Physiology
Insomnia is generally considered to be a disorder of hyperarousal and the
manifestations of this excessive arousal are varied [23]. Initially, investigations
focused on somatic hyperarousal in patients with insomnia compared
to good sleepers. In these investigations, patients with insomnia were found
to have elevations in heart rate, body temperature, galvanic skin conductance,
and whole body metabolic rate, all suggestive of elevated activity of
the sympathetic nervous system [24,25]. These effects are paralleled by findings
that there is elevated activation of the hypothalamic-pituitary-adrenal
(HPA) axis in terms of higher levels of cortisol in the blood [26]. These
differences seem to be strongest at night and it is as if the body is in a state
of ‘fight-or-flight,’ instead of minimizing arousal in preparation for sleep.
For a number of years, an enigma in the sleep research field was
the finding that patients with insomnia often did not have evidence of
PhysiologyInsomnia is generally considered to be a disorder of hyperarousal and themanifestations of this excessive arousal are varied [23]. Initially, investigationsfocused on somatic hyperarousal in patients with insomnia comparedto good sleepers. In these investigations, patients with insomnia were foundto have elevations in heart rate, body temperature, galvanic skin conductance,and whole body metabolic rate, all suggestive of elevated activity ofthe sympathetic nervous system [24,25]. These effects are paralleled by findingsthat there is elevated activation of the hypothalamic-pituitary-adrenal(HPA) axis in terms of higher levels of cortisol in the blood [26]. Thesedifferences seem to be strongest at night and it is as if the body is in a stateof ‘fight-or-flight,’ instead of minimizing arousal in preparation for sleep.For a number of years, an enigma in the sleep research field wasthe finding that patients with insomnia often did not have evidence of
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