Skip to main content
SpringerLink
Log in

Neuere Modellvorstellungen zu Ätiologie und Pathophysiologie der psychophysiologischen Insomnie

Recently developed concepts on the etiology and pathophysiology and psychophysiological insomnia

  • Published:
Somnologie - Schlafforschung und Schlafmedizin Aims and scope Submit manuscript

Zusammenfassung

Bei der psychophysiologischen Insomnie treten Fehlwahrnehmungen des Schlafzustandes auf, die a) mit einer häufigen Einschätzung von polysomnographisch definitertem Schlaf als Wachen; b) mit einer Überschätzung der Einschlaflatenz und nächtlicher Wachzeiten bzw. Unterschätzung der Gesamtschlafdauer; c) mit einer subjektiven Überschätzung der schlafinduzierenden Wirkung von Hypnotika einhergehen. Nach dem behavioralen Modell besteht bei der chronischen psychophysiologischen Insomnie während der Einschlafphase ein “konditioniertes Arousal” auf somatischer und kognitiver Ebene. Das behaviorale Modell wurde vor kurzem zu einem “neurokognitiven Modell” weiterentwickelt (Perlis et al., J Sleep Res 6:179–188, 1997), in dem somatischen und kognitive Erregungssteigerung zum “kortikalen Arousal” zusammengefaßt werden. Die chronischen psychophysiologische Insomnie wird demnach auf ein konditioniertes kortikales Arousal zurückgeführt, das mit einer Hochfrequenzaktivierung im EEG, vermehrter Reiz- und Informationsverarbeitung bzw. verstärkter Gedächtniskonsolidierung während der Einschlafphase einhergeht. Eine Fehlwahrnehmung des Schlafes als Wachsein könnte somit auf ein kortikales Arousal zurückgeführt werden. Ein Großteil der therapeutischen Wirkung von Hypnotika könnte entsprechend auf einer Dämpfung der Reiz- und Informationsverarbeitung sowie auf amnestischen Effekten beruhen. Das neurokognitive Modell verknüpft Befunde verschiedener Beobachtungsebenen und erlaubt die Formulierung schlüssiger Hypothesen, deren experimentelle Überprüfung derzeit allerdings zu einem großen Teil noch aussteht.

Summary

In psychophysiological insomnia misperceptions of sleep state occur resulting in (1) judgement of polysomnographically defined sleep as being awake; (2) an overestimation of sleep latency and an underestimation of total sleep time; (3) an overestimation of the sleep inducing effects of hypnotic medication. According to the behavioural perspective a “conditioned arousal” exists in patients with chronic psychophysiological insomnia, which occurs around sleep onset and is represented on both the somatic and cognitive level. Based on the behavioural model a “neurocognitive perspective” has been recently developed in order to combine somatic and cognitive arousals proposing the construct of “cortical arousal” (Perlis et al., J Sleep Res 6:179–188, 1997). From the neurocognitive perspective chronic psychophysiological insomnia can be linked to a conditioned cortical arousal. Known correlates of the latter are high frequency activation in the EEG, increased sensory and information processing, and enhanced long-term memory processing around sleep onset and during the early phases of sleep. Misperception of sleep therefore might arise from cortical arousal. The therapeutic effect of hyponotics, however, could be for the most part due to their damping influence on sensory and information processing, and to their amnestic properties. The neurocognitive perspective helps to explain findings on different observation levels and allows for the formulation of plausible hypotheses. Presently, several of these hypotheses remain to be tested.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Antrobus J: The neurocognition of sleep mentation: rapid eye movements, visual imagery, and dreaming. In Bootzin RR, Kihlstrom JF, Schachter DL (eds): Sleep and cognition, American Psychological Association, Washington DC, 1990.

    Google Scholar 

  2. Beary, M, Lacey, J, Crutchfield M, Bhat A: Psycho-social stress, insomnia, and temazepam: A sleep laboratory evaluation and a general practice sample, Psychopharmacology 83:17–19, 1984.

    Article  CAS  PubMed  Google Scholar 

  3. Bonnet MH, Arand DL: Hyperarousal and insomnia. Sleep Medicine Reviews 2:97–108, 1997.

    Article  Google Scholar 

  4. Bonnet MH, Arand DL: 24-hour metabolic rate in insomniacs and matched normal sleepers. Sleep 18:581–588, 1995.

    CAS  PubMed  Google Scholar 

  5. Bonnet MH: Memory for events occuring during aorusal from sleep. Psychophysiology 20:81–87, 1983.

    CAS  PubMed  Google Scholar 

  6. Bootzin, RR, Herman CP, Nicassio P: The power of suggestion: Another examination of misattribution and insomnia. J Pers Soc Psychol 34:673–679, 1976.

    Article  CAS  PubMed  Google Scholar 

  7. Borbély A, Akerstedt T, Benoit O, Holsboer F, Oswald I: Hypnotics and sleep physiology: a consensus report. Eur Arch Psy Clin N 241:13–21, 1991.

    Article  Google Scholar 

  8. Coates T, Killen J, Silbeman S, Marchini J, Hamilton S, Thoresen C: Cognitive activity, sleep disturbance, and stage specific differences between recorded and reported sleep. Psychophysiology 20:243, 1983.

    CAS  PubMed  Google Scholar 

  9. Domhoff, GW, Schneider A: New rationales and methods for quantitative dream research outside the laboratory. Sleep 21: 398–404, 1998.

    CAS  PubMed  Google Scholar 

  10. Edinger, J, Fins A: The distribution and clinical significance of sleep time misperceptions among insomniacs. Sleep 4:232–239, 1995.

    Google Scholar 

  11. Engle-Friedman M, Baker E, Bootzin RR: Reports of wakefulness during EEG identified stages of sleep, Behavioral Assessment 14:152, 1985.

    Google Scholar 

  12. Feige B: Oscillatory brain activity and its analysis on the basis of MEG and EEG, Waxmann, Münster, 1999.

    Google Scholar 

  13. Feige B, Krieger S, Lis, S, Jacobi A, Kiemen A, Hohagen F: CNV im Schlaf- und Wachzustand bei primärer Insomnie. Fortschr Neurol Psychiat 64:60, 1997.

    Google Scholar 

  14. Freedman RR: EEG power in sleep onset insomnia. Electroenceph Clin Neurophysiol 63:408–413, 1986.

    Article  CAS  PubMed  Google Scholar 

  15. Freedman RR, Sattler HL: Physiological and psychological factors in sleep-onset insomnia. J Abnorm Psychol 91:380–389, 1982.

    Article  CAS  PubMed  Google Scholar 

  16. Hall M, Buysse DJ, Reynolds DF, Kupfer DJ, Baum A: Stress related intrusive thoughts disrupt sleep onset and continuity. Sleep Res 25:163, 1996.

    Google Scholar 

  17. Hauri P: Primary insomnia. In: Kryger M, Roth T, Dement WC (eds): Principles and practice of sleep medicine. Saunders, Philadelphia, 1994.

    Google Scholar 

  18. Hobson JA, McCarley RW: The brain as a dream-state generator: an activation synthesis hypothesis of the dream-process. Am J Phychiat 134:1335–1348, 1977.

    CAS  Google Scholar 

  19. Janson C, Gislason T, DeBacker W, Plaschke P, Bjornsson E, Hetta J, Kristbjarnason H, Vermeir P, Boman G: Prevalence of sleep disturbance among young adults in three European countries. Sleep 18:589–597, 1995.

    CAS  PubMed  Google Scholar 

  20. Johnson LC, Hanson, K, Bickford RG: Effect of flurazepam on sleep spindles and K-complexes. Electroenceph Clin Neurophysiol 40:67–77, 1975.

    Article  Google Scholar 

  21. Kales A, Kales J, Bixler E, Soldatos C, Cadieux R, Karshurba G, Vela-Bueno A: Biopsychobehavioral correlates of insomnia: V. Clinical characteristics and behavioral correlates. Am J Psychiat 141:1371–1376, 1984.

    CAS  PubMed  Google Scholar 

  22. Lee JH, Bliwise DL, Lebret-Bories E, Guilleminault C, Dement WC: Dream-disturbed sleep in insomnia and narcolepsy. J Nerv Ment Dis 181:320–24, 1993.

    Article  CAS  PubMed  Google Scholar 

  23. Lichstein KL, Rosenthal TL: Insomniacs' perceptions of cognitive versus somatic determinants of sleep disturbance. J Abnorm Psychol 89:105–107, 1980.

    Article  CAS  PubMed  Google Scholar 

  24. Lutzenberger W, Pulvermüller F, Birbaumer N: Words and pseudowords elicit distinct patterns of 30-Hz EEG responses in humans. Neurosci Lett 176:115–118, 1994.

    Article  CAS  PubMed  Google Scholar 

  25. Meier B: Physiological correlates of REM dream recall. Sleep Res 17:149, 1988.

    Google Scholar 

  26. Mendelson W: Pharmacologic alteration of the perception of being awake. Sleep 16:641–646, 1993.

    CAS  PubMed  Google Scholar 

  27. Mendelson M, Martin J, Stephens H, Giesen H, James S: Effects of flurazepam on sleep, arousal threshold, and perception of being asleep. Psychopharmacology 95:258–262, 1988.

    Article  CAS  PubMed  Google Scholar 

  28. Merica H, Blois R, Gaillard JM: Spectral characteristics of sleep EEG in chronic insomnia. Eur J Neuroscience 10:1826–1834, 1998.

    Article  CAS  Google Scholar 

  29. Mercia H, Gaillard J: The EEG of sleep onset period in insomnia: A discriminant analysis. Physiol Behav 52:199–204, 1991.

    Google Scholar 

  30. Pang E, Fowler B: Discriminating the effects of triazolam on stimulus and response processing by means of reaction time and P300 latency. Psychopharmacology 115:509–515, 1994.

    Article  CAS  PubMed  Google Scholar 

  31. Pantev C: Evoked and induced gamma-band activity of the human cortex. Brain topography 7:321–330, 1995.

    Article  CAS  PubMed  Google Scholar 

  32. Perlis ML, Bootzin RR, Fleming G, Drummond SP, Rose M, Dikman ZV, Giles DE: Alpha sleep and information processing, perception of sleep, pain and arousability in fibromyalgia. Int J Neurosci 89:265–280, 1997a.

    CAS  PubMed  Google Scholar 

  33. Perlis ML, Giles DE, Mendelson WB, Bootzin RR, Wyatt JK: Psychophysiological insomnia: the behavioural model and a neurocognitive perspective. J Sleep Res 6:179–188, 1997b.

    Article  CAS  PubMed  Google Scholar 

  34. Polster M, McCarthy R, O'Sullivan G, Gray P, Park G: Midazolam-induced amnesia: Implications for implicit/explicit memory distinction. Brain and Cognition 22:244–265, 1993.

    Article  CAS  PubMed  Google Scholar 

  35. Portnoff G, Baekeland F, Goodenough DR, Karacan I, Shapiro A: Retention of verbal materials perceived immediately prior to onset of non-REM sleep. Percept Mot Skills 22:751–758, 1996.

    Google Scholar 

  36. Pulvermüller F, Lutzenberger W, Preissl H, Birbaumer N: Spectral responses in the gamma-band: Physiological signs of higher cognitive processes? Neuroreport 6:2059–2064, 1995.

    Article  PubMed  Google Scholar 

  37. Regenstein QR, Dambrosia J, Hallett M, Murawski B, Paine M: Daytime alertness in patients with primary insomnia. Am J Psychiat 150:1529–1534, 1993.

    Google Scholar 

  38. Riemann D, Backhaus J: Behandlung von Schlafstörungen. Beltz, Psychologie Verlags Union, Weinheim, 1996.

    Google Scholar 

  39. Schramm E, Riemann D (eds): Internationale Klassifikation der Schlafstörungen. Beltz, Psychologie Verlags Union, Weinheim, 1995.

    Google Scholar 

  40. Schredl M, Schäfer G, Weber B, Heuser I: Dreaming and insomnia: dream recall und dream content of patients with insomnia. J Sleep Res 7:191–198, 1998.

    Article  CAS  PubMed  Google Scholar 

  41. Spielman A, Caruso L, Glovinsky P: A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 10:541–553, 1987.

    CAS  PubMed  Google Scholar 

  42. Steriade M: Brain electrical activity and sensory processing during waking and sleep states. In: Kryger M, Roth T, Dement WC (eds): Principles and practice of sleep medicine. Saunders, Philadelphia, 1994.

    Google Scholar 

  43. Wood J, Bootzin RR, Kihlstrom J, Schachter D: Implicit and explicit memory for verbal information presented during sleep. Psychological Science 3:236–239, 1992.

    Article  Google Scholar 

  44. Woodward SH: Neurobiological perspectives on sleep in post-traumatic stress, disorder. In: Friedman MJ, Charney DS, Deutch AY (eds): Neurobiological and clinical consequences of stress: From normal adaptation to PTSD. Lippincott-Raven Publishers, Philadelphia, 1995.

    Google Scholar 

  45. Wright K, Badia P, Wauquier A: Topographical and temporal patterns of brain activity during the transition from wakefulness to sleep. Sleep 18:880–889, 1995.

    PubMed  Google Scholar 

  46. Wyatt JK, Allen JJ, Bootzin RR, Anthony JL: Mesograde amnesia during the sleep onset transition: Replication and electrophysiology correlates. Sleep, 1997.

  47. Wyatt JK, Bootzin RR, Anthony J, Bazant S: Sleep onset is associated with retrograde and anterograde amnesia. Sleep 17:502–511, 1994.

    CAS  PubMed  Google Scholar 

  48. Zschocke S: Klinische Elektroenzephalographie. Springer, Berlin, 1995.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Psychiatrie und Psychosomatik, Abteilung für Psychiatrie und Psychotherapie der Albert-Ludwigs-Universität, Hauptstr. 5, D-79104, Freiburg

    T. Sobanski, B. Feige & D. Riemann

Authors
  1. T. Sobanski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Feige
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Riemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Sobanski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sobanski, T., Feige, B. & Riemann, D. Neuere Modellvorstellungen zu Ätiologie und Pathophysiologie der psychophysiologischen Insomnie. Somnologie 3, 247–253 (1999). https://doi.org/10.1007/s11818-999-0031-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11818-999-0031-6

Schlüsselwörter

Keywords

Search

Navigation