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Insomnia
Erin N. Bosman
University of Wisconsin- Eau Claire; Harlaxton College

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Insomnia
Sleep Onset, Sleep Maintenance, Terminal Early Awakening, and Mixed
Sleep Problems are four types of sleep problems associated with insomnia. Insomnia is
correlated with a variety of problems such as distress in essential areas of daily life such
as occupational and social settings (Ritterband, L., & Clerkin, E., n.d.). Insomnia, which
is one of the most common sleep disorders, is characterized by inadequate sleep. It is not
necessarily a result from the hours of sleep an individual receives but rather a result from
the quality of sleep (Insomnia, 2015).
Insomnia can be divided into a variety of categories. In primary insomnia there is
no obvious cause of insomnia while in secondary insomnia there is insufficient sleep due
to disease, stress, or medicinal side effects. It can also be categorized by the length of
time the disorder occurs for and the effect it has on the sleep pattern. When a person
cannot sleep throughout the night, it is called sleep maintenance insomnia. Sleep onsets
insomnia occurs when the individual has difficulty falling asleep (Insomnia, n.d.).
Irritability, exhaustion, and disorientation can all occur as a symptom of insomnia.
In order to be diagnosed with insomnia, patients show a record of the symptoms they are
experiencing and representation of their difficulty sleeping. Often times, sleep history is
shown through a sleep diary. Individuals are evaluated from their medical history, as
well. Generally, the patient has a complaint about difficulty falling or staying asleep.
However, insomnia can occur as a symptom of other sleep disorders such as sleep apnea
or narcolepsy (Insomnia, 2015).
Following diagnosis, Insomnia can be addressed in a number of ways including
sleep restriction, sleeping pills, avoidance of psychoactive drugs, and cognitive

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behavioral therapy. Sleeping pills work for some individuals, but not for others. Due to
this and the fact that sleeping pills have side effects, they are often not recommended for
treatment. However due to their wide availability both over-the-counter and through
prescription, individuals will often attempt to cure their insomnia through sleeping pills
before trying other forms of treatment (Insomnia, n.d.).
Cognitive behavioral therapy for insomnia, CBT-I, helps to identify thoughts and
behaviors that result in sleep problems and replace them with thoughts and behaviors that
encourage sleep. Patients will be encouraged to use their cognitive abilities to recognize
and eliminate negative thoughts, and stressful thoughts. Often times, this is done through
keeping a sleep diary for a couple weeks.
For the behavioral therapy of CBT-I, individuals are encouraged to avoid
behaviors that may be inhibiting sleep and to develop good sleep habits. Some habits
recommended, dependent on apparent causes of the individual's insomnia, are sleep
restriction, stimulus control therapy, and biofeedback. Stimulus control therapy helps
remove the factors that have potentially conditioned the mind to resist sleep such as
through the process of setting a specific sleep schedule and avoiding taking naps. This
also is often done through having the patient avoid being in their bed, unless they are
sleepy. Sleep restriction causes partial sleep deprivation, to increase the individual’s
drowsiness for the following night. After sleep is improved, the individual's time spent
sleeping gradually becomes increased instead of restricted. Finally, biofeedback requires
the individual to observe biological signs throughout the day such as heart rate and
muscle tension. Then, the individual is told how to adjust these factors in order to both
improve and identify sleep patterns (Insomnia treatment: Cognitive behavioral therapy

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instead of sleeping pills, 2014). In addition, some of the techniques used in CBT-I, are
also used as individual treatments such as sleep restriction (Ritterband, L., & Clerkin, E.,
n.d.). Cognitive behavioral therapy for insomnia is often used for long-term treatment
while sleeping pills are used for short-term treatment. Sleeping pills can provide an
immediate solution when needed but are often avoided for long periods. In long- term
cases, other treatments are preferred such as CBT-I, chronotherapy, and relaxation
techniques (Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills,
2014).
Emotional, neurological, and cognitive factors can lead to insomnia. There are a
number of causes of insomnia including jet lag, sleep pattern disturbances, stress,
excitement, and medicinal side effects. It can result simply from one factor or a number
of factors but can be addressed and treated through a variety of treatments including
chronic behavioral therapy and sleeping pills, and can last for a few days or for a long-
term period. Treating Insomnia can be as simple as acquiring healthy habits of exercising
and having a set schedule, or it can require further treatment such as a sleep test.

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References
Insomnia. (2015, February 17). Retrieved April 11, 2015, from
https://www.psychologytoday.com/conditions/insomnia
Insomnia. (n.d.). Retrieved April 11, 2015, from http://www.sleepdex.org/insomnia.htm
Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. (2014,
February 11). Retrieved April 11, 2015, from
http://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-
treatment/art-20046677
Ritterband, L., & Clerkin, E. (n.d.). Insomnia. Retrieved April 11, 2015, from
https://www.div12.org/PsychologicalTreatments/disorders/insomnia_main.php