body temperature is elevated during constant wakefulness in elderly poor sleepers. Sleep. 2000;23(4):504–510.CrossRefGoogle ScholarPubMed
13.Stepanski, E, Zorick, F, Roehrs, T, Young, D, Roth, T. Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep. 1988;11(1):54–60.CrossRefGoogle ScholarPubMed
14.McClure, TK, Drake, CL, Roth, T, Richardson, GS. Sleep and endocrine responses to psychological stress in primary insomnia. Sleep. 2003;26:A311.Google Scholar