Some of the first neurological-related discoveries about insomnia were made by placing healthy sleepers or patients with insomnia inside brain scanners, and measuring changes in the activity in different parts of the brain as they tried to fall asleep. In the good sleepers, three main regions of the brain started to shut down at sleep: 1) emotion-related regions, 2) basic alertness-generating regions, and 3) the sensory awareness gate of the brain.

There were also changes in the functional connectivity of large-scale networks in the brain. In patients with insomnia, the functional connectivity between these networks changes differently. Specifically, two large-scale networks show abnormalities in patients with insomnia: the default mode network, associated with ruminating and thinking about the past and future; and the salience network, associated with detecting threats and instigating changes in mood and emotional reactivity. These two areas become overly communicative and too tightly bound up together in their ongoing chatter of connectivity in patients with insomnia. Once again, this can lead to excessive worry, rumination, and emotion and a feeling of being under threat.

Matt has previously mentioned how patients with insomnia can have an excessive release of stress-related chemicals. Those chemicals can also flood the brain, causing excessive activation in all the stress-related regions described above. Critically, though, it’s a reciprocal relationship—if you have hyperactivation in those parts of the brain, you can also trigger the body to release those stress-related chemicals. This becomes a self-fulfilling, negative-spiral prophecy where, as each response increases, further stress-related brain and body activation occurs.

These measurable changes in the brain and body teach us that insomnia is associated with a specific, and quite complex, set of changes within the brain and the body. No wonder the blunt instruments of old-school sleeping pills are yet to be the ideal way to treat insomnia.

Please note that Matt is not a medical doctor, and none of the content in this podcast should be considered medical advice in any way, shape, or form, nor prescriptive in any way.

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# 30: Insomnia - Part 5

The Matt Walker Podcast