Bad nights versus insomnia disorder
Everyone has a bad night from time to time.
However, for some, the one bad night turns into a steady stream of bad nights. Suddenly, you are not having a bad night anymore. You have insomnia.
The question is: why do sleep problems sometimes stick around?
In this post, I describe the 3P model, which is a theory developed by Dr. Arthur Spielman. The 3P model gives us a framework to understand how insomnia develops and why it sometimes does not go away.
The 3P Model – Defining the Terms
The 3P model stands for: Predisposing, Precipitating, and Perpetuating.
1. Predisposing factors: Predisposing factors are essentially anything that makes you more vulnerable to having sleep problems.
2. Precipitating factors: Precipitating factors are the things that set off bad nights.
3. Perpetuating factors: Perpetuating factors keep our sleep problems going over time.
Let’s get into each one a little deeper.
Predisposing factors
Predisposing factors are things that make it a little easier for some folks to end up with bad nights compared to other folks.
For example, there are some people who tend to worry a bit more or are more reactive to stress. Therefore, when something happens in their life, they tend to be more stressed. As a result, their sleep takes a bigger dip.
Take a moment to consider if there’s anything that makes you more vulnerable to sleep problems. Perhaps you are more sensitive to caffeine. Maybe you are prone to ruminating and stressing out when something goes wrong. Or you have a bit of back pain that makes your sleep a little lighter. All of these can be predisposing factors – it doesn’t mean that you will have insomnia, but it can make you a little more susceptible to sleep problems.
Precipitating factors
Precipitating factors can be basically anything that leads to the start of sleep problems. For example, travelling to a different time zone, having a baby, going through a breakup, studying for an exam, or starting a new job.
As you can see, pretty much anything that causes some stress can be a precipitating factor – regardless of whether it’s a good thing (like starting a new job) or a bad thing (like losing a loved one).
The fact that our sleep takes a dip when we are stressed makes complete sense from an evolutionary perspective. In ancient times, when there is danger (like a bear attack) we wouldn’t want to be asleep for it!
The point is not to never have a bad night. The point is to make sure it goes away when the stressor is over. However, sometimes sleep problems do not go away. This is because of the third P.
Perpetuating factors
Sometimes, when people have sleep problems, they begin to change the way they think about sleep and their associated behaviours throughout the day when they have a bad night. This can lead to perpetuating factors that maintain sleep problems.
Importantly, the perpetuating factors are what we focus on in therapy in order to break the insomnia cycle.
When there are multiple bad nights, some folks start worrying about. their sleep. They get scared that they won’t get enough sleep or that it will affect their day.
This can lead to ways of coping that help with anxiety in the short term but do not help in the long term – like going to bed early or reducing activity to save energy throughout the day. However, from what we know about the science of sleep, these behaviours can actually make our sleep problems worse.
For example, spending too much time in bed can affect how much deep sleep we get. It’s kind of like wearing a size 10 shoe when you have size 7 feet. Therefore, if we spend 10 hours in bed but only need 7 hours of sleep, our sleep is very light and we spend a lot of time awake. Moreover, if we spend too much time in bed awake, our brain might start associating the bed with wakefulness (and worrying). This can make it even harder to sleep.
If you’re interested, here’s more information on the how to fix the causes of insomnia disorder.
How the 3P’s all fit together
Here is a visual diagram on how the 3P model comes together. As you can see, the predisposing factors make us a little more vulnerable to sleep problems. When a precipitating event comes up (like an exam or a travel event to a different time zone), it makes it easier for us to cross the insomnia threshold. Usually, this is not an issue and you can see the sleep problems go away when the stressor disappears.
However, sometimes the perpetuating factors take hold and that’s when common sleep disturbances starts moving into insomnia disorder category.
It is important to know when these factors are taking hold because they are the thing we need to address. This article helps you to learn more about the frontline recommended treatment for insomnia disorder – CBT for insomnia.
Best wishes,
P
Simply mental health 