Before we delve into looking at our sleep diaries we should review a very important concept in treating chronic insomnia.
One of the key features of chronic insomnia is a concept called “conditioned arousal.”
Some clues to conditioned arousal in the history might sound like this:
❗️I’m exhausted but the minute I get in bed I feel wide awake.
❗️I sleep really well on vacation but when I come home my insomnia comes right back.
❗️Just the thought of going to bed makes me feel panicked and anxious.
I like the way my mentor Dr. Rachel Manber, a professor at Stanford explains conditioned arousal. Imagine if you went out to eat at a restaurant and every time you went there you got food poisoning. After awhile just seeing the restaurant would make you feel sick. It’s a learned association. Some of you may remember Pavlov’s dog from your intro to psychology class in college. Same concept – when the dog hears the bell it salivates.
What has happened is the person has unknowingly developed a conditioned response to bedtime and then the chronic insomnia feeds on itself in an involuntary manner.
How do we correct this? We use a component of CBT-I called stimulus control therapy. It’ll probably sound familiar when I discuss it in more detail. I’ve found that explaining the mechanism for why it’s important makes the instructions much easier to implement and execute.
Tomorrow I’ll look at my sleep diary with you and talk about how I use it to evaluate sleep.
What else do you want to know about sleep?
Understanding Insomnia Part 4
