In insomnia, which is a very common sleep disorder, objective sleep measures, EEG
activity, physiologic findings, HPA axis activity, and inflammation markers suggest
that it is not a state of sleep loss, but a disorder of hyperarousal present both
during the night and the daytime. Several psychological and physiological factors
contribute to the onset and perpetuation of insomnia, such as anxious-ruminative personality
traits, stressful events, age-related sleep homeostasis weakening mechanisms, menopause,
and biologic-genetic diathesis of CNS hyperarousal. The therapeutic approach in insomnia
should be multidimensional, reducing the overall emotional and physiologic hyperarousal
and its underlying factors present throughout the 24-hour sleep/wake period.
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