0996 A New Insomnia Phenotype: Coronasomnia Misophonia Syndrome

Abstract

Abstract Introduction Misophonia is a complex neuropsychiatric phenomenon characterized by an intense selective auditory hypersensitivity to auditory stimuli accompanied by emotional intolerance consisting of anger, anxiety, and frustration. We report on four subjects who presented with significant sleep onset insomnia coinciding with the mandated stay-at-home order in March 2020. All patients reported unique and specific irritability and aversion to sounds in their proximal environment - the misophonic trigger (MT). While a previous study reported on the capacity of misophonia to emerge during venerable periods of confinement, we report a series of four patients in whom misophonia was a unique precipitant of insomnia, a “misophonic response” accompanied by hypervigilance and insomnia. Our findings support the consideration of a unique insomnia phenotype - Coronasomnia Misophonia Syndrome (CMS). Report of case(s) Subject A is a 29-year-old female with a history of OCD and mild insomnia (MT: humming refrigerator). Subject B is a 31-year-old female with a history of delayed sleep phase disorder in her teenage years (MT: husband’s breathing). Subject C is a 36-year-old male with well-controlled sleep-onset insomnia (MT: electric humming from walls). Subject D is a 46-year-old male with well-controlled depression (MT: carotid pulsation transmitted through his pillow). All but one patient had reasonable improvement with mindfulness therapy combined with systematic desensitization. Subject A improved after pharmacological modification of OCD therapy. Conclusion Our case series supports CMS as a unique insomnia phenotype coinciding with social isolation during the COVID-19 pandemic. The MT might have served as a precipitant through classical conditioning. Desensitization with mindfulness therapy was helpful, but the presence of comorbid OCD led to a refractory course supporting pervasive sensory processing in this patient. Our data highlights the need for more dedicated investigation for MT in patients presenting with insomnia during times of confinement and unprecedented anxiety. Additional data is needed to support our observation and investigate the potential psychophysiological mechanism, particularly the proposed alteration in auditory processing in response to the MT in healthy and psychiatric cohorts. Support (if any)