Insomnia Disorder

Insomnia disorder is a sleep disorder characterized by persistent difficulty with sleep initiation, maintenance, or quality, despite adequate opportunity and circumstances for sleep, resulting in daytime impairment. **Types of insomnia:** - **Sleep onset insomnia**: Difficulty falling asleep (lying awake 30+ minutes) - **Sleep maintenance insomnia**: Waking during the night and difficulty returning to sleep - **Early morning awakening**: Waking too early and unable to fall back asleep **Acute vs. Chronic:** - **Acute insomnia**: Short-term, often triggered by stress, lasts days to weeks - **Chronic insomnia**: Occurs at least 3 nights per week for 3+ months **The 3P Model of Insomnia:** 1. **Predisposing factors**: Natural tendency toward light sleep, anxiety proneness 2. **Precipitating factors**: Stressors that trigger insomnia (job loss, illness, etc.) 3. **Perpetuating factors**: Behaviors that maintain insomnia (staying in bed too long, napping, worrying about sleep) **The Insomnia Paradox:** Trying harder to sleep often makes insomnia worse. Sleep is a natural process that cannot be forced. Performance anxiety about sleep becomes a perpetuating factor.

Insomnia develops from an interaction of vulnerability and maintaining factors: **Hyperarousal:** People with insomnia often have elevated physiological and cognitive arousal—their "alert" systems are overactive, making it hard to transition to sleep. **Conditioned arousal:** The bedroom becomes associated with wakefulness and frustration rather than sleep. This conditioned response can persist long after the original stressor resolves. **Contributing factors:** - Stress and worry - Depression and anxiety - Poor sleep habits - Irregular sleep schedule - Stimulants (caffeine, nicotine) - Alcohol (disrupts sleep quality) - Medical conditions - Medications - Aging (changes in sleep architecture) **Why acute insomnia becomes chronic:** Behaviors people use to cope (sleeping in, napping, drinking alcohol, spending more time in bed) actually perpetuate insomnia. These well-meaning strategies backfire.