Abstract
Psychophysiological insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional magnetic resonance imaging (fMRI). BOLD changes after CBT-I in patients were also examined. PI patients showed higher BOLD activation to SS in the precentral, prefrontal, fusiform, and posterior cingulate cortices before CBT-I. The increased responses to SS were reduced after CBT-I. The increased response to SS in the precentral cortex was associated with longer wake time after sleep onset (WASO), and its reduction after CBT-I was associated with improvements in WASO. Clinical improvements after CBT-I were correlated with BOLD reduction in the right insula and left paracentral cortex in response to SS. PI showed hyper-responses to SS in the precentral cortex, prefrontal cortex, and default mode network and these brain hyper-responses were normalized after CBT-I. CBT-I may exert its treatment effects on PI by reducing hyper-responses to SS in the precentral cortex and insula.
Highlights
Insomnia symptoms can be accompanied by various psychiatric and medical illnesses
There were no significant differences in age or gender between Psychophysiological insomnia (PI) and good sleepers (GS)
PSG showed that PI patients had lower total sleep time (TST; t = 2.541, p = 0.016) and higher wake time after sleep onset (WASO) (t = 2.187, p = 0.037) than GS
Summary
Insomnia symptoms can be accompanied by various psychiatric and medical illnesses. the International Classification of Sleep Disorders (ICSD) regards insomnia disorder as an independent illness rather than as merely dependent on other conditions[1]. Intent, and effort to achieve good sleep increase sleep-related anxiety, maintaining insomnia. Another cognitive model of insomnia[3] suggests that excessive worry and fear over disrupted sleep renders individuals anxious and aroused. Only two functional magnetic resonance imaging (fMRI) studies of insomnia investigating brain activation in response to SS have been conducted by a single research group[9,10] These authors showed increased amygdala activity in insomnia patients in response to insomnia-related pictures, but they were unable to find any differences in brain activity between insomnia patients and good sleepers (GS) in response to sleep-related words
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