Elsevier

Sleep Medicine

Volume 14, Supplement 1, December 2013, Pages e240-e241
Sleep Medicine

Hyperarousal in insomnia

https://doi.org/10.1016/j.sleep.2013.11.581Get rights and content

Introduction

Insomnia is a common sleep disorder in the world, studies show that has been associated with affective disorders. The hyperarousal state associated with primary insomnia is usually present throughout wakefulness and during sleep, and may be due to an increase in activity of ascending reticular activating system or a reduction in the adaptive drive to sleep. Objectives: analyse the association between insomnia and hyperarousal.

Materials and methods

Retrospective study in a sleep medicine unit, 55 patients (27 men’s and 28 woman’s) age between 17 and 84 (57, 2 years old) with a primary diagnosis of insomnia without medication were included. Insomnia diagnosis was defined by ICSD2. In the polysomnography (PSG) objective insomnia was defined by: sleep onset latency longer than 30 min (sleep onset insomnia), wake after sleep onset lasting more than 30 min (sleep maintenance insomnia), total sleep time shorter than 360 min and a terminal wakefulness longer than 30 min (insomnia with too short duration or early morning awakening) or a combination of previous quantitative criteria (mixed type insomnia). The hyperarousal state was defined by index 14/hour of arousal spontaneous index in no REM sleep (ANREM). Association between depressive and anxiety symptoms was determined by a cut-off 50 in each by zung test and compare the PSG of patients who had normal zung test, insomnia severity index (ISI) 15 has defined as clinical insomnia moderate or severe.

Results

Patient with comorbidity anxiety and depression (81%) were categorized and 19% without mood disorders. 28% of the patients had sleep onset insomnia, 22% sleep maintenance insomnia, 28% insomnia with too short duration or early morning aweking and 22% mixed type insomnia. Of all patients 78% had hyperarousal state, the arousal spontaneous index in no REM sleep was 28.4 per hour (0.8–71). The correlation coefficients were significant between ANREM and anxiety (P < 0.05), and not significant in depression. The ANREM was significant higher in patients with mood disorder compare with other patients (P < 0.001) and depression have a significant correlation with an increase of REM sleep. ISI found 94% of all patients had clinical insomnia moderate or severe.

Conclusion

There are electrophysiological evidence of hyperarousal and anxiety in patients with primary insomnia. This suggests that the hyperarousal disorder underlying this condition affects both sleep and wake-fullness.

Acknowledgement

Hospital La Princesa, Almevan, Circadin.

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