Page 43 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Psychosomatic influences on insomnia

indicating a persistent state of physiological arousal. This and actual sleep experience creates cognitive dissonance,
48
heightened autonomic arousal further impairs the ability fueling anxiety and perpetuating insomnia.
to achieve restorative sleep, perpetuating the insomnia
cycle. The interplay between hyperarousal and the 2.2.2. Emotional regulation and affective states
51
autonomic nervous system underscores the importance Emotional regulation refers to the ability to manage and
of considering both central and peripheral factors in respond to emotional experiences in a flexible and adaptive
understanding insomnia. way. Impairments in emotional regulation are closely
This heightened brain activity reflects a failure to linked to insomnia, particularly when negative emotions
adequately downregulate arousal systems during the such as anxiety, depression, and stress are involved. 59,60
transition from wakefulness to sleep, contributing to Anxiety is one of the most common psychological factors
the sustained wakefulness and sleep fragmentation associated with insomnia. It can manifest as generalized
characteristic of insomnia. In addition to these central anxiety disorder, specific phobias, or situational anxiety
mechanisms, hyperarousal is also linked to autonomic related to stressors such as work, relationships, or health
nervous system dysregulation. This heightened autonomic concerns. Anxiety enhances cognitive arousal, making it
arousal further interferes with the ability to achieve difficult to relax and fall asleep (Figure 2). Furthermore,
restorative sleep, perpetuating the cycle of insomnia anxiety can trigger hypervigilance during the night,
(Figure 1). 51,52 causing frequent awakenings and poor sleep quality. The
chronic nature of anxiety can lead to sustained insomnia,
2.2. Psychological mechanisms
with each reinforcing the other. 57,61
Psychological mechanisms also play a pivotal role in the Depression is another major contributor to insomnia,
development and maintenance of insomnia, particularly causing many individuals to experience difficulty in
in the context of psychosomatic influences. These both falling asleep and maintaining sleep. 62,63 Depression
mechanisms encompass a range of cognitive and emotional is often associated with negative rumination and a
factors that interact with neurobiological processes, pervasive sense of hopelessness, which can disrupt
contributing to the persistence of sleep disturbances.
sleep. In addition, changes in sleep architecture, such as
2.2.1. Cognitive factors reduced slow-wave sleep and shortened REM latency, are
common in depression, further impairing sleep quality.
Cognitive factors are central to the psychosomatic The bidirectional relationship between insomnia and
model of insomnia, with dysfunctional thought patterns depression means that sleep disturbances can exacerbate
often exacerbating or even initiating sleep difficulties. depressive symptoms, creating a vicious cycle. 56,57,64
Individuals with insomnia frequently engage in excessive
rumination and worry, particularly about their inability Furthermore, individuals with insomnia often struggle
to sleep and the potential consequences of poor sleep. with emotional dysregulation, characterized by difficulty in
This cognitive activity typically occurs during the pre- managing intense emotions and stress. This dysregulation
sleep period, when the individual is lying in bed, leading can lead to heightened emotional responses to everyday
to increased arousal and difficulty in falling asleep. The stressors, increasing cognitive and physiological arousal
53
repetitive nature of these thoughts creates a cycle of anxiety at bedtime. Over time, this chronic state of emotional
and hyperarousal, which further impairs sleep. Another dysregulation can condition the mind and body to associate
critical factor is catastrophizing, which is described as the bedtime with stress and negative emotions, making sleep
tendency to anticipate the worst possible outcomes, often increasingly difficult to achieve. 65
related to the effects of sleep loss. For instance, individuals
with insomnia might believe that a poor night’s sleep will 2.2.3. Stress and the role of hyperarousal
severely impair their ability to function the next day, leading Stress is a well-established trigger for insomnia, particularly
to heightened anxiety and stress (Figure 2). This negative when it leads to hyperarousal, a state of heightened
54
thinking not only exacerbates insomnia but also reinforces physiological and cognitive alertness that interferes with
the perception that sleep is beyond their control, further the ability to fall and stay asleep. Stress-related insomnia
compounding sleep difficulties. In addition, patients with often arises in response to life events such as work pressures,
insomnia often hold unrealistic expectations about how relationship difficulties, or health concerns. When stress
much sleep they need or how quickly they should fall becomes chronic, it can lead to sustained hyperarousal,
asleep. 55-58 These expectations can lead to frustration and which is characterized by increased heart rate, elevated
increased effort to sleep, which paradoxically makes sleep cortisol levels, and intrusive thoughts (Figure 2). Over
more elusive. The discrepancy between their expectations time, the bed and sleep environment can become

Volume 3 Issue 1 (2025) 37 doi: 10.36922/jcbp.4588