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Chronic Insomnia / Insomnia Disorder

Risk Factors & Development

Factors of the 3P model that contribute to the development of insomnia disorder include:

Predisposing factors that place an individual at greater risk of developing insomnia

  • Predisposition to anxiety, stress or worry
  • Inappropriate expectations about sleep
  • Genetic factors

Precipitating factors that trigger/cause the initial sleep disturbance

  • Stressful life event including death in family, relationship difficulties, job loss, starting a new job, newborn
  • Pain
  • Menopause
  • Shift work including hospitality work
  • Travel between time zones and circadian disruption (daylight savings)
  • Environmental factors (noise disturbance, temperature)
  • Caffeine and alcohol
  • Medication with stimulant properties
  • Mental health disorders (which often have a bidirectional relationship with insomnia)
  • Medical disorders including respiratory, cardiovascular, endocrine, neurological, gastro-oesophageal reflux, frequent nocturia, and itch
  • Other sleep health disorders including obstructive sleep apnea, restless legs syndrome

Perpetuating factors that self-maintain the chronic insomnia over time

  • Conditioned insomnia or learned insomnia
  • Anxiety about sleep
  • Counter-productive compensatory behaviours
  • Misperceptions about the quality and quantity of sleep
  • Dysfunctional beliefs about sleep

Source: Alexander Sweetman


AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset