Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder
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Background Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia. Methods In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal. Results Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency. Conclusions Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.
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Insomnia is frequently associated with cognitive and somatic hyperarousal, including in autism.
“However, insomnia is frequently associated with cognitive (Kalmbach et al ., 2020; Vargas et al ., 2020) and somatic hyperarousal (Vargas et al ., 2020), including in autism (Baker et al ., 2019b; Richdale et al ., 2014).”
From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Kalmbach et al ., 2020
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Additional file 2 of Limited predictive value of admission time in clinical psychiatry
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- Authors
- Kalmbach, D. A., Buysse, D. J., Cheng, P., Roth, T., Yang, A., & Drake, C. L.
- Affiliations
- Henry Ford Health (US)
- University of Pittsburgh Medical Center (US)
- Corresponding author
- Drake, Christopher L.
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 71
- Pages
- 151-160
- ISSN
- 1389-9457 (ISSN-L)
- PMC
- PMC8212183
- OpenAlex
- W2987227727
- Cited by
- 100
- References
- 80
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 15 · 2023: 8 · 2022: 16 · 2021: 11 · 2020: 9
- FWCI
- 10.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- cognitive arousal, insomnia, sleep disorders, nocturnal wakefulness, wake after sleep onset, sleep latency, sleep efficiency, multiple sleep latency test, depression, somatic arousal, treatment-resistant insomnia
- MeSH terms
- Adult, Arousal, Cognition, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Sleep, Polysomnography
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