Being told that you have psychophysiological insomnia can seem intimidating. After all, the word “psychophysiological” alone is daunting! Regardless of the type of insomnia you have been diagnosed with, your treatment options do not have to be complicated. Exercise and behavioral therapy can help improve just about any form of insomnia.
Despite its lengthy name, psychophysiological insomnia is one of the most common primary insomnia disorder. It occurs when your fears of being unable to sleep prevent you from getting the rest you need. Psychophysiological insomnia treatment options involve teaching your mind not to get worked up over sleep. Here is all you need to know about psychophysiological insomnia.
What is Psychophysiological Insomnia?
Psychophysiological insomnia is defined as the heightened arousal and learned behaviors associated with sleep prevention that results in insomnia and a decreased ability to function properly during wakeful periods (1). In simpler terms, it is a learned sleep disorder where a person experiences anxiety about falling asleep, which makes them unable to do so.
You must meet the following qualifications to be diagnosed with psychophysiological insomnia (1):
- Difficulty initiating or maintaining sleep
- Waking up earlier than you’d like, which results in poor overall sleep quality
- Problems with sleep despite spending enough time in bed or having adequate circumstances for sleep
- Sleep problems for at least one month
- Evidence of learned sleep problems or heightened arousal in bed due to focusing on one’s inability to fall asleep and maintain sleep
- A perceived failure to relax before sleep
- The ability to fall asleep better away from home than at home
- Participating in mental activity that keeps you awake at night, such as racing thoughts
- Experiencing sleep disturbances that are not explained by another sleep disorder, neurological disorder, medication use, a mental disorder or substance abuse disorder
The term “psychophysiological” became popular in the 1960s and 1970s. It represents the idea that cognitive influences, such as intrusive thoughts, stress, and worry, have an impact on physiological behavior, including one’s sleep patterns. The result is a tendency to lay in bed awake due to an increased neurohormonal activation. This means that a person with psychophysiological insomnia experiences anxious thoughts that increase stress hormones that keep them awake (1). The continuous cycle of anxiety and insomnia makes it impossible to fall asleep. It’s a classic case of how your mind influences your body.
Approximately 30 percent of the population experiences insomnia symptoms, and ten percent have severe or chronic insomnia (1). Insomnia symptoms are more likely to occur in the elderly and women. Research shows that about 50 percent of patients with chronic insomnia go untreated over a period of 20 years. While the data on psychophysiological insomnia is unclear, it is estimated that it affects about 12 to 15 percent of people who have been clinically diagnosed with primary insomnia (1). These numbers don’t take into account the thousands of people who likely have insomnia and are yet to be diagnosed.
How is Psychophysiological Insomnia Different From Other Forms Of Insomnia?
There are about 11 types of insomnia. The main categories are primary and secondary. Psychophysiological insomnia is a form of primary insomnia. It occurs as a stand-alone condition and is not related to any other medical conditions. Secondary insomnia is often due to another disorder, such as chronic pain, anxiety or depression, and even other sleeping disorders.
Most insomnia patients have secondary insomnia. Their treatment options focus on addressing the underlying medical condition that is causing their insomnia. People with psychophysiological insomnia may experience other symptoms as a side effect of their condition, but an underlying disorder does not cause them.
Causes and Symptoms of Psychophysiological Insomnia
Sleep deprivation is a state of health that deserves your attention, but people with psychophysiological insomnia tend to obsess over it. Psychophysiological insomnia occurs when your concerns over your insomnia sabotage your sleep. Unlike many other types of insomnia, psychophysiological insomnia is a learned behavior.
For example, if you experience several nights of sleep loss, this may cause you to feel anxious. You become stressed over the fact that you haven’t slept for a few nights, and you carry this stress with you when you prepare for bed. Your body tenses and your mind races with anxious thoughts. You may feel the effects of sleep loss the next day while you’re at work, and this makes you feel even more stressed. Eventually, stress and anxiety become a part of your new bedtime routine. You begin to relate sleep to stress and anxiety. These thoughts become obsessive and overwhelming. Before you know it, you’re trapped in a vicious circle of stress and sleep. What started out as a few nights of sleep loss may have turned into a whirlwind of insomnia that you can no longer control.
Not surprisingly, people with psychophysiological insomnia may have higher levels of anxiety than most. According to a 2008 study, people with psychophysiological insomnia showed more signs of anxiety and depression than good sleepers (3). The study indicated that there were increased signs of cortical arousal in people with psychophysiological insomnia, especially when waking first thing in the morning. During sleep onset, they may have problems disengaging themselves from wakeful processes. They also experience a reduced ability to initiate regular sleep when compared to people without sleep problems.
It can be hard to differentiate between psychophysiological insomnia and other types of insomnia, but a sleep specialist should be able to help you with that. The main characteristic of psychophysiological insomniacs is that they show signs of hyperarousal during the onset of sleep. Some people even start to worry about sleep well before they climb into bed. Individuals who are known to be worriers or overthinkers may be at an increased risk. Here are some common symptoms and characteristics of a person with psychophysiological insomnia:
- There is substantial difficulty falling asleep at night accompanied by anxiety symptoms.
- You focus on the adverse effects of not being able to sleep, such as impaired concentration and memory during the day.
- You become agitated or moody when bedtime is nearing.
- You experience obsessive compulsive thoughts and tendencies about sleep or your lack of sleep.
- There is no other cause for your sleep loss, such as medication, an underlying medical condition, or a snoring partner.
- You experience anxiety and depression.
- You engage in unhealthy habits to help you fall asleep, such as drinking alcohol or taking over-the-counter sleep aids.
- You spend more time than you should in bed with hopes of getting sleep.
Psychophysiological Insomnia Cure
People with psychophysiological insomnia have taught themselves how to prevent sleep by worrying about it to the extent that they become physically unable to achieve it. It’s easy to tell a person with this condition to relax, but the answer is not that simple. Because psychophysiological insomnia is a learned disorder, you’ll need to unlearn the behavior that created it in the first place.
Cognitive behavior therapy is one of the most popular treatment options for insomniacs. It involves working through stressful situations or behaviors by redirecting negative thoughts to positive ones. Most cognitive behavioral therapy can be conducted in a mental health professionals office where you will learn how to deal with the anxious thoughts that prevent you from falling asleep at night. Then, you can apply these principles to your nighttime routine when you feel stressed about sleep.
According to a 2015 study, cognitive behavioral therapy significantly benefited patients with psychophysiological insomnia. The study found that after four weeks, patients reduced the time it took them to fall asleep by 32 percent. Their overall sleep efficiency increased to 90 percent. Patients decreased their symptoms of insomnia and some of the prescription sleep aids they required to sleep (2).
The three most common types of cognitive behavioral therapy include (1):
- Stimulus control therapy: instructions include restricting your bed to sleep and sex; limiting the amount of time you spend awake in bed; and making sure your bedroom environment is sleep-friendly. Stimulus control therapy asks you to get out of bed if you haven’t fallen asleep within 30 minutes and perform a relaxing activity before trying again. It also suggests that you make your sleep environment comfortable by removing all electronics and limiting light. Finally, don’t watch TV or use electronics in bed so that you associate it with sleep.
- Sleep restriction therapy: this type of treatment includes limiting your time in bed to reduce your overall sleep time. The idea behind sleep restriction therapy is that you will fall asleep quicker and have less worrisome thoughts when you’re slightly sleep deprived.
- Sleep hygiene therapy: a type of sleep intervention that includes improving the patient’s sleep patterns or habits. For example, a patient should pay attention to their caffeine and alcohol intake throughout the day. Establishing a bedtime routine is also helpful. Many people with insomnia find that it helps to go to bed and wake up at the same time each day. Exercising or finding a healthy outlet for stress is of particular importance for people with psychophysiological insomnia.
Tips For Treating Psychophysiological Insomnia
Because psychophysiological insomnia is linked to stress and anxiety, it may help to reduce stress levels through a healthy outlet. Avoid developing a coping mechanism to help you get to sleep, such as drinking or taking prescription sleeping pills. Exercise is one of the best stress reducers available. It has been shown to improve sleep quality in people with insomnia.
According to the American Psychological Association, exercise alleviates long-term depression and anxiety. It also improves your mood. Researchers found that when you’re threatened or anxious, it sends your nervous system into action, which causes you to sweat, become dizzy, and have a racing heartbeat. People who are anxious are more likely to experience fear. Psychophysiological insomnia involves the fear of being unable to sleep. This causes you to become panicked at the thought of sleep loss. But regular exercises soothes your response to anxiety and stress, making your nervous system less likely to jump into action so that you can rest (4).
Studies show that exercise has a calming effect on the brain and the body. It also teaches you how to control your body and thoughts. According to a 2013 study, exercise gives you self-efficacy by trusting your ability to manage possible threats (5), such as the fear of not being able to sleep. The study suggests that as your fitness levels improve, you receive greater feedback of endurance, duration abilities, and less pain. All of these factors can be used to help you manage and control the way your body and mind respond to stress.
Mental health exercises, such as meditation and quiet rest, were effective at reducing anxiety by distracting you from stressors. One study found that taking a “time-out” from your daily activities decreased anxiety (5). Using mindful practices in addition to exercise appears to be an effective treatment for most types of insomnia. Follow these tips to reduce stress and ease the tension associated with going to bed:
- Kill your stressors early in the day. Even if your insomnia is caused by your fear of falling asleep at night, you can start treating your condition earlier in the day. Exercise first thing in the morning to reduce anxiety and energize your day. Exercise should also help make you tired so that when you go to bed, it will be easier to sleep. The idea is to overpower your anxious thoughts by sweating them out through physical exercise.
- Calm yourself down before bed by doing something that relaxes you. Some people meditate while others take a warm bath. Avoid using alcohol to fall asleep as this may have the opposite effect. Lavender essential oil has been shown to reduce anxiety. Diffuse some into your room or add a few drops into a hot bath.
- Visualize something pleasant. One of the main reasons why people with psychophysiological insomnia cannot sleep is because they are too focused on anxious thoughts. Visualization therapy asks you to picture a relaxing or calming scenario instead of worrying. Try laying in bed, closing your eyes, and remembering your favorite vacation or scene from a book. When your thoughts start to race again, return them to your pleasant visualization.