The essence of psychophysiological insomnia is the focused attention on inability to sleep. Psychophysiological insomnia usually begins as a somaticized response to a stressful event and then, depending on genetic and other environmental variables, becomes a more chronic condition because of negative conditioning. This form of insomnia occurs in 1% to 2% of the general population and 12% to 15% of patients presenting to a sleep disorders center.
Three types of factors play a role in the development of psychophysiological insomnia: (1) predisposing or constitutional factors, eg, the tendency to worry excessively and the tendency to be hyperaroused; (2) precipitating factors, eg, a transient stressor; and (3) perpetuating factors, eg, the individual’s expectation of a poor night’s sleep that becomes a self-fulfilling prophecy.
In this article, Dr. Deirdre Conroy of the University of Michigan discusses diagnosis, complications, and treatment of psychophysiological insomnia. Updates include new information regarding the pathophysiology and unique electroencephalogram characteristic of psychophysiological insomnia. Dr. Conroy also discusses additional data to support cognitive behavioral therapy for insomnia as first-line treatment for psychophysiological insomnia.
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