A diagnosis of Insomnia Disorder is utilized when one’s predominant complaint is difficulty initiating and/or maintaining sleep. Studies estimate that approximately 6-10% of adults meet criteria for Primary Insomnia, further characterized by:
While no specific criteria have been established as an adequate number of hours of sleep, Insomnia is a diagnosis based on one’s complaint and impaired daytime functioning. Frequent aspects of daytime impairment include fatigue, irritability, problems with attention/concentration, and distress regarding getting adequate sleep.
Often times, short-term insomnia occurs as a normal and possibly even adaptive response to a significant life stressor. Certain patterns of thought and behavior in reaction to this short-term sleep difficulty can exacerbate the problem, turning the insomnia into a more chronic condition. These reactions include the development of negative and worrisome thoughts about sleep, maladaptive sleep behaviors, compensatory behaviors such as allotting more time for sleep or using alcohol or drugs to induce sleep, as well as overall daily stress.
People with chronic insomnia often experience negative and worrisome thoughts regarding sleep that can have a significant negative impact on sleep. Some examples of negative sleep thoughts include:
“I’m going to toss and turn all night.”
“I must get eight hours of sleep.”
“I’ll never be able to work tomorrow.”
“There’s something wrong with me.”
“I hate bedtime.”
“I didn’t sleep at all last night.”
“I can’t sleep without a sleeping pill.”
Such negative thoughts regarding sleep can increase feelings of anxiety, frustration, and stress. These thoughts are often times automatic, maladaptive, and make it more difficult to fall asleep.
In an attempt to cope with short-term insomnia, people may develop sleep habits that ultimately serve to create chronic insomnia. Such habits include:
Insomnia is maintained by these behavioral habits, as well as certain thoughts and associated physical reactions that are targeted for change in treatment.
Cognitive Behavioral Therapy of Insomnia (CBT-I) is an individualized, structured, and evidence-based form of psychotherapy that targets particular patterns of behavior and thought associated with insomnia. A typical course of treatment begins with the patient recording a sleep diary for one to two weeks. The sleep diary will provide the baseline “data” that will assist in measuring and guiding the treatment, as well as evaluating the treatment progress. The sleep diary will also identify behaviors that maintain the insomnia. The most common cognitive-behavioral interventions for insomnia include:
Research studies have shown that Cognitive-Behavioral Therapy for Insomnia can be a highly effective treatment, with approximately 75% of individuals in treatment significantly improving sleep onset and maintenance compared to those without treatment. Studies have also shown that those who go through treatment consistently experience at least a 50% reduction in symptoms that is maintained or improved at follow up after discontinuing treatment. A full course of treatment in these research studies ranges from 6-12 sessions.
"If you are distressed by anything external, the pain is not due to the thing itself, but to your estimate of it, and this you have the power to revoke at any moment - Marcus Aurelius 121-180 AD"