Page 44 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Psychosomatic influences on insomnia

conditioned stimuli that trigger hyperarousal. For example, asleep. The nocturnal symptoms of gastroesophageal
after repeated nights of poor sleep, individuals may begin reflux disease, such as heartburn and regurgitation, can be
to associate their bed with wakefulness, frustration, and particularly disruptive, resulting in poor sleep quality. 71,72
anxiety. This conditioned arousal perpetuates insomnia, Conditions such as asthma and chronic obstructive
as the very act of getting into bed triggers the body’s stress pulmonary disease can lead to breathing difficulties
response, making sleep even more difficult to achieve. The during the night, causing awakenings and disrupted
way individuals appraise and cope with stress also plays sleep. The need to manage symptoms, such as coughing
a significant role in insomnia. Those who perceive stress or shortness of breath, can make it difficult to maintain
as overwhelming or unmanageable are more likely to continuous sleep. 73,74 Cardiovascular conditions, such as
experience sleep disturbances. Ineffective coping strategies, hypertension and heart disease, are often accompanied by
such as avoidance, denial, or maladaptive behaviors nocturnal symptoms, including palpitations, chest pain,
(e.g., substance use), can further exacerbate stress and and difficulty breathing. These symptoms can interfere
contribute to the persistence of insomnia. 66 with the ability to achieve and maintain sleep, leading
to insomnia. 75,76 Conditions such as Parkinson’s disease,
2.3. Somatic mechanisms restless legs syndrome, and multiple sclerosis are associated
Somatic mechanisms play a critical role in the manifestation with a range of symptoms that can disrupt sleep, including
and perpetuation of insomnia, particularly when physical muscle rigidity, involuntary movements, and sensory
symptoms and chronic health conditions contribute disturbances. These symptoms often worsen at night,
to sleep disturbances. These mechanisms involve the contributing to sleep fragmentation and insomnia. 77-80
interaction between the body’s physiological state and its 2.3.3. Somatic hypervigilance and perception of
impact on sleep quality, often exacerbated by underlying bodily symptoms
psychological factors.
Somatic hypervigilance refers to an increased awareness
2.3.1. Chronic pain and insomnia and monitoring of bodily sensations, often accompanied
Chronic pain is one of the most common somatic by an exaggerated response to these sensations. Individuals
contributors to insomnia. Pain can interfere with sleep in with insomnia, particularly those with psychosomatic
several ways, including difficulty in finding a comfortable influences, may exhibit heightened sensitivity to normal
sleeping position, frequent awakenings due to pain bodily sensations, such as heart rate, breathing, or
flare-ups, and increased arousal due to discomfort. The muscle tension. This heightened awareness can lead to
relationship between chronic pain and insomnia is amplification of symptoms such as somatic hypervigilance,
bidirectional, with each condition exacerbating the other. which can cause individuals to perceive normal bodily
The presence of chronic pain increases physiological sensations as more intense or distressing than they are,
81
arousal, making it difficult for individuals to relax and fall leading to increased anxiety and arousal. For example, a
asleep. 67,68 Pain triggers the body’s stress response, leading person might become overly focused on their heart rate
to the release of stress hormones such as cortisol and or breathing pattern while trying to fall asleep, which can
adrenaline, which further disrupt sleep. This heightened increase stress and interfere with the sleep process. The
state of arousal can persist throughout the night, leading to preoccupation with bodily sensations can also lead to
fragmented and non-restorative sleep. Sleep deprivation, sleep-related anxiety, where individuals become fearful of
in turn, increases sensitivity to pain, creating a vicious the sensations they experience at night, such as palpitations
cycle. When sleep is disrupted, the body’s ability to or shortness of breath. This anxiety further disrupts sleep
modulate pain is impaired, leading to an increase in pain by increasing arousal and making it difficult to relax.
perception. This heightened pain sensitivity can exacerbate Somatic conditions often have a significant impact on
chronic pain conditions, further interfering with sleep and psychological well-being, contributing to the development
perpetuating insomnia. 69,70 of insomnia. Chronic pain, for example, is associated with
increased rates of depression and anxiety, both of which
2.3.2. Medical conditions and sleep disturbances are common comorbidities in individuals with insomnia.
71
A variety of medical conditions are associated with The presence of a chronic medical condition can lead to
insomnia, either directly through symptoms that interfere feelings of helplessness, frustration, and fear about the
with sleep or indirectly through the psychological distress future, all of which contribute to sleep disturbances. In
they cause. Gastroesophageal reflux disease can cause addition, the interaction between cognitive processes
discomfort and pain, particularly when lying down, (such as worry about health) and affective states (such as
leading to frequent awakenings and difficulty falling back anxiety and depression) can exacerbate somatic symptoms

Volume 3 Issue 1 (2025) 38 doi: 10.36922/jcbp.4588