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Insomnien – Stand der Forschung

Insomnia – state of the science

Der Nervenarzt volume 85, pages 43–49 (2014)Cite this article

Zusammenfassung

ICD-10 und DSM-IV wurden häufig kritisiert, der Komplexität und Heterogenität von Insomnien nicht gerecht zu werden. Mit der ICSD-2 (International Classification of Sleep Disorders) und den RDC (Research Diagnostic Criteria) konnten besser geeignete diagnostische Systeme etabliert werden. Das vor kurzem veröffentlichte DSM-5 etablierte die Diagnose „insomnia disorder“ (insomnische Störung), wodurch die Dichotomie primäre vs. sekundäre Insomnien aufgegeben wurde. Neue Befunde aus der Grundlagenforschung weisen auf relevante genetische und epigenetische Faktoren bei der Genese von Insomnien hin. Pathophysiologische Modelle werden vom sog. 3-P-Modell („predisposing“, „precipitating“ und „perpetuating“ Faktoren) und dem Hyperarousalkonzept dominiert. Die nichtpharmakologische Insomniebehandlung, insbesondere die kognitiv-verhaltenstherapeutische Behandlung der Insomnien (KVT-I), die durch viele Evidenzen sowohl als kurz- als auch langfristig wirksam bestätigt wurde, sollte als „First-line“-Behandlung akzeptiert werden. Leider besteht jedoch nur für eine Minderheit von Betroffenen wegen mangelnder Ressourcen eine gute Zugangsmöglichkeit zu dieser Behandlungsform. Sogenannte „Stepped-care“-Modelle schlagen zur Lösung dieses Versorgungsproblems Selbsthilfeprogramme, internetbasierte Ansätze, gemeindezentrierte Aktivitäten und erst zuletzt Fachärzte/Psychotherapeuten und Schlafspezialisten als Behandlungsoptionen vor.

Summary

Diagnostic systems such as the international classification of diseases (ICD-10) or the diagnostic and statistical manual of mental disorders (DSM IV) have frequently been criticized as not adequately reflecting the complexity and heterogeneity of insomnia. Progress was made through the introduction of the international classification of sleep disorders (ICSD-2) and the research diagnostic criteria (RDC). The DSM-5 introduced the new category of insomnia disorder, thus relinquishing the traditional dichotomy of primary versus secondary insomnia. Recent basic research indicates that genetic and epigenetic factors are involved in the etiology of insomnia; the so-called three P model (i.e. predisposing, precipitating and perpetuating factors) and the hyperarousal concept have gained much attention in trying to explain the pathophysiology of insomnia. With respect to the cognitive-behavioral therapy of insomnia (CBT-I), a plethora of empirical evidence supports the first-line character of this type of treatment for insomnia. Unfortunately, CBT-I is still administered to only a minority of afflicted patients, probably due to a lack of resources in the healthcare system. As a consequence, stepped-care models to improve insomnia therapy encompass self-help programs, internet-based treatment avenues, community-centered activities (specially trained nurses) and as a last resort medical specialists/psychotherapists and sleep experts to deal with insomnia.

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Literatur

  1. Ohayon M (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6:97–111

    PubMed  Article  Google Scholar 

  2. Hayashino Y, Fukuhara S, Suzukamo Y et al (2007) Relation between sleep quality and quantity, quality of life, and risk of developing diabetes in healthy workers in Japan: the high risk and population strategy for occupational health promotion. BMC Public Health 7:129–137

    PubMed  Article  PubMed Central  Google Scholar 

  3. Sofi F, Cesari F, Casini A et al (im Druck) Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol

  4. Daley M, Morin CM, LeBlanc M et al (2009) The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep 32:55–64

    PubMed  Google Scholar 

  5. Kessler RC, Berglund PA, Coulouvrat C et al (2011) Insomnia and the performance of US workers: results from the America insomnia survey. Sleep 34:1161–1171

    PubMed  Google Scholar 

  6. Benca RM, Obermeyer WH, Thisted RA, Gillin JC (1992) Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry 49:651–668

    CAS  PubMed  Article  Google Scholar 

  7. Riemann D, Berger M, Voderholzer U (2001) Sleep in depression: results from psychobiologic studies. Biol Psychol 57:67–103

    CAS  PubMed  Article  Google Scholar 

  8. Spiegelhalder K, Regen W, Nanovska S et al (2013) Comorbid sleep disorders in neuropsychiatric disorders across the life cycle. Curr Psychiatry Rep 15:364

    PubMed  Article  Google Scholar 

  9. Riemann D, Voderholzer U (2003) Primary insomnia: a risk factor to develop depression? J Affect Disord 76:255–259

    PubMed  Article  Google Scholar 

  10. Baglioni C, Battagliese G, Feige B et al (2011) Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 135:10–19

    PubMed  Article  Google Scholar 

  11. Wulff K, Gatti S, Wettstein JG, Foster RG (2010) Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci 11:1–11

    Article  Google Scholar 

  12. Harvey AG, Murray G, Chandler RA et al (2011) Sleep disturbance as transdiagnostic consideration of neurobiological mechanisms. Clin Psychol Rev 31:225–235

    PubMed  Article  PubMed Central  Google Scholar 

  13. Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262:1479–1484

    CAS  PubMed  Article  Google Scholar 

  14. Perlis ML, Giles DE, Mendelson WB et al (1997) Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 6:179–188

    CAS  PubMed  Article  Google Scholar 

  15. Riemann D, Spiegelhalder K, Feige B et al (2010) The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev 14:19–31

    PubMed  Article  Google Scholar 

  16. Ellis J, Gehrmann P, Espie C et al (2012) Acute insomnia: current conceptualizations and future directions. Sleep Med Rev 16:5–14

    PubMed  Article  Google Scholar 

  17. Baglioni C, Spiegelhalder K, Nissen C, Riemann D (2013) Future directions in insomnia diagnosis and treatment. In: Kushida C (Hrsg) Encyclopedia of sleep, Bd 2. S 354–361

  18. Baglioni C, Spiegelhalder K, Nissen C et al (2013) Insomnische Störungen. Herausforderungen und offene Fragen. Somnologie 17:6–14

    Article  Google Scholar 

  19. Riemann D, Spiegelhalder K, Espie CA et al (2011) Chronic insomnia: clinical and research challenges – an agenda. Pharmacopsychiatry 44:1–14

    CAS  PubMed  Article  Google Scholar 

  20. WHO (1999) ICD-10: Internationale Klassifikation psychischer Störungen, 3. Aufl. Hans Huber, Bern

  21. AASM (American Academy of Sleep Medicine) (2005) International classification of sleep disorders, 2. Aufl. Westchester, Il

  22. Edinger JD, Bonnet MH, Bootzin RR et al (2004) Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 27:1567–1596

    PubMed  Google Scholar 

  23. Riemann D (2007) Insomnia and comorbid psychiatric disorders. Sleep Med 4:S15–S20

    Article  Google Scholar 

  24. Lichstein K (2006) Secondary insomnia: a myth dismissed. Sleep Med Rev 10:3–5

    PubMed  Article  Google Scholar 

  25. Riemann D (2009) Does effective management of sleep disorders reduce depressive symptoms and the risk of depression? Drugs 69:43–64

    CAS  PubMed  Article  Google Scholar 

  26. NIH (2005) National Institutes of Health State of the Science Conference Statement. Manifestations and management of chronic insomnia in adults. Sleep 28:1049–1057

    Google Scholar 

  27. APA (2013) Diagnostic and statistical manual of mental disorders – fifth editon. DSM-5. American Psychiatric Publishing, Washington

  28. Insel T (2013) NIMH research domain criteria (RDoC). http://www.nimh.nih.gov/research-priorities/rdoc/

  29. Pollmächer T, Wetter TC, Happe S et al (2014) Schlafmedizinische Differenzialdiagnostik in Psychiatrie und Psychotherapie. Nervenarzt

  30. Riemann D, Hajak G (2009) Insomnien: Ätiologie, Pathophysiologie und Diagnostik. Nervenarzt 9:1060–1069

    Article  Google Scholar 

  31. Mayer G, Fietze I, Fischer J et al (2009) S3-Leitlinie Nicht-erholsamer Schlaf/Schlafstörungen. Somnologie 13(Suppl 1):1–160

    Google Scholar 

  32. Riemann D (2012) Insomnia research is coming of age. Sleep 35:175

    PubMed  Google Scholar 

  33. Carney CE, Buysse DJ, Ancoli-Israel S et al (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35:287–302

    PubMed  Google Scholar 

  34. Kushida CA, Littner M, Morgenthaler T et al (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28:499–521

    PubMed  Google Scholar 

  35. Feige B, Al-Shajlawi A, Nissen C et al (2008) Does REM sleep contribute to subjective wake time in primary insomnia? A comparison of polysomnographic and subjective sleep in 100 patients. J Sleep Res 17:180–190

    PubMed  Article  Google Scholar 

  36. Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO (2013) Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev 17:241–254

    PubMed  Article  Google Scholar 

  37. Baglioni C, Regen W, Tehgen A et al (im Druck) Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies. Sleep Med Rev

  38. Palagini L, Biber K, Riemann D (im Druck) The genetics of insomnia – evidence for epigenetic mechanisms? Sleep Med Rev

  39. Revel FG, Gottowik J, Gatti S et al (2009) Rodent models of insomnia: a review of experimental procedures that induce sleep disturbances. Neurosci Biobehav Rev 33:874–899

    PubMed  Article  Google Scholar 

  40. Cano G, Mochizuki T, Saper CB (2008) Neural circuitry of stress-induced insomnia in rats. J Neurosci 28:10167–10184

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  41. Spielman AJ, Caruso LS, Glovinsky PB (1987) A behavioral perspective on insom nia treatment. Psychiatr Clin North Am 10:541–553

    CAS  PubMed  Google Scholar 

  42. Spielman AJ, Shaskin P, Thorpy M (1987) Treatment of insomnia by restriction of time in bed. Sleep 10:45–56

    CAS  PubMed  Google Scholar 

  43. Morin CM (1993) Insomnia. Guildford Press, New York

  44. Harvey A, Tang NK, Browning L (2005) Cognitive approaches to insomnia. Clin Psychol Rev 25:593–611

    PubMed  Article  Google Scholar 

  45. Espie CA, Broomfield NM, MacMahon KM et al (2006) The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review. Sleep Med Rev 10:215–245

    PubMed  Article  Google Scholar 

  46. Spiegelhalder K, Kyle SD, Feige B et al (2010) The impact of sleep-related attentional bias on polysomnographically measured sleep in primary insomnia. Sleep 33:107–112

    PubMed  Google Scholar 

  47. Spiegelhalder K, Fuchs L, Ladwig J et al (2011) Heart rate and heart rate variability in subjectively reported insomnia. J Sleep Res 20:137–145

    PubMed  Article  Google Scholar 

  48. Spiegelhalder K, Regen W, Feige B et al (2012) Increased EEG sigma and beta power during NREM sleep in primary insomnia. Biol Psychol 91:329–333

    PubMed  Article  Google Scholar 

  49. Feige B, Baglioni C, Spiegelhalder K et al (2013) The microstructure of sleep in primary insomnia: a review and new data. Int J Psychophysiol 89:171–180

    PubMed  Article  Google Scholar 

  50. Riemann D, Spiegelhalder K, Nissen C et al (2012) REM sleep instability – a new pathway for insomnia? Pharmacopsychiatry 45:167–176

    CAS  PubMed  Google Scholar 

  51. Nofzinger EA, Buysse DJ, Germain A et al (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161:2126–2129

    PubMed  Article  Google Scholar 

  52. Riemann D, Voderholzer U, Spiegelhalder K et al (2007) Chronic insomnia and MRI-measured hippocampal volumes: a pilot study. Sleep 30:955–958

    PubMed  Google Scholar 

  53. Spiegelhalder K, Regen W, Baglioni C et al (2013) Insomnia does not appear to be associated with substantial structural brain changes. Sleep 36:713–737

    Google Scholar 

  54. Spiegelhalder K, Regen W, Prem M et al (2013) Reduced anterior internal capsule white matter integrity in primary insomnia. Hum Brain Mapp (im Druck)

  55. Baglioni C, Spiegelhalder K, Regen W et al (2013) Primary insomnia is associated with amygdala alterations – a possible link to psychopathology? (eingereicht)

  56. Nissen C, Frase L, G. Hajak, Wetter TC (2014) Hypnotika – Stand der Forschung. Nervenarzt

  57. Riemann D, Perlis ML (2009) The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev 13:205–214

    PubMed  Article  Google Scholar 

  58. Spiegelhalder K, Backhaus J, Riemann D (2011) Schlafstörungen – Fortschritte der Psychotherapie. Hogrefe, Göttingen

  59. Espie C (2009) Stepped care: a health technology solution for delivering cognitive behavioral therapy as a first line treatment for insomnia. Sleep 32:1549–1558

    PubMed  Google Scholar 

  60. Ritterband LM, Thorndike FP, Gonder-Frederick LA et al (2009) Efficacy of an internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry 66:692–698

    PubMed  Article  PubMed Central  Google Scholar 

  61. Espie CA, Kyle SD, Williams C et al (2012) A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep 35:769–781

    PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Riemann, C. Baglioni, B. Feige und K. Spiegelhalder geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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  1. Abteilung für Klinische Psychologie und Psychophysiologie/Schlafmedizin der Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland

    D. Riemann, C. Baglioni, B. Feige & K. Spiegelhalder

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  1. D. Riemann
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  2. C. Baglioni
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  3. B. Feige
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  4. K. Spiegelhalder
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Correspondence to D. Riemann.

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Riemann, D., Baglioni, C., Feige, B. et al. Insomnien – Stand der Forschung. Nervenarzt 85, 43–49 (2014). https://doi.org/10.1007/s00115-013-3892-7

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Schlüsselwörter

  • Insomnie
  • Genetik
  • Pathophysiologie
  • Hyperarousal
  • Kognitiv-verhaltenstherapeutische Therapie der Insomnie (KVT-I)

Keywords

  • Insomnia
  • Genetics
  • Pathophysiology
  • Hyperarousal
  • Cognitive behavioral treatment for insomnia (CBT-I)