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Psychophysiological Insomnia

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Clinical Handbook of Insomnia

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

The International Classification of Sleep Disorders defines psychophysiological insomnia as “a disorder of somatized tension and learned sleep-preventing associations that results in a complaint of insomnia and associated decreased functioning during wakefulness” (1). Psychophysiological insomnia is included under the category of primary insomnias in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (2). It is also commonly referred to as learned or conditioned insomnia and less commonly as functionally autonomous or internal arousal insomnia.

O sleep! O gentle sleep! Nature’s soft nurse, how have I frightened thee, That thou no more wilt weigh my eyelids down and steep my senses in forgetfulness?

—William Shakespeare (King Henry IV part 2 Act III Scene I)

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References

  1. American Sleep Disorders Association. (1997) International classification of sleep disorders: diagnostic and coding manual. American Sleep Disorders Association, Rochester, MN.

    Google Scholar 

  2. American Psychiatric Association. (1994) Diagnostic and statistical manual of mental disorders ( 4th ed. ). American Psychiatric Association, Washington DC.

    Google Scholar 

  3. Bettolo, A. (1931) L’insonnia e sua importanza clinica: le sue cause predisponenti e determinanti, i suoi caratteri nelle diverse malattie, la sua importanza prognostica ed il suo trattamento generale e speciale. Studium 21, 54–65.

    Google Scholar 

  4. Strauss, E. (1948) Insomnia. St. Barts Hosp. J. 52, 163–168.

    Google Scholar 

  5. Association of Sleep Disorders Centers. (1979) Disorders Centers. Diagnostic classification of sleep and arousal disorders (1st ed.). Sleep 2, 1–137.

    Google Scholar 

  6. Hauri, P. J. (1983) A cluster analysis of insomnia. Sleep 6 (4), 326–338.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. Buysse, D. J., Reynolds, C. F., III, Kupfer, D. J., et al. (1994) Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial. Sleep 17 (7), 630–637.

    PubMed  CAS  Google Scholar 

  9. Edinger, J. D., Fins, A. I., Goeke, J. M., et al. (1996) The empirical identification of insomnia subtypes: a cluster analytic approach. Sleep 19 (5), 398–411.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  11. Spielman, A. J., Nunes, J., and Glovinsky, P. B. (1996) Insomnia. Neurol. Clin. 14 (3), 513–543.

    Article  PubMed  CAS  Google Scholar 

  12. Bonnet, M. H. and Arand, D. L. (1999) Diagnosis and treatment of insomnia. Respir. Care Clin. N. Am. 5 (3), 333–348.

    PubMed  CAS  Google Scholar 

  13. Bastien, C. H. and Morin, C. M. (2000) Familial incidence of insomnia. J. Sleep Res. 9 (1), 49–54.

    Article  PubMed  CAS  Google Scholar 

  14. Bonnet, M. H. and Arand, D. L. (1995) 24-hour metabolic rate in insomniacs and matched normal sleepers. Sleep 18(7), 581–588.

    Google Scholar 

  15. Pavlova, M., Berg, O., Gleason, R., Walker, F., Roberts, S., and Regestein, Q. (2001) Self-reported hyperarousal traits among insomnia patients. J. Psychosom. Res. 51 (2), 435–441.

    Article  PubMed  CAS  Google Scholar 

  16. Bonnet, M. H. and Arand, D. L. (1998) Heart rate variability in insomniacs and matched normal sleepers. Psychosom. Med. 60 (5), 610–615.

    PubMed  CAS  Google Scholar 

  17. Lushington, K., Dawson, D., and Lack, L. (2000) Core body temperature is elevated during constant wakefulness in elderly poor sleepers. Sleep 23 (4), 504–510.

    PubMed  CAS  Google Scholar 

  18. Bonnet, M. H. and Arand, D. L. (2001) Impact of activity and arousal upon spectral EEG parameters. Physiol. Behav. 74 (3), 291–298.

    Article  PubMed  CAS  Google Scholar 

  19. Bonnet, M. H. and Arand, D. L. (2000) Activity, arousal, and the MSLT in patients with insomnia. Sleep 23 (2), 205–212.

    PubMed  CAS  Google Scholar 

  20. Merica, H., Blois, R. and Gaillard, J. M. (1998) Spectral characteristics of sleep EEG in chronic insomnia. Eur. J. Neurosci. 10 (5), 1826–1834.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  22. Vgontzas, A. N., Zoumakes, M., Papanicolaou, D. A., et al. (2001) Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J. Clin. Endocrinol. Metab. 86 (8), 3787–3794.

    Article  PubMed  CAS  Google Scholar 

  23. Salin-Pascual, R. J., Roehrs, T. A., Merlotti, L. A., Zorick, F., and Roth, T. (1992) Long-term study of the sleep of insomnia patients with sleep state misperception and other insomnia patients. Am. J. Psychiatry 149 (7), 904–908.

    PubMed  CAS  Google Scholar 

  24. Bonnet, M. H. and Arand, D. L. (1998) The consequences of a week of insomnia. II: Patients with insomnia. Sleep 21 (4), 359–368.

    PubMed  CAS  Google Scholar 

  25. Hauri, P. (2000) Primary insomnia. In: Principles and Practice of Sleep Medicine ( Kryger, R. A. D., ed.), W.B. Saunders, Philadelphia, PA, pp. 633–639.

    Google Scholar 

  26. Dumont, M., Montplaisir, J., and Infante-Rivard, C. (1997) Sleep quality of former night-shift workers. Int. J. Occup. Environ. Health 3 (Suppl 2), S10–S14.

    PubMed  Google Scholar 

  27. Suzuki, S., Dennerstein, L., Greenwood, K. M., Armstrong, S. M., and Satohesa, E. (1994) Sleeping patterns during pregnancy in Japanese women. J. Psychosom. Obstet. Gynaecol. 15 (1), 19–26.

    Article  PubMed  CAS  Google Scholar 

  28. Hajak, G. (2000) Insomnia in primary care. Sleep 23 (Suppl 3), S54–S63.

    PubMed  Google Scholar 

  29. Montagna, P., Provini, F., Plazzi, G., Liguori, R., and Lugaresi, E. (1997) Propriospinal myoclonus upon relaxation and drowsiness: a cause of severe insomnia. Mov. Disord. 12 (1), 66–72.

    Article  PubMed  CAS  Google Scholar 

  30. Katz, D. A. and McHorney, C. A. (1998) Clinical correlates of insomnia in patients with chronic illness. Arch. Intern. Med. 158 (10), 1099–1107.

    Article  PubMed  CAS  Google Scholar 

  31. Lichstein, K. L., Riedel, B. W., Lester, K. W., and Aguillard, R. N. (1999) Occult sleep apnea in a recruited sample of older adults with insomnia. J. Consult. Clin. Psychol. 67 (3), 405–410.

    Article  PubMed  CAS  Google Scholar 

  32. Hopf, R. and Moller, A. (2000) [Disturbed sleep caused by sleep apnea. To the sleep laboratory for diagnosis?]. MMW Fortschr. Med. 142(12), 31–33.

    Google Scholar 

  33. Rubinstein, M. L. and Selwyn, P. A. High prevalence of insomnia in an outpatient population with HIV infection. J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. 19(3), 260–265.

    Google Scholar 

  34. Leppik, I. E. (1995) Felbamate. Epilepsia 36 (Suppl 2), S66–S72.

    Article  PubMed  CAS  Google Scholar 

  35. Sadler, M. (1999) Lamotrigine associated with insomnia. Epilepsia 40 (3), 322–325.

    Article  PubMed  CAS  Google Scholar 

  36. Satoh, H. (2000) Occupational and environmental toxicology of mercury and its compounds. Ind. Health 38 (2), 153–164.

    Article  PubMed  CAS  Google Scholar 

  37. Rossini, S. R., Reimao, R., LeFevre, B. H., and Medrado-Faria, M. A. (2000) Chronic insomnia in workers poisoned by inorganic mercury: psychological and adaptive aspects. Arq. Neuropsiquiatr. 58 (1), 32–38.

    Article  PubMed  CAS  Google Scholar 

  38. Owens, J. F. and Matthews, K. A. (1998) Sleep disturbance in healthy middle-aged women. Maturitas 30 (1), 41–50.

    Article  PubMed  CAS  Google Scholar 

  39. Dennerstein, L., Dudley, E. C., Hopper, J. L., Guthrie, J. R., and Burger, H. G. (2000) A prospective population-based study of menopausal symptoms. Obstet. Gynecol. 96 (3), 351–358.

    Article  PubMed  CAS  Google Scholar 

  40. Autret, A., Lucas, B., Mondon, K., et al. (2001) Sleep and brain lesions: a critical review of the literature and additional new cases. Neurophysiol. Clin. 31 (6), 356–375.

    Article  PubMed  CAS  Google Scholar 

  41. Attarian, H. P. (2000) Helping patients who say they cannot sleep. Practical ways to evaluate and treat insomnia. Postgrad. Med. 107(3), 127–130, 133–137, 140–142.

    Google Scholar 

  42. Bastien, C. H., Vallieres, A., and Morin, C. M. (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2 (4), 297–307.

    Article  PubMed  Google Scholar 

  43. Smith, S. and Trinder, J. (2001) Detecting insomnia: comparison of four self-report measures of sleep in a young adult population. J. Sleep Res. 10 (3), 229–235.

    Article  PubMed  CAS  Google Scholar 

  44. Leger, D., Scheuermaier, K., Philip, P., Paillard, M., and Guilleminault, C. (2001) SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom. Med. 63 (1), 49–55.

    PubMed  CAS  Google Scholar 

  45. Roehrs, T., Papineau, K., Rosenthal, L., and Roth, T. (1999) Ethanol as a hypnotic in insomniacs: self administration and effects on sleep and mood. Neuropsychopharmacology 20 (3), 279–286.

    Article  PubMed  CAS  Google Scholar 

  46. Chang, P. P., Ford, D. E., Mead, L. A., Cooper-Patrick, L., and Klag, M. J. (1997) Insomnia in young men and subsequent depression. The Johns Hopkins Precursors Study. Am. J. Epidemiol. 146 (2), 105–114.

    Article  PubMed  CAS  Google Scholar 

  47. Roehrs, T. and Roth, T. (2000) Sleep-wake state and memory function. Sleep 23 (Suppl 3), S64–S68.

    PubMed  Google Scholar 

  48. Szelenberger, W. and Niemcewicz, S. (2000) Severity of insomnia correlates with cognitive impairment. Acta Neurobiol. Exp. (Warsz) 60 (3), 373.

    CAS  Google Scholar 

  49. Hajak, G. (2001) Epidemiology of severe insomnia and its consequences in Germany. Eur. Arch. Psychiatry Clin. Neurosci. 251 (2), 49–56.

    Article  PubMed  CAS  Google Scholar 

  50. Vgontzas, A. N. and Kales, A. (1999) Sleep and its disorders. Annu. Rev. Med. 50, 387–400.

    Article  PubMed  CAS  Google Scholar 

  51. Schenck, C. H. and Mahowald, M. W. (1996) Long-term, nightly benzodiazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am. J. Med. 100 (3), 333–337.

    Article  PubMed  CAS  Google Scholar 

  52. Walsh, J. K. and Schweitzer, P. K. (1999) Ten-year trends in the pharmacological treatment of insomnia. Sleep 22 (3), 371–375.

    PubMed  CAS  Google Scholar 

  53. Doghramji, K. (2000) The need for flexibility in dosing of hypnotic agents. Sleep 23(Suppl 1), S16–S20; discussion S21–S2.

    Google Scholar 

  54. Darcourt, G., Pringuey, D., Salliere, D., and Lavoisy, J. (1999) The safety and tolerability of zolpidem—an update. J. Psychopharmacol. 13 (1), 81–93.

    Article  PubMed  CAS  Google Scholar 

  55. Holm, K. J. and Goa, K. L. (2000) Zolpidem: an update of its pharmacology, therapeutic efficacy and tolerability in the treatment of insomnia. Drugs 59 (4), 865–889.

    Article  PubMed  CAS  Google Scholar 

  56. Hajak, G. (1999) A comparative assessment of the risks and benefits of zopiclone: a review of 15 years’ clinical experience. Drug Saf. 21 (6), 457–469.

    Article  PubMed  CAS  Google Scholar 

  57. Elie, R., Ruther, E., Farr, I., Emilien, G., and Salenas, E. (1999) Sleep latency is shortened during 4 weeks of treatment with zaleplon, a novel nonbenzodiazepine hypnotic. Zaleplon Clinical Study Group. J. Clin. Psychiatry 60 (8), 536–544.

    Article  PubMed  CAS  Google Scholar 

  58. Hedner, J., Yaeche, R., Emilieu, G., Farr, I., and Salinas, E. (2000) Zaleplon shortens subjective sleep latency and improves subjective sleep quality in elderly patients with insomnia. The Zaleplon Clinical Investigator Study Group. Int. J. Geriatr. Psychiatry 15 (8), 704–712.

    Article  PubMed  CAS  Google Scholar 

  59. Dominguez, R. A., Bravo-Valverde, R. L., Kaplavitz, B. R., and Cott, J. M. (2000)Valerian as a hypnotic for Hispanic patients. Cultur. Divers. Ethni. Minor Psychol. 6(1), 84–92.

    Google Scholar 

  60. Dorn, M. (2000) [Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomised, double-blind, clinical, comparative study]. Forsch. Komplementarmed. Klass. Naturheilkd. 7(2), 79–84.

    Google Scholar 

  61. Weiler, J. M., Bloomfield, J. R., Woodworth, G. G., et al. (2000) Effects of fexofenadine, diphenhydramine, and alcohol on driving performance. A randomized, placebo-controlled trial in the Iowa driving simulator. Ann. Intern. Med. 132 (5), 354–363.

    PubMed  CAS  Google Scholar 

  62. Hajak, G., Cluydts, R., Declerck, A., et al. (2002) Continuous versus non-nightly use of zolpidem in chronic insomnia: results of a large-scale, double-blind, randomized, outpatient study. Int. Clin. Psychopharmacol. 17 (1), 9–17.

    Article  PubMed  CAS  Google Scholar 

  63. Beullens, J. (1999) [Determinants of insomnia in relatively healthy elderly. A literature review]. Tijdschr. Gerontol. Geriatr. 30(1), 31–38.

    Google Scholar 

  64. Morin, C. M., Mimeault, V., and Gagne, A. (1999) Nonpharmacological treatment of late-life insomnia. J. Psychosom. Res. 46 (2), 103–116.

    Article  PubMed  CAS  Google Scholar 

  65. Perlis, M., Aloia, M., Millikan, A., et al. (2000) Behavioral treatment of insomnia: a clinical case series study. J. Behav. Med. 23 (2), 149–161.

    Article  PubMed  CAS  Google Scholar 

  66. Espie, C. A., Inglis, S. J., and Harvey, L. (2001) Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: analysis of outcome data at 12 months posttreatment. J. Consult. Clin. Psychol. 69 (1), 58–66.

    Article  PubMed  CAS  Google Scholar 

  67. Edinger, J. D., Wohlgemuth, W. K., Radtke, R. A., Marsh, G. R., and Quillian, R. E. (2001) Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA 285 (14), 1856–1864.

    Article  PubMed  CAS  Google Scholar 

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Attarian, H.P. (2004). Psychophysiological Insomnia. In: Attarian, H.P. (eds) Clinical Handbook of Insomnia. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-662-1_6

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  • DOI: https://doi.org/10.1007/978-1-59259-662-1_6

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-465-4

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