Journal of Sleep Research,
Год журнала:
2023,
Номер
32(4)
Опубликована: Фев. 14, 2023
Summary
Insomnia
disorder
is
considered
as
a
stress‐related
associated
with
hyperarousal,
stress
and
emotion
dysregulation
the
instability
of
‘flip‐flop’
switch
system.
The
orexinergic
system
well
known
for
its
key
role
in
sleep
arousal
processes
but
also
allostatic
regulating
emotions
may
thus
be
major
interest
insomnia
treatment.
Accordingly,
we
discuss
potential
orexins
on
processes,
brain
systems
modulating
implications
pathophysiology.
We
reviewed
available
data
effect
dual
orexin
receptor
antagonists
(DORAs)
stress/emotions
present
our
findings
narrative
review.
Few
animals
humans
have
reported
that
disrupted
related
to
overactivation
system,
while
some
more
consistent
response
acute
disorders.
Taken
together
these
let
us
hypothesise
an
hyperarousal
hyperactivation
arousal‐promoting
insomnia.
On
other
hand,
it
possible
by
rebalancing
DORAs
regulate
both
systems,
turn,
contributing
‘switch
off’
Nevertheless,
studies
are
needed
clarify
evaluate
effects
sleep,
systems.
Journal of Sleep Research,
Год журнала:
2023,
Номер
32(6)
Опубликована: Ноя. 28, 2023
Summary
Progress
in
the
field
of
insomnia
since
2017
necessitated
this
update
European
Insomnia
Guideline.
Recommendations
for
diagnostic
procedure
and
its
comorbidities
are:
clinical
interview
(encompassing
sleep
medical
history);
use
questionnaires
diaries
(and
physical
examination
additional
measures
where
indicated)
(A).
Actigraphy
is
not
recommended
routine
evaluation
(C),
but
may
be
useful
differential‐diagnostic
purposes
Polysomnography
should
used
to
evaluate
other
disorders
if
suspected
(i.e.
periodic
limb
movement
disorder,
sleep‐related
breathing
disorders,
etc.),
treatment‐resistant
(A)
indications
(B).
Cognitive‐behavioural
therapy
as
first‐line
treatment
chronic
adults
any
age
(including
patients
with
comorbidities),
either
applied
in‐person
or
digitally
When
cognitive‐behavioural
sufficiently
effective,
a
pharmacological
intervention
can
offered
Benzodiazepines
(A),
benzodiazepine
receptor
agonists
daridorexant
low‐dose
sedating
antidepressants
(B)
short‐term
(≤
4
weeks).
Longer‐term
these
substances
initiated
some
cases,
considering
advantages
disadvantages
Orexin
antagonists
periods
up
3
months
longer
cases
Prolonged‐release
melatonin
≥
55
years
Antihistaminergic
drugs,
antipsychotics,
fast‐release
melatonin,
ramelteon
phytotherapeutics
are
Light
exercise
interventions
adjunct
therapies
Journal of Sleep Research,
Год журнала:
2022,
Номер
31(4)
Опубликована: Апрель 22, 2022
Summary
Insomnia
disorder
comprises
symptoms
during
night
and
day
that
strongly
affect
quality
of
life
wellbeing.
Prolonged
sleep
latency,
difficulties
to
maintain
early
morning
wakening
characterize
complaints,
whereas
fatigue,
reduced
attention,
impaired
cognitive
functioning,
irritability,
anxiety
low
mood
are
key
daytime
impairments.
is
well
acknowledged
in
all
relevant
diagnostic
systems:
Diagnostic
Statistical
Manual
the
American
Psychiatric
Association,
5th
revision,
International
Classification
Sleep
Disorders,
3rd
version,
Diseases,
11th
revision.
as
a
chronic
condition
frequent
(up
10%
adult
population,
with
preponderance
females),
signifies
an
important
independent
risk
factor
for
physical
and,
especially,
mental
health.
diagnosis
primarily
rests
on
self‐report.
Objective
measures
like
actigraphy
or
polysomnography
not
(yet)
part
routine
canon,
but
play
role
research.
Disease
concepts
insomnia
range
from
cognitive‐behavioural
models
(epi‐)
genetics
psychoneurobiological
approaches.
The
latter
derived
knowledge
about
basic
sleep–wake
regulation
encompass
theories
rapid
eye
movement
instability/restless
sleep.
Cognitive‐behavioural
led
conceptualization
therapy
insomnia,
which
now
considered
first‐line
treatment
worldwide.
Future
research
strategies
will
include
combination
experimental
paradigms
neuroimaging
may
benefit
more
attention
dysfunctional
overnight
alleviation
distress
insomnia.
With
respect
therapy,
merits
widespread
implementation,
digital
assist
delivery
along
guidelines.
However,
given
still
considerable
proportion
patients
responding
insufficiently
fundamental
studies
highly
necessary
better
understand
brain
behavioural
mechanisms
underlying
Mediators
moderators
response/non‐response
associated
development
tailored
novel
interventions
also
require
investigation.
Recent
suggest
prove
add
significantly
preventive
strategy
combat
global
burden
disorders.
Journal of Sleep Research,
Год журнала:
2022,
Номер
31(4)
Опубликована: Май 4, 2022
Summary
While
sleep
serves
important
regulatory
functions
for
mental
health,
disturbances,
in
particular
insomnia,
may
favour
a
state
of
allostatic
overload
impairing
brain
neuroplasticity
and
stress
immune
pathways,
hence
contributing
to
disorders.
In
this
framework,
the
aim
work
was
link
current
understanding
about
insomnia
mechanisms
with
knowledge
health
dysregulatory
mechanisms.
The
focus
present
on
mood,
anxiety,
psychotic
disorders,
which
represent
challenges
clinical
practice.
Literature
searches
were
conducted
clinical,
neurobiological,
therapeutic
implications
comorbid
these
Given
complexity
heterogeneity
existing
literature,
we
ended
up
narrative
review.
Insomnia
play
an
role
as
risk
factor,
condition
transdiagnostic
symptom
many
disorders
including
mood/anxiety
schizophrenia.
also
marker
disrupted
dysregulation
different
neurobiological
involved
conditions.
treatment
not
only
foster
normal
processes
but
system,
neuroinflammation
plasticity.
preventive
neuroprotective
cognitive
behavioural
therapy
being
new
evidence
efficacy
psychopathology,
indices
neuroplasticity.
On
other
hand,
pharmacological
pathways
conditions
are
still
well
defined.
Therapeutic
options
acting
melatonergic
systems
orexinergic
represents
interesting
interventions
that
open
windows
Current Biology,
Год журнала:
2021,
Номер
31(22), С. 5009 - 5023.e7
Опубликована: Окт. 14, 2021
To
understand
what
makes
sleep
vulnerable
in
disease,
it
is
useful
to
look
at
how
wake-promoting
mechanisms
affect
healthy
sleep.
Wake-promoting
neuronal
activity
inhibited
during
non-rapid-eye-movement
(NREMS).
However,
sensory
vigilance
persists
NREMS
animals
and
humans,
suggesting
that
wake
promotion
could
remain
functional.
Here,
we
demonstrate
consolidated
mouse
a
brain
state
with
recurrent
fluctuations
of
the
neurotransmitter
noradrenaline
on
∼50-s
timescale
thalamus.
These
occurred
around
mean
levels
greater
than
ones
quiet
wakefulness,
while
(NA)
declined
steeply
REMS.
They
coincided
clustering
spindle
rhythms
forebrain
heart-rate
variations,
both
which
are
correlates
arousability.
We
addressed
origins
these
by
using
closed-loop
optogenetic
locus
coeruleus
(LC)
activation
or
inhibition
timed
moments
low
high
NREMS.
suppress,
lock,
entrain
sleep-spindle
fore-
hindbrain-projecting
LC
neurons
show
coordinated
infraslow
variations
natural
Noradrenergic
modulation
thalamic,
but
not
cortical,
circuits
was
required
for
involved
NA
release
into
primary
reticular
thalamic
nuclei
activated
α1-
β-adrenergic
receptors
cause
slowly
decaying
membrane
depolarizations.
signaling
constitutes
vigilance-promoting
mechanism
renders
mammalian
disruption
close-to-minute
through
sustaining
thalamocortical
autonomic
arousability.Video
abstracthttps://www.cell.com/cms/asset/ab9ec3b8-a3f1-470e-8a9c-a2d6ebebc742/mmc3.mp4Loading
...(mp4,
35.34
MB)
Download
video
Journal of Sleep Research,
Год журнала:
2022,
Номер
31(4)
Опубликована: Май 16, 2022
Summary
For
hundreds
of
years,
mankind
has
been
influencing
its
sleep
and
waking
state
through
the
adenosinergic
system.
~100
years
now,
systematic
research
performed,
first
started
by
testing
effects
different
dosages
caffeine
on
behaviour.
About
70
ago,
adenosine
itself
entered
picture
as
a
possible
ligand
receptors
where
hooks
an
antagonist
to
reduce
sleepiness.
Since
scientific
demonstration
that
this
is
indeed
case,
progress
fast.
Today,
widely
accepted
endogenous
sleep‐regulatory
substance.
In
review,
we
discuss
current
science
in
model
organisms
humans
working
mechanisms
sleep.
We
critically
investigate
evidence
for
direct
involvement
homeostatic
whether
differ
between
acute
intake
chronic
consumption.
addition,
review
more
recent
levels
may
also
influence
functioning
circadian
clock
address
question
homeostasis
interact
signalling.
final
section,
perspectives
clinical
applications
accumulated
knowledge
over
last
century
improve
sleep‐related
disorders.
conclude
our
highlighting
some
open
questions
need
be
answered,
better
understand
how
exactly
regulate
Sleep Medicine Reviews,
Год журнала:
2022,
Номер
62, С. 101592 - 101592
Опубликована: Янв. 21, 2022
Five
decades
ago,
seminal
studies
positioned
the
brainstem
locus
coeruleus
(LC)
norepinephrine
(NE)
system
as
a
key
substrate
for
regulation
of
wakefulness
and
sleep,
this
picture
has
recently
been
elaborated
thanks
to
methodological
advances
in
precise
investigation
experimental
modulation
LC
structure
functions.
This
review
presents
discusses
findings
that
support
major
role
LC-NE
at
different
levels
sleep-wake
organization,
ranging
from
its
involvement
overall
architecture
cycle
associations
with
sleep
microstructure,
while
accounting
intricate
neuroanatomy
surrounding
LC.
Given
particular
position
held
by
being
intersection
dysregulation
initial
pathophysiological
processes
Alzheimer's
disease
(AD),
we
conclude
examining
emerging
opportunities
investigate
mediated
relationships
between
alteration
AD
human
aging.
We
further
propose
several
research
perspectives
could
promising
target
identification
at-risk
individuals
preclinical
stages
AD,
development
novel
preventive
interventions.
Science,
Год журнала:
2022,
Номер
377(6601), С. 63 - 72
Опубликована: Июнь 30, 2022
In
mice,
social
defeat
stress
(SDS),
an
ethological
model
for
psychosocial
stress,
induces
sleep.
Such
sleep
could
enable
resilience,
but
how
promotes
is
unclear.
Activity-dependent
tagging
revealed
a
subset
of
ventral
tegmental
area
γ-aminobutyric
acid
(GABA)-somatostatin
(VTA
Journal of Sleep Research,
Год журнала:
2023,
Номер
32(6)
Опубликована: Май 14, 2023
Summary
Insomnia
disorder
is
among
the
most
frequent
mental
disorders,
making
research
on
its
aetiology
and
pathophysiology
particularly
important.
A
unifying
element
of
many
aetiological
pathophysiological
models
that
they
support
or
even
centre
role
some
form
hyperarousal.
In
this
theoretical
review,
we
aim
to
summarise
current
evidence
hyperarousal
in
insomnia.
Hyperarousal
discussed
as
a
state
relatively
increased
arousal
physiological,
cortical
cognitive‐emotional
domains.
Regarding
physiological
hyperarousal,
there
no
conclusive
for
involvement
autonomous
variables
such
heart
rate
variability,
whereas
recent
points
neuroendocrine
variables.
addition,
literature
supports
central
arousal,
is,
high‐frequency
electroencephalographic
activity.
An
increasingly
important
focus
other
microstructural
sleep
parameters,
especially
existence
microarousals
during
sleep.
Beyond
that,
broad
range
exists
supporting
insomnia‐related
thought
worries,
their
concomitant
emotional
symptoms.
Besides
being
marker
insomnia,
considered
crucial
predisposition
insomnia
development
comorbid
disorders.
Thus,
beyond
presenting
from
cross‐sectional
studies
markers
hypotheses
about
mechanisms
are
presented.
Nevertheless,
longitudinal
needed
further
elucidate
mechanism
throughout
course
disorder,
future
should
also
similarities
differences
across
different
diagnostic
entities.
