Cognitive Behavioral Therapy for Insomnia & Sleep EEG Hyperarousal

American Academy of Sleep Medicine. The international classification of sleep disorders (ICSD-3). 2014.

Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, et al. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135:10–19.

Google Scholar

Rössler W, Angst J, Ajdacic-Gross V, Haker H, Berrouiguet S, Ujeyl M, et al. Sleep disturbances and suicidality–a longitudinal analysis from a representative community study over 30 years. Front Psychiatry. 2018;9:320.

Google Scholar

Hertenstein E, Benz F, Schneider CL, Baglioni C. Insomnia—A risk factor for mental disorders. J Sleep Res. 2023;32:e13930.

Google Scholar

Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Basta M, et al. Insomnia with short sleep duration and mortality: The Penn state cohort. Sleep. 2010;33:1159–64.

Google Scholar

Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep. 2009;32:491–7.

Google Scholar

Li Y, Vgontzas AN, Fernandez-Mendoza J, Bixler EO, Sun Y, Zhou J, et al. Insomnia with physiological hyperarousal is associated with hypertension. Hypertension. 2015;65:644–50.

Google Scholar

Daley M, Morin CM, LeBlanc M, Grégoire J-P, Savard J. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009;32:55–64.

Google Scholar

Sivertsen B, Overland S, Neckelmann D, Glozier N, Krokstad S, Pallesen S, et al. The long-term effect of insomnia on work disability. Am J Epidemiol. 2006;163:1018–24.

Google Scholar

Garbarino S, Magnavita N, Guglielmi O, Maestri M, Dini G, Bersi FM, et al. Insomnia is associated with road accidents. Further evidence from a study on truck drivers. PLoS ONE. 2017;12:e0187256.

Google Scholar

Baglioni C, ECA, & RD. Cognitive-Behavioural Therapy For Insomnia (CBT-I) Across The Life Span. Wiley; 2022.

van Straten A, van der Zweerde T, Kleiboer A, Cuijpers P, Morin CM, Lancee J. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis. Sleep Med Rev. 2018;38:3–16.

Google Scholar

Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Ann Intern Med. 2015;163:191–204.

Google Scholar

Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis. Sleep Med Rev. 2015;23:54–67.

Google Scholar

Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32:e14035.

Google Scholar

American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. 2013.

Galbiati A, Sforza M, Fasiello E, Castronovo V, Ferini-Strambi L. Impact of phenotypic heterogeneity of insomnia on the patients’ response to cognitive-behavioral therapy for insomnia: current perspectives. Nat Sci Sleep. 2019;ume 11:367–76.

Google Scholar

He D, Guo Z, Mcclure MA, Mu Q, Jiang B. Cognitive-behavioral therapy for insomnia with objective short sleep duration phenotype: A systematic review with meta-analysis. Sleep Med Rev. 2023;67:101736.

Google Scholar

Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26:342–92.

Google Scholar

Crönlein T, Geisler P, Langguth B, Eichhammer P, Jara C, Pieh C, et al. Polysomnography reveals unexpectedly high rates of organic sleep disorders in patients with prediagnosed primary insomnia. Sleep Breath. 2012;16:1097–103.

Google Scholar

Ferini-Strambi L, Fossati A, Sforza M, Galbiati A. Subtyping insomnia disorder. Lancet Psychiatry. 2019;6:284.

Google Scholar

Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res. 2023;32:e13910.

Google Scholar

Morin CM, Drake CL, Harvey AG, Krystal AD, Manber R, Riemann D, et al. Insomnia disorder. Nat Rev Dis Primers. 2015. 2015. https://doi.org/10.1038/nrdp.2015.26.

Pérusse AD, Turcotte I, St-Jean G, Ellis J, Hudon C, Bastien CH. Types of primary insomnia: Is hyperarousal also present during napping?. J Clin Sleep Med. 2013;09:1273–80.

Google Scholar

Dai Y, Ma J, Vgontzas AN, Chen B, Chen L, Wu J, et al. Insomnia disorder is associated with 24-hour cortical hyperarousal. Sleep Med. 2024;124:681–7.

Google Scholar

Perlis ML, Merica H, Smith MT, Giles DE. Beta EEG activity and insomnia. Sleep Med Rev. 2001;5:365–76.

Google Scholar

Vgontzas AN, Bixler EO, Lin H-M, Prolo P, Mastorakos G, Vela-Bueno A, et al. Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: Clinical implications. J Clin Endocrinol Metab. 2001;86:3787–94.

Google Scholar

Perlis ML, Smith MT, Pigeon WR. Etiology and pathophysiology of insomnia. Principles and Practice of Sleep Medicine. 2005.

Vgontzas AN, Tsigos C, Bixler EO, Stratakis CA, Zachman K, Kales A, et al. Chronic insomnia and activity of the stress system: A preliminary study. J Psychosom Res. 1998;45:21–31.

Google Scholar

Bastien CH, Turcotte I, St-Jean G, Morin CM, Carrier J. Information processing varies between insomnia types: Measures of N1 and P2 during the night. Behav Sleep Med. 2013;11:56–72.

Google Scholar

Turcotte I, St-Jean G, Bastien CH. Are individuals with paradoxical insomnia more hyperaroused than individuals with psychophysiological insomnia? Event-related potentials measures at the peri-onset of sleep. Int J Psychophysiol. 2011;81:177–90.

Google Scholar

Zhao W, Van Someren EJW, Li C, Chen X, Gui W, Tian Y, et al. EEG spectral analysis in insomnia disorder: A systematic review and meta-analysis. Sleep Med Rev. 2021;59:101457.

Google Scholar

Riemann D, Spiegelhalder K, Nissen C, Hirscher V, Baglioni C, Feige B REM Sleep Instability – A New Pathway for Insomnia? Pharmacopsychiatry. 2012. 30 January 2012. https://doi.org/10.1055/s-0031-1299721.

Feige B, Nanovska S, Baglioni C, Bier B, Cabrera L, Diemers S, et al. Insomnia – Perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia. Sleep. 2018;41:https://doi.org/10.1093/sleep/zsy032.

Kay DB, Buysse DJ. Hyperarousal and beyond: New insights to the pathophysiology of insomnia disorder through functional neuroimaging studies. Brain Sci. 2017;7:23.

Google Scholar

Zou G, Li Y, Liu J, Zhou S, Xu J, Qin L, et al. Altered thalamic connectivity in insomnia disorder during wakefulness and sleep. Hum Brain Mapp. 2021;42:259–70.

Google Scholar

Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev. 2021;101:995–1046.

Google Scholar

Rosen RC, Lewin DS, Goldberg L, Woolfolk RL. Psychophysiological insomnia: combined effects of pharmacotherapy and relaxation-based treatments. Sleep Med. 2000;1:279–88.

Google Scholar

Vincent N, Lewycky S. Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia. Sleep. 2009;32:807–15.

Google Scholar

Wu R, Bao J, Zhang C, Deng J, Long C. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom. 2006;75:220–8.

Google Scholar

Miller CB, Kyle SD, Gordon CJ, Espie CA, Grunstein RR, Mullins AE, et al. Physiological markers of arousal change with psychological treatment for insomnia: A preliminary investigation. PLoS ONE. 2015;10:e0145317.

Google Scholar

Jarrin DC, Chen IY, Ivers H, Lamy M, Vallières A, Morin CM. Nocturnal heart rate variability in patients treated with cognitive–behavioral therapy for insomnia. Health Psychol. 2016;35:638–41.

Google Scholar

O’Byrne JN, Berman Rosa M, Gouin JP, Dang-Vu TT. Neuroimaging findings in primary insomnia. Pathologie Biologie. 2014;62:262–9.

Google Scholar

Spiegelhalder K, Regen W, Baglioni C, Nissen C, Riemann D, Kyle SD. Neuroimaging insights into insomnia. Curr Neurol Neurosci Rep. 2015;15:9.

Google Scholar

Spiegelhalder K, Regen W, Baglioni C, Riemann D, Winkelman JW. Neuroimaging Studies in Insomnia. Curr Psychiatry Rep. 2013;15:405.

Google Scholar

Tahmasian M, Noori K, Samea F, Zarei M, Spiegelhalder K, Eickhoff SB, et al. A lack of consistent brain alterations in insomnia disorder: An activation likelihood estimation meta-analysis. Sleep Med Rev. 2018;42:111–8.

Google Scholar

Smith MT, Perlis ML, Chengazi VU, Soeffing J, McCann U. NREM sleep cerebral blood flow before and after behavior therapy for chronic primary insomnia: preliminary single photon emission computed tomography (SPECT) data. Sleep Med. 2005;6:93–94.

Google Scholar

Lee YJG, Kim S, Kim N, Choi JW, Park J, Kim SJ, et al. Changes in subcortical resting-state functional connectivity in patients with psychophysiological insomnia after cognitive–behavioral therapy: Changes in resting-state FC after CBT for insomnia patients. Neuroimage Clin. 2018;17:115–23.

Google Scholar

Park HY, Lee H, Jhee JH, Park KM, Choi EC, An SK, et al. Changes in resting-state brain connectivity following computerized cognitive behavioral therapy for insomnia in dialysis patients: A pilot study. Gen Hosp Psychiatry. 2020;66:24–29.

Google Scholar

Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late-life insomnia. JAMA. 1999;281:991.

Google Scholar

Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia. JAMA. 2009;301:2005.

Google Scholar

Mitchell LJ, Bisdounis L, Ballesio A, Omlin X, Kyle SD. The impact of cognitive behavioural therapy for insomnia on objective sleep parameters: A meta-analysis and systematic review. Sleep Med Rev. 2019.

Perrault AA, Pomares FB, Smith D, Cross NE, Gong K, Maltezos A, et al. Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med. 2022;97:13–26.

Google Scholar

Cervena K, Dauvilliers Y, Espa F, Touchon J, Matousek M, Billiard M, et al. Effect of cognitive behavioural therapy for insomnia on sleep architecture and sleep EEG power spectra in psychophysiological insomnia. J Sleep Res. 2004. 2004. https://doi.org/10.1111/j.1365-2869.2004.00431.x.

Hogan SE, Delgado GM, Hall MH, Nimgaonkar VL, Germain A, Buysse DJ, et al. Slow-oscillation activity is reduced and high frequency activity is elevated in older adults with insomnia. J Clin Sleep Med. 2020. 2020. https://doi.org/10.5664/jcsm.8568.

Vallières A, Ceklic T, Bastien CH, Espie CA. A preliminary evaluation of the physiological mechanisms of action for sleep restriction therapy. Sleep Disord. 2013;2013:1–15.

Google Scholar

Krystal AD, Edinger JD Sleep EEG predictors and correlates of the response to cognitive behavioral therapy for insomnia. Sleep. 2010. 2010. https://doi.org/10.1093/sleep/33.5.669.

Dang-Vu TT, Hatch B, Salimi A, Mograss M, Boucetta S, O’Byrne J, et al. Sleep spindles may predict response to cognitive-behavioral therapy for chronic insomnia. Sleep Med. 2017. 2017. https://doi.org/10.1016/j.sleep.2017.08.012.

Maurer LF, Espie CA, Omlin X, Emsley R, Kyle SD. The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial. Sleep. 2022;45:zsab223.

Google Scholar

Lunsford-Avery JR, Edinger JD, Krystal AD. Optimizing computation of overnight decline in delta power: Evidence for slower rate of decline in delta power in insomnia patients. Clin Neurophysiol. 2021;132:545–53.

Google Scholar

Sforza M, Morin CM, Dang-Vu TT, Pomares FB, Perrault AA, Gouin J, et al. Cognitive-behavioural therapy for insomnia mechanism of action: Exploring the homeostatic K-complex involvement. J Sleep Res. 2024. 30 December 2024. https://doi.org/10.1111/jsr.14452.

Krystal AD. Non-REM sleep EEG spectral analysis in insomnia. Psychiatr Ann. 2008;38:615–20.

Maes J, Verbraecken J, Willemen M, De Volder I, van Gastel A, Michiels N, et al. Sleep misperception, EEG characteristics and Autonomic Nervous System activity in primary insomnia: A retrospective study on polysomnographic data. Int J Psychophysiol. 2014;91:163–71.

Google Scholar

Gorgoni M, Scarpelli S, Annarumma L, D’atri A, Alfonsi V, Ferrara M, et al. The regional eeg pattern of the sleep onset process in older adults. Brain Sci. 2021;11:1261.

Google Scholar

D’Atri A, Scarpelli S, Schiappa C, Pizza F, Vandi S, Ferrara M, et al. Cortical activation during sleep predicts dream experience in narcolepsy. Ann Clin Transl Neurol. 2019;6:445–55.

Google Scholar

Scarpelli S, D’atri A, Bartolacci C, Gorgoni M, Mangiaruga A, Ferrara M, et al. Dream recall upon awakening from non-rapid eye movement sleep in older adults: Electrophysiological pattern and qualitative features. Brain Sci. 2020;10:343.

Google Scholar

Fasiello E, Gorgoni M, Galbiati A, Sforza M, Berra F, Scarpelli S, et al. Decreased Delta/Beta ratio index as the sleep state-independent electrophysiological signature of sleep state misperception in Insomnia disorder: A focus on the sleep onset and the whole night. Neuroimage. 2024;298:120782.

Google Scholar

Dai Y, Vgontzas AN, Chen L, Zheng D, Chen B, Fernandez-Mendoza J, et al. A meta-analysis of the association between insomnia with objective short sleep duration and risk of hypertension. Sleep Med Rev. 2024;75:101914.

Google Scholar

Saulnier KG, Singh R, Lenker KP, Calhoun SL, He F, Liao D, et al. Association of insomnia phenotypes based on polysomnography-measured sleep duration with suicidal ideation and attempts. Sleep Health. 2022;8:391–7.

Google Scholar

American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. (ICSD-2). 2005.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC; 1994.

Sateia MJ. International classification of sleep disorders-third edition highlights and modifications. Chest. 2014;146:1387–94. https://doi.org/10.1378/chest.14-0970. International classification of sleep disorders-third edition Sateia, M. J. (2014)highlights and m. Chest. 2014.

Google Scholar

Espie CA The psychological treatment of insomnia. Chichester: Wiley; 1991.

Google Scholar

Hauri PJ Sleep Hygiene, Relaxation Therapy, and Cognitive Interventions. In: Case Studies in Insomnia. Boston, MA: Springer US; 1991. pp. 65–84.

Google Scholar

Morin CM Insomnia: Psychological assessment and management. Guilford Press; 1993.

Google Scholar

Bootzin RR, Epstein D, Wood JM Stimulus Control Instructions. In: Case Studies in Insomnia. Boston, MA: Springer US; 1991. pp. 19–28.

Google Scholar

Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10:45–56.

Google Scholar

Lichstein KLL Clinical relaxation strategies. New York: Wiley; 1988.

Google Scholar

Bastien C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.

Google Scholar

Castronovo V, Galbiati A, Marelli S, Brombin C, Cugnata F, Giarolli L, et al. Validation study of the Italian version of the Insomnia Severity Index (ISI). Neurol Sci. 2016;37:1517–24.

Google Scholar

Morin CM, Belleville G, Bélanger L, Ivers H. The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34:601–8.

Google Scholar

Natale V, Léger D, Bayon V, Erbacci A, Tonetti L, Fabbri M, et al. The consensus sleep diary: Quantitative criteria for primary insomnia diagnosis. Psychosom Med. 2015;77:413–8.

Google Scholar

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012. 2012. https://doi.org/10.5664/jcsm.2172.

Vallat R, Walker MP. An open-source, high-performance tool for automated sleep staging. eLife. 2021;10:e70092.

Google Scholar

Gramfort A. MEG and EEG data analysis with MNE-Python. Front Neurosci. 2013;7:267.

Google Scholar

Lee G, Gommers R, Waselewski F, Wohlfahrt K, O’Leary A. PyWavelets: A Python package for wavelet analysis. J Open Source Softw. 2019;4:1237.

Google Scholar

Adam Paszke SGFMSC. PyTorch: an imperative style, highperformance deep learning library. Vancouver; 2019.

Gardner JGPKQWDBAGW. GPyTorch: Blackbox Matrix-Matrix Gaussian Process Inference with GPU Acceleration. Montreal; 2018.

Dean DA, Goldberger AL, Mueller R, Kim M, Rueschman M, Mobley D, et al. Scaling up scientific discovery in sleep medicine: The national sleep research resource. Sleep. 2016;39:1151–64.

Google Scholar

Zhang G-Q, Cui L, Mueller R, Tao S, Kim M, Rueschman M, et al. The National Sleep Research Resource: towards a sleep data commons. J Am Med Inform Assoc. 2018;25:1351–8.

Google Scholar

Welch P. The use of fast Fourier transform for the estimation of power spectra: A method based on time averaging over short, modified periodograms. IEEE Trans Audio Electroacoust. 1967;15:70–3.

Google Scholar

Love J, Selker R, Marsman M, Jamil T, Dropmann D, Verhagen J, et al. JASP: Graphical statistical software for common statistical designs. J Stat Softw. 2019;88:1–17.

Cohen J Statistical power analysis for the behavioural sciences. Hillside. NJ: Lawrence Earlbaum Associates; 1988.

Google Scholar

Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17:255–62.

Google Scholar

Bonnet MH, Arand DL. Hyperarousal and insomnia: State of the science. Sleep Med Rev. 2010;14:9–15.

Google Scholar

Perlis ML, Ellis JG, Kloss JD, Riemann DW Etiology and Pathophysiology of Insomnia. In: Principles and Practice of Sleep Medicine. Elsevier; 2017. pp. 769–84.e4.

Google Scholar

Altena E, Ellis J, Camart N, Guichard K, Bastien C. Mechanisms of cognitive behavioural therapy for insomnia. J Sleep Res. 2023;32:e13860.

Google Scholar

Lancee J, Harvey AG, Morin CM, Ivers H, van der Zweerde T, Blanken TF. Network Intervention Analyses of cognitive therapy and behavior therapy for insomnia: Symptom specific effects and process measures. Behav Res Ther. 2022;153:104100.

Google Scholar

Fernandez-Mendoza J Insomnia with objective short sleep duration. In: Encyclopedia of Sleep and Circadian Rhythms. Elsevier; 2023. pp. 64–72.

Google Scholar

Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO. Insomnia with objective short sleep duration: The most biologically severe phenotype of the disorder. Sleep Med Rev. 2013.

Li Y, Vgontzas AN, Fernandez-Mendoza J, Fang J, Puzino K, Bixler EO. Effect of trazodone versus cognitive-behavioural treatment on high- and slow-frequency activity during non-rapid eye movement sleep in chronic insomnia: A pilot, randomized clinical trial. J Sleep Res. 2021;30:e13324.

Google Scholar

Vgontzas AN, Puzino K, Fernandez-Mendoza J, Krishnamurthy VB, Basta M, Bixler EO. Effects of trazodone versus cognitive behavioral therapy in the insomnia with short sleep duration phenotype: a preliminary study. J Clin Sleep Med. 2020;16:2009–19.

Google Scholar

Blanken TF, Benjamins JS, Borsboom D, Vermunt JK, Paquola C, Ramautar J, et al. Insomnia disorder subtypes derived from life history and traits of affect and personality. Lancet Psychiatry. 2019;6:151–63.

Google Scholar