Insomnia in Neurological Diseases

Abstract

Insomnia is the most common sleep complaint. Insomnia is not a disease itself but mostly a clinical sign of an underlying disease. Degenerative and vascular diseases involving the central nervous system (CNS) may impair sleep either as a result of the brain lesion or because of illness-related discomfort (motor immobility, social and familial impairment, depression, drugs). Some neurological conditions characterized by movement disorders that start or persist during sleep hinder sleep onset and/or sleep continuity, causing a poor sleep complaint. CNS lesions and/or dysfunction in three specific neurological conditions (fatal familial insomnia, Morvan's chorea, and delirium tremens) impair the basic mechanisms of sleep generation inducing a syndrome in which the inability to sleep is consistently associated with motor and sympathergic overactivation. Agrypnia excitata is the term that aptly defines this generalized overactivation syndrome.

Behavioural and Neurophysiologic Features of State Dissociation: A Brief Review of the Literature and Three Descriptive Case Studies

“…Clinical and neurophysiologic patterns similar to those described in this case can be seen in Morvan's disease and in delirium tremens, which combine lack of NREM, especially SWS, with oneirism, prominent autonomic activation and severe motor agitation [50]. Both conditions are characterised, as FFI, by thalamic involvement.…”

Therapeutic Effects of Melatonin Receptor Agonists on Sleep and Comorbid Disorders

“…Among the clinical features of PD are motor impairments involving resting tremor, bradykinesia, postural instability and rigidity along with non-motoric symptoms such as autonomic, cognitive and psychiatric problems [ 83 , 84 , 85 ]. Several studies have demonstrated the high prevalence of sleep disturbances in PD, which in some cases was close to 90% which is correlated to the severity of the disease [ 86 , 87 ].…”

Psychoanalysis and Neuroscience

“…Severe agrypnia usually lasts only a few weeks in about 90% of cases, but occasionally may persist and lead to death; it is associated in most cases with intense anxiety, delirium and often remarkable hallucinatory behavior with enacted dreams [159]. In addition, patients exhibit symptoms of autonomic hypertension and peculiar motor disturbances with agitation, cramps, myoclonic jerks and fasciculations ("fibrillary chorea").…”