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Understanding Insomnia and the 3 Ps

September 22, 2022
Understanding Insomnia Risk Factors: The 3 Ps Model
Understanding Insomnia and the 3 Ps

While recognizing insomnia seems easy — especially late on another sleepless night — understanding insomnia feels much harder. Looking at insomnia causes and risk factors can help us learn about our sleep patterns and find paths to better sleep. Sometimes, chronic insomnia can be traced to a certain time in your life. An event or medical condition may have caused you to have trouble falling asleep, and then your condition persists for weeks, months, or even years later. But in other cases, insomnia may have started for a reason that you can’t identify.

Why is insomnia so hard to shake? What can you do to overcome your insomnia? In this article, we’ll talk about understanding insomnia, the 3 Ps sleep model, and ways you can treat your sleep disorder.

How Do Your Thoughts and Feelings Impact Sleep?

Thoughts and feelings that cause stress or anxiety can quickly impact your sleep patterns. On a biological level, negative thoughts, emotions, and general stress can cause physiological responses.  Acute stress can increase the stress hormones adrenaline, noradrenaline, and cortisol, and also increase your heart rate and cause stronger contractions of the heart muscle. These physical changes can make it difficult to fall asleep at night, and it can cause you to be restless, waking up throughout the night.

Our thoughts and feelings have a significant effect on our sleep. It’s essential to manage your stress and your negative thoughts to get your sleep back on track. If you have a mood disorder like anxiety or depression, these can have a bidirectional relationship with sleep, causing a cycle where your depression or anxiety makes it more difficult to sleep, and your lack of sleep can worsen the symptoms of your anxiety or depression. These conditions may need further treatment and lifestyle changes if you want to get better, deeper sleep.

Arthur Spielman's Model of Insomnia

Outside of emotional triggers, there are a number of other insomnia risk factors. Sleep research pioneer Arthur Spielman introduced a model — commonly referred to as the 3 Ps model — to help understand the reasons behind insomnia in the 1980s.  Spielman’s research suggests three main factors contribute to insomnia:

  • Predisposing: as in risk factors for insomnia largely out of your control
  • Precipitating: risk factors that come right before the onset of insomnia
  • Perpetuating: risk factors that cause acute insomnia to continue and possibly evolve into chronic insomnia

In addition to explaining the reasoning behind insomnia, this model can also be used to explain how our thoughts and emotions can cause sleep disorders and other medical conditions including gastrointestinal disorders and chronic pain.

1. Predisposing Factors

Predisposing factors are the initial risk and factors that can contribute to someone having sleep problems. Just as you may be genetically predisposed to heart disease or cancer, the same could be said for insomnia. Predisposing factors don’t cause insomnia, they simply mean that if other P factors enter the equation, you’re more likely to develop sleep disorders. 

Some predisposing factors can technically be changed, but often doing so takes significant resources that many do not have available. For example, you live near train tracks or the airport and frequently wake up from the noise. Or maybe you have an irregular work schedule that causes you to work night shifts.

2. Precipitating Factors

Precipitating factors are the things that start you on a path toward insomnia. These factors may cause you to miss a few nights of sleep, which can lead to more sleepless nights. This cycle of lost sleep can continue until you’re experiencing clinical insomnia. These factors are typically short-term stressors that cause sleep disruptions, such as temporary stress or illness. Traumatic stressors can also be precipitating factors, such as the death of a loved one or a serious injury. 

It’s also important to note that precipitating factors don’t have to be one specific instance. There can be multiple situations that lead to you developing chronic insomnia.

Though precipitating factors may cause you to lose a few nights of sleep, most people are not pushed into chronic insomnia. Typically, if you’re experiencing sleepless nights for a few days or less than a couple of weeks, you’re dealing with acute insomnia. Chronic insomnia will often persist indefinitely unless it’s treated.

3. Perpetuating Factors

Finally we have perpetuating factors. If precipitating factors are causing you to lose sleep over time, you may begin to develop bad sleep habits. These sleep habits may help you overcome your initial sleep issues from the precipitating events, but they can cause you to have a desynchronized sleep schedule in the long term.

Here’s a concrete example:  Let’s say that stress from preparing your work presentation kept you up late for a few nights. Once your presentation is finished on Friday, you go home and take a nap to “catch up” on sleep. You also sleep in the next day for several hours more than normal to make up for the other nights where you had poor sleep. 

These habits can cause disruptions to your natural 24-hour sleep cycle. As you begin to lose out on sleep consistently, you may also start to get anxiety around bedtime, knowing that you’re going to have trouble falling asleep and staying asleep. This negative relationship with sleep contributes to perpetuating your bad sleep habits. As you can see, perpetuating factors that turn into precipitating factors can be causes of insomnia. 

The benefit of the 3 Ps model of sleep is that it gives us a framework to understand why we still experience insomnia even when our typical stressors and stressful events have been resolved. These triggers aren’t the reason you continue to lose sleep. Rather, it’s the thoughts and habits you developed as a result of these initial triggers that can cause insomnia.

How Behaviors Relate to Sleep Anxiety

Despite our best intentions, we often do things or think in ways that make our sleep worse. By identifying these harmful habits and perpetuating behaviors, you can start to work on changing them.

Remember, perpetuating behaviors, unlike many predisposing factors, are things that you actually have the power to change. While changing habits can be challenging, it’s more than possible with the right guidance, persistence, and support.

What Can You Do if You Suffer From Chronic Insomnia?

If you’re suffering from chronic insomnia, it’s not something that you just have to endure and power through. Insomnia is a treatable condition that affects many Americans every year. There are tools and methods to help you overcome your insomnia and get your sleep back on track. 

One of the best things you can do is work on your sleep hygiene. Sleep hygiene involves creating an ideal environment for sleep and developing good sleep habits. Here are some ideas to get you started on your journey to better sleep:

  • Optimize your sleep environment: If you’re trying to sleep with too many environmental stimuli, you may find it hard to fall and stay asleep. Make sure your room is dark, cool, and quiet. It’s also a good idea to get comfortable bedding. If you have predisposing risk factors for insomnia, like a partner with a late shift or a bedroom near a noisy intersection, you may want to try some items that can help reduce the impact these factors have. For example, an eye mask can block light from a partner turning on the bathroom light or earplugs and a white noise machine can help with muting sound.  
  • Stick to a sleep schedule: It’s a good idea to get your body used to a regular sleep schedule. Try to go to bed at the same time every night and wake up at the same time every morning, even on weekends. If you miss your sleep window, don’t get discouraged. No one can keep a perfect sleep schedule at all times. Just try again the next night and get back on track.
  • Exercise: Exercise is a great way to get a better night’s sleep. Make sure that you’re not exercising too close to bedtime, as this can cause you to feel energetic when you want to wind down for the night.
  • Watch caffeine and alcohol intake: While you don’t need to cut caffeine and alcohol from your life, you should make sure to avoid consuming either too close to bedtime. Caffeine can take up to seven hours to leave your system, depending on the individual. When you’re working on your insomnia, you may want to limit caffeine to early morning and early afternoon. For alcohol, it’s best to stop drinking four hours before your scheduled bedtime.
  • Try relaxation techniques: Relaxation techniques near bedtime can prepare your body and mind for sleep. Meditation, breathing exercises, light stretching, and progressive muscle relaxation are all great techniques to try. Mindfulness and meditation can be especially helpful for those with sleep anxiety.
  • Create a sleep routine: You want to create a positive association with bedtime and have positive thoughts leading up to going to sleep. A good way to do this is with an enjoyable and calming sleep routine that you look forward to. This might involve things like taking a warm bath, reading a relaxing book, or spending time with a pet.
  • Dim phone screens: Make sure to dim your phone screens near bedtime or switch them to night mode. Also, avoid looking at content or news that might be stressful.
  • Avoid large meals near bedtime: Large meals take time to digest, and digestion takes energy. This can cause you to feel more awake and make it difficult to fall asleep.

Getting into routine sleep habits and sticking to them is a great, natural treatment for insomnia.

Treatment for Sleep Disorders

Though sleep disorders like insomnia can be frustrating, they’re not untreatable. When you identify your perpetuating factors and practice good sleep hygiene, you can reverse the bad habits you’ve picked up and find a path to better sleep. With the right program, you can start experiencing the benefits of treatment in weeks, and the benefits can be lifelong.

You don’t have to go on the journey to better sleep alone. Sleep Reset can help!

Take Our Sleep Assessment

Sleep Reset is a self-sleep clinic you can do at home. With Sleep Reset, you’ll get a personalized sleep program designed to address your sleep concerns and help you fall asleep faster and wake up feeling refreshed. Our program uses science-backed and proven sleep methods to help you retrain your sleep without the need for sleeping pills or supplements.

Along with your custom sleep program, you’ll also get a dedicated sleep coach, sleep tracking, our sleep app, and more. You get all the tools and support you need to get better and deeper sleep. Sleep Reset helps you learn why you’re not sleeping well so you can stop waking up exhausted.

Take our sleep assessment today to see how Sleep Reset can help you!

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