Psychophysiological Insomnia

Abstract

Of all the forms of chronic insomnia, perhaps the most insidious is Psychophysiologic insomnia, also called Primary Insomnia in the DSM-IV. This sleep disorder is a final common pathway for many people who initially develop sleeplessness in the context of acute stressors (e.g., pain, job loss), but then acquire a form of “learned” sleeplessness as they become increasingly overconcerned about their unsatisfying sleep patterns. Patients report reduced total sleep time, with increased sleep latency (greater than 30 min), or increased wakeafter sleep onset time, though these findings are not always corroborated on PSG studies. Patients with this form of chronic insomnia are often vexed by its seemingly unpredictable nature from night to night, but to be diagnosed symptoms must be present on three or more nights per week, for more than 1 month (DSM-IV) or 6 months (ICSD-2). The essential feature of this form of insomnia is a pattern of sleep disturbance that evolves over time as a result of psychological distress that triggers unhelpful behaviors and physiological arousal. This chapter will summarize the current understanding of the development of this disorder, and the clinical approaches that may be useful to resolve it.