Poor sleep plagues many North Americans. Unfortunately, troublesome nights are a chronic condition for a large portion of sleepers. Fifteen percent of poor sleepers have psychophysiological insomnia. According to the International Classification of Sleep Disorders (ICSD) psychophysiological insomnia is a disorder of somatized tension and learned sleep-preventing associations that result in a complaint of insomnia and associated decreased functioning during wakefulness.
In order to be diagnosed with psychophysiological insomnia, a person’s symptoms must match six ICSD diagnostic criteria. First, the person must describe him or herself as suffering from insomnia and as having impaired performance during wakefulness. Secondly, learned sleep-preventing associations must be demonstrated. These associations include trying too hard to sleep and conditioned arousal to the bedroom or sleep-related activities. Evidence for the former association is the inability to fall asleep when desired. Evidence for the latter association can be found in the person’s ability to fall asleep more easily when not at home or when not carrying out normal bedtime rituals.
The remaining four criteria are also found in many people. People often show:
- increased levels of muscle tension,
- agitation, and
- vasoconstriction, all of which are evidence of an increase in somatized tension.
- Finally, the symptoms must not be attributable to any other medical or psychiatric disorder.
Overnight sleep studies for insomniacs usually show increased sleep onset latency ranging from 30 minutes to hours. Increased wakefulness after sleep onset is also very typical. This results in a decreased sleep efficiency. Sleep efficiency is defined as the percentage of time in bed spent asleep. Stage one sleep duration is also significantly increased, resulting in the subjective experience of not sleeping. The increase in stage one sleep is frequently found alongside a decrease in delta sleep resulting in additional complaints of sleeplessness. There may also be increased electromyographic (muscle) activity and increased alpha activity in the electroencephalograph (brainwaves). Finally, psychophysiological insomnia may coexist with other sleep disorders.
Psychophysiological insomnia can be a very distressing disorder. It is considered a chronic condition when its duration is in excess of six months, sub-acute when its duration is more than four weeks and less than six months, and acute when its duration is less than four weeks. The disorder usually begins during a period of acute stress in young adulthood and gradually worsens until the insomniac seeks treatment during middle adulthood.
People suffering from insomnia usually describe themselves as light sleepers. Although a predisposition toward light sleep may have a genetic component, it appears that the over concern with sleep and health behaviours is more strongly influenced by learned behaviours emphasized in some families. Females report more insomnia than males. Insomnia leads to decreased feelings of well-being during the day. Although there is generally no increase in objective sleepiness, insomnia leads to a deterioration of mood and motivation, decreased cognitive abilities of attention, vigilance and concentration. Energy is decreased and fatigue and malaise are increased. Insomnia usually occurs in people who are guarded and sensation avoiders. The use of denial and repression are often the main defences for insomniacs. Stress related psychophysiological problems are also common such as gastric-intestinal problems, tension headaches, and cold hands and feet.