Psychophysiological Insomnia

What is Insomnia and how it affects you?

Insomnia is a condition wherein you either find it too difficult to fall asleep; or you wake up too frequently during the night, or you wake up too early. All of these characteristics are the different manifestations of insomnia. Insomnia is more commonly also called sleep disorder. Insomnia can affect you in varying degrees, and it largely depends on some root causes(s), like stress and anxiety etc.

Sleep is the most important requisite for human beings to live. Although, the amount of daily sleep varies from person to person, but 7-8 hours of it is what you should ideally have each night. But having said this, I would also like to inform you that some of you might belong to the other category of the humans who can do well with only 4-5 hours of sleep each night. But again, this is not the norm. It is only an exception which holds true for a very small portion of the population.

Psychophysiological Insomnia

When you are constantly deprived of full sleep, night after night, it severely affects your daytime functioning. Your eyes would be watery during the day; you would experience frequent mood swings during the day, feel irritable most of the time and find it too difficult to perform tasks which call for concentration of your mind and eyes.

A bulk of the adult population experiences insomnia at some point of time in their lives. However, the degree or the extent of the sleeplessness greatly varies from person to person and the related conditions. Insomnia affects all age groups but is more common in the adults and in them itself; it is more common in women.

What is Psychophysiological Insomnia?

Depending on its severity and the duration it affects you, insomnia can be of different types. Broadly insomnia can be categorized into two types: the primary (which can lasts from a couple of nights to a week), and chronic (which can lasts for a couple of weeks to months, and in severe cases, for years too).

Psychophysiological Insomnia is the most common form of primary insomnia affecting up to 10% of the adult population. You will be surprised to know that this type of insomnia is in fact associated with excessive worrying about sleep itself! The essence of psychophysiological insomnia is your focused attention on your inability to sleep, which is perceived to be the only source of distress.

What happens here is that when your sleep is disturbed (and this could be due to any reason) for a couple of nights, then after a few days of sleeping poorly, you would become concerned about your inability to sleep. You would also try harder and harder to get to sleep. Your thoughts would specifically be focused on “I won’t be able to sleep when I get into bed.

This insomnia may begin suddenly following an event. It may also develop slowly over many years. This disorder makes you obsessed over whether or not you will sleep?

Factors responsible for Psychophysiological Insomnia

The following three factors play the most important role in the development of psychophysiological insomnia:

Predisposing or constitutional factor – It is the tendency to worry excessively and the tendency to be hyper aroused. Many studies have reported hyper arousal in cognitive, somatic, autonomic, and hormonal and EEG domains in patients with primary insomnia. Hyper arousal and its concomitants may be a link to the association of primary insomnia to such complications as hypertension, diabetes and increased mortality.

Precipitating factor – This could be a transient stressor affecting your sleep.

Perpetuating factor – This could be your expectation of a poor night’s sleep that becomes a self-fulfilling prophecy.

Psychophysiological Insomnia FactorsLet me explain these factors to you. Suppose you experience some anxiety over any issue and you have difficulty in falling asleep. Next night you again go to bed and try to sleep. Then, since you had difficulty in falling asleep the last night, you become so tense in trying to sleep, that you have difficulty in sleeping that night also, and all of this continues every night. It sets up a cycle for your ongoing insomnia. Because you are not able to sleep properly during the night, you also start worrying too much about being tired the next day.

As a result, you unknowingly learn to become tense and anxious every evening as your bedtime approaches. Eventually, you will start associating your bedtime, the bedroom and the related activities with tension.

If you were to sleep in the sleep laboratory, on the sofa in the living room or in a motel, then you would have no problem in falling and remaining asleep. Your main anxiety would arise only when you would have to sleep in your own bed.

If you suffer from psychophysiological insomnia, you would also experience anxiety about going to sleep at night; remain tired during the day because of this, and would often nap during the day. You would also always suffer with fatigue, mood swings, and cognitive impairment. All of this would also severely affect the quality of your life.

Symptoms of psychophysiological insomnia:

You could experience the following common symptoms if you suffer from psychophysiological insomnia:

  • You would have a daily focused and excessive worrying about sleep and the negative effects of not being able to achieve full sleep.
  • You would have a great difficulty falling asleep every night.
  • You would find your agitation and tension increasing whenever bedtime approaches.
  • There would be no other apparent cause for your insomnia except for your excessive worrying about your sleep.
  • You would not be able to identify any medical, psychological or neurological problem that would explain your insomnia.
  • You would also find it too hard to make out certain behaviors, medications or substances that would relate to and explain your insomnia.
  • Since you would start thinking too much about your sleep, hence you may even engage in bad behaviors to try to fall asleep. This could include taking sleeping pills or drinking alcohol.
  • You might start spending too much time in bed hoping to get more sleep.

However, in order to ascertain your sleep disorder as psychophysiological insomnia, the following criteria must be satisfied:

  • You should have a complaint of insomnia, as well as a complaint of decreased functioning during wakefulness.
  • You should show indications of learned, sleep preventing associations, such as trying too hard to sleep or showing conditioned arousal to the bedroom.
  • You should have evidence regarding increasing somatized tension, such as agitation, high muscle tension as manifest in tension headaches, or increased sympathetic tone during daytime.

If you undergo a polysomnogram (a test to measure your brain activity and sleep), it should show disturbed sleep.

You suffer from no other medical or psychiatric disorder that can account for the severity of your sleep disturbance. However, most patients with psychophysiological insomnia are somewhat anxious and dysphoric (a state of feeling unwell or being unhappy; a feeling of emotional and mental discomfort as a symptom of discontentment, restlessness, dissatisfaction, malaise, depression, anxiety or indifference).

Some other sleep disorders may also coexist with your insomnia, for example, poor sleep hygiene, and even obstructive sleep apnea.

Who are at risk to suffer with psychophysiological insomnia?

Psychophysiological Insomnia RiskVarious researches and studies have been conducted in this field, and they all have established that psychophysiological insomnia is more common in women than men. Teens and adults of all ages may have it. However, it is uncommon in children.

It has also been found that there is no genetic factor behind psychophysiological insomnia. This condition does seem to run in families, but this link may not be related to genetics. Worrying too much about sleep may simply be transferred/learned from others in the home, and this could be one of the major reasons for psychophysiological insomnia to seem to run in families.

How can the Sleep Specialist Help?

Psychophysiological insomnia can be ongoing and can grow in its intensity. It may cause you to engage in bad behaviors, including excessive medication or alcohol use. Ongoing insomnia also increases your risk for depression. Due to these reasons, you should discuss you sleep problems with your family doctor. Discuss your problem with your doctor that how you worry too much about sleep.

You should also tell the doctor that due to repeated sleep deprivation you get so tired that you are unable to function well during the day. In this case, your doctor may refer you to sleep specialist. Your doctor will likely ask you many sleep related and medical questions. The doctor may suggest you to change any of your behaviors that make your insomnia worse.

You may sleep better by simply following the practices of good sleep hygiene.

What all to tell your Doctor?

Your doctor would want to know:

  • Whether or not you snore.?
  • He or she will like to know about your bedtime, number or awakenings, naps.
  • Whether you have any problems functioning normally during the day?
  • If you are having any psychological or medical problem?
  • About your medication which you are using for any other condition.
  • Your family history, as it may also provide important details.

Your doctor will give you a sleep diary to fill to monitor your progress before and after treatment. Your doctor will ask you to perform some routine blood tests or thyroid test. If you are suspected of having another sleep disorder than your doctor may ask you to do an overnight sleep study which is called polysomnography. It records the brain waves, heart beat, breathing, movement of your arms and legs. The video sleep study will also show if you get out of the bed and do anything unusual during the night.

You should be very frank with your doctor and you should not hesitate in telling even the minutest of details or your feelings about your sleep. This would help your doctor to provide the best solution to cure your problem and provide your sleep back to you.

Treatment

Psychophysiological insomnia is a vicious cycle of first worrying about insomnia, and then not sleeping because of it. This condition will pursue your life until you change your perception of sleep and your sleep habits.

Psychophysiological insomnia Treatment

The administration of sedative-hypnotic drugs and cognitive behavioral therapy are 2 effective tools for the management of psychophysiological insomnia.

There are many ways to treat insomnia that are common and effective. You should talk to your primary care doctor to discuss these options. You may also want to visit a sleep center to get more expert advice. You should see a sleep specialist if your insomnia causes you to nod off during the day.

The treatment for psychophysiological insomnia is similar to that of the other forms of insomnia. Your doctor would treat your insomnia in either or all of the following ways:

Sleep hygiene – Sleep hygiene consists of good thing that you can do to improve sleep. For example you should get up at the same time every day. You should also avoid drinks with caffeine just before going to bed. Caffeine plays the notorious role in disturbing your sleep.

Cognitive behavioral therapy – This involves relaxation exercises and other methods that help improve your sleep. You could listen to relaxing music, or can learn breathing exercises from a psychologist. Some other methods teach you to do things such as limiting the time you spend in bed etc.

Sleeping pills and sleeping aids – Doctors sometimes prescribe sleeping pills to treat insomnia. These are called hypnotics. At times your insomnia is related to depression and some anxiety. In such cases, medications may be prescribed by your doctor to help and cure your insomnia.

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