Case 2 sleep problem?
Spielman model = 3p model
Cognitive model = Harvey
1. What is insomnia
- the diagnostic procedure for insomnia, and its co-
morbidities, should include a clinical interview
consisting of a sleep history (sleep habits, sleep
environment, work schedules, circadian factors), the use
of sleep questionnaires and sleep diaries, questions
about somatic and mental health, a physical
examination and additional measures if indicated (i.e.
blood tests, electrocardiogram, electroencephalogram;
strong recommendation, moderate- to high-quality
evidence). Polysomnography can be used to evaluate
other sleep disorders if suspected (i.e. periodic limb
movement disorder, sleep-related breathing disorders),
in treatment-resistant insomnia, for professional at-risk
populations and when substantial sleep state
misperception is suspected (strong recommendation,
high-quality evidence). Cognitive behavioural therapy
for insomnia is recommended as the first-line treatment
for chronic insomnia in adults of any age (strong
recommendation, high-quality evidence). A
pharmacological intervention can be offered if cognitive
behavioural therapy for insomnia is not sufficiently
effective or not available. Benzodiazepines,
benzodiazepine receptor agonists and some
antidepressants are effective in the short-term treatment
of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence).
Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended
for insomnia treatment (strong to weak
recommendations, low- to very-low-quality evidence).
Light therapy and exercise need to be further evaluated
to judge their usefulness in the treatment of insomnia
(weak recommendation, low-quality evidence).
Complementary and alternative treatments (e.g.
homeopathy, acupuncture) are not recommended for
insomnia treatment(weak recommendation, very-low-
quality evidence.
- patients with insomnia have a significantly reduced total
sleep time, significantly prolonged sleep-onset latencies, and an increased number of
nocturnal awakenings and amount of time awake during the night. Furthermore, slow-
wave sleep and REM sleep percentages are reduced compared with good sleepers
- 6% of adults have insomnia, age related increase, more females, 70% of the patients
show persistent symptoms over the course of 1 year, 46% of those suffering from
insomnia showed persistent symptoms over the course of 3 years.
- Health risks: cardiovascular diseases, type 2 diabetes, obesity, cognitive impairment,
cortical atrophy, depression, suicide, sick leave and accidents in work place, traffic
accidents
- Acute insomnia: after stressor, when stressor leaves the insomnia stops
1
, - 790 euro per year per patient, high financial burden in Europe
2. What causes it according to the 3P model?
- Chronic and acute stress
- Maladaptive coping
- Arousal models: increased arousal levels in the cognitive, emotional and physiological
domains represent both predisposing ‘and’ perpetuating factors
- worry, rumination -> cognitive models
- circadian factors like shift work
- predisposing factors precede the onset of sleep difficulties and increase individuals'
vulnerability to insomnia; precipitating factors typically involve acute stressors that
trigger the onset of insomnia; and perpetuating factors maintain symptoms by
mismatching sleep opportunity and sleep ability
article van de laar personality traits
- The susceptibility to develop insomnia may be linked to the presence of certain
personality features. Here, we review studies that assessed this particular aspect of
insomnia. Due to various methodological issues, definitive conclusions cannot be
drawn as of yet, and several conflicting findings remain. However, there is a common
trend indicating that insomniacs display more signs of ‘neuroticism’, ‘internalization’,
anxious concerns and traits associated with perfectionism. These factors may play
varying roles depending on the specific subdiagnosis of insomnia. In addition, certain
personality traits may be related to the response to (cognitive) behavioral treatment.
For instance, insomniacs reporting less ‘guardedness’ and have a higher score on the
MMPI ‘hypomania’ scale show less improvement through psychological treatment.
The specific role of personality traits in the etiology of insomnia is not yet clear,
because of a lack of longitudinal data. Personality factors may play a causal role in the
development of insomnia, but may also be a consequence of the sleep problem and the
associated daytime dysfunction
- In the present paper we review relevant
studies that deal with the role of
personality in insomnia. We discuss
findings on personality traits in different
types of insomnia and studies that
distinguish different insomnia types
(partly) based on personality traits. In
addition, studies comparing personality
profiles in insomnia versus other sleep
disorders are examined. Personality traits
may also influence the effects of
cognitive behavioral therapy for insomnia. Finally, we discuss the hypothetical
etiological role that personality may play in the development of insomnia
- personality pattern of general dissatisfaction and sensitivity to anxiety, obsessive
worrying and hypochondriacal concerns, differentiating subjects with insomnia from
normal sleepers. ‘internalization’ has been put forward as an important personality
aspect of insomniacs. insomniacs showed more neurotic and anxious symptomatology
than control subjects. A constant finding in insomnia patients is a tendency to be
overconcerned. These personality traits are typically associated with perfectionism and
self-imposed strain. insomniacs tended to show a pathological concern over bodily
functioning, dissatisfaction, ‘histrionic somatization’ and ‘neuroticism’
2
Spielman model = 3p model
Cognitive model = Harvey
1. What is insomnia
- the diagnostic procedure for insomnia, and its co-
morbidities, should include a clinical interview
consisting of a sleep history (sleep habits, sleep
environment, work schedules, circadian factors), the use
of sleep questionnaires and sleep diaries, questions
about somatic and mental health, a physical
examination and additional measures if indicated (i.e.
blood tests, electrocardiogram, electroencephalogram;
strong recommendation, moderate- to high-quality
evidence). Polysomnography can be used to evaluate
other sleep disorders if suspected (i.e. periodic limb
movement disorder, sleep-related breathing disorders),
in treatment-resistant insomnia, for professional at-risk
populations and when substantial sleep state
misperception is suspected (strong recommendation,
high-quality evidence). Cognitive behavioural therapy
for insomnia is recommended as the first-line treatment
for chronic insomnia in adults of any age (strong
recommendation, high-quality evidence). A
pharmacological intervention can be offered if cognitive
behavioural therapy for insomnia is not sufficiently
effective or not available. Benzodiazepines,
benzodiazepine receptor agonists and some
antidepressants are effective in the short-term treatment
of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence).
Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended
for insomnia treatment (strong to weak
recommendations, low- to very-low-quality evidence).
Light therapy and exercise need to be further evaluated
to judge their usefulness in the treatment of insomnia
(weak recommendation, low-quality evidence).
Complementary and alternative treatments (e.g.
homeopathy, acupuncture) are not recommended for
insomnia treatment(weak recommendation, very-low-
quality evidence.
- patients with insomnia have a significantly reduced total
sleep time, significantly prolonged sleep-onset latencies, and an increased number of
nocturnal awakenings and amount of time awake during the night. Furthermore, slow-
wave sleep and REM sleep percentages are reduced compared with good sleepers
- 6% of adults have insomnia, age related increase, more females, 70% of the patients
show persistent symptoms over the course of 1 year, 46% of those suffering from
insomnia showed persistent symptoms over the course of 3 years.
- Health risks: cardiovascular diseases, type 2 diabetes, obesity, cognitive impairment,
cortical atrophy, depression, suicide, sick leave and accidents in work place, traffic
accidents
- Acute insomnia: after stressor, when stressor leaves the insomnia stops
1
, - 790 euro per year per patient, high financial burden in Europe
2. What causes it according to the 3P model?
- Chronic and acute stress
- Maladaptive coping
- Arousal models: increased arousal levels in the cognitive, emotional and physiological
domains represent both predisposing ‘and’ perpetuating factors
- worry, rumination -> cognitive models
- circadian factors like shift work
- predisposing factors precede the onset of sleep difficulties and increase individuals'
vulnerability to insomnia; precipitating factors typically involve acute stressors that
trigger the onset of insomnia; and perpetuating factors maintain symptoms by
mismatching sleep opportunity and sleep ability
article van de laar personality traits
- The susceptibility to develop insomnia may be linked to the presence of certain
personality features. Here, we review studies that assessed this particular aspect of
insomnia. Due to various methodological issues, definitive conclusions cannot be
drawn as of yet, and several conflicting findings remain. However, there is a common
trend indicating that insomniacs display more signs of ‘neuroticism’, ‘internalization’,
anxious concerns and traits associated with perfectionism. These factors may play
varying roles depending on the specific subdiagnosis of insomnia. In addition, certain
personality traits may be related to the response to (cognitive) behavioral treatment.
For instance, insomniacs reporting less ‘guardedness’ and have a higher score on the
MMPI ‘hypomania’ scale show less improvement through psychological treatment.
The specific role of personality traits in the etiology of insomnia is not yet clear,
because of a lack of longitudinal data. Personality factors may play a causal role in the
development of insomnia, but may also be a consequence of the sleep problem and the
associated daytime dysfunction
- In the present paper we review relevant
studies that deal with the role of
personality in insomnia. We discuss
findings on personality traits in different
types of insomnia and studies that
distinguish different insomnia types
(partly) based on personality traits. In
addition, studies comparing personality
profiles in insomnia versus other sleep
disorders are examined. Personality traits
may also influence the effects of
cognitive behavioral therapy for insomnia. Finally, we discuss the hypothetical
etiological role that personality may play in the development of insomnia
- personality pattern of general dissatisfaction and sensitivity to anxiety, obsessive
worrying and hypochondriacal concerns, differentiating subjects with insomnia from
normal sleepers. ‘internalization’ has been put forward as an important personality
aspect of insomniacs. insomniacs showed more neurotic and anxious symptomatology
than control subjects. A constant finding in insomnia patients is a tendency to be
overconcerned. These personality traits are typically associated with perfectionism and
self-imposed strain. insomniacs tended to show a pathological concern over bodily
functioning, dissatisfaction, ‘histrionic somatization’ and ‘neuroticism’
2
