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Functional neuroimaging evidence for hyperarousal in insomnia.

Eric A Nofzinger1, Daniel J Buysse, Anne Germain

  • 1Western Psychiatric Institute and Clinic, Sleep Neuroimaging Research Program, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213-2593, USA. nofzingerea@upmc.edu

The American Journal of Psychiatry
|October 30, 2004
PubMed
Summary

Insomnia patients exhibit higher brain metabolism during sleep and wakefulness, indicating altered neurobiology. This heightened brain activity, particularly in the prefrontal cortex, may explain daytime fatigue and sleep difficulties.

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Area of Science:

  • Neuroscience
  • Sleep Medicine
  • Medical Imaging

Background:

  • Insomnia is characterized by poor sleep quality and daytime fatigue.
  • The underlying neurobiological mechanisms require further investigation.

Purpose of the Study:

  • To explore the neurobiological underpinnings of insomnia.
  • To assess regional cerebral glucose metabolism in individuals with and without insomnia.

Main Methods:

  • Utilized [(18)F]Fluorodeoxyglucose positron emission tomography (PET).
  • Assessed regional cerebral glucose metabolism in seven insomnia patients and 20 healthy controls.

Main Results:

  • Insomnia patients displayed greater global cerebral glucose metabolism during both sleep and wakefulness compared to controls.

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  • A diminished decline in relative metabolism from waking to sleep states was observed in wake-promoting regions in insomnia patients.
  • Reduced relative metabolism in the prefrontal cortex was noted in insomnia patients while awake.

    • Conclusions:

    • Greater brain metabolism is associated with subjective sleep disturbances in insomnia.
    • Difficulty initiating sleep may stem from a failure of arousal mechanisms to decrease activity from wake to sleep states.
    • Daytime fatigue in insomnia could result from decreased prefrontal cortex activity due to inefficient sleep.