Dressle Raphael J, Spiegelhalder Kai, Schiel Julian E, Benz Fee, Johann Anna, Feige Bernd, Jernelöv Susanna, Perlis Michael, Riemann Dieter
Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
J Sleep Res. 2025 Oct;34(5):e70091. doi: 10.1111/jsr.70091. Epub 2025 May 9.
Insomnia Disorder (ID) is a highly debilitating disorder affecting up to 10% of the general population. In recent years, the number of studies in this area has increased rapidly, resulting in a wealth of accumulated knowledge. ID is generally regarded as a hyperarousal disorder affecting cognitive, emotional, cortical and physiological domains. Nevertheless, there is still a significant lack of knowledge about the pathophysiology of ID. For example, the existence of insomnia subtypes is discussed, albeit no uniform definition has yet been found. Significant progress has been made in understanding the neurobiology of insomnia, which points to a dysfunction in emotion regulation. However, neuroimaging studies frequently have small sample sizes and allow only for limited causal conclusions. The assessment of sleep has been significantly influenced by the increasing availability of methods for ambulatory sleep measurement. While these methods enable sleep to be measured more cost-effectively than polysomnography, many devices lack sufficient empirical evidence of validity. In terms of insomnia treatment, cognitive behavioural therapy for insomnia (CBT-I) has been shown to be highly effective. However, the underlying mechanisms of CBT-I remain partially unclear, and the optimal sequence for applying the individual components, as well as the effectiveness of CBT-I in cases of comorbidity, remain open questions. Furthermore, many widely applied pharmacological treatment approaches are used off-label with only a limited empirical evidence base. This narrative review aims to summarise the current state of research on ID and attempts to outline a selection of the important future challenges in insomnia research.
失眠症（ID）是一种极具致残性的疾病，影响着高达10%的普通人群。近年来，该领域的研究数量迅速增加，积累了丰富的知识。ID通常被视为一种影响认知、情绪、皮层和生理领域的过度觉醒障碍。然而，对于ID的病理生理学仍存在重大知识空白。例如，虽然讨论了失眠亚型的存在，但尚未找到统一的定义。在理解失眠的神经生物学方面已取得重大进展，这表明情绪调节存在功能障碍。然而，神经影像学研究的样本量往往较小，只能得出有限的因果结论。动态睡眠测量方法的日益普及对睡眠评估产生了重大影响。虽然这些方法比多导睡眠图能更经济高效地测量睡眠，但许多设备缺乏足够的有效性实证证据。在失眠治疗方面，失眠认知行为疗法（CBT-I）已被证明非常有效。然而，CBT-I的潜在机制仍部分不明，应用各个组成部分的最佳顺序以及CBT-I在合并症病例中的有效性仍是悬而未决的问题。此外，许多广泛应用的药物治疗方法是在缺乏充分实证依据的情况下超适应症使用的。本叙述性综述旨在总结ID的当前研究现状，并试图概述失眠研究中一些重要的未来挑战。
