Zusammenfassung
Chronische Insomnie ist eine der häufigsten Schlafstörungsarten. In den meisten Fällen besteht eine Komorbidität mit anderen Erkrankungen. Umgekehrt weisen Patienten mit chronischen Schlafstörungen ein gesteigertes Risiko für psychiatrische Krankheiten, insbesondere Depressionen auf. Dieser Artikel beschäftigt sich mit der Frage, ob die chronische Insomnie eher als ein Sekundärsymptom einer Primärerkrankung zu betrachten ist oder ob es sich um eine eigenständige Erkrankung handelt, die entsprechend eines eigenen Behandlungsansatzes bedarf. Neuere Studien zur Pathophysiologie der Insomnie, insbesondere neue Ergebnisse bez. eines chronischen Hyperarousals sprechen für die Sichtweise, dass es sich um eine eigenständige Erkrankung und nicht nur um ein Symptom handelt.
Abstract
Chronic insomnia is the most common sleep disorder. In most cases insomnia is comorbid with other conditions. Patients with insomnia have an increased risk for psychiatric disorders, especially depression. This article focusses on the question of whether chronic insomnia is just a symptom of these other disorders or whether it is a primary disorder that itself merits treatment. Recent research into the pathophysiology of insomnia, especially new insights in the concept of chronic hyperarousal, underlines the trend for considering insomnia as a disorder and not merely a symptom.
Schlüsselwörter
Insomnie - HPA Achse - Hyperarousal
Key words
insomnia - HPA axis - hyperarousal
Literatur
-
1
American Academy of Sleep Medicine
.The International Classification of Sleep Disorders. 2nd ed.: Diagnostic and coding manual. Westchester (IL): American Academy of Sleep Medicine 2005
-
2
Hajak G.
SINE Study Group
.
Study of Insomnia in Europe. Epidemiology of severe insomnia and its consequences in Germany.
Eur Arch Psychiatry Clin Neurosci.
2001;
251
((2))
49-56
-
3
Hohagen F, Rink K, Käppler C. et al .
Prevalence and treatment of insomnia in general practice. A longitudinal study.
Eur Arch Psychiatry Clin Neurosci.
1993;
242
((6))
329-336
-
4
Morphy H, Dunn KM, Lewis M. et al .
Epidemiology of insomnia: a longitudinal study in a UK population.
Sleep.
2007;
1;30
((3))
274-280
-
5
Walsh JK, Engelhardt CL.
The direct economic costs of insomnia in the United States for 1995.
Sleep.
1999;
1;22
((Suppl 2))
386-393
-
6
Phillips B, Mannino DM.
Does insomnia kill?.
Sleep.
2005;
1;28
((8))
965-971
-
7
Taylor DJ, Lichstein KL, Durrence HH.
Insomnia as a health risk factor.
Behav Sleep Med.
2003;
1
((4))
227-247
-
8
Taylor DJ.
Insomnia and depression.
Sleep.
2008;
1;31
((4))
447-448
-
9
LeBlanc M, Beaulieu-Bonneau S, Mérette C. et al .
Psychological and health-related quality of life factors associated with insomnia in a population-based sample.
J Psychosom Res.
2007;
63
((2))
157-166
-
10
Wittchen HU, Krause P, Höfler M. et al .
NISAS-2000: The „Nationwide Insomnia Screening and Awareness Study”. Prevalence and interventions in primary care.
Fortschr Med Orig.
2001;
119
((1))
9-19
-
11 Hajak G, Rüther E. Insomnie – Schlaflosigkeit – Ursachen, Symptomatik und Therapie. Springer Verlag Berlin Heidelberg 1995
-
12
Roth T, Franklin M, Bramley TJ.
The state of insomnia and emerging trends.
Am J Manag Care.
2007;
13
((5 Suppl))
117-120
-
13
National Institutes of Health .
National Institutes of Health State of the Science Conference statement on manifestations and management of chronic insomnia in adults, June 13–15, 2005.
Sleep.
2005;
1;28
((9))
1049-1057
-
14
Lichstein KL.
Secondary insomnia: a myth dismissed.
Sleep Med Rev.
2006;
10
((1))
3-5
-
15
Steinberg R, Einhäupl K, Hippius H. et al .
Chronic hyposomnias in ambulatory sleep care service.
Nervenarzt.
1984;
55
((9))
471-476
-
16 Spielman AJ, Glovinsky PB. Introduction: the varied nature of insomnia. In: Hauri PJ, ed. Case Studies in Insomnia. New York: Plenum 1991: 1-15
-
17
Taylor DJ, Mallory LJ, Lichstein KL. et al .
Comorbidity of chronic insomnia with medical problems.
Sleep.
2007;
30
((2))
213-218
-
18
Harvey AG, Tang NK, Browning L.
Cognitive approaches to insomnia.
Clin Psychol Rev.
2005;
25
((5))
593-611
-
19
Harvey AG.
A cognitive model of insomnia.
Behav Res Ther.
2002;
40
((8))
869-893
-
20
Kales A, Caldwell AB, Soldatos CR. et al .
Biopsychobehavioral correlates of insomnia. II. Pattern specificity and consistency with the Minnesota Multiphasic Personality Inventory.
Psychosom Med.
1983;
45
((4))
341-356
-
21
Riedel BW, Lichstein KL.
Insomnia and daytime functioning.
Sleep Med Rev.
2000;
4
((3))
277-298
-
22
Orff HJ, Drummond SP, Nowakowski S. et al .
Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia.
Sleep.
2007;
30
((9))
1205-1211
-
23
Edinger JD, Krystal AD.
Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?.
Sleep Med Rev.
2003;
7
((3))
203-214
-
24
Weigand D, Michael L, Schulz H.
When sleep is perceived as wakefulness: an experimental study on state perception during physiological sleep.
J Sleep Res.
2007;
16
((4))
346-353
-
25
Perlis ML, Giles DE, Mendelson WB. et al .
insomnia: the behavioural model and a neurocognitive perspective.
J Sleep Res..
1997;
6
((3))
179-188
-
26
Espie CA, Broomfield NM, MacMahon KM. et al .
The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review.
Sleep Med Rev.
2006;
10
((4))
215-245
-
27
Lichstein K.
Psychological Models of Chronic Insomnia.
Journal of Clinical Sleep Medicine.
2005;
1
((4))
459-460
-
28 Morin CM. Psychological management of insomnia. Guilford, New York 1993
-
29
Dauvilliers Y, Morin C, Cervena K. et al .
Family studies in insomnia.
J Psychosom Res.
2005;
58
((3))
271-278
-
30
Feusner J, Ritchie T, Lawford B. et al .
GABA(A) receptor beta 3 subunit gene and psychiatric morbidity in a post-traumatic stress disorder population.
Psychiatry Res.
2001;
104
((2))
109-117
-
31
Rétey JV, Adam M, Khatami R. et al .
A genetic variation in the adenosine A2A receptor gene (ADORA2A) contributes to individual sensitivity to caffeine effects on sleep.
Clin Pharmacol Ther.
2007;
81
((5))
692-698
-
32
Roth T, Roehrs T.
Insomnia: epidemiology, characteristics, and consequences.
Clin Cornerstone.
2003;
5
((3))
5-15
-
33
Ohayon MM, Lemoine P.
Sleep and insomnia markers in the general population.
Encephale.
2004;
30
((2))
135-140
-
34 Clarenbach P. Schlafstörungen im Rahmen neurologischer Erkrankungen. In: Berger M, Hrsg. Handbuch des normalen und gestörten Schlafs. Berlin, Heidelberg: Springer 1992: 329-356
-
35
Kupfer DJ.
Pathophysiology and management of insomnia during depression.
Ann Clin Psychiatry.
1999;
11
((4))
267-276
-
36
Roth T, Roehrs T, Pies R.
Insomnia: pathophysiology and implications for treatment.
Sleep Med Rev.
2007;
11
((1))
71-79
-
37
Stepanski E, Zorick F, Roehrs T. et al .
Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects.
Sleep.
1988;
11
((1))
54-60
-
38
Merica H, Blois R, Gaillard JM.
Spectral characteristics of sleep EEG in chronic insomnia.
Eur J Neurosci.
1998;
10
((5))
1826-1834
-
39
Perlis ML, Merica H, Smith MT. et al .
Beta EEG activity and insomnia.
Sleep Med Rev.
2001;
5
((5))
363-374
-
40
Perlis ML, Smith MT, Andrews PJ. et al .
Beta/Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls.
Sleep.
2001;
24
((1))
110-117
-
41
Rodenbeck A, Rüther E, Cohrs S. et al .
Quantifizierte Arousal-Analyse bei Patienten mit einer psychophysiologischen Insomnie.
Somnologie.
2000;
4
((2))
55-60
-
42
Drummond SP, Smith MT, Orff HJ. et al .
Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia.
Sleep Med Rev.
2004;
8
((3))
227-242
-
43
Nofzinger EA, Buysse DJ, Germain A. et al .
Functional neuroimaging evidence for hyperarousal in insomnia.
Am J Psychiatry.
2004;
161
((11))
2126-2128
-
44
Basta M, Chrousos GP, Vela-Bueno A. et al .
Chronic Insomnia and Stress System.
Sleep Med Clin.
2007;
2
((2))
279-291
-
45
Buckley TM, Schatzberg AF.
On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep:normal HPA axis activity and circadian rhythm, exemplary sleep disorders.
J Clin Endocrinol Metab.
2005;
90
((5))
3106-3114
-
46
Vgontzas AN, Bixler EO, Lin HM. et al .
Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications.
J Clin Endocrinol Metab.
2001;
86
((8))
3787-3794
-
47
Rodenbeck A, Huether G, Rüther E. et al .
Interactions between even-ing and nocturnal cortisol secretion and sleep parameters in patients with severe chronic primary insomnia.
Neurosci Lett.
2002;
324
((2))
159-163
-
48
Vgontzas AN, Bixler EO, Wittman AM. et al .
Middle-aged men show higher sensitivity of sleep to the arousing effects of corticotropin-releasing hormone than young men: clinical implications.
J Clin Endocrinol Metab.
2001;
86
((4))
1489-1495
-
49
Coevorden A Van, Mockel J, Laurent E. et al .
Neuroendocrine rhythms and sleep in aging men.
Am J Physiol.
1991;
260
((4))
E651-661
-
50
Arborelius L, Owens MJ, Plotsky PM. et al .
The role of corticotropin-releasing factor in depression and anxiety disorders.
J Endocrinol.
1999;
160
((1))
1-12
-
51
Riemann D, Voderholzer U, Spiegelhalder K. et al .
Chronic insomnia and MRI-measured hippocampal volumes: a pilot study.
Sleep.
2007;
30
((8))
955-958
-
52
Harvey AG, Tang NK.
Cognitive behaviour therapy for primary insomnia: can we rest yet?.
Sleep Med Rev.
2003;
7
((3))
237-262
-
53
Morin CM, Hauri PJ, Espie CA. et al .
Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review.
Sleep.
1999;
22
((8))
1134-1156
-
54
Buysse DJ, Reynolds 3rd CF, Monk TH. et al .
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.
Psychiatry Res.
1989;
28
((2))
193-213
-
55
Johns MW.
A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
Sleep.
1991;
14
((6))
540-545
-
56
Fulda S.
Diaries of sleep behavior.
Wien Med Wochenschr.
1995;
145
((17–18))
476-477
-
57
Wohlgemuth WK, Krystal AD.
Hypnotics should be considered for the initial treatment of chronic insomnia.
Pro. J Clin Sleep Med.
2005;
1
((2))
120-124
-
58
Stepanski EJ.
Hypnotics should not be considered for the initial treatment of chronic insomnia.
Con. J Clin Sleep Med.
2005;
1
((2))
125-128
-
59
Lichstein KL, Riedel BW, Wilson NM. et al .
Relaxation and sleep compression for late-life insomnia: a placebo-controlled trial.
J Consult Clin Psychol.
2001;
69
((2))
227-239
-
60
Riedel BW, Lichstein KL, Dwyer WO.
Sleep compression and sleep education for older insomniacs: self-help versus therapist guidance.
Psychol Aging.
1995;
10
((1))
54-63
-
61
Stepanski EJ, Wyatt JK.
Use of sleep hygiene in the treatment of insomnia.
Sleep Med Rev.
2003;
7
((3))
215-225
-
62
Jacobs GD, Pace-Schott EF, Stickgold R. et al .
Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.
Arch Intern Med.
2004;
164
((17))
1888-1896
-
63
Morin CM, Colecchi C, Stone J. et al .
Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.
JAMA.
1999;
281
((11))
991-999
-
64
Perlis ML, McCall WV, Krystal AD. et al .
Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia.
J Clin Psychiatry.
2004;
65
((8))
1128-1137
-
65
Hajak G.
Zolpidem „as needed” versus continuous administration: Pan-European study results.
Sleep Med Rev.
2002;
6
((Suppl 1))
S21-28
-
66
Lange K, Geisler P, Klein HE. et al .
Sedierende Antidepressiva in der Behandlung von Patienten mit primärer Insomnie. Ein evidenzbasiertes Vorgehen?.
Psychiat Prax.
2007;
34
((Suppl 1))
95-97
-
67
Wade AG, Ford I, Crawford G. et al .
Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes.
Curr Med Res Opin.
2007;
23
((10))
2597-2605
-
68
Wafford KA, Ebert B.
Emerging anti-insomnia drugs: tackling sleeplessness and the quality of wake time.
Nat Rev Drug Discov.
2008;
7
((6))
530-540
Korrespondenzadresse
Dr. T. H. Müller
Klinik & Poliklinik für Neurologie
Sektion Schlafmedizin
Albert Schweitzer Str. 33
48149 Münster
Email: Info@schlafgestoert.de
