title: Prefrontal hypoactivation and recovery in insomnia.
abstract: OBJECTIVE
  Although subjective complaints about daytime cognitive functioning are an essential symptom of chronic insomnia, abnormalities in functional brain activation have not previously been investigated. This study was designed to investigate functional brain activation differences as a possible result of chronic insomnia, and the reversibility of these differences after nonmedicated sleep therapy.
  
  
  METHODS
  Insomniacs and carefully matched controls underwent functional magnetic resonance imaging (fMRI) scanning during the performance of a category and a letter fluency task. Insomniacs were randomly assigned to either a 6-week period of nonpharmacological sleep therapy or a wait list period, after which fMRI scanning was repeated using parallel tasks. Task-related brain activation and number of generated words were considered as outcome measures.
  
  
  METHODS
  The outpatient sleep clinic of the VU University Medical Center, Department of Clinical Neurophysiology; fMRI was performed at the Department of Radiology.
  
  
  METHODS
  Twenty-one patients suffering from chronic insomnia and 12 matched controls.
  
  
  METHODS
  Nonpharmacological sleep therapy for 6 weeks, consisting of cognitive behavioral therapy, body temperature and bright light interventions, sleep hygiene, and physical activity counseling.
  
  
  RESULTS
  Compared to controls, insomnia patients showed hypoactivation of the medial and inferior prefrontal cortical areas (Brodmann Area 9, 44-45), which recovered after sleep therapy but not after a wait list period.
  
  
  CONCLUSIONS
  Insomnia interferes in a reversible fashion with activation of the prefrontal cortical system during daytime task performance.
authors.affiliation: Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands. e.altena@nin.knaw.nl
authors.forename: Ellemarije
authors.initials: E
authors.lastname: Altena
authors.forename: Ysbrand D
authors.initials: YD
authors.lastname: Van Der Werf
authors.forename: Ernesto J
authors.initials: EJ
authors.lastname: Sanz-Arigita
authors.forename: Thom A
authors.initials: TA
authors.lastname: Voorn
authors.forename: Serge A R B
authors.initials: SA
authors.lastname: Rombouts
authors.forename: Joost P A
authors.initials: JP
authors.lastname: Kuijer
authors.forename: Eus J W
authors.initials: EJ
authors.lastname: Van Someren
mesh_terms: D000368:Aged; D001831:Body Temperature; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003376:Counseling; D004292:Dominance, Cerebral / Q000502:physiology; D015444:Exercise; D005260:Female; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010364:Pattern Recognition, Visual / Q000502:physiology*; D010789:Phototherapy; D017397:Prefrontal Cortex / Q000503:physiopathology*; D012660:Semantics; D007319:Sleep Initiation and Maintenance Disorders / Q000503:physiopathology* / Q000628:therapy*
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