The hyperarousal model of insomnia: a review of the concept and its evidence

Sleep Med Rev. 2010 Feb;14(1):19-31. doi: 10.1016/j.smrv.2009.04.002. Epub 2009 May 28.


Primary insomnia is defined as difficulties in falling asleep, maintaining sleep or non-restorative sleep accompanied by significantly impaired daytime functioning in the absence of a specific physical, mental or substance-related cause. The current review provides substantial support for the concept that hyperarousal processes from the molecular to the higher system level play a key role in the pathophysiology of primary insomnia. Autonomous, neuroendocrine, neuroimmunological, electrophysiological and neuroimaging studies demonstrate increased levels of arousal in primary insomnia during both night and daytime. In the light of neurobiological theories of sleep-wake regulation, primary insomnia may be conceptualized as a final common pathway resulting from the interplay between a genetic vulnerability for an imbalance between arousing and sleep-inducing brain activity, psychosocial/medical stressors and perpetuating mechanisms including dysfunctional sleep-related behavior, learned sleep preventing associations and other cognitive factors like tendency to worry/ruminate.

Publication types

  • Review

MeSH terms

  • Arousal / physiology*
  • Electroencephalography
  • Evoked Potentials, Auditory / physiology
  • Galvanic Skin Response
  • Humans
  • Risk Factors
  • Sleep Initiation and Maintenance Disorders / diagnosis*
  • Sleep Initiation and Maintenance Disorders / physiopathology*