Don’t Play the Insomnia Blame Game by Dr. Eric Zhou
Almost half of us report that we have at least one sleep-related problem (e.g., problem falling asleep, staying asleep, daytime fatigue as a result of poor sleep etc.), and many will meet criteria for a clinical diagnosis of insomnia. According to the National Sleep Foundation, the percentage of Americans who regularly do not get sufficient sleep has increased over the past decade. Not surprisingly, the United States Food and Drug Administration reports that caffeine intake has also increased!
Despite insomnia being an ongoing issue for many of us, there are many myths about the development and persistence of insomnia that can get in the way of proper treatment. Many insomniacs play the blame game, and fault themselves, or their bed partners for their poor sleep, instead of actively seeking professional treatment that can efficiently, and effectively resolve their sleep issues!
To start with the process of helping you think about your sleep, we should consider 2 questions frequently asked by those suffering from insomnia:
1) “Where did my sleeping problems come from?”
2) “Why won’t my sleeping problems go away?”
To answer these questions, we can refer to Spielman’s 3 Ps for insomnia. When thinking about our insomnia, we must look at the 1) Predisposing, 2) Precipitating, and 3) Perpetuating factors for our sleep issues! Let’s explore what these 3 Ps mean.
Predisposing factors: Before any of us develop insomnia, there are certain risk factors that make it more likely that we will develop a sleep problem. Risk factors include:
- Being a female.
- Being over 60 years of age.
- Shift work (particularly working the overnight shift), or frequent travel across time zones.
Precipitating factors: These are the acute issues that cause us to sleep poorly to begin with! Some common stressors that may initially trigger insomnia include:
- Health-related problems (e.g., pain, medical illness, menopause etc.).
- Important life events, both positive (e.g., having a child) and negative (e.g., loss of a job, divorce).
- Mental health issues, including substance use.
Perpetuating factors: These factors reinforce the dysfunctional internal clock (our circadian rhythm) that sets our sleep/wake schedule, and are the psycho-physiological issues that keep our sleep problems from magically disappearing by themselves. It is important to remember that perpetuating factors maintain the insomnia, even when the acute problems that initially caused the insomnia have been resolved. Frequent perpetuating factors include:
- Inconsistent sleep/wake times.
- Spending excessive time in bed.
- Daytime naps.
- Being conditioned to not sleeping in bed.
Treatment: As mentioned earlier, chronic insomnia (at least 1 month of insomnia symptoms, 3 nights/week or more) differs from acute insomnia in that the original stressors that may have caused the insomnia to start are often no longer a concern. Rather, the insomnia has taken on a life of its own! The perpetuating factors that were triggered by your behaviors when you were trying to fight through the initial insomnia (often months, or even years ago!) remain to make your sleep miserable. The take home point here is simple: even if you resolved the original problems that caused your insomnia, your sleep may still be disrupted because of problematic cognitions and behaviors that you developed afterwards.
Chronic insomnia is a medical issue that can, and should, be addressed by a qualified sleep expert. There are, unfortunately, no magic potions that can resolve your insomnia overnight. So if you come across a website, or an infomercial promising a quick fix for your sleeping issues, be very wary! But there are treatment options that research has demonstrated to be very effective in helping your insomnia symptoms! Interested insomniacs can check out the National Sleep Foundation’s website (http://www.sleepfoundation.org) to start learning more about insomnia (and other sleep disorders), and to access a directory of sleep professionals in their local area.
Eric Zhou, PhD
PhD in Clinical Psychology (Health) from the University of Miami
Internship in Behavioral Medicine at Brown University Alpert Medical School
Post-doctoral fellow in Cancer Survivorship at the Dana-Farber Cancer Institute/Harvard Medical School