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Behavioral model of insomnia

Predisposing factors for developing insomnia may include traits such as chronic hyperarousal and proneness to worry or rumination. Precipitating factors are events or acute stressors that interact with predisposing factors to cause acute insomnia symptoms. Perpetuating factors are maladaptive coping behaviors that are adopted to relieve transient insomnia symptoms but ultimately serve to maintain insomnia. (From: Spielman A, Caruso L, Glovinsky P. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 1987;10(4):541-53.)

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Associated Disorders

  • anxiety disorder
  • bipolar disorder
  • environmental disturbances, eg, noise, heat, cold
  • epilepsy, eg, nocturnal seizures
  • excessive consumption of beverages interfering with sleep, eg, alcohol, caffeine
  • gastroesophageal reflux disease
  • major depressive disorder
  • movement disorders, eg, Parkinson disease, restless legs syndrome, periodic limb movement disorder
  • neurodegenerative disorders, eg, Alzheimer disease
  • obstructive sleep apnea
  • painful conditions, eg, headaches
  • parasomnias, eg, REM sleep behavior disorder, nightmares, hypnagogic hallucinations, somnambulism, restless legs syndrome
  • psychotic disorders
  • stress-related disorder
  • substance use disorders
  • urinary disturbances, eg, enuresis