Poor sleep has a habit of taking on a life of its own. You may know exactly when and why your poor sleep started, perhaps during a particular time of high stress. However, that stress may be over now, and you find that you are still not sleeping well on a regular basis. Often the reasons why the poor sleep continues has nothing to do with the factors that triggered the poor sleep in the first place.
Here we discuss how chronic insomnia can develop from a combination of factors (presented in the 3Ps Model) and what you can do to prevent acute insomnia from becoming chronic.
- Almost everyone sleeps poorly sometimes
It’s not unusual to have the occasional night of poor sleep. You may have trouble falling asleep on some nights, when usually you drop off straight away. You may wake up repeatedly during the night when this normally doesn’t happen. Sometimes people will wake up too early in the morning and can’t go back to sleep, even though they typically need an alarm to wake up. Other symptoms of poor sleep may include:
- Not feeling well-rested in the morning
- Daytime tiredness or sleepiness
- Irritability, depression or anxiety
- Difficulty paying attention, focusing on tasks or having some troubles with your memory
- Acute insomnia versus chronic insomnia
We sometimes call short-term poor sleep ‘acute insomnia’. Acute insomnia can last from one night to a few weeks. If short-term insomnia is in response to a particular situation (such as a bushfire emergency or death of a loved one) it is called ‘situational insomnia’. You may worry that these nights of poor sleep are developing into chronic insomnia. The formal definition of chronic insomnia is when a person has insomnia at least three nights a week for three months or longer.
- The 3Ps Model
The 3Ps Model explains how chronic insomnia can develop and become ongoing. Importantly this model can also inform us on how to prevent acute insomnia becoming chronic. The model outlines that predisposing factors (like your genetic make-up) are responsible for the occasional night of poor sleep. Acute (and/or situational) insomnia symptoms can occur when precipitating factors (like stress) also contribute. Chronic insomnia develops when perpetuating factors (like bad sleep habits) are also added in. It is the combination of all three factors which leads to chronic insomnia.
The figure below sets out the 3Ps Model.
Figure source: https://sleeponitcanada.ca/sleep-disorders/chronic-insomnia/
- Factors that put a person at risk of insomnia.
In the 3Ps Model, Predisposing factors are characteristics that make you more likely to develop poor sleep. It may be your genetic make-up. We know insomnia can run in families. An individual’s personality may make them more prone to anxiety or depression. Or they may have a strong perfectionist streak that leads to undue worry, unrealistic standards and a tendency to criticise themselves and/or others. Individuals with these types of personalities may find getting a good night of sleep more difficult.
We also know that being female may put you more at risk of poor sleep, although we don’t fully understand why this is the case. As people get older their sleep often becomes lighter and more fragmented (especially in the over 60s group) and this is also a predisposing factor to insomnia.
- Factors that can trigger acute insomnia.
We call these Precipitating factors and they include:
- Working long or irregular hours which disrupt your body clock (see Shiftwork or Body Clock)
- A crisis, such as a period of emergency threat, such as bushfire
- Fragmented sleep due to caring needs, such as with a newborn baby or sick relative (see Sleep Tips for New Mothers and Fatigue as an Occupational Hazard)
- Depression and Anxiety (see Anxiety and Sleep and Depression and Sleep)
- Relationship difficulties, financial worries and/or work stress
- Physical illness, hospitalisation and/or pain
- Grief and/or trauma (see Post-traumatic Stress Disorder)
- Menopause or Menstruation (see Menopause and Sleep and Menstrual Cycle and Sleep)
- Factors that maintain the poor sleep symptoms and can lead to chronic insomnia
There are some behaviours and beliefs, called Perpetuating factors, that make it more likely that a sleep problem will develop into chronic insomnia. Some of these are listed below. For more detail on each point see our fact sheet Common Mistakes with Sleep.
- Not going to bed and getting up at consistent times each day
- Poor sleep environment
- Not unwinding and preparing for sleep
- Spending too much time napping during the day
- Frequent use of sedative drugs
- Using alcohol to help sleep
- Television in the bedroom
- Staying in bed when unable to sleep
- Thinking the problem with your sleep is worse than it really is
- Ignoring the possibility of having a specific sleep disorder that needs attention
- Preventing chronic insomnia
Think about your individual predisposing, precipitating and perpetuating factors. What do you need to change to prevent chronic insomnia? Adopt Good Sleep Habits, and learn more about the various issues that can affect how well we sleep (see Understanding and Helping Poor Sleep).
If you believe you already have chronic insomnia you may need to talk to your GP about treatment options.
A Mindful Way (www.amindfulway.com.au) is an Australian six week digital online self-help program, that teaches mindfulness and cognitive-behavioural skills for sleep improvement at a cost. A Monash University randomised control pilot study showed completion of the program led to significant improvement in measures of insomnia. (This link is provided for information only and is not an endorsement of their products and services.)