ABSTRACT
HISTORY AND RATIONALE FOR MULTIMODAL CBT As described in previous chapters, insomnia is a highly prevalent and often serious health condition that may be precipitated by stress, environmental factors, changes in the sleep-wake cycle, medical or psychiatric illnesses, and/or use of sleep-disrupting substances. Regardless of its initial cause(s), insomnia may assume a chronic course perpetuated by cognitive, emotional, and behavioral factors that persist over time and cause continual sleep disruption (43). Included among the cognitive factors are unhelpful beliefs and attitudes that may contribute to sleep-related performance anxiety and lead to sleep-disruptive bedtime arousal (1). In addition, misconceptions about how one should respond to a poor night’s sleep might 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 interfere with normal homeostatic mechanisms designed to correct for accumulated sleep debt. Alternately, the habit of “sleeping in” beyond the normal rising time following a poor night’s sleep may disrupt circadian mechanisms that regulate the normal sleep-wake rhythm. Additionally, engaging in mentally demanding work late into the evening without allotting sufficient wind down time before bed may result in excessive mental arousal that interferes with sleep onset. Over time, these cognitive and behavioral factors may result in the repeated association of the bed and bedroom with unsuccessful sleep attempts and lead to the development of a sleep-disruptive conditioned arousal in response to the home sleeping environment.
