Psychophysiological insomnia: How worrying becomes a cycle

Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD
Jun 5, 20215 min read
A woman awake in bed

What is Psychophysiological Insomnia?

Psychophysiological insomnia is a type of chronic insomnia characterized by difficulty falling asleep, or staying asleep due to heightened bodily and cognitive arousal.

A person that struggles with psychophysiological insomnia will have a tendency to worry about their sleep and how a lack of sleep will affect their day. Over time this becomes a vicious cycle, causing a heightened state of arousal which continues to cause difficulty initiating and maintaining sleep. In other words, worrying about sleep interferes with their sleep. Each sleepless night only makes the situation worse.

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The Two Types of Insomnia

Broadly, insomnia is classified into two types — primary and secondary. Primary insomnia refers to insomnia that is not attributed to a physical or mental health disorder. In contrast, secondary insomnia is caused by tangible, identifiable conditions such as depression, sleep apnea, or chronic pain, which keep people awake at night.

Psychophysiological insomnia is a form of primary insomnia where negative emotions and unhelpful coping strategies drive the insomnia.

Primary insomnia might not be linked to physical disease or medication, but various factors still influence the onset. 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 perpetuates 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 doze 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.

How do I overcome psychophysiological insomnia?

The first step to overcoming 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. Okay, maybe not that bad, but close.

Because primary insomniacs often spend a great deal of the day worrying about the consequences of not getting sleep, they get stage fright when the time comes. 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.

Turn off the "stage lights," and all this goes away. This is why primary insomniacs have little to no trouble sleeping away from their bed.

Psychophysiological insomnia treatment

Fortunately, psychophysiological insomnia is curable. Cognitive-behavioral therapy (CBT) is an effective treatment for psychophysiological insomnia. Initially developed to treat depression, CBT has been adapted to help people change habits and thinking patterns related to sleep, which 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.

Cure Your Psychophysiological Insomnia Today!

To learn more and use Dawn’s proven CBT-I to cure your psychophysiological insomnia, reach out to us today!

Frequently Asked Questions (FAQs)

1. What is the definition of psychophysiological insomnia?

Psychophysiological insomnia is a form of primary insomnia resulting from disruptive worrying about sleep. In other words, the dysfunctional thinking pattern leads to the insomnia.

2. Can you cure psychophysiological insomnia?

Yes. Since psychophysiological insomnia results from bodily arousal caused by unhelpful habits and thinking patterns, it can be cured. In fact, CBT for insomnia (CBT-I) has time and again helped patients cure psychophysiological insomnia once and for all. Just remember that a cure reflects a return to your own healthy sleep patterns and not a “perfect ideal of sleep”.

3. Can insomnia be psychological?

Yes. Insomnia can be due to any factor, psychological or physical, that prevents you from sleeping. Anxiety and worry can prevent you from sleeping just as much as loud music or bright lights.

4. What are the major physiological causes of insomnia?

There are many physiological causes of insomnia. The major ones include:

  • Stress
  • Anxiety and worry
  • Grief and depression
  • Recent physical or mental trauma
  • Irregular bedtime schedule
  • Poor sleeping habits (such as taking caffeine before bed, using screens in bed, etc.)
  • Traveling between time zones

Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD

Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.

Dr. Ehrnstrom is not a medical provider and is not providing any recommendations regarding medications. Rather, she is sharing and reviewing the research as it relates to education when learning how best to treat insomnia.

It’s time to stop blaming the night monsters.

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