It is like having an alarm in your head that continuously rings. This is the cause of insomnia, a disorder that is quite common, especially in women. Ten percent of the Italian population is affected by it in a severe way while over a quarter of us have experienced at least a mild form of this sleep problem. On this topic professor Dieter Riemann, full professor of clinical psychology at the University of Freiburg, held a lecture at the School of Medicine of our University. The lecture, entitled "Chronic insomnia and the hyperarousal concept", was held Tuesday the 30th of August : another sign of the interest for the topic was the presence of numerous attendees despite the summer holidays.
This lecture, organized also with the contribution of the IRIS Foundation was an occasion for dialogue between the German psychological school represented by Prof. Riemann and the one held in Pisa by professor Guazzelli, full professor of Clinical Psychology and chair of the Clinical Psychology Unit of AOUP (Azienda Ospedaliero-Unversitaria Pisana).
"The concept of hyperarousal – prof. Guazzelli said – is a theory that suggests that insomnia is caused by a hyperactivity of the wake centers: those widely distributed networks of neuronal cells that maintains our brain in a condition of normal vigilance and adequate ability to detect external stimuli. To put it differently when this mechanism does not work anymore we are in a continuous situation of arousal and we 'can say goodbye to our sleep' ".
However is still not clear how and why this hyperarousal rises. According to the top-down model this hyperactivity is related to problems of mentation: emotions, rumination, worries that maintain the alert. Paradoxically the worriness itself of not sleeping is per se a cause of insomnia. Another possible interpretation, the so called bottom-up theory, more followed in Pisa and in Freiburg, suggests that insomnia basically derives from a brain hyperactivity that can be, in part, hereditary and that has is roots in the physiology of brain function. "Wherever the hyperarousal comes from – Guazzelli concluded – insomnia is the cause of several health problems including depression but also somatic diseases like hypertension and other cardiovascular problems. Is like a vicious circle, the less you sleep the worse your neuro-vegetative system works and the less you sleep. Of course the less you sleep the worse the homoeostasis of systems and organs goes".
Is it possible to have the lost sleep back?
One possibility is to use hypnotic drugs, but Guazzelli warns "Hypnotic drugs have the risk to stimulate the wake centers even more, and they might undergo tolerance effects". Psychological treatments and in particular cognitive-behavioral treatments can represent a more feasible solution.
"You can start with relaxation techniques – Riemann explains – like contract and then relax groups of muscles. However it is also important to correct some typical errors that people make.
Some small changes can really make the difference: avoid coffee and alcohol before sleep; avoid effortful mental or physical activity in the hour preceding bedtime, go to bed only when you are sleepy and do not anticipate the time to go to bed because you are afraid of not sleeping". Riemann concluded that "sometimes the worst enemy is not insomnia per se but the fear of not sleeping"
(trasalted by Claudio Gentili)