Page 46 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Psychosomatic influences on insomnia

strategy that focuses on limiting the time spent in bed Other compounds such as melatonin, a hormone
to match the actual amount of sleep obtained, thereby that regulates the SWC, and melatonin receptor agonists
increasing sleep efficiency and reducing the time spent such as ramelteon, can be used to address circadian
awake in bed. 97-100 Another strategy known as stimulus rhythm disturbances and improve sleep onset. Melatonin
control therapy centers on reinforcing the association is particularly useful in cases of delayed sleep phase
between the bed and sleep by establishing a regular sleep– syndrome or jet lag. 115,116 Orexin receptor antagonists, such
wake schedule and avoiding activities such as reading or as suvorexant, are a newer class of sleep medications that
watching TV in bed. 101 target the orexin system, which regulates wakefulness.
Other approaches such as relaxation techniques, These medications help to reduce wakefulness and
such as progressive muscle relaxation, deep breathing, promote sleep without the sedative side effects associated
or mindfulness meditation, reduce pre-sleep arousal with other hypnotics. 117-119 Finally, antihistamines
and facilitate the sleep onset process. Mindfulness-based (e.g., diphenhydramine) are sometimes used as sleep aids
120
stress reduction (MBSR) is a therapeutic approach that due to their sedative effects. However, they are generally
incorporates mindfulness meditation and awareness not recommended for long-term use due to the potential
practices to reduce stress and enhance emotional side effects, including next-day drowsiness and cognitive
regulation. For individuals with psychosomatic insomnia, impairment.
MBSR can help break the cycle of stress and hyperarousal Cannabinoids are therapeutic agents that are gaining
that disrupts sleep. By fostering a non-judgmental a lot of interest in this field. Cannabinoids are the active
awareness of thoughts and sensations, MBSR allows compounds found in the cannabis plant. The most
patients to disengage from unhelpful cognitive patterns prominent cannabinoids, namely tetrahydrocannabinol
that contribute to insomnia. 102-104 Also, acceptance and (THC) and cannabidiol (CBD) interact with the body’s
commitment therapy focuses on helping individuals accept endocannabinoid system (ECS), which is integral to
their insomnia-related thoughts and feelings without regulating sleep, mood, pain, and other physiological
trying to control or avoid them. The therapy emphasizes processes. The ECS is a complex network that includes
the importance of living a meaningful life despite sleep cannabinoid receptors, primarily CB1 and CB2, along
difficulties, which can reduce the anxiety and frustration with endogenous cannabinoids such as anandamide and
associated with insomnia. 105-107 Lastly, biofeedback, which 2-arachidonoylglycerol. 121,122 These receptors are widely
involves using electronic devices to monitor physiological distributed throughout the central nervous system
processes such as heart rate, muscle tension, and skin and peripheral tissues. The ECS helps regulate various
temperature, enables patients to learn to control these physiological functions, including the SWC, by modulating
processes through relaxation techniques, which can help neurotransmitter release and influencing neural activity in
reduce physiological arousal and improve sleep quality. 108 brain regions involved in sleep regulation. 123,124 THC, the

4.2. Pharmacological approaches psychoactive component of cannabis, is known for its ability
to induce sedation and alter sleep patterns. THC primarily
Pharmacological treatment may be considered for acts on CB1 receptors, which are abundant in brain regions
individuals with psychosomatic insomnia, particularly associated with sleep regulation, such as the hypothalamus
when psychological interventions alone are insufficient. and brainstem. By binding to these receptors, THC can
However, medications should be used with caution and reduce sleep latency (i.e., the time it takes to fall asleep)
typically as part of a broader treatment plan. 109 and increase overall sleep duration, making it a potential
Short-term use of hypnotic medications, such as remedy for individuals with insomnia. However, THC’s
benzodiazepines (e.g., temazepam) or non-benzodiazepine effects on sleep architecture are complex. While it may
sleep aids (e.g., zolpidem, eszopiclone), can help alleviate increase slow-wave sleep (deep sleep), it can also reduce
acute sleep disturbances. These medications are effective REM sleep, which is essential for cognitive functions such
in reducing sleep latency and improving sleep duration as memory consolidation. 125,126 The reduction in REM
but should be prescribed cautiously due to the risk of sleep could be a potential drawback, especially for long-
dependence, tolerance, and withdrawal symptoms. 110,111 term use. CBD, on the other hand, has gained popularity
Certain antidepressants, particularly those with sedative for its non-psychoactive properties and its ability to
properties such as trazodone or mirtazapine, are often promote relaxation and reduce anxiety. CBD interacts
prescribed to treat insomnia, especially when the patient with the ECS differently than THC. It has a low affinity for
is comorbid with depression or anxiety. These medications CB1 and CB2 receptors but exerts its effects by influencing
can help regulate sleep architecture and reduce the other receptors and pathways, such as serotonin receptors
psychological symptoms that contribute to insomnia. 112-114 (specifically 5-HT1A) and GABAergic transmission. CBD

Volume 3 Issue 1 (2025) 40 doi: 10.36922/jcbp.4588