Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder

FU Hanxin; ZHANG Xin; HU Linlin

doi:10.16766/j.cnki.issn.1674-4152.004073

Volume 23 Issue 7

Jul. 2025

Turn off MathJax

Article Contents

Article Navigation > Chinese Journal of General Practice > 2025 > 23(7): 1098-1102

FU Hanxin, ZHANG Xin, HU Linlin. Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder[J]. Chinese Journal of General Practice, 2025, 23(7): 1098-1102. doi: 10.16766/j.cnki.issn.1674-4152.004073

Citation:

FU Hanxin, ZHANG Xin, HU Linlin. Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder[J]. Chinese Journal of General Practice, 2025, 23(7): 1098-1102. doi: 10.16766/j.cnki.issn.1674-4152.004073

Citation:

PDF( 471 KB)

Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder

doi: 10.16766/j.cnki.issn.1674-4152.004073

FU Hanxin¹
, ZHANG Xin²
, HU Linlin^{1
,
,}

1.
Sleep Medicine Center of Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, China

Funds:

82205000

2024-XK-59

Received Date: 2024-04-17
Available Online: 2025-10-25

Abstract

Abstract

Insomnia disorder is the most prevalent type of sleep-wake disorder. Recent research on the etiology and pathogenesis has increasingly emphasized hyperarousal, which is now recognized as a core feature. Thus, this article summarizes the concept of the hyperarousal and its relationship with insomnia disorder, including hypothesis regarding its relationship with insomnia disorders, the clinical features of hyperarousal, and recent advances in both traditional Chinese and western medical treatment. Firstly, this article outlines the definition of hyperarousal, along with its main manifestations and detection methods of hyperarousal at the cortical, physiological, and cognitive levels. Secondly, this article introduces several hypotheses and models of insomnia disorders, all of which highlight hyperarousal as an important factor in the occurrence and progression of insomnia. In addition, previous studies have demonstrated that individuals with insomnia exhibit hyperarousal across multiple domains, including autonomic nervous activity, neuroendocrine, neuroimmune, neuroelectrophysiology, and neuroimaging. Finally, both traditional Chinese and western medical treatments have been shown to act on mechanisms involved in reducing the level of hyperarousal. Future clinical treatment and pharmacological research should place increased emphasis on addressing hyperarousal, aiming to explore more effective therapeutic methods to reduce its impact and enhance the quality of sleeping.
- Hyperarousal,
- Insomnia,
- Research progress

FullText(HTML)

References(50)

References

[1]	赵文瑞. 失眠的过度觉醒机制[D]. 重庆: 西南大学, 2022. ZHAO W R. The hyperarousal mechanism underlying insomnia[D]. Chongqing: Southwest University, 2022.
[2]	DRESSLE R J, RIEMANN D. Hyperarousal in insomnia disorder: current evidence and potential mechanisms[J]. J Sleep Res, 2023, 32(6): e13928. DOI: 10.1111/jsr.13928.
[3]	MORIN C M, JARRIN D C, IVERS H, et al. Incidence, persistence, and remission rates of insomnia over 5 years[J]. JAMA Netw Open, 2020, 3(11): e2018782. DOI: 10.1001/jamanetworkopen.2020.18782.
[4]	焦玥. 经皮耳穴电刺激抑制过度觉醒治疗失眠障碍的临床机制研究[D]. 北京: 中国中医科学院, 2022. JIAO Y. Study on the clinical mechanism of transcutaneous electrical stimulation of auricular points to inhibit hyperarousal in treating insomnia disorder[D]. Beijing: China Academy of Chinese Medical Sciences, 2022.
[5]	DRESSLE R J, RIEMANN D, SPIEGELHALDER K, et al. On the relationship between EEG spectral analysis and pre-sleep cognitive arousal in insomnia disorder: towards an integrated model of cognitive and cortical arousal[J]. J Sleep Res, 2023, 32(4): e13861. DOI: 10.1111/jsr.13861.
[6]	SPIELMAN A J, CARUSO L S, GLOVINSKY P B. A behavioral perspective on insomnia treatment[J]. Psychiatr Clin North Am, 1987, 10(4): 541-553. doi: 10.1016/S0193-953X(18)30532-X
[7]	RIEMANN D, SPIEGELHALDER K, FEIGE B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence[J]. Sleep Med Rev, 2010, 14(1): 19-31. doi: 10.1016/j.smrv.2009.04.002
[8]	VAN SOMEREN E J W. Brain mechanisms of insomnia: new perspectives on causes and consequences[J]. Physiol Rev, 2021, 101(3): 995-1046. doi: 10.1152/physrev.00046.2019
[9]	COSGRAVE J, PHILLIPS J, HAINES R, et al. Revisiting nocturnal heart rate and heart rate variability in insomnia: a polysomnography-based comparison of young self-reported good and poor sleepers[J]. J Sleep Res, 2021, 30(4): e13278. DOI: 10.1111/jsr.13278.
[10]	WIX-RAMOS R, GÁLVEZ-GOICURÍA J, VERONA-ALMEIDA M, et al. Monitoring differences in the function of the autonomic nervous system in patients with chronic insomnia using a wearable device[J]. Sleep Med, 2024, 115: 122-130. doi: 10.1016/j.sleep.2024.02.017
[11]	TRACY E L, ZHANG J, WILCKENS K, et al. Homeostatic response to sleep deprivation and circadian rhythmicity are intact in older adults with insomnia[J]. Sleep, 2022, 45(9): zsac162. DOI: 10.1093/sleep/zsac162.
[12]	REN R, ZHANG Y, YANG L H, et al. Insomnia with physiological hyperarousal is associated with lower weight: a novel finding and its clinical implications[J]. Transl Psychiatry, 2021, 11(1): 604. DOI: 10.1038/s41398-021-01672-5.
[13]	JOHANN A F, HERTENSTEIN E, FEIGE B, et al. Cognitive behavioural therapy for insomnia does not appear to have a substantial impact on early markers of cardiovascular disease: a preliminary randomized controlled trial[J]. J Sleep Res, 2020, 29(5): e13102. DOI: 10.1111/jsr.13102.
[14]	KVNZEL H, KLUGE M, ZEISING M, et al. Sleep in pituitary insufficient patients compared to patients with depression and healthy controls at baseline and after challenge with CRH[J]. J Psychiatr Res, 2020, 129: 124-128. doi: 10.1016/j.jpsychires.2020.06.029
[15]	YAMAZAKI E M, ANTLER C A, CASALE C E, et al. Cortisol and C-reactive protein vary during sleep loss and recovery but are not markers of neurobehavioral resilience[J]. Front Physiol, 2021, 12: 782860. DOI: 10.3389/fphys.2021.782860.
[16]	ZHANG X X, SUN S Y, MA Z J, et al. Changed nocturnal levels of stress-related hormones couple with sleep-wake states in the patients with chronic insomnia disorder: a clinical pilot study[J]. Sleep Med, 2024, 117: 177-183. doi: 10.1016/j.sleep.2024.03.017
[17]	DRESSLE R J, FEIGE B, SPIEGELHALDER K, et al. HPA axis activity in patients with chronic insomnia: a systematic review and meta-analysis of case-control studies[J]. Sleep Med Rev, 2022, 62: 101588. DOI: 10.1016/j.smrv.2022.101588.
[18]	NIE L, PAN X L, ZHANG X B, et al. Research on the correlation of immunity in patients with chronic insomnia[J]. Front Psychiatry, 2022, 13: 1034405. DOI: 10.3389/fpsyt.2022.1034405.
[19]	KELLY L, KOLLEN P. Stress and the immune system[J]. Science, 2019, 364(6443): 846.19-848. doi: 10.1126/science.2019.364.6443.twis
[20]	张萍. 基于睡眠反应性的慢性失眠发生机制研究及其在临床中的应用[D]. 合肥: 安徽医科大学, 2022. ZHANG P. Research on the mechanism of occurrence of chronic insomnia based on sleep reactivity and its clinical application[D]. Hefei: Anhui Medical University, 2022
[21]	QING H, DESROULEAUX R, ISRANI-WINGER K, et al. Origin and function of stress-induced IL-6 in murine models[J]. Cell, 2020, 182(6): 1660. DOI: 10.1016/j.cell.2020.08.044.
[22]	YU L Y, YANG L, XU H, et al. Inhibitory deficits of insomnia disorder: a meta-analysis on event related potentials in auditory oddball task[J]. Behav Sleep Med, 2024, 22(1): 100-114. doi: 10.1080/15402002.2023.2192499
[23]	OH D Y, PARK S M, CHOI S W. Daytime neurophysiological hyperarousal in chronic insomnia: a study of qEEG[J]. J Clin Med, 2020, 9(11): 3425. DOI: 10.3390/jcm9113425.
[24]	SHI Y, REN R, LEI F, et al. Elevated beta activity in the nighttime sleep and multiple sleep latency electroencephalograms of chronic insomnia patients[J]. Front Neurosci, 2022, 16: 1045934. DOI: 10.3389/fnins.2022.1045934.
[25]	KALMBACH D A, BUYSSE D J, CHENG P, et al. Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder[J]. Sleep Med, 2020, 71: 151-160. doi: 10.1016/j.sleep.2019.11.1184
[26]	AQUINO G, BENZ F, DRESSLE R J, et al. Towards the neurobiology of insomnia: a systematic review of neuroimaging studies[J]. Sleep Med Rev, 2024, 73: 101878. DOI: 10.1016/j.smrv.2023.101878.
[27]	ZHU Y F, ZHAO X M, YIN H, et al. Functional connectivity density abnormalities and anxiety in primary insomnia patients[J]. Brain Imaging Behav, 2021, 15(1): 114-121. doi: 10.1007/s11682-019-00238-w
[28]	LI S M, WANG B A, LI C, et al. Progressive gray matter hypertrophy with severity stages of insomnia disorder and its relevance for mood symptoms[J]. Eur Radiol, 2021, 31(8): 6312-6322. doi: 10.1007/s00330-021-07701-7
[29]	REIMANN G M, KüPPERS V, CAMILLERI J A, et al. Convergent abnormality in the subgenual anterior cingulate cortex in insomnia disorder: a revisited neuroimaging meta-analysis of 39 studies[J]. Sleep Med Rev, 2023, 71: 101821. DOI: 10.1016/j.smrv.2023.101821.
[30]	ZOU G Y, LI Y Z, LIU J Y, et al. Altered thalamic connectivity in insomnia disorder during wakefulness and sleep[J]. Hum Brain Mapp, 2021, 42(1): 259-270. doi: 10.1002/hbm.25221
[31]	ZOU G Y, XU J, ZHOU S Q, et al. Functional MRI of arousals in nonrapid eye movement sleep[J]. Sleep, 2020, 43(2): zsz218. DOI: 10.1093/sleep/zsz218.
[32]	LI Y Z, ZOU G Y, SHAO Y, et al. Sleep discrepancy is associated with alterations in the salience network in patients with insomnia disorder: an EEG-fMRI study[J]. Neuroimage Clin, 2022, 35: 103111. DOI: 10.1016/j.nicl.2022.103111.
[33]	PERLIS M L, POSNER D, RIEMANN D, et al. Insomnia[J]. Lancet, 2022, 400(10357): 1047-1060. doi: 10.1016/S0140-6736(22)00879-0
[34]	ZHANG C X, YANG L L, LIU S, et al. One-week self-guided internet cognitive behavioral treatments for insomnia in adults with situational insomnia during the COVID-19 outbreak[J]. Front Neurosci, 2020, 14: 622749. DOI: 10.3389/fnins.2020.622749.
[35]	蔡李佳, 张亚男, 李惠敏, 等. 睡眠限制疗法治疗失眠的研究进展[J]. 中风与神经疾病杂志, 2023, 40(3): 229-231. CAI L J, ZHANG Y N, LI H M, et al. Research progress of sleep restriction therapy in the treatment of insomnia[J]. Journal of Apoplexy and Nervous Diseases, 2023, 40(3): 229-231.
[36]	DAVID A K, PHILIP C, JASON C O, et al. A three-arm randomized controlled trial examining mindfulness-based and cognitive-behavioral therapies for prenatal insomnia[J]. Sleep, 2023, 46(Supplement_1): A164. DOI: 10.1093/sleep/zsad077.0370.
[37]	海峡两岸医药卫生交流协会睡眠医学专业委员会. 曲唑酮临床应用中国专家共识[J]. 中华医学杂志, 2022, 102(7): 468-478. Academy Society Of Sleep Medicine, Cross-Straits Medicine Exchange Association. Chinese expert consensus on the clinical application of trazodone[J]. National Medical Journal of China, 2022, 102(7): 468-478.
[38]	倪喆, 刘露. 低频重复经颅刺激对原发性失眠患者的临床效果及神经内分泌的影响[J]. 中华全科医学, 2022, 20(1): 62-64. doi: 10.16766/j.cnki.issn.1674-4152.002277 NI Z, LIU L. Clinical effect and neuroendocrine effect of low-frequency repetitive transcranial stimulation on patients with primary insomnia[J]. Chinese Journal of General Practice, 2022, 20(1): 62-64. doi: 10.16766/j.cnki.issn.1674-4152.002277
[39]	METH E M S, BRANDÃO L E M, VAN EGMOND L T, et al. A weighted blanket increases pre-sleep salivary concentrations of melatonin in young, healthy adults[J]. J Sleep Res, 2023, 32(2): e13743. DOI: 10.1111/jsr.13743.
[40]	柴士伟, 范栢爽, 宋学姣, 等. 矿物类中药治疗失眠的药理作用及临床应用研究进展[J]. 天津中医药, 2024, 41(3): 403-408. CHAI S W, FAN B S, SONG X J, et al. Research progress on pharmacological effects and clinical applications of mineral chinese medicine in the treatment of insomnia[J]. Tianjin Journal of Traditional Chinese Medicine, 2024, 41(3): 403-408.
[41]	DONG Y J, JIANG N H, ZHAN L H, et al. Soporific effect of modified suanzaoren decoction on mice models of insomnia by regulating Orexin-A and HPA axis homeostasis[J]. Biomed Pharmacother, 2021, 143: 112141. DOI: 10.1016/j.biopha.2021.112141.
[42]	张思佳, 周颖靓, 王茹, 等. 温胆汤及其类方治疗失眠研究进展[J]. 辽宁中医药大学学报, 2023, 25(10): 192-198. ZHANG S J, ZHOU Y L, WANG R, et al. Research progress in wendan decoction and its similar prescriptions treating insomnia[J]. Journal of Liaoning University of Traditional Chinese Medicine, 2023, 25(10): 192-198.
[43]	赵亚楠, 吴文忠, 王晓秋, 等. 观察调神针法对慢性失眠症患者过度觉醒状态的影响[J]. 世界科学技术-中医药现代化, 2021, 23(7): 2538-2543. ZHAO Y N, WU W Z, WANG X Q, et al. To observe the effect of tiaoshen acupuncture on hyperarousal in patients with chronic insomnia[J]. World Science and Technology-Modernization of Traditional Chinese Medicine, 2021, 23(7): 2538-2543.
[44]	奚晗清, 吴文忠, 刘成勇, 等. 针刺调神组方对慢性失眠症患者过度觉醒状态的影响[J]. 中国针灸, 2021, 41(3): 263-267. XI H Q, WU W Y, LIU C Y, et al. Effect of acupuncture at tiaoshen acupoints on hyperarousal state in chronic insomnia[J]. Chinese Acupuncture & Moxibustion, 2021, 41(3): 263-267.
[45]	李沐风, 刘成勇, 万青云, 等. 基于默认模式网络探讨针刺治疗失眠症过度觉醒机制的研究进展[J]. 磁共振成像, 2024, 15(9): 130-134, 145. LI M F, LIU C Y, WAN Q Y, et al. Research progress on the hyperarousal of insomnia treated by acupuncture based on the default mode network[J]. Chinese Journal of Magnetic Resonance Imaging, 2024, 15(9): 130-134, 145.
[46]	张欣雨, 张艺馨, 刘璐, 等. 针刺调节心脾两虚型慢性失眠症过度觉醒状态的临床研究[J]. 北京中医药, 2024, 43(7): 747-753. ZHANG X Y, ZHANG Y X, LIU L, et al. Acupuncture for regulating hyperarousal state in chronic insomnia with deficiency of heart and spleen: a clinical trial study[J]. Beijing Journal of Traditional Chinese Medicine, 2024, 43(7): 747-753.
[47]	郅晓宇. 振腹环揉法治疗心脾两虚型慢性失眠的过度觉醒机制研究[D]. 长春: 长春中医药大学, 2023. ZHI X Y. Study on the mechanism of hyperarousal in the treatment of chronic insomnia of deficiency of heart and spleen with "vibro-annular" abdominal massage therapy[D]. Changchun: Changchun University of Chinese Medicine, 2023.
[48]	金婕, 陈紫君, 林丽华, 等. 子午流注结合五行音乐疗法治疗心脾两虚型失眠的临床效果观察[J]. 中华全科医学, 2021, 19(10): 1742-1744, 1796. doi: 10.16766/j.cnki.issn.1674-4152.002156 JIN J, CHEN Z J, LIN L H, et al. Observation on the clinical effect of meridian flow theory combined with five elements music therapy in treating insomnia with deficiency of heart and spleen[J]. Chinese Journal of General Practice, 2021, 19(10): 1742-1744, 1796. doi: 10.16766/j.cnki.issn.1674-4152.002156
[49]	胡霖霖, 张芯, 张永华. 基于数据挖掘探析张永华情志辨证治疗失眠的用药特点及思路[J]. 中国现代医生, 2024, 62(29): 62-65. HU L L, ZHANG X, ZHANG Y H. Data mining research on medication characteristics and thoughts of Zhang Yonghua in the treatment of insomnia with emotional syndrome differentiation[J]. China Modern Doctor, 2024, 62(29): 62-65.
[50]	胡霖霖, 刘文娟, 张蕾, 等. 加味酸枣仁汤对焦虑性失眠患者躯体过度觉醒水平的影响[J]. 浙江临床医学, 2020, 22(8): 1123-1125. HU L L, LIU W J, ZHANG L, et al. Effect of modified suan zao ren tang on somatic hyperarousal in insomniacs with anxiety[J]. Zhejiang Clinical Medical Journal, 2020, 22(8): 1123-1125.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (28) PDF downloads(0)

Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder

doi: 10.16766/j.cnki.issn.1674-4152.004073

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Research progress in traditional Chinese and western medicine on hyperarousal in insomnia disorder

doi: 10.16766/j.cnki.issn.1674-4152.004073

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

Export File

Citation

Format

Content