Page 45 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Psychosomatic influences on insomnia

and contribute to the perpetuation of insomnia. Somatic essential for gathering detailed information about a
conditions can also lead to maladaptive behaviors that patient’s sleep history, psychological state, and somatic
perpetuate insomnia, such as avoiding physical activity due symptoms. Interviews should explore the onset, duration,
to pain or discomfort, which can disrupt sleep patterns and and nature of sleep disturbances, as well as any associated
reduce sleep quality. 64,65,82,83 In some cases, individuals may psychological or physical factors. Patients may be asked
engage in behaviors that they believe will improve sleep to maintain a sleep diary over a period of 1 – 2 weeks.
but that actually worsen it, such as spending excessive time The diary typically includes entries on sleep onset, wake
in bed or using sleep medications inappropriately. times, nighttime awakenings, sleep quality, and daytime
functioning. This tool helps to identify patterns in sleep
3. Diagnosis of psychosomatic insomnia behavior and the impact of psychosomatic factors on sleep.

Diagnosing psychosomatic insomnia requires a nuanced Several validated questionnaires and self-report scales can
approach that considers the intricate interplay between be used to assess insomnia severity, psychological distress,
psychological, somatic, and neurobiological factors. The and somatic symptoms. Commonly used tools include: the
diagnostic process involves identifying the underlying Insomnia Severity Index, a widely used questionnaire that
psychosomatic influences that contribute to sleep assesses the severity of insomnia and its impact on daily
88
disturbances, distinguishing psychosomatic insomnia life; the Pittsburgh Sleep Quality Index, a comprehensive
from other sleep disorders, and utilizing appropriate tool for assessing sleep quality and disturbances over the
89
assessment tools to accurately evaluate the condition. past month; the Beck Depression Inventory and Beck
Anxiety Inventory, tools that assess the presence and
3.1. Diagnostic criteria severity of depressive and anxiety symptoms, which are
often associated with insomnia; the Brief Pain Inventory,
90
The diagnosis of psychosomatic insomnia typically relies a tool for assessing the severity of pain and its impact
on a combination of clinical criteria that reflect the on daily functioning, useful in cases where chronic pain
psychological and somatic components of the disorder: contributes to insomnia; polysomnography, employed
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(i) Difficulty initiating sleep, maintaining sleep, or in cases where there is a suspicion of coexisting sleep
experiencing non-restorative sleep, occurring at least disorders such as sleep apnea, or when the diagnosis is
3 nights per week for a minimum of 3 months 84,85
(ii) The presence of sleep disturbance that is significant unclear; and actigraphy, a non-invasive method involving
wearing a wristwatch-like device that monitors movement
enough to cause distress or impairment in daytime to estimate sleep patterns over several days or weeks. 92
functioning
(iii) The presence of psychological factors that contribute 4. Treatment strategies
to the onset or maintenance of insomnia, such as
stress, anxiety, or depression, which manifest as Effective treatment of psychosomatic insomnia
excessive worry about sleep, cognitive hyperarousal, requires a multidisciplinary approach that addresses
or emotional dysregulation 86 the psychological, somatic, and behavioral aspects
(iv) Manifestation of somatic symptoms or chronic medical of the disorder. Treatment strategies typically involve
conditions, including chronic pain, gastrointestinal a combination of psychological interventions,
issues, respiratory problems, or other sleep-interfering pharmacological approaches, integrative and holistic
physical conditions, that may contribute to sleep therapies, and lifestyle modifications.
disturbances 4.1. Psychological interventions
(v) The presence of significant daytime impairment due to
sleep disturbances, such as fatigue, mood disturbances, Psychological interventions are central to the treatment of
cognitive impairment, or decreased quality of life psychosomatic insomnia, particularly given the significant
(vi) The presence of sleep disturbance is not accounted for role of cognitive and emotional factors in the disorder.
by another sleep disorder (e.g., sleep apnea and restless As the gold-standard psychological treatment for
legs syndrome) or causally related to the effects of insomnia, cognitive-behavioral therapy for insomnia
substance use or medication. 85-87 (CBT-I) can effectively address both cognitive and
behavioral aspects of the disorder. 93-95 The core components
3.2. Assessment tools
of CBT-I include cognitive restructuring, which focuses
Accurate diagnosis of psychosomatic insomnia requires on identifying and challenging dysfunctional beliefs
the use of various assessment tools that help identify and attitudes about sleep, such as catastrophic thinking
the contributing factors and severity of the disorder. about the consequences of poor sleep or unrealistic sleep
Structured or semi-structured clinical interviews are expectations. Sleep restriction therapy is a well-known
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Volume 3 Issue 1 (2025) 39 doi: 10.36922/jcbp.4588