Indian Journal of Sleep Medicine

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VOLUME 9 , ISSUE 1 ( January-March, 2014 ) > List of Articles


Insight into the pathophysiology of insomnia

Deepak Shrivastava

Citation Information : Shrivastava D. Insight into the pathophysiology of insomnia. Indian Sleep Med 2014; 9 (1):7-10.

DOI: 10.5958/0974-0155.2014.01099.7

License: CC BY-SA 4.0

Published Online: 01-03-2018

Copyright Statement:  Copyright © 2014; The Author(s).


Insomnia is a major public health hazard. Complexity of insomnia patho-physiology is intriguing and is an exciting subject of inquiry. The current article summarizes the recent developments in our understanding of insomnia. Although the early models of insomnia were unidirectional, they provided foundation for development of more integrative models. Sleep- wake regulation and more specifically conceptual understanding of sleep homeostasis, circadian influence, and hyperarousal further added new dimensions to our understanding of insomnia. However, there is more appreciation than ever of the fact that a lot more work must be done before even thinking about finding a conclusive evidence of what causes insomnia and what maintains it. Some of the legendary work is cited in the reference section to develop an understanding of intricate interplay of multiple systems within the body that cause sleep and lack of it.

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  1. Spielman A, Yang CM, Glovinsky PB. Assessment techniques for insomnia. In: Kryger M, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders; 2011. pp. 1631–1645.
  2. Perlis ML, Shaw PJ, Cano G, Espie CA. Models of insomnia. In: Kryger M, Roth T, Dement WC, editors. Principles and Practice of Sleep Medicine. Philadelphia: WB Saunders; 2011.
  3. Morin CM, Espie CA. Insomnia: A Clinical Guide to Assessment and Treatment. New York: Kluwer Academic/ Plenum Press; 2003.
  4. Epstein DR, Sidani S, Bootzin RR, Belyea MJ. Dismantling multicomponent behavioral treatment for insomnia in older adults: A randomized controlled trial. Sleep 2012;35:797– 805.
  5. Harris J, Lack L, Kemp K, Wright H, Bootzin R. A randomized controlled trial of intensive sleep retraining (ISR): A brief conditioning treatment for chronic insomnia. Sleep 2012;35:49–60.
  6. Vgontzas AN, Tsigos C, Bixler EO, et al. Chronic insomnia and activity of the stress system: a preliminary study. J Psychosom Res 1998;45(1):21–31.
  7. Vgontzas AN, Zoumakis M, Papanicolaou DA, et al. Chronic insomnia is associated with a shift of interleukin-6 and tumor necrosis factor secretion from nighttime to daytime. Metabolism 2002;51:887–892.
  8. Riemann D, Klein T, Rodenbeck A, et al. Nocturnal cortisol and melatonin secretion in primary insomnia. Psychiatry Res 2002;113(1–2):17–27.
  9. Perlis ML, Giles DE, Mendelson WB, Bootzin RR, Wyatt JK. Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 1997;6:179– 188.
  10. Espie CA, Broomfield NM, MacMahon KMA, Macphee LM, Taylor LM. The attention-intention effort pathway in the development of psycho-physiologic insomnia: An invited theoretical review. Sleep Med Rev 2006;10:215–245.
  11. Saper CB, Chou TC, Scammell TE. The sleep switch: Hypothalamic control of sleep and wakefulness. Trends Neurosci 2001;24:726–731.
  12. Krueger JM, Rector DM, Roy S, Van Dongen HP, Belenky G, Panksepp J. Sleep as a fundamental property of neuronal assemblies. Nat Rev Neurosci 2008;9:910–919.
  13. Seugnet L, Suzuki Y, Thimgan M, et al. Identifying sleep regulatory genes using a Drosophila model of insomnia. J Neurosci 2009;29:7148–7157.
  14. Cano G, Mochizuki T, Saper CB. Neural circuitry of stressinduced insomnia in rats. J Neurosci 2008;28:10167– 10184.
  15. Hamet P, Tremblay J. Genetics of the sleep-wake cycle and its disorders. Metabolism 2006;55(suppl 2):S7–S12.
  16. Gehrman PR, Meltzer LJ, Moore M, et al. Heritability of insomnia symptoms in youth and their relationship to depression and anxiety. Sleep 2011;34:1641–1646.
  17. Drake CL, Friedman NP, Wright KP, Roth T. Sleep reactivity and insomnia: Genetic and environmental influences. Sleep 2011;34:1179–1188.
  18. Corsi-Cabrera M, Figueredo-Rodriguez P, Rio-Portilla Y, Sánchez-Romero J, Galán L, Bosch-Bayard J. Enhanced frontoparietal synchronized activation during the wake-sleep transition in patients with primary insomnia. Sleep 2012;35:501–511.
  19. Riemann D, Spiegelhalder K, Nissen C, Hirscher V, Baglioni C, Feige B. REM sleep instability: A new pathway for insomnia? Pharmacopsychiatry 2012;45:167–176.
  20. Chen HY, Cheng IC, Pan YJ, et al. Cognitive-behavioral therapy for sleep disturbance decreases inflammatory cytokines and oxidative stress in hemodialysis patients. Kidney Int 2011;80:415–422.
  21. Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clin Psychol Rev 2011;31:225–235.
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