Chronic Insomnia and the Stress System
Section snippets
The role of emotional stress and psychiatric disorders
The emotional factors involved in the development and persistence of insomnia have been assessed in numerous studies investigating stressful life events, personality patterns, and psychiatric diagnoses.
Stressful life events are closely associated with the onset of chronic insomnia and are mediated by certain predisposing personality factors. Insomniacs, compared with controls, tend to be more discontent, both as children and as adults, have less satisfying interpersonal relations, and
Evaluation
Chronic insomnia is a difficult disorder to treat and the importance of a multidimensional evaluation that includes thorough sleep history, medical history, physical examination, and drug/substance use, as well as psychiatric assessment has been stressed for many years, although frequently overlooked in daily practice [20].
The data reviewed in the “etiologic factors and pathophysiologic models” section of this article call for an emphasis on elements of the evaluation that should be
Summary
Insomnia is considered to be the most common sleep disorder. Several different approaches suggest that insomnia is a state of 24-hour hyperarousal rather than sleep loss: insomniacs compared with normal sleepers are not sleepier during the day, have an increased level of high-frequency EEG rhythm during sleep, have elevated brain metabolism during sleep and decreased during wakefulness in functional neuroimaging studies, have similar cognitive function and performance, and also have a 24-hour
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