Insomnia and Anxiety (Series in Anxiety and Related Disorders) (4 page)

core of the model focuses on perpetuating factors in insomnia like a repetitive

thought process and maladaptive coping behaviors. Certainly, the presence of an

anxiety disorder could be a stressor that causes the initial sleep disruption to occur.

In such a case, we might expect the sleep disruption to resolve when the stressor

resolves; that is, we might not expect chronic insomnia. We would expect chronic

insomnia when perpetuating factors are activated. For example, whereas an anxiety

disorder may be the original impetus (stress) for sleep disruption, an individual’s

subsequent efforts to compensate for lost sleep could have a negative effect on the

sleep regulatory system and perpetuate a chronic (and comorbid) insomnia. In such

a case, we might anticipate the problem of residual insomnia after remission from

the treated anxiety disorder. Although the original stressor may have been removed

(i.e., via recovery from the anxiety disorder), there remains important untreated

perpetuating factors that sustain the insomnia problem. We say untreated because

as you will see in subsequent chapters, anxiety disorder treatments do not address

the thoughts and behaviors that lead to sleep dysregulation. Cognitive Behavior

Fig. 1.2
Proposed model for relation between anxiety and insomnia

References

9

Therapy for insomnia primarily targets the perpetuating causes of insomnia, as

these proximal factors become the primary reason for the insomnia’s continuation.

Some more distal, predisposing factors (e.g., maladaptive beliefs about sleep) may

also act as perpetuating factors, and are thus also targeted. Lastly, in cases wherein

the initial stressor was not an anxiety disorder and a chronic insomnia ensues (via

perpetuating factors), the experience of chronic distress/anxiety, worry about sleep

and functioning could potentially act as a stressor that could activate a more general

anxiety process and lead to the development of an anxiety disorder.

Summary

There is a close relationship between insomnia and anxiety. Unfortunately, our

understanding of this relationship has been hindered by faulty assumptions (i.e., insom-

nia is always a mere symptom). This is unfortunate given that insomnia can be

effectively treated in the context of a variety of comorbid disorders. Subsequent

chapters will elaborate further on the perpetuating factors of insomnia in anxiety

disorders and how to treat them with CBT for insomnia.

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Chapter 2

Considerations for Assessment

Abstract
Before we consider complex issues such as the relation between sleep

and anxiety, the sleep-related features of anxiety disorders, and the way sleep prob-

lems with co-existing anxiety are treated, it is imperative to consider diagnostic

and assessment issues. Thus, this chapter provides an overview of assessment and

measurement. While a comprehensive review of assessment techniques across all

sleep and anxiety disorders is beyond the scope of this book, we focus on com-

monly used and supported measures and techniques for assessment, including

physiologic, clinical, and structured interviews, and self-reported measures of sleep

and anxiety.

This book focuses on the relation between sleep and anxiety, the sleep-related

features of anxiety disorders, and the way the sleep problems are treated when there

is coexisting anxiety. Before we consider these diagnostic features and treatment

issues, it may be prudent to begin with an overview of assessment and measurement.

A thorough review of assessment techniques across all sleep and anxiety disorders

is beyond the scope of this book, but we provide information on commonly used

measures and techniques for assessment.

Assessment of Sleep

When thinking about the assessment of sleep, many people conjure an image of a