Insomnia

Question 1

3 facets of insomnia from psychological point of view

Answer 1

1. ) Hyperarousal,
2. ) Inadequate coping attempts addressing sleep problems and daytime consequences,
3. ) Worries and anxiety connected to sleep and lack of it

Question 2

Causes of hyperarousal

Answer 2

• Lifestyle effects. Evening fasting, excessive consumption of stimulants (e.g. coffee, cola), physical exercises or any rousing activities (e.g. work, watching exciting movies, computer games) (too close to bedtime, Thoughts independent of sleep but inducing tension (e.g. ruminating on the day’s worries in the evening)
• Concerns and worries associated with sleep or the lack of sleep
• Unmanaged daytime tress (e.g. a whole day of hard work)
• Environmental stimuli that subjectively irritate the person (“the neighbours are noisy again”)

Question 3

Examples of inadequate coping techniques

Answer 3

A. Behaviours which are aimed to facilitate falling asleep, but which paradoxically impede it:

• Counting sheep
• Evening activities done in bed, “If the urge to fall asleep comes, it should find me in bed”
• Striving to control environmental stimuli (e.g. ear-plugs, shading systems)

B. Daytime behaviours, which are aimed to manage sleep loss, but which reduce the chances of sleep on the following night

• Daytime naps that break circadian rhythm
• Increasing time spent in bed (“even if I don’t sleep, at least I’m having a rest”)
• Avoidance of daytime activities (justified by sleep loss) that promote sleep (e.g. socializing, party, physical activities, etc.)
• Attempting to force sleep: going to bed too early that breaks circadian rhythm (“I’m tired, at 9 I should be in bed”)
• Over-consumptions of stimulants (coffee, cola, tea, energy drinks)

Question 4

Treatment

Answer 4

1. Sleep education
2. Shift focus from Subjective complaints to objective indicators: keeping a sleeping-diary
3. Sleep hygiene and life-style counselling, stimulus control
4. Sleep restriction
5. Teaching stress treatment techniques
6. Introducing “Second-line” interventions - relaxation, cognitive restructuring
7. Relapse prevention