Conceptual Framework for Insomnia: A Cognitive Model in Practice

Zahra Vaziri; Mohammad Nami; João Pereira Leite; Alexandre Cláudio Botazzo Delbem; Miguel Angelo Hyppolito; Iman Ghodratitoostani

doi:10.3389/fnins.2021.628836

Conceptual Framework for Insomnia: A Cognitive Model in Practice

Front Neurosci. 2021 Jul 22:15:628836. doi: 10.3389/fnins.2021.628836. eCollection 2021.

Authors

Zahra Vaziri^{1

2}, Mohammad Nami^{3

4

5

6

7}, João Pereira Leite², Alexandre Cláudio Botazzo Delbem^{1

8}, Miguel Angelo Hyppolito⁹, Iman Ghodratitoostani^{1

8}

Affiliations

¹ Neurocognitive Engineering Laboratory (NEL), Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil.
² Department of Neuroscience and Behavioural Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
³ Neuroscience Center, Instituto de Investigaciones Científicas Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama.
⁴ Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Dana Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran.
⁶ Academy of Health, Senses Cultural Foundation, Sacramento, CA, United States.
⁷ Department of Cognitive Neuroscience, Institute for Cognitive Science Studies (ICSS), Pardis, Iran.
⁸ Reconfigurable Computing Laboratory, Institute of Mathematics and Computer Science, University of São Paulo, São Carlos, Brazil.
⁹ Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Abstract

Insomnia is a widespread neuropsychological sleep-related disorder known to result in various predicaments including cognitive impairments, emotional distress, negative thoughts, and perceived sleep insufficiency besides affecting the incidence and aggravation of other medical disorders. Despite the available insomnia-related theoretical cognitive models, clinical studies, and related guidelines, an evidence-based conceptual framework for a personalized approach to insomnia seems to be lacking. This study proposes a conceptual cognitive framework (CCF) providing insight into cognitive mechanisms involved in the predisposition, precipitation, and perpetuation of insomnia and consequent cognitive deficits. The current CCF for insomnia relies on evaluative conditional learning and appraisal which generates negative valence (emotional value) and arousal (cognitive value). Even with the limitations of this study, the suggested methodology is well-defined, reproducible, and accessible can help foster future high-quality clinical databases. During clinical insomnia but not the neutral one, negative mood (trait-anxiety) causes cognitive impairments only if mediating with a distorted perception of insomnia ( Ind-1 = 0.161, 95% CI 0.040-0.311). Further real-life testing of the CCF is intended to formulate a meticulous, decision-supporting platform for clinical interventions. Furthermore, the suggested methodology is expected to offer a reliable platform for CCF-development in other cognitive impairments and support the causal clinical data models. It may also improve our knowledge of psychological disturbances and complex comorbidities to help design rehabilitation interventions and comprehensive frameworks in line with the "preventive medicine" policies.

Keywords: appraisal; cognitive model; conceptual cognitive framework; distorted perception; evaluative conditional learning; insomnia; mediator model; valence.