We have seen that insomnia over time has moved from being seen as a symptom of another issue into being seen as an issue worth treating on its own. Since 2013 the DSM-5 has stated that regardless of whether it is a symptom, or the primary issue insomnia should be addressed in isolation. It is now known as ‘Insomnia Disorder.’
So, what are the 3 Ps? Insomnia while relatively easy to diagnose its cause is not so easy. There can be multiple factors, any one of which could be in isolation the reason or one of many reasons for triggering or causing insomnia.
Because of this, since the 1980’s, the 3 P’s model for understanding reoccurring health issues was brought into sleep science. The 3 Ps stand for predisposing, precipitating and perpetuating.
Predisposition to insomnia
In itself, not a cause but undoubtedly a contributing factor is the predisposition to it. But how do we develop or have an inclination to insomnia? Is it hereditary? Well, the jury is out on the latter point, but if your family are known poor sleepers, this could become part of your identity, of how you see yourself, by association or by falling into similar patterns and lifestyles as close family members.
This falling into the identity of being ‘an insomniac’ or ‘suffering from insomnia’ is something we can perhaps change through Metacognitive NLP and meditation. By redefining ‘the story of me’ we all subscribe to.
Precipitating factors in our insomnia
A precipitating factor is a trigger, that is something that causes or fires insomnia. It could be a life-changing event such as a breakup, the death of a loved one, a problem at home or work such as an argument and so forth. Often these are quite easy for the insomniac to self-diagnose or see for themselves after the sleepless episode. Often constant thoughts and feelings around the trigger being the thing that is keeping them up all night are and aid to diagnosing the precipitating factors.
The third and final P is that of perpetuation. This P as it sounds covers issues that may preserve, prolong or enhance the condition. Such as those thoughts that keep you up all night. On top of these can be issues such as anxiety and depression or contributing factors such as drinking too much coffee or lousy bedtime behaviour.
Ok well, those are sources of definitions of the words but what are the medical and scientific understandings in more detail.
Now let’s get a bit more Scientific
Why is the science relevant to our understanding of insomnia? Well, the science is important because science can go a long way to treating and helping us live with and understand our insomnia. It’s not the only source of information, understanding or treatment but is an important part.
Some scientific history of diagnosis:
In the 1980’s insomnia was defined as a symptom of but not a primary disorder. A symptom of other disorders such as depression or other mental or physical primary disorder.
The treatment for this was to either focus on the primary disorder and hope that insomnia will sort itself out by sorting out the main confusion or to ignore insomnia as of no major concern or if treated use hypnotics as a short-term treatment.
Chronic insomnia was defined as occurring only as part of another psychological or physical illness.
Author's side note: this probably goes some way to explaining why as we grew up and as an when we talked about or heard others talk about the fact they can't sleep or we have insomnia the usual response was “why what's on your mind?” or “you must be depressed” and so on. If the doctors, psychologists and scientist were thinking along these lines back then-then it would no doubt filter down into society through the media.
Around about 2005 this viewpoint and understanding within the scientific community changed somewhat (I have mentioned this in a previous blog post, but as this is becoming part of what is hoped to be a continuing series it's worth going back over).
In 2005, insomnia changed from being classed as a symptom to being classed as a disorder in its own right. It was seen to be typically combined with other disorders or illnesses, but this is a necessary change in classification.
It was now acknowledged that chronic insomnia did indeed exist and it in itself should be treated. Whether seen in conjunction with another disorder or not.
Author’s side note: this should have been a sigh of relief for those of us who have lived with insomnia for some years and had become convinced that there must be something psychologically or physiologically wrong with us other thaninsomnia because well society was telling us so. I remember many a time thinking “well I don’t feel depressed or ill but Imust be, everyone keeps telling me so, maybe I just can't see it”. As insomniacs, we all know how the internal dialogue of “why can’t I sleep?” or “I hope I can get some sleep tonight” becomes the thing that will keep us awake in a vicious spiralling circle.
Treatment was from that point on, in 2005, focused on both insomnia and the illness or disorder itself. Often finding that treating insomnia helped treat the illness or disorder.
In 2014, DSM-IV-TR stated used to diagnose insomnia said it is that the predominant complaint is difficulty initiating or maintaining sleep, or nonrestorative sleep, for at least 1 month.
This is important because now not only does it become a disorder in its own right but it has the criteria for diagnosis. This is not "important” in the understanding of the word so that you can tell everyone you have the diagnosable disorder, but more importantly, so you have it taken seriously by your doctor and treatment be found.
It also means that we can get away from the endless nights of self-pity and torment about why we have insomnia and what can it mean and means we can move to say “I have insomnia how am I going to live with it?”. At InsomniaChat.com, we believe acceptance is crucial. Once you accept insomnia as part of your life, you go from suffering from insomnia to living with insomnia, this is a fundamental change in mindset.
So now we have some understanding of diagnosing insomnia and its meaning in our next blog we will look into the Cause and Effect of Insomnia.
In fact, lets, in the future we will look a little deeper into what insomnia is and where this relatively new phenomenon came from.
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