Insomnia pathophysiology: Difference between revisions

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__NOTOC__
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{{Insomnia}}
{{Insomnia}}
{{CMG}}
{{CMG}} ; {{AE}} {{Adnan Ezici}}
==Overview==
==Overview==
'''Insomnia''' is a [[sleep disorder]] characterized by an inability to [[sleep]] and/or inability to remain asleep for a reasonable period. It might occur as a standalone condition or along with existing physical or mental comorbidities.
It is thought that insomnia is caused by either molecular mechanism, hyperarousal model, sleep switch Model, cognitive and behavioural Model(3P model), and genetic factors. Genes involved in the pathogenesis of insomnia include [[apoE4]], [[PER3]], 5HTTLPR SNP ([[Single Nucleotide Polymorphism]]), CLOCK gene, HLA-DQB1*0602, CRY1.


==Pathophysiology==
==Pathophysiology==
===Physiology===
The normal physiology of sleep can be understood as follows:
The sleep-wake cycle is mediated by circadian rhythm and sleep-wake homeostasis, which is essential for sleeping at night and wakefulness during the day.<ref name="pmid33683929">{{cite journal |vauthors=Sutton EL |title=Insomnia |journal=Ann Intern Med |volume=174 |issue=3 |pages=ITC33–ITC48 |date=March 2021 |pmid=33683929 |doi=10.7326/AITC202103160 |url=}}</ref>
Although sleep is influenced by a myriad of conditions, both physical and environmental, most sleep patterns follow a circadian rhythm which is in turn regulated by a number of compounds in the body.<ref name="pmid21494683">{{cite journal| author=Ban HJ, Kim SC, Seo J, Kang HB, Choi JK| title=Genetic and metabolic characterization of insomnia. | journal=PLoS One | year= 2011 | volume= 6 | issue= 4 | pages= e18455 | pmid=21494683 | doi=10.1371/journal.pone.0018455 | pmc=3071826 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21494683  }} </ref>
*These compounds are broadly divided into either sleep-promoting or wake-promoting.<ref name="pmid23743247">{{cite journal| author=Griffith LC| title=Neuromodulatory control of sleep in Drosophila melanogaster: integration of competing and complementary behaviors. | journal=Curr Opin Neurobiol | year= 2013 | volume= 23 | issue= 5 | pages= 819-23 | pmid=23743247 | doi=10.1016/j.conb.2013.05.003 | pmc=3783581 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23743247  }} </ref>
* Examples of sleep-promoting compounds are [[melatonin]], [[adenosine]], [[serotonin]], etc.
* Wake-promoting compounds include [[catecholamines]], [[histamine]], etc.
* Although all cases of insomnia cannot be explained by an imbalance between sleep-promoting and wake-promoting compounds, an imbalance or an excess of either points to a sleep-wake disorder of some kind.
* Comorbid conditions like [[GERD]], [[restless leg syndrome]], [[anxiety]] disorder can result in chronic insomnia.
* Local sleep theory proposed by Krueger et al, defines sleep as a "fundamental emergent property of highly interconnected neurons"<ref name="pmid18985047">{{cite journal| author=Krueger JM, Rector DM, Roy S, Van Dongen HP, Belenky G, Panksepp J| title=Sleep as a fundamental property of neuronal assemblies. | journal=Nat Rev Neurosci | year= 2008 | volume= 9 | issue= 12 | pages= 910-9 | pmid=18985047 | doi=10.1038/nrn2521 | pmc=2586424 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18985047  }} </ref>. This theory states that in insomnia, compounds which regulate sleep act locally at the site of [[neuron]]s and influence sleep-wake regulation.
===Pathogenesis===
It is thought that insomnia is mediated by<ref name="urlSleep Medicine: Insomnia and Sleep - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/30862990/ |title=Sleep Medicine: Insomnia and Sleep - PubMed |format= |work= |accessdate=}}</ref>:
*Molecular Mechanism
**Hormones causing wakefulness: Catecholamine, Histamine, Orexin
**Hormones promoting sleep: Adenosine, serotonin, GABA, melatonin, Prostaglandin D2
*Hyperarousal model
**Cognitive
**Physiologic
**Cortical
* Sleep switch Model (Orexin mediated)
** Inhibition of sleep-promoting areas:[[Ventrolateral preoptic nucleus]] and median preoptic nucleus
** Stimulation of wake-promoting areas:[[Tuberomammillary nucleus]], [[dorsal raphe nucleus]], [[locus coeruleus]]
*Cognitive and Behavioural Model(3P model): This model of insomnia helps to explain how acute insomnia becomes chronic and aids in assessing insomnia in individual patients
**Precipitating factors
**Predisposing factors
**Perpetuating factors
===Genetics===
===Genetics===
A gene is reported to be responsible for insomnia, called human circadian clock gene CRY1 .
Genes involved in the pathogenesis of insomnia include:<ref name="urlSleep Medicine: Insomnia and Sleep - PubMed">{{cite web |url=https://pubmed.ncbi.nlm.nih.gov/30862990/ |title=Sleep Medicine: Insomnia and Sleep - PubMed |format= |work= |accessdate=}}</ref>
*[[ApoE4]]
*[[PER3]]
*5HTTLPR SNP ([[Single Nucleotide Polymorphism]])
*CLOCK gene
*HLA-DQB1*0602
*CRY1.<ref name="pmid28388406">{{cite journal |vauthors=Patke A, Murphy PJ, Onat OE, Krieger AC, Özçelik T, Campbell SS, Young MW |title=Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder |journal=Cell |volume=169 |issue=2 |pages=203–215.e13 |date=April 2017 |pmid=28388406 |pmc=5479574 |doi=10.1016/j.cell.2017.03.027 |url=}}</ref>


===Pathogenesis===
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]

Overview

It is thought that insomnia is caused by either molecular mechanism, hyperarousal model, sleep switch Model, cognitive and behavioural Model(3P model), and genetic factors. Genes involved in the pathogenesis of insomnia include apoE4, PER3, 5HTTLPR SNP (Single Nucleotide Polymorphism), CLOCK gene, HLA-DQB1*0602, CRY1.

Pathophysiology

Physiology

The normal physiology of sleep can be understood as follows: The sleep-wake cycle is mediated by circadian rhythm and sleep-wake homeostasis, which is essential for sleeping at night and wakefulness during the day.[1] Although sleep is influenced by a myriad of conditions, both physical and environmental, most sleep patterns follow a circadian rhythm which is in turn regulated by a number of compounds in the body.[2]

  • These compounds are broadly divided into either sleep-promoting or wake-promoting.[3]
  • Examples of sleep-promoting compounds are melatonin, adenosine, serotonin, etc.
  • Wake-promoting compounds include catecholamines, histamine, etc.
  • Although all cases of insomnia cannot be explained by an imbalance between sleep-promoting and wake-promoting compounds, an imbalance or an excess of either points to a sleep-wake disorder of some kind.
  • Comorbid conditions like GERD, restless leg syndrome, anxiety disorder can result in chronic insomnia.
  • Local sleep theory proposed by Krueger et al, defines sleep as a "fundamental emergent property of highly interconnected neurons"[4]. This theory states that in insomnia, compounds which regulate sleep act locally at the site of neurons and influence sleep-wake regulation.

Pathogenesis

It is thought that insomnia is mediated by[5]:

  • Molecular Mechanism
    • Hormones causing wakefulness: Catecholamine, Histamine, Orexin
    • Hormones promoting sleep: Adenosine, serotonin, GABA, melatonin, Prostaglandin D2
  • Hyperarousal model
    • Cognitive
    • Physiologic
    • Cortical
  • Sleep switch Model (Orexin mediated)
  • Cognitive and Behavioural Model(3P model): This model of insomnia helps to explain how acute insomnia becomes chronic and aids in assessing insomnia in individual patients
    • Precipitating factors
    • Predisposing factors
    • Perpetuating factors

Genetics

Genes involved in the pathogenesis of insomnia include:[5]

References

  1. ↑ Sutton EL (March 2021). "Insomnia". Ann Intern Med. 174 (3): ITC33–ITC48. doi:10.7326/AITC202103160. PMID 33683929 Check |pmid= value (help).
  2. ↑ Ban HJ, Kim SC, Seo J, Kang HB, Choi JK (2011). "Genetic and metabolic characterization of insomnia". PLoS One. 6 (4): e18455. doi:10.1371/journal.pone.0018455. PMC 3071826. PMID 21494683.
  3. ↑ Griffith LC (2013). "Neuromodulatory control of sleep in Drosophila melanogaster: integration of competing and complementary behaviors". Curr Opin Neurobiol. 23 (5): 819–23. doi:10.1016/j.conb.2013.05.003. PMC 3783581. PMID 23743247.
  4. ↑ Krueger JM, Rector DM, Roy S, Van Dongen HP, Belenky G, Panksepp J (2008). "Sleep as a fundamental property of neuronal assemblies". Nat Rev Neurosci. 9 (12): 910–9. doi:10.1038/nrn2521. PMC 2586424. PMID 18985047.
  5. ↑ 5.0 5.1 "Sleep Medicine: Insomnia and Sleep - PubMed".
  6. ↑ Patke A, Murphy PJ, Onat OE, Krieger AC, Özçelik T, Campbell SS, Young MW (April 2017). "Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder". Cell. 169 (2): 203–215.e13. doi:10.1016/j.cell.2017.03.027. PMC 5479574. PMID 28388406.
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