OBJECTIVE: In the absence of clear distinctions in alertness between
patients with primary insomnia and normal subjects, the goal of this study
was to identify psychometric and electrophysiological measures that would
distinguish these two groups. METHOD: The daytime alertness of 20 primary
insomnia patients and 20 normal subjects was investigated through their
scores on a 26-item hyperarousal scale and measurement of auditory evoked
potentials and alpha and nonalpha band EEG activity. Statistical analysis
of the data included correlation of the hyperarousal scores and the
electrophysiological measures. RESULTS: The hyperarousal scores showed
clearly higher daytime alertness in the insomnia patients compared with the
normal subjects. In addition, during wakefulness, the insomnia patients
showed greater amplitudes of P1N1, a durable, intrinsic, late (cortical)
component of the auditory evoked potential, as well as greater EEG activity
across the frequency spectrum. The hyperarousal scores correlated
positively with the amplitude of P1N1 at each of three sound intensities.
CONCLUSIONS: To the authors' knowledge, this is the first study to offer
evidence that patients with primary insomnia have objectively definable
features during wakefulness that clearly distinguish them from normal
subjects. The measurement of hyperarousal might be used to refine
descriptions of insomnia populations in experimental studies.
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