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Colin A. Espie - One of the best experts on this subject based on the ideXlab platform.
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Paradoxical Intention Therapy
Behavioral Treatments for Sleep Disorders, 2011Co-Authors: Colin A. EspieAbstract:Publisher Summary Paradoxical intention (PI) is thought to be ideal for Insomnia disorder, particularly where there is intense preoccupation about sleep, sleep loss, and its consequences. The Psychophysiological Insomnia phenotype, as characterized in ICSD-2, couples sleep preoccupation with the notion of “striving” to sleep, and the maladaptive relationship between effort to sleep and ability to sleep. The guiding rationale is that because sleep is essentially an involuntary physiological process, attempts to place it under voluntary control are likely to make matters worse. PI is thought to work by reducing performance anxiety (the poor sleeper's inability to produce the criterion performance for good sleep) and by reducing associated sleep worry and sleep preoccupation. Paradoxical techniques in psychotherapy have been described for a long time—for example, 100 years ago, methods were described of treating impotence through the simultaneous prescription of intimate physical contact and the prohibition of sexual intercourse.
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Selective Processing of Sleep-Related Words in Psychophysiological Insomnia: A Novel Eye-Tracking Study
2010Co-Authors: Heather Cleland Woods, Kerry Ann Ross, Christoph Scheepers, Stephany M. Biello, Colin A. EspieAbstract:Objectives: The aim of this study was to move forward from: ‘‘snapshot’’ cognitive probe studies used to establish selective attention in Insomnia and understand processing of salient sleep words over time within the context of approach and avoidance. Methods: The novel methodology to Insomnia research, eye tracking, was used to monitor the eye movements of individuals with Psychophysiological Insomnia (PI) and good sleepers (GS) to sleep positive, sleep negative and neutral words over a three second period. Results: The data shows that individuals with Insomnia are less accurate [F(1.39) = 4.6, P < .05], take longer to fixate on the target word [F(1.39) = 5.0, P < .05] and take longer to move from distractor to target word [F(1.39) = 3.9, P < .05]. There is a trend towards significance suggestive of faster processing of positive sleep words compared to sleep negative or neutral words [F(2.78) = 2.9, P = .07]. Conclusions: Irrespective of word salience, the PI would appear to show detrimental processing overall compared to GS. Interesting questions arise within this context of whether this is an artefact of fatigue or there is indeed a processing impairment. The trend toward faster processing of sleep positive words would suggest that there is a possible selective processing impairment.
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The clock as a focus of selective attention in those with primary Insomnia: an experimental study using a modified Posner paradigm.
Behaviour research and therapy, 2009Co-Authors: Heather Cleland Woods, Stephany M. Biello, L M Marchetti, Colin A. EspieAbstract:Espie and colleagues [(2006). The attention-intention-effort pathway in the development of Psychophysiological Insomnia: a theoretical review. Sleep Medicine Reviews, 10, 215-245] propose a route into Psychophysiological Insomnia along the attention-intention-effort pathway which focuses on the inhibition of sleep-wake automaticity. A contributing factor to this is selective attention to sleep (alongside explicit intention to sleep and effort in the sleep engagement process). Following on from previous work on selective attention to sleep [Marchetti, L. M., Biello, S. M., Broomfield, N. M., MacMahon, K. M. A., & Espie, C. A. (2006). Who is pre-occupied with sleep?. A comparison of attention bias in people with psychphysiological Insomnia, delayed sleep phase syndrome and good sleepers using the induced change blindness paradigm. Journal of Sleep Research, 15, 212-221; MacMahon, K., Broomfield, N., Macphee, L., & Espie, C. A. (2006). Attention bias for sleep related stimuli in primary Insomnia and delayed sleep phase syndrome using the dot-probe task. Sleep, 29, 11] and considering the importance of monitoring both internal and external cues in the maintenance of Insomnia, as highlighted in the cognitive model of Insomnia [Harvey, A. G. (2002). A cognitive model of Insomnia. Behaviour Research and Therapy, 40, 869-893], a cognitive probe task was employed to investigate further the role of the clock as a focus of selective attention in those with primary Insomnia. A 2 x 2 between participants design comparing reaction time of individuals with primary Insomnia (n=22) and normal sleepers (n=22) on a modified Posner paradigm. Responses obtained from a computer task presenting times which fall within a normal sleep period were analysed. Individuals with primary Insomnia demonstrated delayed disengagement to the clock (F(1,84)=6.9, p
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Understanding Insomnia through cognitive modelling.
Sleep medicine, 2007Co-Authors: Colin A. EspieAbstract:Cognitive models of Insomnia have received growing support in recent years and are embraced by the current diagnostic framework. Many people with Insomnia report that mental events, such as intrusive thoughts or a racing mind, prevent them from achieving or maintaining sleep. Dysfunctional cognition may play an important role in perpetuating Insomnia, with many individuals with Psychophysiological Insomnia reporting a distorted perception of sleep. Neurocognitive studies have indicated that high-frequency EEG activity associated with cognitive processes is enhanced in patients with Insomnia at or around sleep onset, which may distort the individual's judgement about sleep initiation and duration. A subtype of Psychophysiological Insomnia has been proposed--attention-intention-effort (AIE) syndrome--that takes into consideration the interaction between behavioral and cognitive factors in the development and maintenance of Insomnia. A series of studies from the University of Glasgow Sleep Centre using cognitive probe tasks has provided insight into this pathway, particularly with regard to the role of attention bias towards sleep stimuli in mediating Insomnia. Further research is required to explore the cortical correlates of attention bias, investigate AIE as a potential causal mechanism of Insomnia and examine AIE in other Insomnia groups.
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who is pre occupied with sleep a comparison of attention bias in people with Psychophysiological Insomnia delayed sleep phase syndrome and good sleepers using the induced change blindness paradigm
Journal of Sleep Research, 2006Co-Authors: L M Marchetti, Stephany M. Biello, Niall M Broomfield, Kenneth M A Macmahon, Colin A. EspieAbstract:SUMMARY Cognitive models of Insomnia suggest that selective attention may be involved inmaintaining the disorder. However, direct assessment of selective attention is limited.Using the inducing change blindness (ICB) paradigm we aimed to determine whetherthere is attentional preference for sleep-related stimuli in Psychophysiological Insomnia(PI) relative to delayed sleep phase syndrome (DSPS) and good sleepers (GS). In theICB task, a visual scene, comprising both sleep-related and neutral stimuli, flickersback and forth with one element (sleep or neutral) of the scene changing betweenpresentations. Therefore, a 2 · 3 totally between-participants design was employed.The dependent variable was the number of flickers it took for the participant to identifythe change. Ninety individuals (30 per group) were classified using ICSD-R criteria,self-report diaries and wrist actigraphy. As predicted, PI detected a sleep-related changesignificantly quicker than DSPS and GS, and significantly quicker than a sleep-neutralchange. Unexpectedly, DSPS detected a sleep-related change significantly quicker thanGS. No other differences were observed between the two controls. These results supportthe notion that there is an attention bias to sleep stimuli in PI, suggesting that selectiveattention tasks such as the ICB may be a useful objective index of cognitive arousal inInsomnia. The results also suggest that there may be an element of sleep preoccupationassociated with DSPS. Results are discussed with reference to other experiments onattentional processing in Insomnia.keywords attention bias, cognitive arousal, delayed sleep phase syndrome, inducingchange blindness flicker paradigm, Insomnia
Wallace B. Mendelson - One of the best experts on this subject based on the ideXlab platform.
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Differential rates of psychopathology symptoms in periodic limb movement disorder, obstructive sleep apnea, Psychophysiological Insomnia, and Insomnia with psychiatric disorder.
Sleep, 1999Co-Authors: James E. Aikens, Peter A. Vanable, Lakshminarayana Tadimeti, Brendan Caruana-montaldo, Wallace B. MendelsonAbstract:STUDY OBJECTIVE: To determine patterns and relative intensity of psychopathology, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), in 108 patients with either Psychophysiological Insomnia (PI; n=20), Insomnia with psychiatric disorder (IPD; n=30), periodic limb movement disorder (PLM; n=28), or obstructive sleep apnea (OSA; n=30). DESIGN: Cross-sectional. SETTING: University sleep disorders center. MEASUREMENTS AND RESULTS: Subjects completed the MMPI prior to overnight diagnostic polysomnographic assessment followed by Multiple Sleep Latency Test (MSLT). Seventy five percent of the entire sample had at least one MMPI elevation (T>70). Groups showed significant baseline differences in age, BMI, and MSLT latency (all ps
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differential rates of psychopathology symptoms in periodic limb movement disorder obstructive sleep apnea Psychophysiological Insomnia and Insomnia with psychiatric disorder
Sleep, 1999Co-Authors: James E. Aikens, Peter A. Vanable, Lakshminarayana Tadimeti, Brendan Caruanamontaldo, Wallace B. MendelsonAbstract:STUDY OBJECTIVE: To determine patterns and relative intensity of psychopathology, as measured by the Minnesota Multiphasic Personality Inventory (MMPI), in 108 patients with either Psychophysiological Insomnia (PI; n=20), Insomnia with psychiatric disorder (IPD; n=30), periodic limb movement disorder (PLM; n=28), or obstructive sleep apnea (OSA; n=30). DESIGN: Cross-sectional. SETTING: University sleep disorders center. MEASUREMENTS AND RESULTS: Subjects completed the MMPI prior to overnight diagnostic polysomnographic assessment followed by Multiple Sleep Latency Test (MSLT). Seventy five percent of the entire sample had at least one MMPI elevation (T>70). Groups showed significant baseline differences in age, BMI, and MSLT latency (all ps<.05). Logistic regression indicated that even after statistically controlling for these three diagnostic covariates, MMPI elevation was more likely among PLM and IPD patients than OSA or PI patients (all ps<.05). Followup pairwise comparisons indicated that this same pattern of group differences occurred for the Depression, Psychasthenia, and Schizophrenia scales (all ps<.05). CONCLUSIONS: Irrespective of age, obesity, and daytime sleepiness, patients with untreated PLM or IPD are more likely to experience clinically significant psychological difficulties than those with either OSA or PI. These differences are most likely to be manifested in terms of depressive symptoms, anxiety symptoms (tension, worry, guilt), social alienation, and diminished mental concentration. Finally, PLM may be associated with greater MMPI elevations than previously suspected, and agree with earlier clinical reports of high rates of psychiatric treatment in PLM.
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Long-term follow-up of chronic Insomnia.
Sleep, 1995Co-Authors: Wallace B. MendelsonAbstract:In order to assess the long-term outcome of sleep disturbance, 28 well-characterized patients with Psychophysiological Insomnia or sleep state misperception were given structured interviews 40 months and 64 months after initial assessment. Most patients still reported sleep disturbance, albeit with some improvement. The number of nights per week of disturbed sleep decreased, subjective total sleep time increased, daytime sleepiness declined, there was an increase in feeling refreshed in the morning and there was a trend toward decreased global complaints of poor sleep. Subjective sleep latency was unchanged, and the only parameter that worsened was difficulty falling asleep. Only a minority of the patients (18%) were taking prescription hypnotics at follow-up, but these patients believed that they were of benefit. There was a significant rate of increase in the use of over-the-counter hypnotics at the time of the second follow-up, although there was a low rate of satisfaction associated with them.
Göran Hajak - One of the best experts on this subject based on the ideXlab platform.
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regensburg Insomnia scale ris a new short rating scale for the assessment of psychological symptoms and sleep in Insomnia study design development and validation of a new short self rating scale in a sample of 218 patients suffering from Insomnia and
Health and Quality of Life Outcomes, 2013Co-Authors: Tatjana Cronlein, Göran Hajak, Berthold Langguth, Roland Popp, Helmut Lukesch, Christoph Pieh, Peter GeislerAbstract:Background: The Regensburg Insomnia Scale (RIS) is a new self-rating scale to assess cognitive, emotional and behavioural aspects of Psychophysiological Insomnia (PI) with only ten items. A specific purpose of the new scale is the evaluation of the outcome of Insomnia- specific cognitive behaviour therapy (CBT-I). Methods: Internal consistency of the RIS has been validated in 218 patients with PI. For determining sensitivity and specificity, this sample has been compared to 94 healthy controls. Sensitivity to change and pre-post cross-validation with the Pittsburgh Sleep Quality Index (PSQI) has been tested in a separate sample of 38 patients with PI undergoing CBT-I. Results: RIS distinguishes well between controls and patients with PI. Internal consistency was within a good range (Cronbach alpha = .890). RIS was sensitive for detecting improvements after CBT-I in sleep parameters and target symptoms such as sleep-related thinking. Conclusion: The RIS is a valid and feasible instrument for assessing psychological PI-symptoms and sleep parameters.
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Insomnien: I. Ätiologie, Pathophysiologie und Diagnostik
Der Nervenarzt, 2009Co-Authors: Dieter Riemann, Göran HajakAbstract:Difficulties to initiate or maintain sleep, early morning awakening and resulting impairment of daytime functioning are a frequent comorbidity of many psychiatric and medical disorders. The so-called primary or Psychophysiological Insomnia as a distinct independent form of Insomnia is a far less frequent condition. This article gives an overview of the diagnostic process for Insomniac disorders. Furthermore, up to date neurobiological models of Insomnia are discussed.
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Quantified arousal analysis in patients with Psychophysiological Insomnia
2000Co-Authors: Andrea Rodenbeck, Eckart Rüther, Stefan Cohrs, Göran HajakAbstract:Arousals are transient, brief and abrupt frequency shifts in the electroencephalogram during sleep. A lot of studies considered that the impaired daytime functioning in patients with sleep disturbances may be caused by such sleep fragmentations. In 1992 the American Sleep Disorders Association (ASDA) defined criteria concerning the rating of arousals. Nevertheless, data on arousal patterns according to ASDA criteria in patients with Insomnia are still missing. Therefore, we studied the arousal distribution according to ASDA criteria in 25 patients with Psychophysiological Insomnia divided into four age groups and 10 young healthy controls. Young patients showed a significantly increased arousal index per hour total sleep time (18.3±6.3) compared to age-matched controls (10.5±3.1, p≤0.01). Within the patient groups the arousal index increased with increasing age (maximal index: 27,6±11.5). All patients showed high percentages of non-movement related arousals. In spite of the explorative character of the presented study, the results indicate that the Insomniacs' sleep is disturbed by arousal-related sleep fragmentation. The increased arousal frequency suggests to be a neurophysiological correlate of the postulated hyperarousal in Psychophysiological Insomnia.
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Quantifizierte Arousal-Analyse bei Patienten mit einer psychophysiologischen Insomnie
Somnologie - Schlafforschung und Schlafmedizin, 2000Co-Authors: Andrea Rodenbeck, Eckart Rüther, Stefan Cohrs, Göran HajakAbstract:Arousals are transient, brief and abrupt frequency shifts in the electroencephalogram during sleep. A lot of studies considered that the impaired daytime functioning in patients with sleep disturbances may be caused by such sleep fragmentations. In 1992 the American Sleep Disorders Association (ASDA) defined criteria concerning the rating of arousals. Nevertheless, data on arousal patterns according to ASDA criteria in patients with Insomnia are still missing. Therefore, we studied the arousal distribution according to ASDA criteria in 25 patients with Psychophysiological Insomnia divided into four age groups and 10 young healthy controls. Young patients showed a significantly increased arousal index per hour total sleep time (18.3±6.3) compared to age-matched controls (10.5±3.1, p≤0.01). Within the patient groups the arousal index increased with increasing age (maximal index: 27,6±11.5). All patients showed high percentages of non-movement related arousals. In spite of the explorative character of the presented study, the results indicate that the Insomniacs' sleep is disturbed by arousal-related sleep fragmentation. The increased arousal frequency suggests to be a neurophysiological correlate of the postulated hyperarousal in Psychophysiological Insomnia. Arousal sind sekundenkurze Frequenzbeschleunigungen im Elektroenzephalogramm des schlafenden Menschen. Viele Untersuchungen weisen auf einen Zusammenhang zwischen einem Arousal-gestörten Schlaf und einer eingeschränkten Tagesbefindlichkeit bei schlafgestörten Patienten hin. Seit 1992 existieren standardisierte Kriterien zur Bestimmung von Arousals der American Sleep Disorders Association (ASDA). Daten zur diesbezüglichen Feinstruktur des Schlafes bei Patienten mit einer Insomnie fehlen aber bisher. Wir untersuchten daher die Arousal-Muster unter Berücksichtigung der ASDA-Kriterien bei 25 Patienten mit einer psychophysiologischen Insomnie unterschiedlichen Alters und 10 gesunden Kontrollen. Junge Patienten zeigten einen signifikant (p≤0,01) höheren Arousal-Index pro Stunde Gesamtschlafzeit (18,3±6,3) als altersentsprechende Gesunde (10,5±3,1). Der Arousal-Index der Patienten stieg mit zunehmendem Alter leicht an (maximal 27,6±11,5). Bei allen Patienten war insbesondere der Anteil der nicht mit einer Bewegung einhergehenden Arousal erhöht. Der Schlaf der Insomniepatienten wird demnach durch eine Arousal-bedingte Fragmentierung gestört. Die Ergebnisse dieser explorativen und hypothesengenerienrenden Untersuchung legen nahe, dass das Modell eines generellen pscyhophysiologischen Hyperarousal der psychophysiologischen Insomnie sich neurophysiologisch im vermehrten Auftreten von Arousal zeigt.
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Quantifizierte Arousal‐Analyse bei Patienten mit einer psychophysiologischen Insomnie
Somnologie, 2000Co-Authors: Andrea Rodenbeck, Eckart Rüther, Stefan Cohrs, Göran HajakAbstract:Arousals are transient, brief and abrupt frequency shifts in the electroencephalogram during sleep. A lot of studies considered that the impaired daytime functioning in patients with sleep disturbances may be caused by such sleep fragmentations. In 1992 the American Sleep Disorders Association (ASDA) defined criteria concerning the rating of arousals. Nevertheless, data on arousal patterns according to ASDA criteria in patients with Insomnia are still missing. Therefore, we studied the arousal distribution according to ASDA criteria in 25 patients with Psychophysiological Insomnia divided into four age groups and 10 young healthy controls. Young patients showed a significantly increased arousal index per hour total sleep time (18.3±6.3) compared to age-matched controls (10.5±3.1, p≤0.01). Within the patient groups the arousal index increased with increasing age (maximal index: 27,6±11.5). All patients showed high percentages of non-movement related arousals. In spite of the explorative character of the presented study, the results indicate that the Insomniacs' sleep is disturbed by arousal-related sleep fragmentation. The increased arousal frequency suggests to be a neurophysiological correlate of the postulated hyperarousal in Psychophysiological Insomnia.
Dieter Riemann - One of the best experts on this subject based on the ideXlab platform.
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Insomnien: I. Ätiologie, Pathophysiologie und Diagnostik
Der Nervenarzt, 2009Co-Authors: Dieter Riemann, Göran HajakAbstract:Difficulties to initiate or maintain sleep, early morning awakening and resulting impairment of daytime functioning are a frequent comorbidity of many psychiatric and medical disorders. The so-called primary or Psychophysiological Insomnia as a distinct independent form of Insomnia is a far less frequent condition. This article gives an overview of the diagnostic process for Insomniac disorders. Furthermore, up to date neurobiological models of Insomnia are discussed.
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Neuere Modellvorstellungen zu Ätiologie und Pathophysiologie der psychophysiologischen Insomnie
Somnologie - Schlafforschung und Schlafmedizin, 1999Co-Authors: Tomasz Sobanski, Bernd Feige, Dieter RiemannAbstract: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.ZusammenfassungBei 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.
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Neuere Modellvorstellungen zu Ätiologie und Pathophysiologie der psychophysiologischen Insomnie
Somnologie - Schlafforschung und Schlafmedizin, 1999Co-Authors: Tomasz Sobanski, Bernd Feige, Dieter RiemannAbstract: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. 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.
Yu Jin Lee - One of the best experts on this subject based on the ideXlab platform.
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Decreased regional brain activity in response to sleep-related sounds after cognitive behavioral therapy for Psychophysiological Insomnia.
Psychiatry and clinical neurosciences, 2019Co-Authors: Nambeom Kim, Seog Ju Kim, Yu Jin Lee, Soohyun Kim, Jae Won Choi, Juhyun Park, Ah Reum Gwak, Seung Gul Kang, Hang-keun KimAbstract:Aim Patients with Psychophysiological Insomnia (PI) experience hyperarousal, especially as a reaction to sound stimuli. In the current study, we explored brain activity changes in response to sleep-related sounds (SS) in patients with Insomnia after cognitive behavioral therapy for Insomnia (CBT-I). Methods In 14 drug-free PI patients, regional brain activity in response to SS, and to white noise sound (NS) as neutral stimuli, was investigated before and after individual CBT-I using functional magnetic resonance imaging. Blood oxygen level-dependent (BOLD) signals to SS and NS were compared before and after CBT-I. In addition, the association between clinical improvement after CBT-I and changes in brain activity in response to SS and NS was analyzed. Results Compared with baseline, regional brain activity in response to SS after CBT-I decreased in the left middle temporal and left middle occipital gyrus. In regression analysis, a reduction in the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) Scale score after CBT-I was associated with decrease in brain activity in response to SS in both thalami. However, brain activity in response to NS showed no BOLD signal changes and no association with DBAS change. Conclusion Cortical hyperactivity, which may cause hyperarousal in PI, was found to decrease after CBT-I. CBT-I targeting changes in beliefs and attitudes about sleep may induce its therapeutic effects by reducing thalamic brain activity in response to sleep-related stimuli.
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Changes in subcortical resting-state functional connectivity in patients with Psychophysiological Insomnia after cognitive-behavioral therapy: Changes in resting-state FC after CBT for Insomnia patients.
NeuroImage. Clinical, 2017Co-Authors: Yu Jin G. Lee, Seog Ju Kim, Nambeom Kim, Soohyun Kim, Jae Won Choi, Juhyun Park, Ah Reum Gwak, Yu Jin LeeAbstract:Abstract Study objectives To examine the resting-state functional connectivity (FC) between subcortical regions in relation to whole-brain activity in patients with Psychophysiological Insomnia (PI) and changes following cognitive–behavioral therapy for Insomnia (CBTi). Methods The FC between subcortical seed regions (caudate, putamen, pallidum, amygdala, thalamus, and hippocampus) and whole-brain voxels were compared between the PI group (n = 13, mean age: 51.0 ± 10.2 years) and good sleepers (GS, n = 18, mean age: 42.7 ± 12.3 years). Also, in the PI group, FC was compared before and after 5 weeks of CBTi. Results Compared to the GS group, the PI group exhibited stronger FC between the thalamus and prefrontal cortex and between the pallidum and precuneus but weaker FC between the pallidum and angular gyrus, the caudate and orbitofrontal cortex, and the hippocampus and fusiform gyrus. After CBTi, the PI group exhibited decreased FC between the thalamus and parietal cortex, the putamen and motor cortices, and the amygdala and lingual gyrus, but increased FC between the caudate and supramarginal gyrus, the pallidum and orbitofrontal cortex, and the hippocampus and frontal/parietal gyri. Conclusions The present findings demonstrate different FC in PI patients compared to GS and provide insight into the neurobiological rationale for CBTi.
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Exploration of changes in the brain response to sleep-related pictures after cognitive–behavioral therapy for Psychophysiological Insomnia
Scientific reports, 2017Co-Authors: Seog Ju Kim, Yu Jin Lee, Nambeom Kim, Soohyun Kim, Jae Won Choi, Juhyun Park, Ah Reum Gwak, Chang Ki Kang, Seung Gul Kang, Un JeongAbstract:Psychophysiological Insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for Insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional magnetic resonance imaging (fMRI). BOLD changes after CBT-I in patients were also examined. PI patients showed higher BOLD activation to SS in the precentral, prefrontal, fusiform, and posterior cingulate cortices before CBT-I. The increased responses to SS were reduced after CBT-I. The increased response to SS in the precentral cortex was associated with longer wake time after sleep onset (WASO), and its reduction after CBT-I was associated with improvements in WASO. Clinical improvements after CBT-I were correlated with BOLD reduction in the right insula and left paracentral cortex in response to SS. PI showed hyper-responses to SS in the precentral cortex, prefrontal cortex, and default mode network and these brain hyper-responses were normalized after CBT-I. CBT-I may exert its treatment effects on PI by reducing hyper-responses to SS in the precentral cortex and insula.
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exploration of changes in the brain response to sleep related pictures after cognitive behavioral therapy for Psychophysiological Insomnia
Scientific Reports, 2017Co-Authors: Seog Ju Kim, Yu Jin Lee, Nambeom Kim, Soohyun Kim, Jae Won Choi, Juhyun Park, Ah Reum Gwak, Chang Ki Kang, Seung Gul Kang, Do Un JeongAbstract:Psychophysiological Insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for Insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional magnetic resonance imaging (fMRI). BOLD changes after CBT-I in patients were also examined. PI patients showed higher BOLD activation to SS in the precentral, prefrontal, fusiform, and posterior cingulate cortices before CBT-I. The increased responses to SS were reduced after CBT-I. The increased response to SS in the precentral cortex was associated with longer wake time after sleep onset (WASO), and its reduction after CBT-I was associated with improvements in WASO. Clinical improvements after CBT-I were correlated with BOLD reduction in the right insula and left paracentral cortex in response to SS. PI showed hyper-responses to SS in the precentral cortex, prefrontal cortex, and default mode network and these brain hyper-responses were normalized after CBT-I. CBT-I may exert its treatment effects on PI by reducing hyper-responses to SS in the precentral cortex and insula.