What Is Psychophysiological Insomnia? Causes, Symptoms, And Treatments

Insomnia is a condition characterized by a person’s inability to fall or stay asleep at night. Sleep is critical for our physical and mental health, and being unable to sleep can lead to numerous problems that can impact everyday life.

Psychophysiological insomnia is a type of insomnia that is usually related to anxiety surrounding trying to fall asleep at night. Learn everything you need to know about it, including its symptoms, diagnosis, and treatment, below.

What is insomnia?

Insomnia is a sleep disorder that makes getting enough sleep difficult. It is usually broken down into two categories: acute and chronic.

Acute insomnia is common, and many people experience bouts of acute insomnia during stressful times. It can increase your stress and negatively impact your mental and physical health in the short term. It is common for people with acute insomnia to suffer from increased feelings of stress and an inability to focus.

Chronic insomnia is a long-term inability to get enough sleep, and it is associated with higher rates of cardiovascular disease, type 2 diabetes, cancer, and obesity.

Insomnia can be a difficult condition to treat, but there are a few treatment options that may be able to help you get more and better sleep in the long term.

If you believe you may be suffering from insomnia, talk to your doctor about your concerns to get an official diagnosis, information about possible lifestyle changes to improve your symptoms, and treatment options to help in the short and long term.

Two types of insomnia

Beyond the distinction between acute and chronic insomnia, there are two classes of insomnia: primary and secondary¹. 

Primary insomnia is not caused by another condition but can be worsened by stress due to difficult life events. Secondary insomnia, on the other hand, is caused by another factor, whether it is a physical or mental condition, medication, or something else. 

Psychophysiological insomnia is considered primary insomnia² because it relates to stress and worries about a person’s inability to sleep. 

Psychophysiological insomnia

Psychophysiological insomnia³ shares traits with performance anxiety, as it is characterized by a person’s inability to fall asleep due to worries about whether they can fall asleep. 

When you experience temporary insomnia, you may think about the consequences of your lack of sleep, such as an inability to focus at work or school, or the physical health conditions that are associated with poor sleep.

This can cause anxiety around bedtime, and you may suddenly feel wide awake as soon as you lay down despite being drowsy a few moments earlier. Additionally, you might start associating going to sleep with stress and anxiety instead of rest and relaxation, so you may experience a burst of energy and alertness when you lay down. 

If you have noticed feeling fearful about not being able to sleep, you may be dealing with psychophysiological insomnia. 

How psychophysiological insomnia is diagnosed

If you struggle to fall asleep due to anxiety, it might be helpful to see your doctor and explain your situation. Your doctor may be able to diagnose you with psychophysiological insomnia if you meet the following criteria:

• Your insomnia has lasted for at least one month

• Your insomnia is not related to another physical or mental health condition or medication

• You struggle to fall asleep when you plan to but may fall asleep when you don’t intend to, such as when watching television or reading a book

• You have difficulty sleeping even though you give yourself plenty of opportunities to get adequate sleep

• Your sleep quality is consistently poor

• You feel more alert when you try to fall asleep at planned bedtimes

Your doctor may also conduct a physical exam⁴ to look for physical signs of poor sleep, and they may ask you to keep records of your sleep habits for a few days or weeks. Your doctor could also order a sleep study to monitor various parameters while you sleep, such as brain waves, eye movements, and breathing. 

Treatment options for psychophysiological insomnia

There isn’t currently a framework for treating psychophysiological insomnia⁵ specifically, but the treatment options available for general insomnia may also prove effective. 

Some of the most common treatment options for insomnia include:

Cognitive-behavioral therapy for insomnia (CBT-I)

Cognitive-behavioral therapy⁶ for insomnia is often recommended as a first-line treatment for insomnia. CBT-I can be just as effective as medications used to treat insomnia, and in some cases, it’s even more effective than medications. 

This type of therapy focuses on investigating your thoughts, feelings, and behaviors that may contribute to the problem you are facing. It can also be used to treat various conditions outside of insomnia, like anxiety and depression. 

The main goal of CBT-I is to help you notice destructive thought patterns about your sleep that might make it more difficult for you to fall asleep at night and stay asleep until morning. 

This type of therapy can help you address the frustration you may feel about not being able to get enough sleep, especially if you notice your sleepiness causing problems at work, school, or in your relationships. CBT therapists or counselors can provide you with some effective relaxation techniques and lifestyle changes that can make falling asleep easier. 

CBT-I also includes education on sleep hygiene and stimulus control⁷, such as keeping a sleeping routine by waking up at the same time every morning. It may also involve sleep restriction therapy⁸, which prompts you to spend less time in bed per night to consolidate the amount of time you actually spend sleeping. The time spent in bed is gradually increased, and it can help you get more and better quality sleep over time.

Sleep medications

Some medications can be taken on an as-needed basis, and there are others that are effective for long-term use. These prescription medications can help you fall asleep faster, stay asleep longer, or both.

Some long-term sleeping medications include:

• Zolpidem

• Zaleplon

• Ramelteon

• Eszopiclone

These medications may have some side effects, like feeling groggy during the daytime, and they can be habit-forming. Take these medications as prescribed by your doctor, and let your doctor or pharmacist know if you experience any concerning side effects.

Over-the-counter sleep aids

There are a few over-the-counter sleep aids that may help you feel more sleepy, which can help you fall asleep faster at night, such as:

• Melatonin

• Diphenhydramine

• Doxylamine

• Valerian

These sleep aids may be helpful on occasion, but it is easy to develop a tolerance for them. They can also produce some side effects, and they should not be mixed with alcohol. 

Talk to your doctor about over-the-counter sleep aids before giving them a try to ensure that they won’t produce negative interactions with prescription drugs you may be taking. 

Sleep hygiene habits that can help

In addition to the above treatment options, there are also some lifestyle changes and sleep habits you can do to help yourself get better sleep, like:

Avoiding screens before bed

Scrolling on social media or watching television before bed can interfere with your sleep because screens emit blue light⁹. It can trick your brain into thinking there is sunlight, and the content you view can keep your brain stimulated instead of relaxed. Put away phones and tablets at least half an hour to an hour¹⁰ before bedtime.

Limiting sleeping in or afternoon napping

Your body likes routine, and sleeping in later than usual to make up for poor sleep can throw off its routine, making it more difficult for you to fall asleep at night. Napping in the afternoon can also have a negative impact on your sleep cycle, so it’s best to stick to early afternoon naps if you need one during the day.

On that same note, establishing a regular sleep schedule even through the weekend can help you fall asleep better and wake up at the same time each day.

Cutting off caffeine or alcohol consumption early on

Caffeine may help you feel more alert during the day if you didn’t sleep well the night before, but it can stay in your system for longer than most people realize. This can negatively impact your ability to sleep at night.

If you want to drink coffee or tea, consume them only in the morning, and cut off caffeinated beverages at least 6 hours before bedtime.

Alcohol may make you sleepy when you drink it, but it doesn’t help you sleep better. In fact, it has been shown to disrupt sleep quality, and the more alcohol consumed, the bigger the disruption. Keep your alcohol consumption limited, or avoid it altogether for better sleep.

The lowdown

If you are struggling to get proper sleep regularly, you may benefit from speaking with your doctor. Your doctor can give you a few treatment options. They may also be able to send you to a specialist who can help you learn more about bedtime anxiety and give you strategies to fall asleep faster and stay asleep longer.

Sleep is a critical aspect of health, and insomnia of any kind can be difficult to manage. Some trial and error and working closely with a qualified health professional can make all the difference.