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Insomnia: Neurophysiological and NeuropsychologicalApproaches

Abstract

Insomnia is a symptom, a syndrome and a comorbid disorder. Its diagnosis relies on subjective reports from the afflicted individual and is defined as difficulties in initiating sleep, maintaining sleep, waking up too early or non-restorative sleep. However, insomnia and especially, primary insomnia, has received much attention in insomnia research with the use of objective measures. Insomnia, its peculiarities, most frequent subtypes and two most prominent models will first be briefly introduced. Then, insomnia will be reviewed according to results obtained with the use of neurophysiological measures as basic/traditional as polysomnography to more sophisticated ones such as power spectral analysis, neuroimaging, cyclic alternating patterns and event-related potentials. In addition, a review of the discrepancies between subjective and objective reports of cognitive alterations through neuropsychological testing is offered. The need to combine measures is then highlighted in conclusion.

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Abbreviations

APA:

American Psychiatric Association

ARAS:

Ascending Reticular Activating System

BZD (BZDs):

Benzodiazepine (Benzodiazepines)

CAP:

Cyclic Alternating Pattern

CBT-I:

Cognitive-Behavioral Therapy for Insomnia

CNS:

Central Nervous System

EEG:

Electroencephalogram

EKG:

Electrocardiogram

EMG:

Electromyogram

EOG:

Electrooculogram

ERPs:

Event-Related Potentials

FFT:

Fast Fourier Transforms

fMRI:

Functional Magnetic Resonance Imaging

GABA:

Gamma-aminobutyric acid

LORETA:

Low Resolution Electromagnetic Tomography Analysis

N100 (N1):

Negative wave peaking at about 100 ms after stimulus onset

N350:

Negative wave peaking at about 350 ms after stimulus onset

NCAP:

Non-Cyclic Alternating Pattern

NREM:

Non Rapid Eye Movement

P50:

Positive wave peaking at about 50 ms after stimulus onset

P200 (P2):

Positive wave peaking at about 200 ms after stimulus onset

P300 (P3):

Positive wave peaking at about 300 ms after stimulus onset

PET:

Positron Emission Tomography

PSA:

Power Spectral Analysis

PSG:

Polysomnography

REM:

Rapid Eye Movement

SPECT:

Single-Photon-EmissionComputed Tomography

SWA:

Slow Wave Activity

SWS:

Slow Wave Sleep

TMS:

Transcranial Magnetic Stimulation

References

  • Altena, E., Van Der Merf, Y. D., Strijers, R. J., & Van Someren, E. J. W. (2008). Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. Journal of Sleep Research, 17(3), 335–343.

    PubMed  Google Scholar 

  • Altena, E., Van Der Merf, Y. D., Sanz-Arigita, E. J., Voorn, T. A., Rombouts, S. A., Kuijer, J. P., et al. (2008). Prefrontal hypoactivation and recovery in insomnia. Sleep, 31(9), 1271–1276.

    PubMed  Google Scholar 

  • American Academy of Sleep Medicine. (2005). International classification of sleep disorders: Diagnostic and coding manual (2nd ed.). Westchester: American Academy of Sleep Medicine.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. Fourth Edition, Text Revision (DSM-IV-TR). Washington: American Psychiatric Association.

    Google Scholar 

  • Backhaus, J., Junghanns, K., Born, J., Hohaus, K., Faasch, F., & Hohagen, F. (2006). Impaired declarative memory consolidation during sleep in patients with primary insomnia: influence of sleep architecture and nocturnal cortisol release. Biological Psychiatry, 60, 1324–1330.

    CAS  PubMed  Google Scholar 

  • Bastien, C. H. (2008). ERP measures during wakefulness and sleep-onset in psychophysiological and paradoxical insomnia sufferers. Journal of Sleep Research, 17(Suppl. 1), 235.

    Google Scholar 

  • Bastien, C. H., Fortier-Brochu, E., Rioux, I., LeBlanc, M., Daley, M., & Morin, C. M. (2003). Cognitive performance and sleep quality in elderly suffering of chronic insomnia: relations between objective and subjective measures. Journal of Psychosomatic Research, 54(1), 39–49.

    PubMed  Google Scholar 

  • Bastien, C. H., Leblanc, M., Carrier, J., & Morin, C. M. (2003). Sleep EEG power spectra insomnia and chronic use of benzodiazepines. Sleep, 26(3), 313–317.

    PubMed  Google Scholar 

  • Bastien, C. H., Vallières, A., & Morin, C. M. (2004). Precipitating factors of insomnia. Behavioral Sleep Medicine, 2(1), 50–62.

    PubMed  Google Scholar 

  • Bastien, C. H., Guimond, S., Lemelin, S., St-Jean, G., & Turcotte, I. (2008a). Signs of insomnia in borderline personality individuals. Journal of Clinical Sleep Medicine, 4(5), 462–470.

    PubMed  Google Scholar 

  • Bastien, C. H., St-Jean, G., Turcotte, I., Morin, C. M., & Carrier, J. (2008b). Chronic psychophysiological insomnia: hyperarousal and/or inhibition deficits? An ERPs investigation. Sleep, 31(6), 887–898.

    PubMed  Google Scholar 

  • Bastien, C. H., St-Jean, G., Turcotte, I., Morin, C. M., Lavallée, M., & Carrier, J. (2009a). Sleep spindles in chronic psychophysiological insomnia. Journal of Psychosomatic Research, 66, 59–65.

    PubMed  Google Scholar 

  • Bastien, C. H., St-Jean, G., Turcotte, I., Morin, C. M., Lavallée, M., Carrier, J., et al. (2009b). Spontaneous K-complexes in chronic psychophysiological insomnia. Journal of Psychosomatic Research, 67, 117–125.

    PubMed  Google Scholar 

  • Bonnet, M. H., & Arand, D. L. (1995). 24-Hour metabolic rate in insomniacs and matched normal sleepers. Sleep, 18, 581–588.

    CAS  PubMed  Google Scholar 

  • Bonnet, M. H., & Arand, D. L. (1997). Hyperarousal and insomnia. Sleep Medicine Reviews, 1(2), 97–108.

    CAS  PubMed  Google Scholar 

  • Bootzin, R. R., & Rider, S. P. (1997). Behavioral techniques and biofeedback for insomnia. In M. R. Pressman & W. C. Orr (Eds.), Understanding sleep: The evaluation and treatment of sleep disorders (pp 315–338). APA.

  • Bootzin, R. R., Epstein, D., & Wood, J. M. (1991). Stimulus control instructions. In P. Hauri (Ed.), Case studies in insomnia (pp. 19–28). New York: Plenum Press.

    Google Scholar 

  • Broadbent, D. E., Cooper, P. F., Fitzgerald, P., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. The British Journal of Clinical Psychology, 21, 16–21.

    Google Scholar 

  • Broman, J. E., Lundh, L. G., Aleman, K., & Hetta, J. (1992). Subjective and objective performance in patients with persistent insomnia. Scandinavian Journal of Behavior Therapy, 21, 115–126.

    Google Scholar 

  • Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29(9), 11551173.

    Google Scholar 

  • Buysse, D. J., Germain, A., Hall, M. L., Moul, D. E., Nofzinger, E. A., Begley, A., et al. (2008). EEG spectral analysis in primary insomnia: NREM period effects and sex differences. Sleep, 31(12), 1673–1682.

    PubMed  Google Scholar 

  • Cervena, K., Dauvilliers, Y., Espa, F., Touchon, J., Matousek, M., Billiard, M., et al. (2004). Effect of cognitive behavioral therapy for insomnia on sleep architecture and sleep EEG power spectra in psychophysiological insomnia. Journal of Sleep Research, 13(4), 385–393.

    PubMed  Google Scholar 

  • Coates, T. J., Killen, J. D., George, J., Marchini, E., Silverman, S., & Thoresen, C. (1982). Estimating sleep parameters: a multitrait—multimethod analysis. Journal of Consulting and Clinical Psychology, 50, 345–352.

    CAS  PubMed  Google Scholar 

  • Coates, T. J., Killen, J. D., Silverman, S., George, J., Marchini, E., Hamilton, S., et al. (1983). Cognitive activity, sleep disturbance, and stage specific differences between recorded and reported sleep. Psychophysiology, 20, 243–250.

    CAS  PubMed  Google Scholar 

  • Colrain, I. M. (2005). The K-complex: a 7-decade history. Sleep, 28(2), 255–273.

    PubMed  Google Scholar 

  • Colrain, I. M., & Campbell, K. B. (2007). The use of evoked potentials in sleep research. Sleep Medicine Reviews, 11, 277–293.

    PubMed  Google Scholar 

  • De Gennaro, L., & Ferrara, M. (2003). Sleep spindles, an overview. Sleep Medicine Review, 7, 423–440.

    Google Scholar 

  • Declerck, A. C., Ruwe, F., OHanlon, J. F., & Wauquier, A. (1992). Effects of Zolpidem and Flunitrazepam on nocturnal sleep of women subjectively complaining of insomnia. Psychopharmacology, 106(4), 497–501.

    CAS  PubMed  Google Scholar 

  • Devoto, A., Violani, C., Lucidi, F., & Lombardo, C. (2003). P300 amplitude in subjects with primary insomnia is modulated by their sleep quality. Journal of Psychosomatic Research, 54, 3–10.

    PubMed  Google Scholar 

  • Devoto, A., Manganelli, S., Lucidi, F., Lombardo, C., Russo, P. M., & Violani, C. (2005). Quality of sleep and P300 amplitude in primary insomnia: a preliminary study. Sleep, 28(7), 859–863.

    PubMed  Google Scholar 

  • Dorsey, C. M., & Bootzin, R. R. (1997). Subjective and psychophysiologic insomnia: an examination of sleep tendency and personality. Biological Psychiatry, 41, 209–216.

    CAS  PubMed  Google Scholar 

  • Edinger, J. D., & Krystal, A. D. (2003). Subtyping primary insomnia: is sleep state misperception a distinct clinical entity? Sleep Medicine Reviews, 7(3), 203–214.

    PubMed  Google Scholar 

  • Edinger, J. D., Bonnet, M. H., Bootzin, R. R., et al. (2004). Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep, 27(8), 1567–1596.

    PubMed  Google Scholar 

  • Edinger, J., Means, M. K., Carney, C. E., & Krystal, A. D. (2008). Psychomotor deficits and their relation to prior’snight sleep among insomnia individuals with primary insomnia. Sleep, 31(5), 599–607.

    PubMed  Google Scholar 

  • Espie, C. A. (2002). Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorders in adults. Annual Review of Psychology, 53, 215–243.

    PubMed  Google Scholar 

  • Ferri, R., Bruni, O., Miano, S., Plazzi, G., & Terzano, M. G. (2005). All-night EEG power spectral analysis of the cyclic alternating pattern components in young adult subjects. Clinical Neurophysiology, 116, 2429–2940.

    PubMed  Google Scholar 

  • Ferri, R., Bruni, O., Miano, S., & Terzano, M. G. (2005). Topographic mapping of the spectral components of the cyclic alternating pattern (CAP). Sleep Medicine, 6(1), 29–36.

    PubMed  Google Scholar 

  • Forget, D., Morin, C., & Bastien, C. (2007). Spectral characteristics surrounding the spontaneous K-Complex in good sleepers. Sleep, 30, A34.

    Google Scholar 

  • Fortier-Brochu, E., Beaulieu-Bonneau, S., Ivers, H., & Morin, C. M. (2008). Insomnia and neuropsychological performance. Sleep, 31(Suppl. 1), A226.

    Google Scholar 

  • Freedman, R. R. (1986). EEG power spectra in sleep-onset insomnia. Electroencephalography and Clinical Neurophysiology, 63, 408–413.

    CAS  PubMed  Google Scholar 

  • Fulda, S., & Schulz, H. (2001). Cognitive dysfunction in sleep disorders. Sleep Medicine Reviews, 5(6), 423–445.

    PubMed  Google Scholar 

  • Gottesmann, C. (2002). GABA mechanisms and sleep. Neuroscience, 111, 231–239.

    CAS  PubMed  Google Scholar 

  • Gu, Y., Wahlund, B., Liljenström, H., von Rosen, D., & Liang, H. (2005). Analysis of phase shifts in clinical EEG evoked by ECT. Neurocomputing, 65–66, 475–483.

    Google Scholar 

  • Haimov, I., Hanuka, E., & Horowitz, Y. (2008). Chronic insomnia and cognitive functioning among older adults. Behavioral Sleep Medicine, 6(1), 32–54.

    PubMed  Google Scholar 

  • Halasz, P., Terzano, M. G., Parrino, L., & Bodizs, R. (2004). The nature of arousal in sleep. Journal of Sleep Research, 13, 1–23.

    PubMed  Google Scholar 

  • Harvey, A. G. (2002). A cognitive model of insomnia. Behavior and Research Therapy, 40, 869–893.

    CAS  Google Scholar 

  • Hatoum, H. T., Kong, S. X., Kania, C. M., Wong, J. M., & Mendelson, W. B. (1998). Insomnia, health-related quality of life and healthcare resource consumption. A study of managed-care organisation enrolees. Pharmacoeconomics, 14, 629–637.

    CAS  PubMed  Google Scholar 

  • Hauri, P. J. (1991). Case studies in insomnia. New York: Plenum Press.

    Google Scholar 

  • Hauri, P. J. (1997). Cognitive deficits in insomnia patients. Acta Neurologica Belgia, 97, 113–117.

    CAS  Google Scholar 

  • Hauri, P. J., & Fisher, J. (1986). Persistent psychophysiologic (learned) insomnia. Sleep, 9(1), 38–53.

    CAS  PubMed  Google Scholar 

  • Hauri, P., & Olmstead, E. (1980). Childhood onset insomnia. Sleep, 3(1), 59–65.

    CAS  PubMed  Google Scholar 

  • Hauri, P. J., & Olmstead, E. (1983). What is the moment of sleep onset for insomniacs? Sleep, 6(1), 10–15.

    CAS  PubMed  Google Scholar 

  • Haynes, S. N., Fitzgerald, G., Shute, G., & O'Meary, M. (1985). Responses of psychophysiologic and subjective insomniacs to auditory stimuli during sleep: a replication and extension. Journal of Abnormal Psychology, 94(3), 338–345.

    CAS  PubMed  Google Scholar 

  • Hess, R. (1965). Sleep and sleep disturbances in the electroencephalogram. In K. Akert, C. Belly, & J. Schade (Eds.), Sleep mechanisms (pp. 127–139). Amsterdam: Elsevier.

    Google Scholar 

  • Hillman, D. R., Murphy, A. S., Antic, R., & Pezzullo, L. (2006). The economic cost of sleep disorders. Sleep, 29(3), 299–305.

    PubMed  Google Scholar 

  • Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., et al. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatrica Scandinavica, 90, 102–108.

    CAS  PubMed  Google Scholar 

  • Holbrook, A. M., Crowther, R., Lotter, A., Cheng, C., & King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. Canadian Medical Association Journal, 162, 225–233.

    CAS  PubMed  Google Scholar 

  • Hull, J. S. (1993). Event-related potentials during the wake/sleep transition in adults with and without primary insomnia [dissertation]. Hattiesburg: Univ. of Southern Mississippi.

    Google Scholar 

  • Jacobs, G. D., Benson, H., & Friedman, R. (1993). Home-based central nervous system assessment of a multifactor behavioral intervention for chronic sleep onset insomnia. Behavior Therapy, 24(1), 159–174.

    Google Scholar 

  • Jankel, W. R., & Niedermeyer, E. (1985). Sleep spindles. Journal of Clinical Neurophysiology, 2, 1–35.

    CAS  PubMed  Google Scholar 

  • Krystal, A. D., Edinger, J. D., Wohlgemuth, W. K., & Marsh, G. R. (2002). NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep, 25(6), 630–640.

    PubMed  Google Scholar 

  • Kupfer, D. J., & Reynolds, C. F. (1997). Management of insomnia. The New England Journal of Medicine, 336, 341–346.

    CAS  PubMed  Google Scholar 

  • Lack, L. C., & Wright, H. R. (2007). Treating chronobiological components of chronic insomnia. Sleep Medicine, 8, 637–644.

    PubMed  Google Scholar 

  • Lader, M. (2008). Effectiveness of benzodiazepines: do they work or not? Expert Review of Neurotherapeutics, 8(8), 1189–1191.

    CAS  PubMed  Google Scholar 

  • Lader, M., Tylee, A., & Donoghue, J. (2009). Withdrawing benzodiazepines in primary care. CNS Drugs, 23(1), 19–34.

    CAS  PubMed  Google Scholar 

  • Lamarche, C. H., & Ogilvie, R. D. (1997). Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs and normal sleepers. Journal of Sleep Research and Sleep Medicine, 20(9), 724–733.

    CAS  Google Scholar 

  • Léger, D., Scheuermaier, K., Philip, P., Paillard, M., & Guilleminault, C. (2001). SF36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosomatic Medicine, 63, 49–55.

    PubMed  Google Scholar 

  • Lichstein, K. L. (2000). Relaxation. In K. L. Lichstein & C. M. Morin (Eds.), Treatment of late-life insomnia (pp. 185–206). Thousand Oaks: Sage.

    Google Scholar 

  • Lichstein, K. L., Durrence, H. H., Bayen, U. J., & Riedel, B. W. (2001). Primary versus secondary insomnia in older adults: subjective sleep and daytime functioning. Psychology and Aging, 16(2), 264–271.

    Google Scholar 

  • Loewy, D. H., & Bootzin, R. (1998). Event-related potentials measures ofinformation processing in insomniacs at bedtime and during sleep. Sleep, 21(Suppl. 1), 98.

    Google Scholar 

  • Loewy, D. H., Burdik, R. S., Al-Shajlawi, A., Franzen, P., & Bootzin, R. (1999). Enhanced information processing at the peri-sleep onset period in insomniacs as measured by event-related potentials. Sleep, 22(Suppl. 1), S152.

    Google Scholar 

  • Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R., & Alessi, C. A. (2007). A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns. The Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 62(1), 67–72.

    Google Scholar 

  • Mendelson, W. B., Garnett, D., Gillin, J. C., & Weingartner, H. (1984). The experience of insomnia and daytime and nighttime functioning. Psychiatry Research, 12(3), 235–250.

    CAS  PubMed  Google Scholar 

  • Mendelson, W. B., James, S. P., Garnett, D., Sack, D. A., & Rosenthal, N. E. (1986). A psychophysiological study of insomnia. Psychiatry Research, 19, 267–284.

    CAS  PubMed  Google Scholar 

  • Merica, H., & Gaillard, J. (1992). The EEG of the sleep onset period in insomnia: a discriminant analysis. Physiology & Behavior, 52, 199–204.

    CAS  Google Scholar 

  • Merica, H., Blois, R., & Gaillard, J.-M. (1998). Spectral characteristics of sleep EEG in chronic insomnia. The European Journal of Neuroscience, 10, 1826–1834.

    CAS  PubMed  Google Scholar 

  • Milner, C. E., Cuthbert, B. P., Kertesz, R. S., & Cote, K. A. (2009). Sensory gating impairments in poor sleepers during presleep wakefulness. NeuroReport, 20(3), 331–336.

    PubMed  Google Scholar 

  • Monti, J. M., Alvariño, F., & Monti, D. (2000). Conventional and power spectrum analysis of the effects of Zolpidem on sleep EEG in patients with chronic primary insomnia. Sleep, 23(8), 1075–1084.

    CAS  PubMed  Google Scholar 

  • Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press.

    Google Scholar 

  • Morin, C. M. (2004). Cognitive-behavioral approaches to the treatment of insomnia. The Journal of Clinical Psychiatry, 65(Suppl. 16), 33–40.

    PubMed  Google Scholar 

  • Morin, C. M., & Wooten, V. (1996). Psychological and pharmacological approaches to treating insomnia. Clinical Psychology Review, 6, 521–542.

    Google Scholar 

  • Morin, C. M., LeBlanc, M., Daley, M., Grégoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinant of help-seeking behaviors. Sleep Medicine, 7, 123–130.

    CAS  PubMed  Google Scholar 

  • Moul, D. E., Nofzinger, E. A., Pikonis, P. A., Houck, P. R., Miewald, J. M., & Buysse, D. J. (2002). Symptom reports in severe chronic insomnia. Sleep, 25(5), 553–563.

    PubMed  Google Scholar 

  • National Institutes of Health. (1991). Consensus development conference statement: the treatment of sleep disorders of older people. Sleep, 14, 169–177.

    Google Scholar 

  • National Institutes of Health. (2005). National Institutes of Health State of the Science Conference statement on manifestations and management of chronic insomnia in adults. Sleep, 28, 1049–1057.

    Google Scholar 

  • Nissen, C., Kloepfer, C., Nofzinger, E. A., Feige, B., Voderholzer, U., & Riemann, D. (2006). Impaired sleep-related memory consolidation in primary insomnia. Sleep, 29, 1068–1073.

    PubMed  Google Scholar 

  • Nofzinger, E. A., Nowell, P. D., Buysee, D. J., Vasko, R. C., Thase, M. E., Frank, E., et al. (1999). Towards a neurobiology of sleep disturbance in insomnia and depression: a comparison of subjective, visually-scored, period amplitude, and power spectral density sleep measures. Sleep, 22(Suppl. 1), S99.

    Google Scholar 

  • Nofzinger, E. A., Buysse, D. J., Germain, A., Price, J. C., Miewald, J. M., & Kupfer, D. J. (2004). Functional neuroimaging evidence for hyperarousal in insomnia. American Journal of Psychatry, 161(11), 2126–2128.

    Google Scholar 

  • Ohayon, M. M. (2002). Epidemiology of insomnia: what we know and we still need to learn. Sleep Medicine Reviews, 6, 97–111.

    PubMed  Google Scholar 

  • Orff, H. J., Drummond, S. P., Nowakowski, S., & Perlis, M. L. (2007). Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia. Sleep, 30(9), 1205–1211.

    PubMed  Google Scholar 

  • Oswald, I., Taylor, A. M., & Treisman, M. (1960). Discriminative responses to stimulation during human sleep. Brain, 83, 440–452.

    CAS  PubMed  Google Scholar 

  • Ouellet, D. R., Turcotte, I., St-Jean, G., Carrier, J., & Bastien, C. H. (2010). Contribution of age, gender and insomnia subtypes to the microstructure of sleep. Journal of Sleep Research, 19(Suppl. 2), 162.

    Google Scholar 

  • Parrino, L., Ferrillo, F., Smerieri, A., Spaggiari, M. C., Palomba, V., Rossi, M., et al. (2004). Is insomnia a neurophysiological disorder? The role of sleep microstructure. Brain Research Bulletin, 63(5), 377–383.

    PubMed  Google Scholar 

  • Parrino, L., Milioli, G., De Paolis, F., Grassi, A., & Terzano, M. G. (2009). Paradoxical insomnia: the role of CAP and arousals in sleep misperception. Sleep Medicine, 10(10), 1139–1145.

    PubMed  Google Scholar 

  • Pennestri, M., Adam, B., Paquet, J., Denesle, R., & Montplaisir, J. (2003). First-night effect in severe psychophysiological insomnia. Sleep, 26(Suppl. 1), A311–A312.

    Google Scholar 

  • Perlis, M. L., Giles, D. E., Mendelson, W. B., Bootzin, R. R., & Wyatt, J. K. (1997). Psychophysiological insomnia: the behavioral model and a neurocognitive perspective. Journal of Sleep Research, 5(3), 179–188.

    Google Scholar 

  • Perlis, M. J., Kehr, E. L., Smith, M. T., Andrews, P. J., Orff, H., & Giles, D. E. (2001). Temporal and stagewise distribution of high frequency EEG activity in patients with primary and secondary insomnia and good sleeper controls. Journal of Sleep Research, 10, 93–104.

    CAS  PubMed  Google Scholar 

  • Perlis, M., Shaw, P. J., Cano, G., & Espie, C. A. (2011). Models of insomnia. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practice of sleep medicine (5th ed., pp. 850–865). St Louis: Elsevier Saunders.

    Google Scholar 

  • Randazzo, A. C., Schwitzer, P. K., Stone, K. L., Compton, J. D., & Walsh, J. K. (2000). Impaired cognitive function in insomniacs vs normals. Sleep, 23(Suppl. 2), 4.

    Google Scholar 

  • Rechtschaffen, A., & Kales, A. A. (1968). Manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain Information/Brain Research Institute, UCLA.

    Google Scholar 

  • Regestein, Q. R., & Reich, P. (1983). Incapacitating childhood-onset insomnia. Comprehensive Psychiatry, 24(3), 244–248.

    CAS  PubMed  Google Scholar 

  • Regestein, Q. R., Dambrosia, J., Hallett, M., Murawski, B., & Paine, M. (1993). Daytime alertness in patients with primary insomnia. The American Journal of Psychiatry, 150, 1529–1534.

    CAS  PubMed  Google Scholar 

  • Reite, M., Buysse, D., Reynolds, C., & Mendelson, W. (1995). The use of polysomnography in the evaluation of insomnia. Sleep, 18(1), 58–70.

    CAS  PubMed  Google Scholar 

  • Reynolds, C. F., III, Taska, L. S., Sewitch, D. E., Restifo, K., Coble, P. A., & Kupfer, D. J. (1984). Persistent psychophysiologic insomnia: preliminary research diagnostic criteria and EEG sleep data. The American Journal of Psychiatry, 141, 804–805.

    PubMed  Google Scholar 

  • Riedel, B. W., & Lichstein, K. L. (2000). Insomnia and daytime functioning. Sleep Medicine Reviews, 4(3), 277–298.

    PubMed  Google Scholar 

  • Riemann, D., Kloepfer, C., & Berger, M. (2009). Functional and structural brain alterations in insomnia: implications for pathophysiology. The European Journal of Neuroscience, 29, 1754–1760.

    CAS  PubMed  Google Scholar 

  • Ropars, S., Turcotte, I., St-Jean, G., & Bastien, C. H. (2010). Variation of sleepiness level after a cognitive task in the morning between insomnia sufferers and good sleeper controls. Journal of Sleep Research, 19(Suppl. 2), P840, 287–288.

    Google Scholar 

  • Roth, T., & Ancoli-Israel, S. (1999). Daytime consequences and correlates of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. II. Sleep, 22, S354–S358.

    PubMed  Google Scholar 

  • Sateia, M. J., Doghramji, K., Hauri, P. J., & Morin, C. M. (2000). Evaluation of chronic insomnia. An American Academy of Sleep Medicine Review. Sleep, 23(2), 243–308.

    CAS  PubMed  Google Scholar 

  • Schmutte, T., Harris, S., Levin, R., Zweig, R., Katz, M., & Lipton, R. (2007). The relation between cognitive functioning and self-reported sleep complaints in nondemented older adults: results from the Bronx aging study. Behavioral Sleep Medicine, 5(1), 39–56.

    PubMed  Google Scholar 

  • Schneider, C., Fulda, S., & Schulz, H. (2004). Daytime variation in performance and tiredness/sleepiness ratings in patients with insomnia, narcolepsy, sleep apnea and normal controls. Journal of Sleep Research, 13(4), 373–383.

    CAS  PubMed  Google Scholar 

  • Schneider-Helmert, D. (1987). Twenty-four-hour sleep-wake function and personality patterns in chronic insomniacs and healthy controls. Sleep, 10(5), 452–462.

    CAS  PubMed  Google Scholar 

  • Seidel, W. F., Ball, S., Cohen, S., Patterson, N., Yost, D., & Dement, W. C. (1984). Daytime alertness in relation to mood, performance, and nocturnal sleep in chronic insomniacs and noncomplaining sleepers. Sleep, 7, 230–238.

    CAS  PubMed  Google Scholar 

  • Sforza, E., & Haba-Rubio, J. (2006). Event-related potentials in patients with insomnia and sleep-related breathing disorders: evening-to-morning changes. Sleep, 29(6), 805–813.

    PubMed  Google Scholar 

  • Shekleton, J. A., Rogers, N. L., & Rajaratnam, S. M. (2010). Searching for the daytime impairments of primary insomnia. Sleep Medicine Reviews, 14(1), 47–60.

    PubMed  Google Scholar 

  • Smith, M. T., Perlis, M. L., Chengazi, V. U., Pennington, J., Soeffing, J., Ryan, J. M., et al. (2002). Neuroimaging of NREM sleep in primary insomnia: a Tc-99-HMPAO single photon emission computed tomography study. Sleep, 25(3), 325–335.

    PubMed  Google Scholar 

  • Smith, M. T., Perlis, M. L., Chengazi, V. U., Soeffing, J., & McCann, U. (2005). NREM sleep cerebral blood flow before and after behavior therapy for chronic primary insomnia: preliminary single photon emission computed tomography (SPECT) data. Sleep Medicine, 6(1), 93–94.

    PubMed  Google Scholar 

  • Spielman, A. J., & Glovinski, P. B. (1991). The varied nature of insomnia. In P. Hauri (Ed.), Case studies in insomnia (pp. 1–15). New York: Plenum.

    Google Scholar 

  • Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10, 45–56.

    CAS  PubMed  Google Scholar 

  • Stepanski, E., Zorick, F., Roehrs, T., Young, D., & Roth, T. (1988). Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep, 11, 54–60.

    CAS  PubMed  Google Scholar 

  • Stickgold, R. (2005). Sleep-dependent memory consolidation. Nature, 437, 1272–1278.

    CAS  PubMed  Google Scholar 

  • St-Jean, G., & Bastien, C. H. (2008a). Sleep disorders and quality of life. In J. C. Verster, S. R. Pandi-Perumal, & D. Streiner (Eds.), Sleep and quality of life in medical illness (pp. 37–46). Humana Press: Springer.

    Google Scholar 

  • St-Jean, G., & Bastien, C. H. (2008b). Rem and N-Rem power spectral analysis on two consecutive nights in relation to sleep quality in psychophysiological and paradoxical insomnia sufferers. Sleep, 31, A247.

    Google Scholar 

  • St-Jean, G., & Bastien, C. H. (2009). Classification of insomnia sufferers based on laboratory PSG recordings and subjective sleep reports. Sleep, 32, A284.

    Google Scholar 

  • Sugerman, J. L., Stern, J. A., & Walsh, J. K. (1985). Daytime alertness in subjective and objective insomnia: some preliminary findings. Biological Psychiatry, 20, 741–750.

    CAS  PubMed  Google Scholar 

  • Szelenberger, W., & Niemcewicz, S. (2001). Event-related current density in primary insomnia. Acta Neurobiologiae Experimentalis (Wars), 61, 299–308.

    CAS  Google Scholar 

  • Terzano, M. G., & Parrino, L. (2000). Origin and significance of the cyclic alternating pattern (CAP). Sleep Medicine Reviews, 4, 101–123.

    PubMed  Google Scholar 

  • Terzano, M. G., Mancia, D., Salati, M. R., Costani, G., Decembrino, A., & Parrino, L. (1985). The cyclic alternating pattern as a physiologic component of normal NREM sleep. Sleep, 8, 137–145.

    CAS  PubMed  Google Scholar 

  • Terzano, M. G., Parrino, L., Boselli, M., Dell’Orso, S., Moroni, M., & Spaggiari, M. C. (1995). Changes of cyclic alternating pattern (CAP) parameters in situational insomnia under brotizolam and triazolam. Psychopharmacology, 120, 237–243.

    CAS  PubMed  Google Scholar 

  • Terzano, M. G., Parrino, L., Boselli, M., Smerieri, A., & Spaggiari, M. C. (2000). CAP components and EEG synchronization in the first 3 sleep cycles. Clinical Neurophysiology, 111, 283–290.

    CAS  PubMed  Google Scholar 

  • Terzano, M. G., Parrino, L., Spaggiari, M. C., Palomba, V., Rossi, M., & Smerieri, A. (2003). CAP variables and arousals as sleep electroencephalogram markers for primary insomnia. Clinical Neurophysiology, 114, 1715–1723.

    PubMed  Google Scholar 

  • Terzano, M. G., Parrino, L., Smerieri, A., Carli, F., Nobili, L., Donadio, S., et al. (2005). CAP and arousals are involved in the homeostatic and ultradian sleep processes. Journal of Sleep Research, 14, 359–368.

    PubMed  Google Scholar 

  • Thomas, M., Sing, H., Belenky, G., Holcomb, H., Mayberg, H., Dannals, R., et al. (2000). Neural basis of alertness and cognitive performance impairments during sleepiness, I: effects oh 24 h of sleep deprivation on waking human regional brain activity. Journal of Sleep Research, 9, 335–352.

    CAS  PubMed  Google Scholar 

  • Turcotte, I., & Bastien, C. H. (2009). Is quality of sleep related to the N1 and P2ERPs in chronic psychophysiological insomnia sufferers? International Journal of Psychophysiology, 72, 314–322.

    PubMed  Google Scholar 

  • Turcotte, I., Adam, A., Lecarpentier, M., & Bastien, C. H. (2009). ERPs measures during sleep in psychophysiological and paradoxical insomnia sufferers. Sleep, 32, A271.

    Google Scholar 

  • Vallières, A., Ivers, H., Bastien, C. H., Beaulieu-Bonneau, S., & Morin, C. M. (2005). Variability and predictability in sleep patterns of chronic insomniacs. Journal of Sleep Research, 14, 447–453.

    PubMed  Google Scholar 

  • Van der Werf, Y. D., Altena, E., Van Dijk, K. D., Strijers, R. L. M., De Rijke, W., Stam, C. J., et al. (2010). Is disturbed intracortical excitability a stable trait of chronic insomnia? A study using transcranial magnetic stimulation before and after multimodal sleep therapy. Biological Psychiatry, 68, 950–955.

    PubMed  Google Scholar 

  • Van Someren, E. J. (2006). Mechanisms and functions of coupling between sleep and temperature rhythms. Progress in Brain Research, 153, 309–324.

    PubMed  Google Scholar 

  • Varkevisser, M., & Kerkhof, G. A. (2005). Chronic insomnia and performance in a 24-h constant routine study. Journal of Sleep Research, 14(1), 49–59.

    PubMed  Google Scholar 

  • Vignola, A., Lamoureux, C., Bastien, C. H., & Morin, C. M. (2000). Late-life insomnia, chronic use of benzodiazepines, and daytime performance. Journal of Gerontology: Psychological Sciences, 55, 54–62.

    Google Scholar 

  • Walter, W. G. (1953). The living brain. New York: Norton and Company.

    Google Scholar 

  • Wauquier, A., Aloe, L., & Declerck, A. K. (1995). K-Complexes: are they signs of arousal or sleep protective? Journal of Sleep Research, 4, 138–143.

    PubMed  Google Scholar 

  • Winkelmann, J. W., Buxton, O. M., Jensen, E., Benson, K. L., O’Connor, S. P., Wang, W., et al. (2008). Reduced brain GABA in primary insomnia: preliminary data from 4T proton magnetic resonance spectroscopy (1H-MRS). Sleep, 31, 1499–1506.

    Google Scholar 

  • Yang, C. M., & Lo, H. S. (2007). ERP evidence of enhanced excitatory and reduced inhibitory processes of auditory stimuli during sleep in patients with primary insomnia. Sleep, 30, 585–592.

    PubMed  Google Scholar 

  • Zammit, G. K. (1988). Subjective ratings of the characteristics and sequelae of good and poor sleep in normals. Journal of Clinical Psychology, 44, 123–130.

    CAS  PubMed  Google Scholar 

  • Zammit, G. K., Weiner, J., Damato, N., Sillup, G. P., & McMillan, C. A. (1999). Quality of life in people with insomnia. Sleep, 22, S379–S385.

    PubMed  Google Scholar 

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Bastien, C.H. Insomnia: Neurophysiological and NeuropsychologicalApproaches. Neuropsychol Rev 21, 22–40 (2011). https://doi.org/10.1007/s11065-011-9160-3

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Keywords

  • Insomnia
  • Subtypes
  • PSG
  • Neurophysiological measures