Patients

Where does insomnia come from?  And what keeps it going? If you’re seeking to stay up at night and become part of the night community, some fascinating literary tales of the “romance” of being up at night are available at the New York Times Opinionator blog entitled All-Nighters. If, on the other hand, you’re someone who’d prefer to be asleep at night, read on.

In the Sleep Medicine community, Spielmann’s 3P model provides the best infrastructure so far in seeking answers about insomnia. Spielmann proposed a layered model that has stood the test of time and research in seeking both causes of insomnia and help for its sufferers. The three factors that are the building blocks of chronic insomnia are:

PREDISPOSING: These are biological or medical factors that make an individual more vulnerable to sleep problems.  Some individuals are born with more active nervous systems or other medical issues that make sleep problems more likely.

PRECIPITATING: Into each life, a little rain must fall.  We all have life events that interrupt our sleep – a death in the family, a car accident, job termination, loss of a treasured relationship or many other difficult but normal life stress events.  This is where insomnia starts.  For most people, these triggering events lead to acute insomnia that lasts only a brief time and resolves to normal sleep on its own.

PERPETUATING: These are the things we do with the best of intentions that keep the insomnia going and create a chronic problem of the temporary insomnia.  We begin to stay in bed longer to get more sleep, increase our caffeine, go to bed later or nap during the daytime, getting off of our regular sleep schedule. We drink an extra glass of wine to relax.  We do this to maintain our daytime functioning, as well as to get a better night’s sleep.  When there’s a problem with our sleep at night, you can be sure there will be some trouble in the daytime.  In many situations, it is these factors that not only transform the insomnia into a chronic problem but are the best targets for intervention.

These areas where intervention can be most effective are NOT your grandmother’s old-fashioned sleep hygiene rules (although they are important too), but an elegantly researched, evidence-based set of techniques that identifies your particular problem and what could be keeping it in place.  Changes in our time-worn habits are not easy or painless, but can accomplish getting you back to a regular, comfy schedule of sleep that works for that most precious of human endeavors –  going to bed easily and sleeping through the night.

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