Sleep disorders pathophysiology

Zisapel, N. (2001). Circadian rhythm sleep disorders pathophysiology and potential approaches to management. CNS Drugs 15, 311-28. 

G. S. Richardson and H. V. Malin, Circadian rhythm sleep disorders Pathophysiology and treatment. J. Clin. Neurophysiol. 13, 17-31 (1996). 

SSRIs can cause insomnia and daytime somnolence however, the symptoms seem to reflect a sleep-wake cycle disorder. It is conceivable that disruptions in the normal pattern of melatonin secretion, particularly a delay in the normal early morning fall in plasma concentrations, could be involved in the pathophysiology of these symptoms. The fact that these sleep disorders were seen only with fluvoxamine would also support a role of melatonin (see the section on Endocrine in this monograph). 

Riemann, D. and Vorderholzer, U., Treatment of depression and sleep disorders. Significance of serotonin and L-tryptophan in pathophysiology and therapy, Fortschr. Med., 116(32), 40, 1998. 

Since insomnia is a complex and multifaceted disorder, there is no single pathophysiologic explanation for its various manifestations. Current hypotheses focus on a combination of possible models that incorporate physiologic, cognitive, and cortical arousal. Most insomnia models focus on hyperarousal and its interference with the initiation or maintenance of sleep. 

Sleep-wake state alterations in PD can be broadly classified into disturbances of (1) thalamocortical arousal state and (2) excessive nocturnal movement (Rye and Bliwise 2004 Rye and Iranzo 2005). The former includes the loss of sleep spindles and SWS, daytime sleepiness, and intrusion of REM sleep into daytime naps (i.e. sleep onset REM periods, or SOREMs), and the latter encompass periodic leg movements of sleep (PLMs) and REM sleep behavior disorder (RBD). The pathophysiological basis of sleepiness and SOREMs appears to be dopaminergic cell loss in PD, though excessive nocturnal movements are not as clearly related to dopaminergic deficits. 

Primary insomnia, with underlying pathophysiology of sleep Insomnia secondary to a psychiatric disorder Insomnia secondary to a medication or drug of abuse... 

Germain A, Nielsen TA (2003) Sleep pathophysiology in posttrraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry 54 1092-1098... 

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