Psychophysiologic Insomnia Persistent psychophysiologic insomnia is a behavioral disorder in which patients are preoccupied with a perceived inability to sleep adequately at night. This sleep disorder begins like any other acute insomnia; however, the poor sleep habits and sleep-related anxiety ("insomnia phobia") persist long after the initial incident. Such patients become hyperaroused by their own efforts to sleep or by the sleep environment, and the insomnia becomes a conditioned or learned response. Patients may be able to fall asleep more easily at unscheduled times (when not trying) or outside the home environment. Polysomnographic recording in patients with psychophysiologic insomnia reveals. | Chapter 028. Sleep Disorders Part 7 Psychophysiologic Insomnia Persistent psychophysiologic insomnia is a behavioral disorder in which patients are preoccupied with a perceived inability to sleep adequately at night. This sleep disorder begins like any other acute insomnia however the poor sleep habits and sleep-related anxiety insomnia phobia persist long after the initial incident. Such patients become hyperaroused by their own efforts to sleep or by the sleep environment and the insomnia becomes a conditioned or learned response. Patients may be able to fall asleep more easily at unscheduled times when not trying or outside the home environment. Polysomnographic recording in patients with psychophysiologic insomnia reveals an objective sleep disturbance often with an abnormally long sleep latency frequent nocturnal awakenings and an increased amount of stage 1 transitional sleep. Rigorous attention should be paid to improving sleep hygiene correction of counterproductive arousing behaviors before bedtime and minimizing exaggerated beliefs regarding the negative consequences of insomnia. Behavioral therapies are the treatment modality of choice with intermittent use of medications. When patients are awake for 20 min they should read or perform other relaxing activities to distract themselves from insomnia-related anxiety. In addition bedtime and wake time should be scheduled to restrict time in bed to be equal to their perceived total sleep time. This will generally produce sleep deprivation greater sleep drive and eventually better sleep. Time in bed can then be gradually expanded. In addition methods directed towards producing relaxation in the sleep setting . meditation muscle relaxation are encouraged. Adjustment Insomnia Acute Insomnia This typically develops after a change in the sleeping environment . in an unfamiliar hotel or hospital bed or before or after a significant life event such as a change of occupation loss of a loved one illness or .
