12/19/2023 0 Comments Chronic insomnia meaning![]() Therefore, alternative approaches to directly address arousal dysregulation are needed. Furthermore, the rates for re-occurrence of insomnia are higher for patients who still report elevations in pre-sleep arousal at the end of treatment ( 16). CBT-I is now recommended as the first line of treatment for insomnia ( 11).ĭespite the promise of CBT-I, only about 30% to 40% of patients achieve full remission from insomnia following treatment ( 12– 15). Indeed, the rise of cognitive-behavior therapy for insomnia (CBT-I) has demonstrated efficacy with behavioral strategies aimed primarily at restoring sleep regulation and the cognitive components aimed at restructuring maladaptive sleep-related cognitions. These techniques had some evidence to support efficacy for insomnia but it appeared that these behavioral techniques alone were insufficient to effectively manage the cognitive aspects of insomnia. Behavioral techniques such as progressive muscle relaxation, deep breathing, and mental imagery were used to reduce arousal and promote sleep. ![]() Given the evidence for psychophysiological arousal, early treatments for insomnia focused on psychological and physiological relaxation. Furthermore, evidence of psychological arousal is seen with greater levels of pre-sleep cognitive activity ( 7), more negative tone of sleep-related cognitions ( 8) and more dysfunctional sleep-related cognitions ( 9, 10). ![]() There is also evidence of a failure to de-arouse ( 5) as seen in imaging studies that have demonstrated activity in the wake-promoting systems during NREM sleep among people with insomnia compared to healthy controls ( 6). There is evidence of elevations in arousal driven by a sympathetic response such as elevations in cortisol ( 1, 2), daytime body temperature ( 3), and increased alertness on the multiple sleep latency test ( 4). Although the etiology of insomnia remains inconclusive, many theories center on the notion of arousal dysregulation that perpetuates the sleep disturbance and daytime dysfunction. ![]() Insomnia is characterized by difficulty falling or staying asleep that is accompanied by daytime dysfunction. ![]()
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