CHRONIC INSOMNIA | SleepTech

The 3P Model of Insomnia

Chronic insomnia is best conceptualized using Spielman's 3P Model: Predisposing, Precipitating, and Perpetuating factors. While acute insomnia is typically driven by a precipitating event (stress, medical illness), chronic insomnia is maintained by the perpetuating factors (maladaptive behaviors, sleep-related anxiety, conditioned hyperarousal).

ICSD-3 Diagnostic Criteria

The diagnosis of Chronic Insomnia Disorder requires the following:

• Difficulty initiating sleep, maintaining sleep, or waking up too early.
• Adequate opportunity and circumstances for sleep.
• Associated daytime impairment or distress (e.g., fatigue, cognitive impairment, mood disturbance).
• The sleep difficulty occurs at least 3 times per week.
• The sleep difficulty has been present for at least 3 months.
• The sleep difficulty is not better explained by another sleep disorder (though it can be comorbid).

Hyperarousal and Polysomnography

Routine polysomnography is not indicated for the diagnosis of chronic insomnia unless another sleep disorder (like OSA or PLMD) is suspected. However, when recorded, patients with insomnia often show increased high-frequency EEG activity (Beta/Gamma bands) during NREM sleep, a physiological marker of cortical hyperarousal.

Detailed diagnostic criteria and physiological markers required to confirm this condition via polysomnography or clinical evaluation. Reliance on objective data is paramount.

Diagnostic Protocols

Refer to ICSD-3 classifications and ensure rule-out of confounding comorbidities prior to finalizing diagnosis.