ABSTRACT
Insomnia is a prevalent disorder characterized by difficulty initiating or maintaining sleep or by chronically poor sleep quality. Accompanying nocturnal sleep disruption are daytime complaints (e.g., fatigue, poor concentration, lowered social functioning, etc.) that can significantly compromise daily functioning, health status, and quality of life (1-5). Sleep difficulties may arise from a variety of conditions or circumstances, such as stress, environmental factors, changes to the sleep-wake cycle, medical or psychiatric illnesses, or ingestion of sleep-disrupting substances. Regardless of the precipitating factors, insomnia may assume a chronic course perpetuated by psychological, emotional, and behavioral anomalies that persist over time and cause continual sleep disruption (6-8). Included among these are dysfunctional beliefs and attitudes that may contribute to sleep-related performance anxiety and lead to sleep-disruptive bedtime arousal (6,9). In addition, patient’s misconceptions about sleep-promoting practices may give way to a variety of compensatory strategies that only further disrupt sleep. For example, daytime napping or spending extra time in bed in pursuit of elusive, unpredictable sleep may only serve to interfere with normal homeostatic mechanisms designed to operate automatically in the face of sleep debt. Alternately, the habit of remaining in bed well beyond the normal rising time, following a poor night’s sleep, may disrupt circadian mechanisms and make subsequent sleep more difficult. Additionally, failure to discontinue mentally demanding work and allot sufficient wind-down time before bed may serve as a significant sleep inhibitor during the subsequent sleeping period. Over time, these cognitive and behavioral anomalies may result in the repeated association of the bed and bedroomwith unsuccessful sleep attempts and lead to the development of sleep-disruptive conditioned arousal in response to the home sleeping environment.
