“Psychophysiological insomnia” was a diagnosis doctors gave to people experiencing sleeplessness related to anxiety about being unable to sleep. It is no longer in use.
Because anxiety about sleep can condition a person to sleep poorly, doctors may describe this form of insomnia as “learned” or “conditional.” Its symptoms now fall under the type of insomnia known as chronic, which is long-term. They may be less likely to happen when people do not sleep in their own beds.
This article will explain more about sleeplessness due to anxiety around sleep, including symptoms, causes, risk factors, treatment, prevention, and when to call a doctor.
Doctors no longer use the term psychophysiological insomnia. The International Classification of Sleep Disorders, 3rd edition
Medical News Today reached out to Shelby Harris, PsyD, DBSM, a director of sleep health at Sleepopolis, for her perspective.
“Although we don’t label this insomnia as psychophysiological anymore, it is definitely a phenomenon that we still see,” Harris noted. “Essentially, it denotes trouble falling or staying asleep or awakening too early due to a state of heightened mental arousal, physical arousal, or both. We commonly see it at home, where someone routinely has trouble sleeping and is in a state of high arousal.”
The main symptoms are similar to most kinds of insomnia. However, there is a distinguishing factor. “The hallmark differentiator is being extremely anxious about trying to sleep to the point that it results in conditioning to sleep poorly,” said Harris.
“Someone might experience heightened anxiety and have intrusive thoughts or worries about sleep as it gets closer to bedtime at home. Yet they do not experience the same levels of anxiety or worries about sleep when away on vacation, where they are able to fall asleep more easily.”
To qualify as insomnia, symptoms must appear
- overall poor-quality sleep
- waking too early in the morning
- only sleeping for a short amount of time
“People should see a doctor or a sleep specialist if they are routinely having trouble with sleep quality or quantity multiple nights a week,” advised Harris. “There are a lot of effective treatments out there that can promote better sleep, such as CBT-I.”
A 2002 study reported that people with psychophysiological insomnia tended to be excessively concerned about sleep and the daytime effects of not getting adequate sleep.
This resulted in emotional distress and arousal of a part of the nervous system, which caused anxiety. The researchers proposed that heightened anxiety tricks a person into overestimating the severity of insomnia and its effects. However, the anxiety can result in a real sleep deficit.
Jenna Feldman, PsyD., a psychologist who specializes in anxiety, described the role of risk factors in insomnia. She explained that some risk factors serve as triggers, while others keep it going once it develops.
Trigger risk factors
“The risk factors for insomnia are both biological and psychological,” said Feldman. “In terms of the biological, certain people have a sleep regulation system that disruptions can easily throw off track. In terms of the psychological, individuals who are prone to worry or rumination may be more vulnerable to developing insomnia.”
According to Feldman, insomnia can result when someone with these risk factors experiences a stressful event or a sudden change in their sleep schedule.
Common triggers include:
- work or school stress
- social stress
- medical problems
- significant life changes
- travel across time zones
Perpetuating risk factors
“Once something triggers insomnia, certain psychological and behavioral factors can keep it going, such as the way we think about sleep,” continued Feldman. “Insomnia is, of course, extremely unpleasant, and when it happens, we want it to go away.”
“As a result, the idea of sleep becomes anxiety-provoking. Throughout the day, people with insomnia tend to focus on the negative consequences of having had poor sleep the night before. They may also worry about the consequences of getting another bad sleep that night.”
The result of such thinking increases pressure to sleep well, which can lead to unhelpful behaviors. “Bedtimes feel high stakes, and a person might do things to ‘try’ and make themselves fall asleep,” said Feldman. “These thoughts and sleep efforts activate our fight or flight system, interfering with or preventing another night’s sleep.”
“Behaviorally, the things we do to try and compensate for poor sleep, such as napping or sleeping in on the weekends, can affect the physiological sleep regulation system. This makes the insomnia worse.”
“CBT-I is effective, as it targets the psychological and behavioral factors that perpetuate insomnia,” said Feldman. “It changes unhelpful ways of thinking about sleep and counterproductive sleep-related behaviors. The goals are to establish a regular sleep cycle and reduce anxiety about sleep.”
Harris agrees on the value of CBT-I, noting that mental health professionals recommend it as the first-line treatment for insomnia. She also mentioned the importance of sleep hygiene, one of the components of CBT-I, which involves steps such as:
- limiting alcohol intake 3 hours before bed
- limiting caffeine intake 8 hours before bed
- avoiding screens 30–60 minutes before bed
“There are other treatment options available, such as sleep medications or over-the-counter sleep aids,” adds Harris. “However, many sleep medications come with side effects and are not effective long-term solutions for insomnia.”
This aligns with evidence that suggests sleep medications can cause thinking impairments and morning hangovers. These medications can also lead to dependence and tolerance, which means a person may need higher doses to have the same effect.
“Treatment for insomnia can be effective, and there are many different treatment options available,” said Harris. “CBT-I can often be more effective than medications.”
It is important that people use their beds only for sleep and sex, especially with this type of insomnia. “Using the bed for other activities, such as working or watching TV, conditions your brain to associate being in bed with being awake,” said Harris.
“This can make it more difficult for someone to fall asleep in their own bed. If individuals wake up in the middle of the night and are unable to fall back asleep, they should avoid checking their phone or turning on the TV. Such practices can make it more difficult to fall back asleep.”
Instead, Harris suggests some alternatives, including:
- doing breathing exercises
- meditating to calm the mind
- moving to a different room to do something quiet and relaxing after 20 minutes of being unable to sleep
“Some people might also find that journaling or writing down their worries and concerns can reduce their anxious thoughts or feelings before bed.”
Psychophysiological insomnia is a diagnosis that health professionals no longer use, although some report continuing to see people with its symptoms in their practices. The characteristic that distinguishes it from other types of insomnia is that a person’s anxiety about sleep is so high that it conditions them to sleep poorly.
People with a tendency to worry have an increased risk of anxiety related to sleep, and common stressful events can trigger it. CBT-I is an effective treatment. Sleep hygiene measures such as limiting caffeine intake may also help.
If individuals have trouble with sleep quality on multiple nights per week, it is best to contact a doctor for advice.