Psychophysiological insomnia explained

Jun 5, 2021
3 min read
Andreas Meistad profile
Andreas Meistad
Cognitive behavioral therapist

Sleep researchers often use two distinct ways of identifying insomnia – primary and secondary. The term "primary insomnia" refers to insomnia that does not relate to a physical or mental health disorder. On the other hand, secondary insomnia is caused by tangible, identifiable conditions such as depression, sleep apnea, or chronic pain, which keep people awake at night.

Primary insomnia might not be linked to physical disease or medication, but it is still brought on by various factors. Many of these factors have a psychophysiological origin and are rooted in anxiety about the consequences of sleeplessness. In other words, fear of not being able to sleep frequently drives primary insomnia.

How do I know if I am suffering from psychophysiological insomnia?

Do you go to bed at night feeling tired and sleepy, only to feel like a deer in the headlights when your head hits the pillow—alert, awake, alarmed? Tend to fall asleep anywhere but in your bed? Or, do you tend to dose off any time but your bedtime? Do your morning conversations revolve around how bad or good your night has been? And is your psychological state mainly determined by how well or poorly you slept? If you recognize yourself in these descriptions, there is a high probability you are experiencing psychophysiological insomnia.

Performance anxiety and sleep

The first step to alleviating psychophysiological insomnia is to understand it. When people with psychophysiological insomnia go to bed and attempt to sleep, they experience something akin to performance anxiety; the same performance anxiety people get when they walk onto a floodlit stage or have their first job interview. Ok, maybe not that bad, but close.

Primary insomniacs often spend a great deal of the day worrying about the consequences of not getting sleep, and when the time comes, they get stage fright. The brain and body assume that bedtime is "showtime," and the pressure to perform activates the arousal system. The brain interprets the bed or bedtime as a threat and puts the body on high alert instead of letting it slip into forgetfulness.

Can my psychophysiological insomnia be treated?

Cognitive-behavioral therapy (CBT) is an effective treatment for psychophysiological insomnia. Initially developed to treat depression, it was eventually adapted to help people change habits and thinking patterns when it comes to sleep. Which essentially is the driving force of psychophysiological insomnia.

For years, CBT for insomnia (CBT-i) has been the gold standard for treating insomnia and has been proven to work in numerous clinical trials. It empowers people to identify and change unhelpful thinking and habits. It reframes their perception of sleep, reduces the time they spend fretting about sleep, interrupts the iterative sleep obsession sequence, and gradually breaks the insomnia cycle.