Psychophysiologic insomnia, also called learned sleeplessness
Related terms are learned insomnia, conditioned insomnia, primary insomnia, chronically heightened physical tension or psychophysiologic hyposomnia.
Incidence
Psychophysiologic insomnia which is characterized by difficulty in falling or staying asleep or by waking up early in the morning is the most common sleep disorder. Approximately 10 % of the population suffer from it with 50 % of them actually needing therapy. Frequently, it is perceived as a disturbance in the 3rd decade of life. Complaints can worsen with increasing age. Women are affected more often than men.
Causes
It is a sleep disorder which occurs at a chronically heightened physical, emotional and mental tension level. Sleep-preventing associations and misbehaviour with regard to healthy sleep can be observed. Psychophysiologic insomnia highly tends to become chronic.
Symptoms
Observations show that patients frequently make an excessive effort to fall asleep, are frightened of not falling asleep and lack sleep hygiene (e.g. they have irregular bed times, work at night, watch TV, sleep to long in the morning). The inability to switch off and a nocturnal tendency to worry are characteristic for this disease. In many cases, the ability to sleep does not occur until in the morning hours. During the day, the patients experience severe sleepiness, exhaustion and emotional disgruntlement. Very often stress symptoms such as headaches and stomach-aches are observed. Towards evening, a heightened fear of bedtime is seen frequently.
Examination
Primarily, it is necessary to eliminate the existence of organic or psychic disorders which may provoke insomnia. Laboratory values especially thyroid test values, iron values, folic acid values, vitamin B12 status and liver values are also of importance. Drug and addictive drug anamnesis quite often reveals a chronic use of benzodiazepine and/or an increased consumption of alcohol in the evening.
Examination in the sleep laboratory
An inpatient polysomnographic examination in order to rule out other causes of the sleep disorder is recommended particularly in case of chronic difficulty in falling and staying asleep. The polysomnographic examination of the sleep laboratory frequently reveals an extended falling-asleep duration, an increased number and duration of nocturnal wake periods as well as reduced sleep quality. In many cases, the periods of superficial sleep have increased and the periods of deep sleep have decreased. A fine analysis of the nocturnal registration shows an increase in micro-arousals and characteristic interferences in the patients’ electroencephalogram. Despite of the occasional stress caused by the sensors in the examination situation, the patients often sleep better than in their domestic environment.
Therapy
Pharmacological as well as non-pharmacological therapy forms, partly applied in combination, can be taken into account. Most of the therapeutic measures can be carried out as outpatient treatment.
Non-pharmacological methods
Training in sleep hygiene; sleep diary; relaxation techniques; behaviour therapy-oriented personal consultation or group meetings; stimulus control (help to stop brooding); sleep restriction (reducing time spent in bed); paradoxical intention; phototherapy
Pharmacological treatment
Hypnotics should only be taken for a short period of time of a maximum of 2 x 2 weeks and, in a few exceptional cases up to 3 months. Secondary hypnotics such as for example sedative antidepressants can frequently be prescribed for longer periods. In individual cases only, low-potent neuroleptics, phyto-pharmaceuticals, L-tryptophane, melatonin or antihistamines can be considered.