13:  CONDITIONED INSOMNIA

This appears as one of the remaining sleep disruptions of Step E. A major cause of insomnia appears to be the expectation of insomnia.

Some people have a form of transient or short-term insomnia that changes as they become aware of it and begin to become anxious or hyper-aroused at bedtime, in anticipation of its recurrence. Their insomnia is an unconscious learned response to the stimuli of the bedroom.

Because going to sleep involves a giving-in to a natural process, the anticipation of insomnia can make sleep even more difficult to give into.

13a. Diagnosis

Symptoms include:

  • Insomnia lasts long after the precipitating stress has passed. The problem no longer appears to be caused by anything. It just happens, and it happens consistently.
  • When trying to sleep, the person’s mind races. The person may feel anxious, but it’s anxiety about going to sleep, not about dangers in the night or threats coming up the next day.
  • The person is convinced of his/her inability to fall asleep and tense about trying. Efforts to sleep fail. He/she becomes physically tense and cognitively alert.
  • The problem is connected to the person’s normal sleep environment. He/she can sleep more easily elsewhere- on the couch, in a hotel room, or in a friend’s guest room. These other places have not become conditioned stimuli for insomnia. If he/she goes to a sleep lab for evaluation, sleep may come naturally and easily.
  • The person may also be able to nap during the day, especially away from the bedroom,
  • Similar issues may have developed after acute stresses on previous occasions. This could be a sign that the person is easily conditioned, or that anxiety about sleep is being carried over from an earlier time.

13b. Treatment

Anxious people are more likely than others to develop conditioned insomnia, and it may pay to treat anxiety along with the person’s insomnia. (Reite, Weissberg and Ruddy: 202)

Since the reaction is seen as conditioned, it makes sense to help the person break the association between bed and being alert. To do this, a number of sections can apply: limiting use of the bedroom (Section 20), maintain a consistent sleep time (Section 25) limit the amount of time the person spends in bed (Section 29) and don’t take naps (Section32). Together, they should increase the person’s need for sleep to the point of overcoming the conditioned insomnia.

It might be more effective to use a plan designed specifically for this problem, as described by Hauri and Linde, (87-88) and attributed by them to Richard Bootzin. Here, the specific components of the plan are

  • Only go to bed when sleepy
  • Don’t use the bed for anything except sleep
  • Any time you can’t sleep, get up and go into another room until sleepy
  • Get up at the same time every day
  • Don’t take naps