[Jodi]

The title to the post is sort of self-explanatory.

Don’t go me wrong — I appreciate what both Martin and Scott are doing as I believe they are providing valuable support to the larger insomnia community.

However, Martin talks about a specific type of insomnia. It starts with any type of trigger (a stressful life event, etc.) but long after the initial trigger is gone, the insomnia persists because of anxiety surrounding sleep. In the medical community, they call it “psychophysiological insomnia.”

In about 85-90 % of the initial posts on here, users describe anxiety, either anxiety about things going on in their life or anxiety surrounding sleep. I would reply to those posters that you sort of answered your own question in your description of your problem. Whether your insomnia is strictly fueled by anxiety or it is caused by other factors but you worry a lot when you wake up in the Middle of the night about falling back asleep, you can’t expect to get the maximum amount of sleep your body needs (and I say “your body” because everyone’s sleep needs are different) if you don’t have your anxiety on control.

That said, not all cases of insomnia are psychophysiological insomnia (insomnia fueled by sleep anxiety) and not all insomnia is caused by anxiety. Insomnia can be caused by sleep apnea, other mental health issues, medications you take, other physical disorders or in my case, inappropriate use of sleeping pills (Z drugs or benzodiazepines). Actually sometimes even appropriate use of sleeping pills can worsen insomnia (for instance, google the “BenzoBuddies” forum.)

That is why I find it total hubris that a specific poster on here keeps spamming out to every other poster on here that their sleep problem would go away if they simply didn’t worry about sleep (however well-intentioned that advice is). In truth, that advice only applies if their insomnia is fueled by sleep anxiety.

[Martin Reed]

You make a great point that most of the posts here in the forum see individuals mention anxiety — and I am yet to meet someone with chronic insomnia who doesn’t identify anxiety (or at least worry) as something that has a negative effect on their sleep!

With that being said, I need to clarify that I have never claimed insomnia is perpetuated only by anxiety. Insomnia is perpetuated by thought processes and behaviors that weaken sleep drive, disrupt the body clock, and/or heighten arousal.

If someone is regularly going to bed at 6:00 PM, getting out of bed at 6:00 AM and is unhappy with the fact it takes hours to fall asleep, they are spending hours awake later in the night, and they are getting four hours of sleep, we might recognize that this behavior is likely perpetuating their insomnia — rather than anxiety.

If someone gets out of bed at 6:00 AM one day, 10:00 AM the next, 3:00 AM the next, 3:00 PM the next and is unhappy that their sleep doesn’t seem to be consistent and that they often feel fatigued and groggy, we might recognize that this behavior is likely perpetuating their insomnia — rather than anxiety.

Insomnia can be triggered by any number of things — including all the examples you gave. However, if these triggers are no longer relevant and/or are no longer influencing sleep — if there is no medical explanation for sleep difficulties, then an individual likely has chronic insomnia disorder and chronic insomnia disorder is perpetuated by our thought processes AND our behaviors (again, not anxiety alone).

Thank you for your contribution to the forum, for sharing your thoughts, and for giving me the opportunity to clarify my thoughts on the role of anxiety in chronic insomnia.

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