Sleep education

Psychophysiological insomnia explained

Andreas Meistad Cognitive Behavioral Therapist
Last updated
April 1 2019

The hallmark of insomnia is poor sleep quality, trouble falling asleep, or difficulty staying asleep. There are many reasons that people have trouble with sleep, but to provide a simple explanation sleep therapists have often divide insomnia into two subgroups; primary insomnia, and secondary insomnia.

Secondary insomnia means that the insomnia is caused (secondary to) something else. Examples of this can be depression, sleep apnea or chronic pain.

Primary insomnia means that you are having trouble with sleep and you can't blame it on medical factors like a physical disease or a medication. It might sound like primary insomnia doesn't have a cause, but this is not the case. There are others, but one way of understanding primary insomnia is psychophysiological insomnia.

Are you suffering from psychophysiological Insomnia?

Psychophysiological Insomnia is a subgroup of primary insomnia, it's very common and essentially an explanation on what sustains and feeds insomnia for many people. Those who have this kind of insomnia worry a lot about the consequences of not sleeping and often feel stressed about their sleep.

A typical scenario for someone with psychophysiological insomnia is that they will go to bed tired and sleepy, but the moment their head hits the pillow, they will feel more awake than before and unable to fall asleep. It's also often the case that they will easily fall asleep in other places than their bed or at different times than bedtime. The mechanisms of this phenomenon aren't very complicated, but it can be hard to figure out on your own.

Performance anxiety and sleep

When someone with psychophysiological goes to bed and tries to sleep, they will experience something similar to performance anxiety. They have often spent a great deal of the day worrying about the consequences of not getting sleep, and when the time comes, they choke. The brain and body think that bedtime is a time to perform and the arousal system kicks in. The brain interprets the bed or bedtime as something dangerous, and the body is on high alert instead of being relaxed.

Treatment of psychophysiological insomnia

To break the vicious cycle that psychophysiological insomnia is, not thinking so much about sleep is vital. Not thinking about something is very difficult, but learning to not focus so much about sleep can be achieved if you can experience the opposite.

Cognitive behavioral therapy (CBT) is a form of therapy initially developed for the treatment of depression and works by changing unhelpful cognitions (thinking) and behavior. CBT for insomnia has for years been the gold standard for treating insomnia and has been proven to work in numerous clinical trials. CBT for insomnia can help you reduce the time you worry about sleep, make you experience sleeping without overthinking and break the insomnia cycle.