Neurophysiological aspects of primary insomnia: implications for its treatment.
Insomnia has usually been studied from a behavioral perspective. Somatic and/or cognitive conditioned arousal was shown to play a central role in sleep complaints becoming chronic, and was used as a starting point for the development of treatment modalities. The introduction of the neurocognitive perspective, with its focus on cortical or CNS arousal, has given rise to a renewed interest in the neurophysiological characteristics of insomnia. Recent research, using quantitative EEG, neuroimaging techniques and the study of the microstructure of sleep, suggests a state of hyperarousal with a biological basis. Furthermore, insomnia might not be restricted to sleep complaints alone because it appears to be a 24-h disorder, affecting several aspects of daytime functioning as well. These new findings have implications for the treatments used and indicate that a focus on cortical or CNS arousal should be pursued. As such, the use of EEG neurofeedback, a self-regulation method based on the paradigm of operant conditioning, might be a promising treatment modality. Preliminary results for insomnia and successful applications for other disorders suggest that this treatment can have the necessary stabilizing effects on the EEG activity, possibly resulting in a normalizing effect on daytime as well as nighttime functioning.
Cortoos
Aisha
A
Department of Cognitive and Biological Psychology, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium. acortoos@vub.ac.be
Verstraeten
Edwin
E
Cluydts
Raymond
R
D001143:Arousal / Q000502:physiology; D001676:Biofeedback, Psychology / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology; D015928:Cognitive Behavioral Therapy; D003216:Conditioning, Operant / Q000502:physiology; D004569:Electroencephalography; D006801:Humans; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology* / Q000628:therapy*