Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying
asleep, or obtaining restorative and sufficient sleep, despite having the opportunity to
sleep. People with insomnia often experience one or more of the following symptoms:
● Difficulty falling asleep: Individuals with insomnia may have trouble initiating sleep,
often lying awake in bed for an extended period before finally falling asleep.
● Difficulty staying asleep: Those with insomnia may wake up frequently during the night
and have difficulty returning to sleep.
● Early morning awakening: Some individuals with insomnia wake up earlier than
desired and cannot go back to sleep, even if they haven't had enough rest.
● Non-restorative sleep: Even if they do sleep, people with insomnia often wake up
feeling unrefreshed and fatigued, which can lead to daytime drowsiness and
impairments in cognitive and functional abilities.
The pathophysiology of insomnia is multifaceted and can be influenced by a variety of
factors, including physiological, psychological, and environmental elements. Here are
some key aspects of the pathophysiology of insomnia:
Hyperarousal:
● One of the central components of insomnia is hyperarousal, which refers to a heightened
state of physiological and psychological alertness. Individuals with insomnia often
experience increased activity in the sympathetic nervous system, leading to increased
heart rate, elevated cortisol levels, and heightened alertness at bedtime.
● This hyperarousal can make it difficult for individuals to relax and fall asleep.
Altered Sleep-Wake Regulation:
● The circadian rhythm, the body's internal clock that regulates the sleep-wake cycle, can
be disrupted in people with insomnia.
● Irregular sleep schedules, shift work, or exposure to artificial light at night can interfere
with the natural circadian rhythm, making it challenging to initiate and maintain sleep at
appropriate times.
Psychological Factors:
● Stress, anxiety, and depression are common psychological factors associated with
insomnia.
● These conditions can lead to racing thoughts, worry, and rumination, making it difficult to
calm the mind and fall asleep.
Physiological Factors:
● Chronic pain, medical conditions, and hormonal changes (e.g., menopause) can
contribute to insomnia by causing discomfort or altering sleep patterns.
Behavioral Factors:
● Poor sleep hygiene practices, such as irregular bedtime routines, excessive caffeine or
alcohol consumption, and excessive use of electronic devices before bedtime, can
disrupt sleep patterns.
Medications and Substance Use:
● Certain medications, especially stimulants, antidepressants, and medications that affect
the central nervous system, can interfere with sleep.
● Substance abuse, including alcohol and recreational drugs, can also disrupt sleep
patterns.
Primary vs. Secondary Insomnia:
● Insomnia can be classified as primary or secondary. Primary insomnia occurs
independently of other medical or psychiatric conditions, while secondary insomnia is
linked to another underlying disorder or factor.
Cognitive Processes:
● Cognitive factors, such as excessive worry about not being able to sleep or negative
beliefs about sleep, can perpetuate insomnia by creating a cycle of anxiety and
sleeplessness.
Conditioning:
● Over time, people with insomnia may develop conditioned responses to their bedroom,
associating it with difficulty sleeping. This creates a learned association between the
bedroom and wakefulness.
Environmental Factors:
● Noise, temperature, and other environmental factors can disrupt sleep and contribute to
insomnia.
