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The authors present a theoretical overview of the hypothalamic-pituitary-adrenal axis and the central monoaminergic systems, focusing on a putative pathophysiological relationship to insomnia complaints. Insomnia is an independent and self-perpetuating disorder that requires diagnostic and therapeutic attention in the presence of concomitant disorders, likely with bidirectional influence. An adequate understanding of such mechanisms can help for a better understanding of the interplay between clinical features, neurotransmitters, and the adrenal hypothalamic-pituitary axis may help clinicians to better manage insomnia patients.

The hypothalamic-pituitary-adrenal axis and the central monoaminergic systems: a pathophysiological link to insomnia with clinical implications