Health promotion & screening

Definition: subjective complaint of difficulty falling asleep, staying asleep, poor sleep quality or

Biological Psychological Social

 Hyperarousal
Predisposing  Worry  Incompatible bed partner,
 Hyperactivity
factors  Excessive rumination sleep schedule
 Weak sleep generating system

  in social env requiring acute

Precipitating  Medical illness  Acute stress reaction
shift in, or disruption, patients
factors  Injury  Psychiatric illness
preferred sleep phase

 Maladaptive strategies to get more sleep/recover from sleep loss

 Excessive time in bed
Perpetuating
 Staying awake while in bed
factors
Perpetuating factors are the focus of therapy. Patients may also worry/ruminate about the consequences of
poor sleep or adopt unhelpful beliefs about sleep promoting practises.

Patient suitability
Regardless of primary diagnoss, CBT is appropriate for patients p/w:

CBT for insomnia

 Stimulus control therapy
Patient may have associated bed/bedroom with behaviours incompatible w/ sleep.
 Re-establishes bed + bedroom as strong cues for sleep, retrains circadian sleep-

Cognitive biases
Patients may p/w many types of cognitive errors
 Misattribution

Biological Psychological

Predisposing
 
factors

Precipitating
 
factors