Page 39 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Psychosomatic influences on insomnia

often arise from various external factors such as financial, (iii) Duration of sleep problems. The sleep disturbances
personal, or psychological ones that can prevent should be present for at least 3 months to be classified
individuals from having adequate sleep. Insomnia affects as chronic insomnia
an estimated 10 – 30% of the global population, depending (iv) Significant distress or impairment. The insomnia must
on the diagnostic criteria used, with chronic insomnia cause significant distress or impairment in social,
(lasting 3 months or more) affecting about 10% of adults. occupational, educational, academic, behavioral, or
Short-term insomnia impacts up to 30 – 40% of people other important areas of functioning
at some point in their lives, making it a widespread issue. (v) Not attributable to other sleep disorders. The sleep
Notably, women are 1.5 – 2 times more likely than men to disturbance cannot be better explained by other
experience insomnia, largely due to hormonal fluctuations sleep disorders, such as sleep apnea or restless legs
related to menstruation, pregnancy, and menopause, as well syndrome, or be solely attributed to the physiological
as higher rates of anxiety and depression. In contrast, men effects of a substance (e.g., drug abuse and medication)
are more prone to sleep disorders such as obstructive sleep (vi) Exclusion of coexisting conditions. The sleep difficulties
apnea. Insomnia has profound effects on both the mental cannot be better explained by other mental disorders,
and physical health of the affected individuals, increasing such as major depressive disorder or anxiety disorders,
the risk of depression, anxiety, cardiovascular disease, although insomnia can coexist with these conditions.
and impaired daytime functioning. Research indicates
that insomnia is more common among the elderly, with Psychosomatic influences refer to the interplay between
estimates suggesting that approximately 30 – 50% of older psychological processes and physical symptoms, where
adults experience sleep disturbances, compared to around mental states such as stress, anxiety, and depression manifest
4,5
10 – 15% of younger adults. This disparity can be attributed as somatic complaints, including sleep disturbances.
to a combination of physiological, psychological, and In insomnia, these psychosomatic influences involve a
environmental factors. Aging promotes the occurrence complex interaction between psychological stressors,
of physiological changes within sleep architecture, emotional dysregulation, and physiological responses such
6,7
such as reduced slow-wave sleep and alterations in as hyperarousal and neuroendocrine dysfunction. These
circadian rhythms, which can lead to increased nighttime factors often set up a cycle that creates and perpetuates
awakenings and difficulties in initiating sleep. In addition, insomnia, complicating the treatment process.
the prevalence of comorbid conditions, including chronic Insomnia also results from disruptions in the sleep–
pain, depression, and anxiety, is higher in older adults, wake cycle (SWC) regulated by molecular mechanisms that
further contributing to insomnia. Conversely, younger integrate circadian rhythms, homeostatic processes, and
populations, while not immune to sleep disturbances, tend neurotransmitter systems. Circadian rhythms, governed
to experience insomnia primarily due to lifestyle factors by the molecular clock, are central to regulating sleep and
such as stress, irregular sleep schedules, and the pervasive wakefulness. This internal clock coordinates physiological
use of electronic devices. processes, and its disruptions can lead to insomnia and
8,9
Historically, insomnia has been treated from a other sleep disorders. The molecular clock functions
biomedical perspective, focusing on sleep physiology through a network of clock genes, including Clock, Bmal1,
and pharmacological interventions. However, emerging Per1, Per2, Cry1, and Cry2, whose protein products form
research highlights the significant role psychosomatic feedback loops to maintain circadian rhythms. Regulators
factors play in both the onset and perpetuation of such as REV-ERBα, RORα, and DBP help fine-tune these
insomnia, underscoring the need for a more integrative rhythms, aligning sleep with environmental cues such as
approach. 1-3 light exposure. 10-13
The diagnosis of insomnia is based on specific criteria Light serves as a crucial cue that helps synchronize
established in the Diagnostic and Statistical Manual of the circadian rhythm with the environment. Signals
Mental Disorders (DSM-5) and is characterized by the from retinal cells reach the suprachiasmatic nucleus
following key features: of the hypothalamus, the brain’s circadian pacemaker,
(i) Difficulties in sleep initiation, maintenance, or early which adjusts the timing of the molecular clock to align
awakening. Individuals must experience persistent with the day–night cycle, ensuring proper sleep timing
difficulties in falling asleep, staying asleep, or waking and quality. 14,15 Another key player in sleep regulation is
up too early and being unable to return to sleep orexin (also known as hypocretin), a neurotransmitter that
(ii) Sleep disturbances occur at least 3 times per week. These stabilizes wakefulness and appetite. Produced in the lateral
sleep difficulties must occur at least 3 times per week hypothalamus, orexin interacts with brain regions involved
to meet diagnostic criteria in arousal and alertness, such as the ventrolateral preoptic

Volume 3 Issue 1 (2025) 33 doi: 10.36922/jcbp.4588