How does insomnia become chronic?
The development and maintenance of insomnia over the long term generally involves three factors : predisposing (the individual's vulnerability to sleep problems), precipitating (insomnia triggers) and perpetuating factors ( the means put in place by the individual to cope with insomnia and contributing to its long-term maintenance).
Everyone has some degree of vulnerability to insomnia based on biological variables (such as age, sex or genetic heritage); psychological (such as our tendency to ruminate or be anxious); and socio-professional (such as our working hours or family and social constraints). This predisposition will provide more or less fertile ground for the development of sleep difficulties.
In times of emotional stress and/or physical discomfort, insomnia is often one of the first symptoms to appear. Thus, an episode of acute insomnia may occur in the presence of more or less identifiable external triggers (a breakup, a move, the birth of a child, a medical condition, etc.). For most sleepers, however, sleep will normalize when the stressor is gone. At this stage, insomnia is not yet considered chronic.
THE PERPETUATING FACTORS:
For some individuals (perhaps those more vulnerable to sleep difficulties), insomnia is likely to become chronic if they begin to worry excessively about their sleep or the consequences of their difficulties. Thus, a person might begin to anticipate the negative consequences of their lack of sleep on the next day (“I’m still awake, I’m going to be a wreck tomorrow at work”) or to overestimate sleep difficulties (“I don’t haven’t slept a wink again all night”); which can cause a lot of anxiety. This emotional tension and futile attempts to fall asleep can then accentuate sleep difficulties.
With a view to countering insomnia or mitigating its consequences, the person may implement inappropriate behavioral strategies which – although sometimes effective in the short term – contribute to feeding the vicious circle of insomnia by further disrupting the sleep.
For example, these individuals will tend to spend more time in bed, hoping to increase their chances of recovering lost sleep, or they will avoid getting up when they cannot sleep for fear of missing the moment of sleep. falling asleep. It is often these perpetuating factors that maintain sleep difficulties over the long term. Once embarked on this vicious circle, the disappearance of precipitating factors will generally not be enough to put an end to sleep problems.
Find the first article in our sleep series here.
For more advice, do not hesitate to contact our specialist Clément Letesson.