HPA axis activity in patients with chronic insomnia: A systematic review and meta-analysis of case–control studies
Abstract
Insomnia is a highly prevalent disorder and a state of 24 h hyperarousal is considered as a key factor of this condition. Various physiological markers of hyperarousal have been investigated, including the activity of the HPA axis. However, these studies yielded heterogenous results. The aim of this study was to qualitatively and quantitatively evaluate whether there are differences in cortisol levels, the hormonal end product of the HPA axis, between patients with insomnia and good sleeper controls (GSC). The databases PubMed, Cinahl, PsycInfo, PsycArticles and Web of Science were searched for case-control studies comparing cortisol levels in patients with insomnia and GSC. Twenty studies (449 patients with insomnia, limited to ages 18-70 not taking any medications; 357 GSC) met the inclusion criteria. For each study, standardized mean differences (SMD) were calculated as a measure of effect size. Results suggest that patients with insomnia show moderately increased cortisol levels (SMD = 0.50, 95% CI: [0.21-0.80]). Higher effect sizes were found by including only studies using blood samples in the analysis (SMD = 0.67, 95% CI: [0.15-1.18]). Furthermore, a positive, but insignificant association was found between the extent of objective sleep loss in insomnia patients and group differences in cortisol levels.
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Sleep-related safety behaviors are overt or covert strategies employed to prevent feared outcomes related to poor sleep.
“Sleep-related safety behaviors are overt or covert strategies employed to prevent feared outcomes related to poor sleep, such as spending excessive time in bed trying to force sleep, using electronic devices for distraction, or napping during the day to compensate for lost rest [17].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [17]
Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817 · see citing works
Conducting Meta-Analyses in <i>R</i> with the <b>metafor</b> Package
Viechtbauer, W. (2010) · Journal of Statistical Software · doi:10.18637/jss.v036.i03 · Cited by 20,464 · see citing works
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.006 · Cited by 10,578 · see citing works
A basic introduction to fixed-effect and random-effects models for meta-analysis
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2010) · Research Synthesis Methods · doi:10.1002/jrsm.12 · Cited by 6,793 · see citing works
Epidemiology of insomnia: what we know and what we still need to learn
Ohayon, M. M. (2002) · Sleep Medicine Reviews · doi:10.1053/smrv.2002.0186 · Cited by 3,743 · see citing works
Impact of sleep debt on metabolic and endocrine function
Spiegel, K., Leproult, R., & Van Cauter, E. (1999) · The Lancet · doi:10.1016/s0140-6736(99)01376-8 · Cited by 3,672 · see citing works
Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., Lombardo, C., & Riemann, D. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.01.011 · Cited by 2,779 · see citing works
Self-citationBrain corticosteroid receptor balance in health and disease
de Kloet, E. R., Vreugdenhil, E., Oitzl, M. S., & Joëls, M. (1998) · Endocrine Reviews · doi:10.1210/edrv.19.3.0331 · Cited by 2,614 · see citing works
Brain corticosteroid receptor balance in health and disease
de Kloet, E. R. (1998) · Endocrine Reviews · doi:10.1210/er.19.3.269 · Cited by 2,614 · see citing works
Miller, G. E., Chen, E., & Zhou, E. S. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.1.25 · Cited by 2,467 · see citing works
The Corticosteroid Receptor Hypothesis of Depression
Holsboer, F. (2000) · Neuropsychopharmacology · doi:10.1016/s0893-133x(00)00159-7 · Cited by 2,181 · see citing works
Salivary cortisol in psychoneuroendocrine research: recent developments and applications
Kirschbaum, C., & Hellhammer, D. H. (1994) · Psychoneuroendocrinology · doi:10.1016/0306-4530(94)90013-2 · Cited by 2,107 · see citing works
European guideline for the diagnosis and treatment of insomnia
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia‐Borreguero, D., Gjerstad, M., Gonçalves, M., et al. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12594 · Cited by 2,049 · see citing works
Self-citationSalivary cortisol as a biomarker in stress research
Hellhammer, D. H., Wüst, S., & Kudielka, B. M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2008.10.026 · Cited by 1,925 · see citing works
Regulation of the Hypothalamic‐Pituitary‐Adrenocortical Stress Response
Herman, J. P., McKlveen, J. M., Ghosal, S., Kopp, B., Wulsin, A., Makinson, R., Scheimann, J., & Myers, B. (2016) · Comprehensive Physiology · doi:10.1002/cphy.c150015 · Cited by 1,819 · see citing works
The hyperarousal model of insomnia: A review of the concept and its evidence
Riemann, D., Spiegelhalder, K., Feige, B., Voderholzer, U., Berger, M., Perlis, M., & Nissen, C. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.04.002 · Cited by 1,789 · see citing works
Self-citationPruessner, J. C., Wolf, O. T., Hellhammer, D. H., Buske-Kirschbaum, A., von Auer, K., Jobst, S., Kaspers, F., & Kirschbaum, C. (1997) · Life Sciences · doi:10.1016/s0024-3205(97)01008-4 · Cited by 1,450 · see citing works
Insomnia as a predictor of mental disorders: a systematic review and meta-analysis
Hertenstein, E., Feige, B., Gmeiner, T., Kienzler, C., Spiegelhalder, K., Johann, A., Jansson-Fröjmark, M., Palagini, L., Rücker, G., Riemann, D., et al. (2019) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.10.006 · Cited by 1,201 · see citing works
Self-citationRussell, G., & Lightman, S. (2019) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0228-0 · Cited by 1,032 · see citing works
Morin, C. M., & Benca, R. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60750-2 · Cited by 976 · see citing works
Buckley, T. M., & Schatzberg, A. F. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1056 · Cited by 964 · see citing works
Vgontzas, A. N., Bixler, E. O., Lin, H.-M., Prolo, P., Mastorakos, G., Vela-Bueno, A., Kales, A., & Chrousos, G. P. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.8.7778 · Cited by 884 · see citing works
The awakening cortisol response: methodological issues and significance
Clow, A., Thorn, L., Evans, P., & Hucklebridge, F. (2004) · Stress · doi:10.1080/10253890410001667205 · Cited by 856 · see citing works
Psychophysiological insomnia: the behavioural model and a neurocognitive perspective
PERLIS, M. L., GILES, D. E., MENDELSON, W. B., BOOTZIN, R. R., & WYATT, J. K. (1997) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1997.00045.x · Cited by 795 · see citing works
Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder
Vgontzas, A. N., Fernandez-Mendoza, J., Liao, D., & Bixler, E. O. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2012.09.005 · Cited by 776 · see citing works
Hair cortisol, stress exposure, and mental health in humans: A systematic review
Staufenbiel, S. M., Penninx, B. W. J. H., Spijker, A. T., Elzinga, B. M., & van Rossum, E. F. C. (2013) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2012.11.015 · Cited by 736 · see citing works
The neurobiology, investigation, and treatment of chronic insomnia
Riemann, D. W., Nissen, C., Palagini, L., Otte, A., Perlis, M. L., & Spiegelhalder, K. (2015) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00021-6 · Cited by 639 · see citing works
Self-citationCorticotropin-releasing factor activates noradrenergic neurons of the locus coeruleus
Valentino, R. J., Foote, S. L., & Aston‐Jones, G. (1983) · Brain Research · doi:10.1016/0006-8993(83)90615-7 · Cited by 603 · see citing works
Regulation of the Hypothalamic‐Pituitary‐Adrenocortical Stress Response
Herman, J. P., McKlveen, J. M., Ghosal, S., Kopp, B., Wulsin, A. C., Makinson, R. A., Scheimann, J. R., & Myers, B. (2016) · Comprehensive physiology · doi:10.1002/j.2040-4603.2016.tb00694.x · Cited by 541 · see citing works
Insomnia and the Performance of US Workers: Results from the America Insomnia Survey
Kessler, R. C., Berglund, P. A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., Shillington, A. C., Stephenson, J. J., & Walsh, J. K. (2011) · Sleep · doi:10.5665/sleep.1230 · Cited by 527 · see citing works
Stress Hormone Regulation: Biological Role and Translation into Therapy
Holsboer, F., & Ising, M. (2010) · Annual Review of Psychology · doi:10.1146/annurev.psych.093008.100321 · Cited by 473 · see citing works
Measuring cortisol in human psychobiological studies
Levine, A., Zagoory‐Sharon, O., Feldman, R., Lewis, J. G., & Weller, A. (2006) · Physiology & Behavior · doi:10.1016/j.physbeh.2006.08.025 · Cited by 472 · see citing works
A users guide to HPA axis research
Spencer, R. L., & Terrence Deak, B. (2016) · Physiology & Behavior · doi:10.1016/j.physbeh.2016.11.014 · Cited by 408 · see citing works
Chronic insomnia and activity of the stress system
Vgontzas, A. N., Tsigos, C., Bixler, E. O., Stratakis, C. A., Zachman, K., Kales, A., Vela-Bueno, A., & Chrousos, G. P. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00302-4 · Cited by 401 · see citing works
Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies
Baglioni, C., Regen, W., Teghen, A., Spiegelhalder, K., Feige, B., Nissen, C., & Riemann, D. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.04.001 · Cited by 386 · see citing works
Self-citationLéger, D., & Bayon, V. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2010.01.003 · Cited by 376 · see citing works
Cortisol pulsatility and its role in stress regulation and health
YOUNG, E., ABELSON, J., & LIGHTMAN, S. (2004) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2004.07.001 · Cited by 355 · see citing works
Dissociation of ACTH and glucocorticoids
Bornstein, S. R., Engeland, W. C., Ehrhart-Bornstein, M., & Herman, J. P. (2008) · Trends in Endocrinology & Metabolism · doi:10.1016/j.tem.2008.01.009 · Cited by 345 · see citing works
van Dalfsen, J. H., & Markus, C. R. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.10.002 · Cited by 329 · see citing works
Ehlers, C. L., Reed, T. K., & Henriksen, S. J. (2008) · Neuroendocrinology · doi:10.1159/000124489 · Cited by 310 · see citing works
Health economics of insomnia treatments: The return on investment for a good night's sleep
Wickwire, E. M., Shaya, F. T., & Scharf, S. M. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.11.004 · Cited by 290 · see citing works
Sleep disturbances are correlated with decreased morning awakening salivary cortisol
Backhaus, J., Junghanns, K., & Hohagen, F. (2004) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2004.01.010 · Cited by 287 · see citing works
Dettenborn, L., Tietze, A., Kirschbaum, C., & Stalder, T. (2012) · Stress · doi:10.3109/10253890.2012.654479 · Cited by 277 · see citing works
EEG spectral analysis in insomnia disorder: A systematic review and meta-analysis
Zhao, W., Someren, E. J. W. V., Li, C., Chen, X., Gui, W., Tian, Y., Liu, Y., & Lei, X. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101457 · Cited by 274 · see citing works
Backhaus, J., Junghanns, K., Born, J., Hohaus, K., Faasch, F., & Hohagen, F. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.051 · Cited by 265 · see citing works
Rodenbeck, A., Huether, G., Rüther, E., & Hajak, G. (2002) · Neuroscience Letters · doi:10.1016/s0304-3940(02)00192-1 · Cited by 265 · see citing works
Neurochemical regulation of sleep
Steiger, A. (2007) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2006.04.007 · Cited by 262 · see citing works
Holsboer, F., von Bardeleben, U., & Steiger, A. (2008) · Neuroendocrinology · doi:10.1159/000124986 · Cited by 255 · see citing works
A 10-year trend of insomnia prevalence in the adult Norwegian population
Pallesen, S., Sivertsen, B., Nordhus, I. H., & Bjorvatn, B. (2013) · Sleep Medicine · doi:10.1016/j.sleep.2013.10.009 · Cited by 253 · see citing works
The significance of glucocorticoid pulsatility
Lightman, S. L., Wiles, C. C., Atkinson, H. C., Henley, D. E., Russell, G. M., Leendertz, J. A., McKenna, M. A., Spiga, F., Wood, S. A., & Conway-Campbell, B. L. (2008) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2007.11.073 · Cited by 241 · see citing works
Pigeon, W. R., Bishop, T. M., & Krueger, K. M. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0802-x · Cited by 233 · see citing works
The role of personality traits in insomnia
van de Laar, M., Verbeek, I., Pevernagie, D., Aldenkamp, A., & Overeem, S. (2010) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2009.07.007 · Cited by 213 · see citing works
Nocturnal cortisol and melatonin secretion in primary insomnia
Riemann, D., Klein, T., Rodenbeck, A., Feige, B., Horny, A., Hummel, R., Weske, G., Al-Shajlawi, A., & Voderholzer, U. (2002) · Psychiatry Research · doi:10.1016/s0165-1781(02)00249-4 · Cited by 202 · see citing works
Self-citationPersistent Psychophysiologic (Learned) Insomnia
Hauri, P., & Fisher, J. M. (1986) · SLEEP · doi:10.1093/sleep/9.1.38 · Cited by 178 · see citing works
Larsson, C., Gullberg, B., Råstam, L., & Lindblad, U. (2009) · BMC Endocrine Disorders · doi:10.1186/1472-6823-9-16 · Cited by 174 · see citing works
Chronic stress differentially regulates glucocorticoid negative feedback response in rats
Mizoguchi, K., Yuzurihara, M., Ishige, A., Sasaki, H., Chui, D., & Tabira, T. (2001) · Psychoneuroendocrinology · doi:10.1016/s0306-4530(01)00004-x · Cited by 173 · see citing works
Jan Born, A., Späth‐Schwalbe, E., SCHWAKENHOFER, H., Kern, W., & Fehm, H. L. (1989) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-68-5-904 · Cited by 171 · see citing works
Acute Effect of a Glucocorticoid on Normal Human Sleep
Gillin, J. C., Jacobs, L. S., Fram, D. H., & Snyder, F. R. (1972) · Nature · doi:10.1038/237398a0 · Cited by 134 · see citing works
Vgontzas, A. N., Bixler, E. O., Wittman, A. M., Zachman, K., Lin, H.-M., Vela-Bueno, A., Kales, A., & Chrousos, G. P. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.4.7370 · Cited by 134 · see citing works
Sleep Architecture and Sleep Apnea in Patients with Cushing's Disease
Shipley, J. E., SCHTEINGART, D. E., Tandon, R., & Starkman, M. N. (1992) · SLEEP · doi:10.1093/sleep/15.6.514 · Cited by 129 · see citing works
Long-Lasting Effects of Stress on Glucocorticoid Receptor Gene Expression in the Rat Brain
Kitraki, E., Karandrea, D., & Kittas, C. N. (1999) · Neuroendocrinology · doi:10.1159/000054435 · Cited by 123 · see citing works
Krieger, D. T., & Glick, S. M. (1974) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-39-6-986 · Cited by 115 · see citing works
Jiang, C., Zhang, T., Yue, F., Yi, M.-L., & Gao, D. (2013) · Cell Biochemistry and Biophysics · doi:10.1007/s12013-013-9529-4 · Cited by 110 · see citing works
Abell, J. G., Shipley, M. J., Ferrie, J. E., Kivimäki, M., & Kumari, M. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.02.021 · Cited by 106 · see citing works
Castro‐Diehl, C., Roux, A. V. D., Redline, S. S., Seeman, T. E., Shrager, S., & Shea, S. A. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-1198 · Cited by 104 · see citing works
Rodenbeck, A., Cohrs, S., Jordan, W., Huether, G., R�ther, E., & Hajak, G. (2003) · Psychopharmacology · doi:10.1007/s00213-003-1565-0 · Cited by 103 · see citing works
Shaver, J. L. F., Johnston, S., Lentz, M. J., & Landis, C. A. (2002) · Psychosomatic Medicine · doi:10.1097/01.psy.0000024235.11538.9a · Cited by 103 · see citing works
Sleep characteristics as predictor variables of stress systems markers in insomnia disorder
Floam, S., Simpson, N., Nemeth, E., Scott‐Sutherland, J., Gautam, S., & Haack, M. (2015) · Journal of Sleep Research · doi:10.1111/jsr.12259 · Cited by 103 · see citing works
Reverse First Night Effect in Insomnia
Hauri, P., & Olmstead, E. M. (1989) · SLEEP · doi:10.1093/sleep/12.2.97 · Cited by 99 · see citing works
Corticotropin-releasing hormone (CRH) as a regulator of waking
Chang, F.-C., & Opp, M. R. (2001) · Neuroscience & Biobehavioral Reviews · doi:10.1016/s0149-7634(01)00024-0 · Cited by 99 · see citing works
Passos, G. S., Poyares, D., Santana, M. G., Teixeira, A. A. D. S., Lira, F. S., Youngstedt, S. D., Santos, R. V. T. D., Tufik, S., & de Mello, M. T. (2014) · BioMed Research International · doi:10.1155/2014/498961 · Cited by 99 · see citing works
Varkevisser, M., Dongen, H. P. A. V., & KERKHOF, G. A. (2005) · SLEEP · doi:10.1093/sleep/28.12.1588 · Cited by 95 · see citing works
Petersen, H., Kecklund, G., D’Onofrio, P., Nilsson, J., & Åkerstedt, T. (2012) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2012.01034.x · Cited by 87 · see citing works
Spath-Schwalbe, E. (1993) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.77.5.1170 · Cited by 86 · see citing works
Altered ultradian cortisol rhythmicity as a potential neurobiologic substrate for chronic insomnia
Vargas, I., Vgontzas, A. N., Abelson, J. L., Faghih, R. T., Morales, K. H., & Perlis, M. L. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.03.003 · Cited by 85 · see citing works
Zhang, J., Lam, S.-P., Li, S. X., Ronald, C. W., Kong, A. P. S., Chan, M. H. M., Ho, C. S., Li, A. M., & Wing, Y. K. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3728 · Cited by 84 · see citing works
Xia, L., Chen, G.-H., Li, Z.-H., Jiang, S., & Shen, J. (2013) · PLoS ONE · doi:10.1371/journal.pone.0071065 · Cited by 83 · see citing works
D’Aurea, C. V. R., Poyares, D. R., Piovezan, R. D., Passos, G. S., Tufik, S., & de Mello, M. T. (2015) · Arquivos de Neuro-Psiquiatria · doi:10.1590/0004-282x20150053 · Cited by 82 · see citing works
Chapotot, F., Buguet, A., Gronfier, C., & Brandenberger, G. (2001) · Neuroendocrinology · doi:10.1159/000054648 · Cited by 72 · see citing works
Further definition of the effect of corticosterone on the sleep-wake pattern in the male rat.
Vázquez-Palacios, G., Retana-Márquez, S., Bonilla-Jaime, H., & Velázquez-Moctezuma, J. (2001) · Pharmacology, Biochemistry and Behavior · doi:10.1016/s0091-3057(01)00620-7 · Cited by 68 · see citing works
Continuous free cortisol profiles-circadian rhythms in healthy men
Bhake, R. C., Kluckner, V, Stassen, H., Russell, G. M., Leendertz, J., Stevens, K., Linthorst, A. C. E., & Lightman, S. L. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-00449 · Cited by 64 · see citing works
Pathology of Sleep, Hormones and Depression
Steiger, A., Dresler, M., Kluge, M., & SCHÜSSLER, P. (2013) · Pharmacopsychiatry · doi:10.1055/s-0033-1337921 · Cited by 61 · see citing works
Seelig, E., Keller, U. B., Klarhöfer, M., Scheffler, K., Brand, S., Holsboer‐Trachsler, E., Hatzinger, M., & Bilz, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0061780 · Cited by 60 · see citing works
Autonomic dysregulation and sleep homeostasis in insomnia
Grimaldi, D., Reid, K. J., Papalambros, N. A., Braun, R., Malkani, R. G., Abbott, S. M., Ong, J. C., & Zee, P. C. (2020) · SLEEP · doi:10.1093/sleep/zsaa274 · Cited by 60 · see citing works
Chen, I. Y., Jarrin, D. C., Ivers, H., & Morin, C. M. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.09.011 · Cited by 56 · see citing works
The stress hormone system in various sleep disorders
Lattova, Z., Keckeis, M., Maurovich-Horvat, E., Wetter, T. C., Wilde-Frenz, J., Schuld, A., & Pollmächer, T. (2011) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2011.03.013 · Cited by 54 · see citing works
Chronic Insomnia and Daytime Functioning: An Ambulatory Assessment
Varkevisser, M., Dongen, H. P. A. V., van Amsterdam, J., & KERKHOF, G. A. (2007) · Behavioral Sleep Medicine · doi:10.1080/15402000701557425 · Cited by 50 · see citing works
Familial Risk for Insomnia Is Associated With Abnormal Cortisol Response to Stress
Drake, C. L., Cheng, P., Almeida, D. M., & Roth, T. G. (2017) · SLEEP · doi:10.1093/sleep/zsx143 · Cited by 47 · see citing works
Prinz, P. N., Bailey, S. L., Moe, K. E., Wilkinson, C. W., & Scanlan, J. M. (2001) · Journal of Sleep Research · doi:10.1046/j.1365-2869.2001.00236.x · Cited by 45 · see citing works
Patients with chronic insomnia have selective impairments in memory that are modulated by cortisol
Chen, G., Xia, L., Fang, W., Xue‐Wei, L. I., & Jiao, C. (2016) · Psychophysiology · doi:10.1111/psyp.12700 · Cited by 43 · see citing works
Berger, M., Taylor, S. M., Harriss, L. R., Campbell, S., Thompson, F., Jones, S., Sushames, A., Amminger, G. P., Sarnyai, Z., & McDermott, R. A. (2019) · Stress · doi:10.1080/10253890.2019.1572745 · Cited by 39 · see citing works
Bioassay Research Methodology: Measuring CRH in Pregnancy
Latendresse, G., & Ruiz, R. J. (2008) · Biological Research For Nursing · doi:10.1177/1099800408320970 · Cited by 38 · see citing works
Hyyppä, M. T., Lindholm, T., Kronholm, E., & Lehtinen, V. (1990) · Stress Medicine · doi:10.1002/smi.2460060406 · Cited by 37 · see citing works
Glucocorticoid and inflammatory reactivity to a repeated physiological stressor in insomnia disorder
Devine, J. K., Bertisch, S. M., Yang, H., Scott‐Sutherland, J., Wilkins, A., Molina, V., Henrikson, K., & Haack, M. (2018) · Neurobiology of Sleep and Circadian Rhythms · doi:10.1016/j.nbscr.2018.06.001 · Cited by 33 · see citing works
Miller, C. B., Kyle, S. D., Gordon, C. J., Espie, C. A., Grunstein, R. R., Mullins, A. E., Postnova, S., & Bartlett, D. J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145317 · Cited by 31 · see citing works
Acute stress alters autonomic modulation during sleep in women approaching menopause
de Zambotti, M., Sugarbaker, D. S., Trinder, J. C., Colrain, I. M., & Baker, F. C. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.12.017 · Cited by 31 · see citing works
Wang, C., Dai, J., & Li, J. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.07.001 · Cited by 30 · see citing works
Santiago, G. T. P., Galvão, A. C. D. M., de Almeida, R. N., Mota-Rolim, S. A., Palhano-Fontes, F., Maia‐de‐Oliveira, J. P., de Araújo, D. B., Soares, B. L., & Coelho, N. L. G. (2020) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2020.00044 · Cited by 30 · see citing works
Hansen, D., Satterfield, B. C., Layton, M. E., & Dongen, H. P. A. V. (2021) · Military Medicine · doi:10.1093/milmed/usaa464 · Cited by 28 · see citing works
Gender Determines Serum Free Cortisol: Higher Levels in Men
Sofer, Y., Osher, E., Limor, R., Shefer, G., Marcus, Y., Shapira, I., Tordjman, K. M., Greenman, Y., Berliner, S. A., & Stern, N. (2016) · Endocrine Practice · doi:10.4158/ep161370.or · Cited by 25 · see citing works
A Preliminary Evaluation of the Physiological Mechanisms of Action for Sleep Restriction Therapy
Vallières, A., Ceklic, T., Bastien, C., & Espie, C. A. (2013) · Sleep Disorders · doi:10.1155/2013/726372 · Cited by 24 · see citing works
Tsoli, S., Vasdekis, S. N., Tigani, X., Artemiadis, A., Chrousos, G. P., & Darviri, C. (2018) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2018.01.015 · Cited by 19 · see citing works
Gehrman, P., Hall, M. H., Barilla, H., Buysse, D. J., Perlis, M. L., Gooneratne, N. S., & Ross, R. J. M. (2014) · Behavioral Sleep Medicine · doi:10.1080/15402002.2014.940112 · Cited by 18 · see citing works
SCHÜSSLER, P., Kluge, M., Gamringer, W., Wetter, T. C., Yassouridis, A., Uhr, M., Rupprecht, R., & Steiger, A. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.09.015 · Cited by 18 · see citing works
Roehrs, T., & Roth, T. G. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.04.010 · Cited by 17 · see citing works
Both objective and paradoxical insomnia elicit a stress response involving mitokine production
Martucci, M., Conte, M., Ostan, R., Chiariello, A., Miele, F., Franceschi, C., Salvioli, S., Santoro, A., & Provini, F. (2020) · Aging · doi:10.18632/aging.103274 · Cited by 15 · see citing works
Valle, V. I.-D., Silva, J., Castelló-Domenech, A. B., Martínez-Martínez, M., Verdejo, Y., Sanantonio-Camps, L., & Cauli, O. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.03.010 · Cited by 14 · see citing works
Alderling, M., de la Torre, B., Forsell, Y., Lundberg, I., Söndergaard, H. P., & Theorell, T. (2008) · Psychotherapy and Psychosomatics · doi:10.1159/000112892 · Cited by 13 · see citing works
Mohammadi, H., Rezaei, M. B., Amiri, S. M., Rahimi, Z., Mansouri, K., & Khazaie, H. (2018) · Basic and Clinical Neuroscience Journal · doi:10.32598/bcn.9.6.397 · Cited by 13 · see citing works
van Neijenhof, R. J. G. P., van Duijn, E., van den Berg, J. F., de Waal, M. W. M., van der Mast, R. C., & Comijs, H. C. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12570 · Cited by 12 · see citing works
İsmailoğulları, S., Bolattürk, Ö. F., Karaca, Z., Taheri, S., Bayram, K. K., Keleştimur, F., & Aksu, M. (2017) · Sleep and Biological Rhythms · doi:10.1007/s41105-017-0120-z · Cited by 7 · see citing works
Bolattürk, Ö. F., İsmailoğulları, S., Aldemir, R., Tokmakçı, M., & Ulusoy, E. K. (2020) · Sleep And Breathing · doi:10.1007/s11325-020-02032-1 · Cited by 3 · see citing works
Vargas, I. (2016) · Deep Blue (University of Michigan) · Cited by 1 · see citing works
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Immunology of stress: A review article
Alotiby, A. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216394 · Cited by 253 · see citing works
Hyperarousal in insomnia disorder: Current evidence and potential mechanisms
Dressle, R. J., & Riemann, D. (2023) · Journal of Sleep Research · doi:10.1111/jsr.13928 · Cited by 218 · see citing works
Self-citationSheaves, B., Cropley, V. L., Moseley, P., Woodruff, P. W. R., Punton, G., Speth, C., Speth, J., Meerlo, P., & Brederoo, S. G. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf107 · Cited by 6 · see citing works
Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
- Authors
- Dressle, R. J., Feige, B., Spiegelhalder, K., Schmucker, C., Benz, F., Mey, N. C., & Riemann, D.
- Affiliations
- University of Freiburg (DE)
- Corresponding author
- Dressle, Raphael J.
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 62
- Pages
- 101588
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W4206287139
- Semantic Scholar
- 2bc69ace334686c0568e601f58f98ea00bcf3bca
- Cited by
- 161
- References
- 116
- Citations by year
- 2026: 54 · 2025: 56 · 2024: 28 · 2023: 21 · 2022: 2
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- chronic insomnia, hypothalamic-pituitary-adrenal axis, cortisol, hyperarousal, sleep deprivation
- MeSH terms
- Adolescent, Adult, Aged, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Sleep Initiation and Maintenance Disorders, Middle Aged, Pituitary-Adrenal System, Case-Control Studies, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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