• Sleep Medicine and Psychophysiology
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• v.17 no.1
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• pp.34-40
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• 2010

Objectives: This study aimed to evaluate the clinical efficacy of individual cognitive behavioral therapy (CBT) for Patients with Primary or Secondary Insomnia. Methods: Participants were recruited from a primary care sleep clinic from January 2008 to June 2009. The study sample included 64 outpatients with primary insomnia (n=30) and secondary insomnia (n=34) according to the criteria of DSM-IV. Participants completed sleep diaries, Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS), State-Trait Anxiety Inventory (STAI) before CBT and shortly after completion of CBT. CBT was provided in 7 weekly, 40-50-minute individual therapy sessions. Results: Both groups of patients with primary and secondary insomnia showed significant improvement in the DBAS and sleep parameters including sleep onset latency, total sleep time, and sleep efficiency. Repeated-measures ANOVA of the DBAS and sleep parameters showed no significant group-by-time interactions between patients with primary and secondary insomnia, suggesting the efficacy of CBT for patients with secondary insomnia was equivalent to that of CBT for patients with primary insomnia. Conclusion: This study suggests that CBT is effective for the management of primary and secondary insomnia in a primary care setting.

• Sleep Medicine and Psychophysiology
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• v.19 no.2
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• pp.84-88
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• 2012

Introduction: The objective of the present study was to investigate the independent effects of major depressive disorder (MDD) and insomnia on somatization, respectively. Methods: A total of 181 participants (73 males and 108 females ; mean age $41.59{\pm}8.92$) without serious medical problem were recruited from a community and a psychiatric clinic in Republic of Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire : 1) normal controls (n=127), 2) primary insomnia (n=11), 3) MDD without insomnia (n=14), and 4) MDD with insomnia (n=29). All participants were requested to complete the somatization subscores of the Symptom Checklist-90-Revised (SCL-90-R). Results: There were significant between-group differences in somatization score (F=25.30, p<0.001). Subjects with both MDD and insomnia showed higher somatization score compared to normal control (p<0.001), subjects with primary insomnia (p=0.01), or MDD subjects without insomnia (p<0.001). Subjects with primary insomnia had higher somatization score than normal controls (p<0.01), while there was no significant difference between MDD subjects without insomnia and normal controls. In multiple regression, presence of insomnia predicted higher somatization score (beta=0.44, p<0.001), while there was only non-significant association between MDD and somatization (beta=0.14, p=0.08). Conclusion: In the current study, insomnia was associated with somatization independently from major depression. Subjects with primary insomnia showed higher somatization. Within MDD patients, presence of insomnia was related to higher somatization. Our finding suggests that insomnia may partly mediate the relationship between depression and somatization.

• Sleep Medicine and Psychophysiology
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• v.17 no.1
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• pp.21-27
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• 2010

Objectives: It is well established that primary insomnia affects the activity of autonomic nervous system. We tried to know how the activity of autonomic nervous system during night sleep changes by analyzing correlation between heart rate variability (HRV) index and the variables related with sleep structure in primary insomnia. Methods: Thirty three subjects (mean age: $36.2{\pm}14.2$ years, male:female=15:18) who were diagnosed with primary insomnia were selected for the study. Nocturnal polysomnography (NPSG) was carried out on each subject and correlation was analyzed between high frequency/low frequency ratio (LF/HF ratio), one of HRV indices and the variables related with sleep structure which were calculated from NPSG. Results: When age and sex were controlled, LF/HF ratio showed negative correlations with slow wave sleep and stage 2 sleep, respectively ($r_p$=-0.43, p=0.01; $r_p$=-0.37, p=0.04). On the other hands LF/HF ratio showed a positive correlation with arousal index ($r_p$=0.65, p<0.001). The activity of autonomic nervous system responded differentially depending on the change of sleep structure in primary insomnia. Especially the increase of arousal index and the decrease of slow wave sleep and stage 2 sleep which are the components of non-REM sleep provoked hyperactivity of sympathetic nervous system. Conclusion: This study suggests that the typical change of sleep structure in primary insomnia can negatively impact on cardiovascular system.

• Sleep Medicine and Psychophysiology
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• v.12 no.2
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• pp.117-121
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• 2005

Objectives: The purpose of this study was to assess the difference of subjective daytime sleepiness level between primary insomnia patients and healthy control subjects. We also investigated the relationship between subjective daytime sleepiness level and variables of nocturnal polysomnograghic sleep architecture of insomnia patients. Method: Total subjects were 87 patients with primary insomnia diagnosed with polysomnography and 88 normal controls. The daytime sleepiness level in each group was measured by Korean version of Epworth Sleepiness Scale (ESS). The correlations of ESS score and nocturnal polysomnographic variables were calculated in the patient group. Results: Patients with insomnia had the lower ESS scores than the control group. In patients group, the ESS score showed significant negative correlations with total sleep time, sleep efficiency%, and stage 2 sleep time%. The ESS score also showed significant positive correlations with number of awakenings, number of awakenings more than 2 minutes, and wake after sleep onset time. Conclusions: Insomnia patients showed lower level of subjective daytime sleepiness that may indicate their higher alertness comparing to control subjects. Daytime sleepiness of patients with insomnia was associated with polysomnographic variables including total sleep time, sleep efficiency%, stage 2 sleep time% and disrupted continuity of nocturnal sleep.

• Sleep Medicine and Psychophysiology
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• v.19 no.1
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• pp.42-46
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• 2012

Introduction: The objective of the present study was to investigate the defense style of insomnia patients and to grasp the differences in defense style between primary insomnia patients and insomnia patients with history of major depressive disorder. Methods: Forty three subjects with insomnia (11 subjects with primary insomnia and 32 subjects with major depressive disorder) and 138 control subjects participated in this study. To diagnose insomnia and major depressive disorder, interviews including structured clinical interview for DSM-IV (SCID-IV) were done. To assess the defense style, self-reported Korean version of Defense Style Questionnaire (K-DSQ) were completed by the participants. Results: Compared to normal controls, subjects with insomnia used more acting out (t=3.25, p<0.01), consumption (t=2.66, p<0.01), fantasy (t=3.51, p<0.001), resignation (t=5.42, p<0.001), suppression (t=3.28, p<0.01), projection (t=3.92, p<0.01), splitting (t=4.31, p<0.01), undoing (t=2.66, p<0.01), withdrawal (t=6.72, p<0.001) and isolation (t=3.80, p<0.001), and less omnipotence (t=4.08, p<0.001) and humor (t=3.20, p<0.01). Compared to normal controls, subjects with primary insomnia used more undoing and withdrawal. Compared to subjects with primary insomnia, subjects with insomnia with history of major depressive disorder used more resignation and withdrawal, and less humor. Conclusion: In the current study, there were differences in defenses between primary insomnia patients and insomnia patients with major depressive disorder history. To evaluate the pattern of defenses through the K-DSQ might provide important clues to differentiate these two conditions.

• Korean Journal of Biological Psychiatry
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• v.25 no.1
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• pp.1-8
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• 2018

Insomnia is a common sleep-related symptom which occurs in many populations, however, the neural mechanism underlying insomnia is not yet known. The hyperarousal model explains the neural mechanism of insomnia to some extent, and the frontal cortex dysfunction has been known to be related to primary insomnia. In this review, we discuss studies that applied resting state and/or task-related functional magnetic resonance imaging to demonstrate the deficits/dysfunctions of functional activation and network in primary insomnia. Empirical evidence of the hyperarousal model and proposed relation between the frontal cortex and other brain regions in primary insomnia are examined. Reviewing these studies could provide critical insights regarding the pathophysiology, brain network and cerebral activation in insomnia and the development of novel methodologies for the diagnosis and treatment of insomnia.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.9
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• pp.407-421
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• 2016

This paper reports a meta-analysis of sixteen studies that evaluated the efficacy of cognitive behavioral therapy (CBT) for persistent primary insomnia. PubMed, Cochrane Library, EMBASE, CINAHL and several Korean databases were searched between January 2015 and June 2015. The main search strategy involved the terms that indicate CBT-I (Cognitive Behavioral Therapy-Insomnia) and presence of insomnia. Methodological quality was assessed using Cochrane's Risk of Bias. Data were analyzed by the RevMan 5.3 program of Cochrane Library. Sixteen clinical trials met the inclusion criteria, resulting in a total of 1503 participants. Stimulus control, sleep restriction, sleep hygiene education, and cognitive restructuring were the main treatment components. CBT-I was conducted for a mean of 5.4 weeks, 5.5 sessions, and an average of 90 minutes per session. The effects of CBT-i on total sleep time (d=-0.31), sleep onset latency (d=-0.29), awakening time after sleep onset (d=-0.55), sleep efficiency (d=-0.70), insomnia severity (d=-0.77) and sleep belief (d=-0.64) were significant. Overall, we found a range from small to moderate effect size. CBT-I also was effective for anxiety (d=-0.30) and depression (d=-0.35). The findings demonstrate that CBT-I interventions will lead to the improvement of both sleep quality and quantity in patients with insomnia.

• Sleep Medicine and Psychophysiology
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• v.22 no.2
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• pp.70-76
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• 2015

Background and Objectives: Insomnia is the most prevalent sleep disorder in the general population and is considered to be a disorder of hyperarousal. The aim of this study was to measure the psychophysiological responses in insomnia patients using a biofeedback system, and to compare them with results from normal healthy subjects. Materials and Methods: Eighty patients with primary insomnia (35 males and 45 females, average age $49.71{\pm}12.91years$) and 101 normal healthy controls (64 males and 37 females, average age $27.65{\pm}2.77$) participated in this study. Electromyography (EMG), heart rate (HR), skin conductance (SC), skin temperature (ST), and respiratory rate (RR) were recorded using a biofeedback system during 5 phases (baseline, stress 1, recovery 1, stress 2, recovery 2) of a stress reactivity test, and average values were calculated. Difference in values between the two groups in each corresponding phase was analyzed with independent t-test, and change in values across phases of the stress reactivity test was analyzed with paired t-test (all two-tailed, p<0.05). Results: Compared to normal controls, insomnia patients had higher EMG in all 5 phases (baseline : $7.72{\pm}3.88{\mu}V$ vs. $4.89{\pm}1.73{\mu}V$, t = -6.06, p<0.001 ; stress 1 : $10.29{\pm}5.16{\mu}V$ vs. $6.63{\pm}2.48{\mu}V$, t = -5.84, p<0.001 ; recovery 1 : $7.87{\pm}3.86{\mu}V$ vs. $5.17{\pm}2.17{\mu}V$, t = -5.61, p<0.001 ; stress 2 : $10.22{\pm}6.07{\mu}V$ vs. $6.98{\pm}2.98{\mu}V$, t = -4.37, p<0.001 ; recovery 2 : $7.88{\pm}4.25{\mu}V$ vs. $5.17{\pm}1.99{\mu}V$, t = -5.27, p<0.001). Change in heart rate across phases of the stress reactivity test were higher in normal controls than in insomnia patients (stress 1-baseline : $6.48{\pm}0.59$ vs. $3.77{\pm}0.59$, t = 3.22, p = 0.002 ; recovery 1- stress 1 : $-5.36{\pm}0.0.59$ vs. $-3.16{\pm}0.47$, t = 2.91, p = 0.004 ; stress 2-recovery 1 : $8.45{\pm}0.61$ vs. $4.03{\pm}0.47$, t = 5.72, p<0.001 ; recovery 2-stress 2 : $-8.56{\pm}0.65$ vs. $4.02{\pm}0.51$, t = -5.31, p<0.001). Conclusion: Psychophysiological profiles of insomnia patients in a stress reactivity test were different from those of normal healthy controls. These results suggest that the sympathetic nervous system is more highly activated in insomnia patients.

• Sleep Medicine and Psychophysiology
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• v.26 no.1
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• pp.44-48
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• 2019

Objectives: Insomnia is one of the most prevalent sleep disorders. Recent studies suggest that cognitive and physical arousal play an important role in the generation of primary insomnia. Studies have also shown that information processing disorders due to cortical hyperactivity might interfere with normal sleep onset and sleep continuity. Therefore, focusing on central nervous system arousal and normalizing the information process have become current topics of interest. It has been well known that neurofeedback can reduce the brain hyperarousal by modulating patients' brain waves during a sequence of behavior therapy. The purpose of this study was to investigate effects of neurofeedback therapy on electroencephalography (EEG) characteristics in patients with primary insomnia. Methods: Thirteen subjects who met the criteria for an insomnia diagnosis and 14 control subjects who were matched on sex and age were included. Neurofeedback and sham treatments were performed in a random order for 30 minutes, respectively. EEG spectral power analyses were performed to quantify effects of the neurofeedback therapy on brain wave forms. Results: In patients with primary insomnia, relative spectral theta and sigma power during a therapeutic neurofeedback session were significantly lower than during a sham session ($13.9{\pm}2.6$ vs. $12.2{\pm}3.8$ and $3.6{\pm}0.9$ vs. $3.2{\pm}1.0$ in %, respectively; p < 0.05). There were no statistically significant changes in other EEG spectral bands. Conclusion: For the first time in Korea, EEG spectral power in the theta band was found to increase when a neurofeedback session was applied to patients with insomnia. This outcome might provide some insight into new interventions for improving sleep onset. However, the treatment response of insomniacs was not precisely evaluated due to limitations of the current pilot study, which requires follow-up studies with larger samples in the future.

• 대한상한금궤의학회지
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• v.7 no.1
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• pp.45-52
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• 2015

Objective : This case report aims to demonstrate the effect of Oryeong-san on Insomnia. Methods : A 26 year old woman suffered from insomnia with mental and physical exhaustion, reduced stamina, lack of concentration in daytime. According to Diagnostic system based on Shanghanlun provisions, the patient was diagnosed with Taeyang-byung and treated by Oryeong-san decoction. The result of administration was evaluated by Insomnia Severity Index. Results : After administration of Oryeong-san decoction for 1 month, Insomnia Severity Index was decreased from 24(clinical insomnia, severe) to 1(no clinically significant insomnia). Conclusions : The patient completely recovered from insomnia and daytime symptoms as treated by Oryeong-san decoction according to Diagnostic system based on Shanghanlun provisions.