Psychoneuroendokrinologie der Insomnie - Der Circulus vitiosus der psychophysiologischen Insomnie auf psychologischer, elektrophysiologischer und endokriner Ebene

Die psychophysiologische Insomnie basiert auf einem Circulus vitiosus aus Hyperarousal, Schlafstörung und Tagesbeeinträchtigung, was insgesamt als chronischer Stress empfunden wird. Darüber hinaus bestehen neuroendokrine Dysfunktionen, die zumindest krankheitserhaltend wirken. Neben der eingeschränkten Morgen- und Tagesbefindlichkeit sind die feinstrukturelle Schlaffragmentierung und die Aktivierung der Hypothalamus-Hypophysen-Nebennierenrinden-Achse als neuroendokrines Korrelat von Stress mit psychischer Belastung als wichtige psychoneuroendokrine Pathomechanismen der Krankheitsentstehung und -erhaltung zu werten. Die verminderte nächtliche Melatoninsekretion dagegen spiegelt die Chronifizierung insomnischer Beschwerden wider und kann sich ebenfalls störungserhaltend auswirken. Neben der rein psychischen Ebene entsteht somit auch ein neuroendokriner Teufelskreis, dessen zugrundeliegenden Dysfunktionen vermutlich für nichtorganisch bedingte Insomnien unabhängig von deren Genese gültig sind.

The concept of psychophysiological insomnia based on a vicious cycle of hyperarousal, insomnia and impaired daytime well-being. There is increasing evidence that the psychological hyperarousal and insomnia is caused by and perceived as chronic stress. Beside this psychological factor neuroendocrine dysfunctions are supposed to maintain insomnia. Impaired morning and daytime well-being, arousal-related sleep fragmentation, and an increased activation of the hypothalamic-pituitary-adrenal (HPA) axis are major psychoneuroendocrinological pathomechanisms in generating and maintaining insomnia. In contrast, the decreased nocturnal melatonin secretion reflects the chronification of insomniac disturbances and is a contributing factor in maintaining insomnia. These findings could be summarized in a psychoneuroendocrinological vicious cycle of insomnia, whose underlying neuroendocrinological dysfunctions might be true for all non-organic insomnia independent of their origin.

Key words

Insomnia - neuroendocrine dysfunction - psychophysiological hyperarousal - cortisol - melatonin

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