There are many forms of insomnia, and being able to distinguish the different types can be helpful in treatment. Psychophysiological insomnia is one of the most common and difficult types of insomnia to treat.
A patient with psychophysiological insomnia focuses on their sleep, and worries about not getting enough. Their worrying starts when they prepare to go to bed. Patients become anxious that they are not going to get enough sleep. Patients with psychophysiological insomnia fret about how a lack of sleep is going to affect their next day.
This is a learned insomnia. The patient, at some point, experienced insomnia and then became preoccupied with their sleep. They often realize that their worry is keeping them from sleep but can’t seem to stop ruminating about it. The anxiety that they have about their sleep before bed often increases in intensity as they lie in bed awake.
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Patients with suspected psychophysiological insomnia may report that they sleep better away from home. Patients often classify themselves at light sleepers, who hear everything going on around them.
Psychophysiological insomnia affects women more than men and is uncommon in children. It tends to run in families and may be learned from family members.
Longitudinal studies have shown the most effective treatment for psychophysiological insomnia is cognitive behavioral therapy (CBT). This treatment helps patients eliminate the beliefs and misconceptions they have about sleep.
Sometimes, suggesting a patient keep a sleep diary is helpful, as it can help identify nights that are better than others. However in some patients, sleep diaries cause even more hypervigilence about sleep.
If suspected, rule out other sleep disorders. Even though these patients are over focused on their sleep, there may be something else causing their insomnia.
Relaxation exercises before bed can be helpful to calm the anxiety. Biofeedback has also been shown to be very helpful to patients. Sleep hygiene is very important and providing a handout with tips can be helpful to remind the patient about your discussion.
Before prescribing sleep aids, consider all more conservative options first. A sleep aid may need to be prescribed to help them experience a more predictable sleep. Use the lowest dose needed.
Sometimes giving these patients a sleep aid “as a back-up” can be beneficial, because their anxiety can be relieved just knowing that there is something there if they can’t get to sleep on their own.
Sharon M. O’Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
References
Schuman C, Attarian H. (2010) “Psychophysiological Insomnia.” Clinical Handbook of Insomnia. Second ed. Totowa, N. J.: Humana, 2010. 155-65.
