![]() ![]() In last years, a new class of stress response molecules has attracted attention, namely mitokines, i.e. In turn, excessive activation of the HPA axis induces sleep fragmentation, in a sort of vicious cycle between insomnia and stress. Moreover, evening serum levels of cortisol correlate with the number of the nocturnal awakenings, and at the same time sleep fragmentation increases cortisol levels. In particular, a positive association between high serum cortisol levels and the wake-time after sleep onset was found. Cortisol levels are higher in IN patients with respect to normal sleepers. The onset and perpetuation of IN are considered associated with the activation of the Hypothalamic-pituitary-adrenal (HPA) axis with a consequent release of key molecules, such as cortisol hormone. The prevalence of P-IN varies between 9.2 and 50% among insomnia patients. Patients with P-IN experience the same symptoms/complaints of IN patients, though displaying normal sleep patterns, as evaluated by specific objective tests such as polysomnography. Interestingly, a sub-type of chronic insomnia characterized by misperception in quality and quantity of sleep is termed paradoxical insomnia (P-IN). In particular, the occurrence of symptoms for at least three times a week and persistence longer than three months are considered as chronic insomnia (IN), at variance with the sub-acute insomnia or the transient insomnia, which are considered as less pervasive and self-resolving. The frequency and persistence of symptoms determine the severity of insomnia. Clinical consequences include neurocognitive deficits, fatigue, anxiety and depression. ![]() The effects of insomnia on quality of life, social relationships and professional performances represent a considerable social and economic burden. According to the International Classification of Sleep Disorders, 3rd edition (ICSD-3), insomnia is defined as the subjective perception of difficulty in sleep initiation, duration, consolidation and quality, resulting in a non-restorative sleep. Insomnia has higher prevalence rates in women than in men, and is the most common sleep disorder among the elderly population, with a prevalence of 48%. They can be caused by modifications of the physiological sleep architecture that occur during aging, but also by the concomitant presence of psychological stressful conditions such as loneliness, divorce, death of spouse, unemployment, or severe pathologies and use of multiple medications. Sleep disorders become more prevalent in late adulthood and heavily affect the patients’ quality of life. As far as the level of mitokines, we showed that FGF21 and HN in particular resulted altered (decreased and increased, respectively) with respect to control population, however with no difference between the two groups of patients. Therefore, the consequences of paradoxical insomnia on the expression of these parameters are the same as objective insomnia. Results show that the two groups are different as far as sleep efficiency score, as expected, but not for stress parameters, that in some cases resulted within the normality range, although quite close to the top threshold (such as cortisol) or much higher with respect to normality ranges (such as PSS). We have investigated the level of parameters related to stress in a group of post-menopausal female patients (age range 55-70 years) suffering by either objective or paradoxical insomnia, in particular we have measured 24-hours urinary cortisol, allostatic load index, Perceived Stress Scale (PSS) score, and, for the first time, mitokines (mitochondrial stress response molecules) such as FGF21, GDF15 and Humanin (HN). From 9 to 50% of patients suffer of paradoxical insomnia, with the same symptoms and ailments, though characterized by normal sleep patterns. Chronic insomnia is the most common sleep disorder in the elderly population. ![]()
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