The 3 P’s of Chronic Insomnia
How chronic insomnia develops:
Predisposing factors
Precipitating factors
Perpetuating factors
Before we talk about chronic insomnia, let’s review how sleep happens.
Sleep happens when your homeostatic system says that you have accumulated enough sleep drive (need to sleep), your circadian system says it is the right time to sleep, and your arousal system allows it because there is no need to stay awake (e.g. no activity or threat in the vicinity). This complicated three-partner dance is orchestrated by the interaction of different parts of your brain through neurotransmitters such as GABA, Acetylcholine, Adenosine, Serotonin, Hypocretin …. (oh, oh, getting too geeky here!). Anyway, this beautifully elegant system allows your brain the “down” time that we call sleep, a time of restoration. Sleep proceeds in stages until it is time to wake up again… or the alarm sounds.
Chronic Insomnia is difficulty initiating or maintaining sleep, even in the best of conditions. This problem has lasted for at least 3 months, happens at least 3 days a week, and leaves you feeling extremely distressed or impaired.
Does this sound like you? Many people with insomnia say that they feel “tired but wired.”
So, why are you having trouble with sleep? A way to think about it is the 3 P’s of chronic insomnia: predisposing, precipitating, and perpetuating factors (Spielman model).
Predisposing: Your risk of ever developing chronic insomnia is higher if you are by nature a “poor sleeper” or someone that has occasional difficulties, you have a personal history of mental health disorder such as anxiety or depression, or you have a family member who had chronic insomnia.
Precipitating: This is what triggers the initial insomnia. This is a stressor or a major life event such as changing jobs, divorce, or birth of a child.
Perpetuating: This is what maintains the insomnia, even after the initial stressor resolved. These are behaviors and thought processes used to cope with initial insomnia. They may make sense in the short term (sleep is “recovered”) but they dysregulate the systems that help us sleep. For example: attempting to gain more sleep by going to bed early, napping, or staying in bed after waking up, using alcohol to fall asleep, sleeping in late on the weekends, non-sleep activities in the bedroom, and extreme worry about insomnia throughout the day.
HOW DO I FIX THIS? Cognitive Behavioral Therapy for Insomnia offers a structured way to improve sleep quality and reduce sleep interfering thoughts and behaviors. Treatment is tailored to each individual after a comprehensive evaluation. In average treatment takes 6 to 8 sessions.
If this sounds intriguing and you want to know more:
Check my services page
https://www.toolboxpsychological.com/insomnia-treatment
From the Sleep Foundation
https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
From Verywell Health
https://www.verywellhealth.com/what-is-cognitive-behavioral-therapy-for-insomnia-cbti-3015310
your advocate,
