Hyperarousal in insomnia disorder: Current evidence and potential mechanisms

Raphael J. Dressle; Dieter Riemann

doi:10.1111/jsr.13928

journal article Open Access May 14, 2023

Hyperarousal in insomnia disorder: Current evidence and potential mechanisms

Raphael J. Dressle

Dieter Riemann

Journal of Sleep Research Vol. 32 No. 6 · Wiley

View at Publisher Save 10.1111/jsr.13928

Abstract

SummaryInsomnia disorder is among the most frequent mental disorders, making research on its aetiology and pathophysiology particularly important. A unifying element of many aetiological and pathophysiological models is that they support or even centre on the role of some form of hyperarousal. In this theoretical review, we aim to summarise the current evidence on hyperarousal in insomnia. Hyperarousal is discussed as a state of relatively increased arousal in physiological, cortical and cognitive‐emotional domains. Regarding physiological hyperarousal, there is no conclusive evidence for the involvement of autonomous variables such as heart rate and heart rate variability, whereas recent evidence points to a pathophysiological role of neuroendocrine variables. In addition, current literature supports a central involvement of cortical arousal, that is, high‐frequency electroencephalographic activity. An increasingly important focus in the literature is on the role of other microstructural sleep parameters, especially the existence of microarousals during sleep. Beyond that, a broad range of evidence exists supporting the role of cognitive‐emotional hyperarousal in the form of insomnia‐related thought and worries, and their concomitant emotional symptoms. Besides being a state marker of insomnia, hyperarousal is considered crucial for the predisposition to insomnia and for the development of comorbid mental disorders. Thus, beyond presenting evidence from cross‐sectional studies on markers of hyperarousal in insomnia, hypotheses about the mechanisms of hyperarousal are presented. Nevertheless, longitudinal studies are needed to further elucidate the mechanism of hyperarousal throughout the course of the disorder, and future studies should also focus on similarities and differences in hyperarousal across different diagnostic entities.

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Details

Published: May 14, 2023
Vol/Issue: 32(6)
License: View

Authors

R

Raphael J. Dressle

Department of Psychiatry and Psychotherapy Medical Center ‐ University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany

D

Dieter Riemann

Department of Psychiatry and Psychotherapy Medical Center ‐ University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany; Faculty of Medicine, Center for Basics in NeuroModulation (NeuroModulBasics) University of Freiburg Freiburg Germany

Cite This Article

Raphael J. Dressle, Dieter Riemann (2023). Hyperarousal in insomnia disorder: Current evidence and potential mechanisms. Journal of Sleep Research, 32(6). https://doi.org/10.1111/jsr.13928

Hyperarousal in insomnia disorder: Current evidence and potential mechanisms

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