title: Hyperarousal and Beyond: New Insights to the Pathophysiology of Insomnia Disorder through Functional Neuroimaging Studies.
abstract: Neuroimaging studies have produced seemingly contradictory findings in regards to the pathophysiology of insomnia. Although most study results are interpreted from the perspective of a "hyperarousal" model, the aggregate findings from neuroimaging studies suggest a more complex model is needed. We provide a review of the major findings from neuroimaging studies, then discuss them in relation to a heuristic model of sleep-wake states that involves three major factors: wake drive, sleep drive, and level of conscious awareness. We propose that insomnia involves dysregulation in these factors, resulting in subtle dysregulation of sleep-wake states throughout the 24 h light/dark cycle.
authors.affiliation: Department of Psychology, Brigham Young University, Provo, UT 84604, USA. daniel_kay@byu.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kay
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA. buyssedj@upmc.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
keywords: heuristic model; hyperarousal; insomnia; neuroimaging