HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies

Dressle, Raphael J.; Feige, Bernd; Spiegelhalder, Kai; Schmucker, Christine; Benz, Fee; Mey, Nina C.; Riemann, Dieter

doi:10.1016/j.smrv.2022.101588

Cited by 48 publications

(50 citation statements)

References 110 publications

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“…Hyperarousal includes physiological, cognitive and emotional components, and has been considered a stable characteristic of people with insomnia both during the night and during the day (Morin et al, 2015; Riemann et al, 2010, 2015). It has been demonstrated that patients with insomnia show increased levels of autonomic activity (though the issue is discussed critically with respect to heart rate variability; Dodds et al, 2017) and an overactivity of the HPA‐axis, as documented by increased levels of cortisol output during day‐ and night‐time (see meta‐analysis by Dressle et al, 2022). Central nervous system (CNS) indicators of hyperarousal in people with insomnia are increased amounts of micro‐arousals and increases in fast EEG frequencies (in the sigma and beta bands) during sleep (Christensen et al, 2019; Feige et al, 2013; Perlis et al, 1997, 2001; Spiegelhalder et al, 2012), and also wake EEG shows signatures of increased excitation (Colombo, Ramautar, et al, 2016; Colombo, Wei, et al, 2016) and somatic awareness and responsivity (Wei et al, 2016; Wei, Blanken, & Van Someren, 2018; Wei, Ramautar, et al, 2018).…”

Section: Aetiological and Pathophysiological Considerationsmentioning

confidence: 99%

Insomnia disorder: State of the science and challenges for the future

Riemann

Benz

Dressle

et al. 2022

Journal of Sleep Research

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148

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Summary Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self‐report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive‐behavioural models to (epi‐) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep–wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive‐behavioural models of insomnia led to the conceptualization of cognitive‐behavioural therapy for insomnia, which is now considered as first‐line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive‐behavioural therapy for insomnia merits widespread implementation, and digital cognitive‐behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive‐behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non‐response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.

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Section: Aetiological and Pathophysiological Considerationsmentioning

confidence: 99%

Insomnia disorder: State of the science and challenges for the future

Riemann

Benz

Dressle

et al. 2022

Journal of Sleep Research

Self Cite

148

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“…(Lo Martire et al, 2020) The HPA axis and insomnia Alterations to HPA axis activity are relevant to the pathogenesis of both acute insomnia and insomnia disorder. The hyperarousal theoretical model of insomnia suggests that elevated cognitive, emotional and physiological activity (expressed as, for example, heightened autonomic or central nervous system activity) are important in the pathophysiology of insomnia disorder (Dressle et al, 2022;Riemann et al, 2015;Riemann et al, 2010). Acute insomnia, and insomnia disorder, can both be considered to be a stressrelated condition, whereby an initial stressful event can result in physiological hyperarousal, and over time, insomnia disorder becomes stressful in its own right (Dressle et al, 2022).…”

Section: Stress the Hypothalamic-pituitary-adrenal (Hpa) Axis And Ins...mentioning

confidence: 99%

“…Activation of the HPA axis is a feature of acute insomnia, where the initial stress response is observed as a consequence of the response to the initial stressor (Dressle et al, 2022). However, alterations to HPA axis activity are also a feature of the transition from acute insomnia to insomnia disorder, where following the initial stressor, heightened HPA axis activity can negatively affect sleep (Dressle et al, 2022). The initial sleep disturbance which accompanies the acute stressor can potentially cause sleep fragmentation or deprivation.…”

Section: Stress the Hypothalamic-pituitary-adrenal (Hpa) Axis And Ins...mentioning

confidence: 99%

Stress and the hypothalamic–pituitary–adrenal axis: How can the COVID‐19 pandemic inform our understanding and treatment of acute insomnia?

Elder

Altena

Palagini

et al. 2023

Journal of Sleep Research

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Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies which can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal (HPA) axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous HPA axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response (CAR) as a marker of HPA axis function, as cortisol is the end product of the HPA axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions; examining if reducing the impact of stress is effective, and finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.

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“…The difficulty can be in falling asleep, remaining asleep or both. Its prevalence is about 30-50% in general population, in which 10% has chronic insomnia [1] . Chronic insomnia can adversely affect the health, quality of life, academic performance; increase the risk of motor vehicle accidents, decrease productivity at work, irritability and increase daytime drowsiness.…”

Section: Introductionmentioning

confidence: 99%

Added Effect of Pratimarsha Nasya with Ksheerabala Taila (14 Aavartita) over Selected Yoga Techniques in Insomnia

Vrinda

Sunitha²,

Bhadran³

2023

Int J Ayu Pharm Res

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Insomnia is a prevalent psycho physiological sleeping disorder, included in the International Classification of Sleep Disorders-2 (ICSD-2). By definition insomnia is a difficulty in initiating or maintaining sleep, or both or the perception of a poor quality sleep. Insomnia leads to various social, interpersonal and occupational impairments. Clinical studies have proven that Yoga is effective in insomnia. Present study was to find out the added effect of Pratimarsha nasya with Ksheerabala taila (14 Aavartita) over selected Yoga techniques in relieving insomnia. As per Acharya Susrutha in Chikitsa Sthana, doing Pratimarsha nasya daily during evening hours (Sayamkala) renders Sukhanidraprabhodanam. A pre-post interventional study was performed in 40 participants both male and female, satisfying the inclusion and exclusion criteria. Out of 40 participants, 20 each were randomly allocated to Group I and Group II. In Group I, Pratimarsha nasya using Ksheerabala taila (14 Aavartita) was administered 1ml in each nostril at evening time along with the practice of selected yoga techniques during morning hours. In Group II, only selected Yoga techniques were advised. The study period was for 30 days. The pre & post changes in mean score value was assessed using Pittsburgh Sleep Quality Index (PSQI) score. The data was analyzed using unpaired t test, and was statistically significant with a p value ≤0.01. Thus the added effect of Pratimarsha nasya with Ksheerabala taila (14 Aavrtita) over selected Yoga techniques in insomnia is more effective than selected Yoga techniques alone.

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HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies

Cited by 48 publications

References 110 publications

Insomnia disorder: State of the science and challenges for the future

Insomnia disorder: State of the science and challenges for the future

Stress and the hypothalamic–pituitary–adrenal axis: How can the COVID‐19 pandemic inform our understanding and treatment of acute insomnia?

Added Effect of Pratimarsha Nasya with Ksheerabala Taila (14 Aavartita) over Selected Yoga Techniques in Insomnia

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