A lot of folks have asked me to post on insomnia and it’s difficult because there are no quick tricks or tips to curing insomnia. It’s simply too complicated for one post.
To address this need I’ll offer a series of posts on chronic insomnia.
A lot of times when a person comes to see me for insomnia they are looking for a quick fix or a medication to “knock me out.”
In most cases, there are no quick fixes that will be effective and lasting. Medications may be partially effective for a short period of time. It’s also important to note that insomnia can arise for different reasons and that is the most important reason to see a board-certified sleep doctor, to ensure the correct cause of the insomnia is identified. Saying I have insomnia doesn’t identify the root cause.
One common cause of chronic insomnia we sleep doctors call psychophysiological insomnia is viewed as a behavioral disorder. It is conceptualized by the Spielman 3 P model of insomnia. What is the 3 P model of insomnia?
1️⃣ Predisposing factor: genetics, hyper-arousable nervous system
2️⃣ Precipitating factors: A stressful life event such as an illness, loss of a job, a divorce or a combination of stressors.
3️⃣ Perpetuating factors: Casting a wide net, conditioned arousal, napping, poor sleep hygiene, cognitive distortions, etc.
In the 3P model, insomnia persists because of the perpetuating factors, which are to say the coping mechanisms the person developed in the acute phase of insomnia (precipitating phase). Swipe to see a visual representation of the 3 P model. The most important thing to notice is that what causes the insomnia is not what drives it to continue. That’s very important to understand as a clinician and a patient. It isn’t intuitive.
The current state of the art treatment for chronic insomnia is a skills-based modality of treatment called cognitive behavioral therapy for insomnia (CBT-I). CBT-I is aimed at addressing the perpetuating factors and by doing so the patient unlearns maladaptive coping behaviors and learns new and productive strategies to manage insomnia.