Four Conceptual Models for Insomnia

Feb 12, 2013

I think of insomnia from 4 different and overlapping perspectives. First, the Spielman 3P model, a model of progression from normal sleep to chronic insomnia via predisposing, precipitating and perpetuating factors. This model is useful for describing the course of the insomnia and focuses treatment on those behaviors that are identified as perpetuating sleeplessness. Second, Lundh and Broman differentiate between interfering factors, generally hyperarousal related, and interpreting factors, with cognitive and subjective appraisal components. This model points to assessment and treatment of psychological factors such as perfectionism and worry in order to improve sleep. Third, Espie focuses on insomnia as a failure to inhibit wakefulness, primarily due to the body’s failure to adapt to actual or perceived stressors. This leads to a treatment focus on sleep effort and selective attentional processes related to sleep. Finally, Morin’s microanalytic model presents a vicious cycle of insomnia that is fed and feeds on arousal, dysfunctional cognitions, maladaptive habits, and arousal generating consequences. Treatment aims at disputing dysfunctional beliefs about sleep and the arousal generating interpretations of insomnia.

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