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July 2011
Media Announcement from the Section on Psychiatry & Sleep Wakefulness Disorders - "Insomnia: The Extent of the Problem and Its Consequences"

Chair: Berger M
Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

Co-Chair: Soldatos C
Athens University Medical School, 1st Department of Psychiatry, Athens, Greece

Chronic insomnia represents a major public health problem. It is characterised by prolonged sleep onset latency, problems in maintaining sleep, early morning awakenings or the feeling of non-restorative sleep, coupled with significant daytime impairments. Current etiological models emphasize the persistence of hyperarousal processes across the sleep-wake cycle with evidence derived from neuropsychological, neurophysiological and brain imaging studies. Recent research indicates that primary insomnia is a significant and independent risk factor for the development of major somatic and mental disorders, including cardiovascular disease and depression. Targeting insomnia might thus contribute to improving health outcomes that are of high public-health relevance.

EPIDEMIOLOGICAL CONSIDERATIONS REGARDING INSOMNIA

Paparrigopoulos T
Athens University Medical School, 1st Department of Psychiatry, Athens, Greece

Insomnia is a major public health concern affecting about 10% of the general population in its chronic form. Moreover, epidemiological surveys demonstrate that poor sleep and sleep dissatisfaction are even more frequent problems in the community ranging from 10-48%. Several correlates of insomnia have been identified, such as sociodemographic determinants, life habits, mental disorders and physical illnesses. Women are more likely than men to report insomnia symptoms, daytime consequences of disturbed sleep and sleep dissatisfaction, and consequently to receive a diagnosis of insomnia. Also, insomnia symptoms and sleep dissatisfaction increase with age, approaching 50% in the elderly population. In regard to other sociodemographic determinants most studies report a higher prevalence of insomnia in individuals living alone and in less privileged people. Regarding the various factors connected with insomnia these have been divided into primary, secondary (mental disorders, medical conditions, sleep disorders) and self-induced factors (lifestyle, use, abuse or withdrawal of psychoactive substances). For what concerns mental health disorders, insomnia symptoms may be present in over 80% of cases in major depression and in more than one third of cases in any mental disorder. Furthermore, persistent insomnia may increase the likelihood of developing major depression and may be a risk factor of physical health problems as well. The above findings highlight the significance of insomnia symptoms and the need for more active interventions by mental health professionals who should systematically assess such symptoms, since only a modest percentage (27-45%) of insomnia complainers will discuss such problems with their physicians.

Paparrigopoulos, Thomas
Athens University Medical School
1st Department of Psychiatry
Eginition Hospital
74, Vas. Sofias Avenue
115 28 Athens, Greece
Phone: +30 210 7289313 / Fax: +30 210 7251312
tpaparrig@med.uoa.gr

THE HYPERAROUSAL HYPOTHESIS OF PRIMARY INSOMNIA

Berger M, Riemann D, Nissen C
Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

Evidence from the molecular to the higher system level provides substantial support for the idea that hyperarousal processes underlie the development of primary insomnia. Autonomous, neuroendocrine, neuroimmunological, electrophysiological and neuroimaging studies show increased levels of arousal in primary insomnia during both night and daytime. These studies suggest that primary insomnia may be conceptualized as a final common pathway resulting from the interplay between a genetic vulnerability for an imbalance between arousing and sleep-inducing brain activity, psychosocial/medical stressors and perpetuating cognitive and behavioral factors. Strengths and limitations of the concept are discussed.

Berger, Mathias
University Medical Center Freiburg
Department of Psychiatry and Psychotherapy
Hauptstrasse 5, 79104 Freiburg, Germany
Phone: +49 761 270-6501 / Fax: -6619
christoph.nissen@uniklinik-freiburg.de
http://www.uniklinik-freiburg.de

COGNITIVE AND EMOTIONAL CONSEQUENCES OF INSOMNIA

Nissen C, Riemann D, Baglioni C, Berger M
Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

Chronic insomnia has been demonstrated to be associated with a broad variety of negative health outcomes, including increased cardiovascular morbiditiy and mortality and psychological problems. This presentation centers on recent findings on the impact of chronic insomnia on mood and memory consolidation. First, based on a recent meta-analysis, the authors provide support for the concept that primary insomnia is not only a highly prevalent symptom of major depression, but also an independent risk factor for developing major depression. Furthermore, based on novel experimental sleep laboratory studies, the authors show that healthy sleep after learning leads to an improved strengthening of novel memory traces (memory consolidation) and that this process is impaired in patients with primary insomnia in comparison to good sleeper controls. Interventions targeting insomnia at an early stage might bear the potential to decrease the risk of developing major depression and insomnia-related deficits of memory.

Nissen, Christoph
University Medical Center Freiburg
Department of Psychiatry and Psychotherapy
Hauptstrasse 5, 79104 Freiburg, Germany
Phone: +49 761 270-6501 / Fax: -6619
christoph.nissen@uniklinik-freiburg.de
http://www.uniklinik-freiburg.de

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