Common symptoms of hyper-arousal in insomnia are high levels of arousal that interfere with non-restorative sleep, sleep maintenance problems, and sleep initiation issues.

Hyper-arousal Symptoms of Insomnia

The metacognitive model of insomnia posits that the hyperarousal experienced during insomnia can be split into two areas. The first area is primary arousal, which includes the cognitive activities related to ones inability to fall asleep. The second area is secondary arousal, which refers to one’s relationship with their thoughts about sleep. 

University of Michigan - Ann Arbor

A sleep disorder that consists of not getting enough sleep.

Insomnia

Insomnia is a common health concern that causes significant distress and disruption in daily life, due to difficulty with and lack of sleep. Insomnia tends to be associated with an increased risk of developing physical health problems, anxiety, and depression.

Insomnia 

Metacognitive awareness is the acknowledgement that one's thoughts are only thoughts, and they may not be facts. When used as a definition of mindfulness, it is called mindful metacognition, and conceptualizes mindfulness as an information processing style.

Mindful Metacognition/Metacognitive Awareness

Insomnia, the most prevalent sleep disorder, is characterized by a persistent difficulty in initiating or maintaining sleep. Individuals with this condition often experience significant delays before falling asleep and may wake up frequently during the night, struggling to resume sleep. According to diagnostic criteria, these sleep disturbances must occur at least three nights a week for a minimum of one month.

Ong, J. C., & Moore, C. (2020). What do we really know about mindfulness and sleep health? Current Opinion in Psychology, 34, 18–22. https://doi.org/10.1016/j.copsyc.2019.08.020

What do we really know about mindfulness and sleep health?

- sleep-onset insomnia
- sleep-maintenance insomnia

Kinds of Insomnia

Metacognitve Model of Insomnia

- Stimulants
- Antidepressants
- Corticosteroids
- Beta agonists
- Antiparkinsonian agents

Drugs that induce insomnia:

- Trouble falling asleep
- Difficulty staying asleep
- Waking up too early
- Poor quality of sleep overall

Symptoms of insomnia

Cognitive Behavior Therapy for Insomnia is the most widely used and recommended psychological treatment for chronic insomnia. CBT-I uses interventions involving sleep hygiene, stimulus control, sleep restriction, and cognitive therapy. CBT-I is moderately effective, but may not address hyper-arousal, which is known as a perpetuating factor for insomnia. If CBT-I is not effective in reducing hyper-arousal, then Mindfulness-Based Therapy should be used as treatment for chronic insomnia. MBTI uses the development of a metacognitive process and meditation practice to reduce cognitive and physiological hyper-arousal.Through the improvement of maladaptive thinking instead of challenging content directly, MBTI is ideal to improve sleep for those who do not respond to CBT-I.

Insomnia: The Difference in Treatment between Cognitive Behavior Therapy (CBT-I) and Mindfulness-Based Therapy for Chronic Insomnia (MBTI)

This qualitative study explores how sleep in older adults is increasingly framed as a problem requiring medical or pharmaceutical attention. Through interviews with UK health professionals, the authors find that sleep issues in older age are often normalized, yet insomnia is also increasingly viewed through a medical lens, especially in general practice. However, medicalization is uneven: doctors often express reluctance to prescribe, and some are moving toward non-drug interventions or “de-pharmaceuticalisation.”

Medicalisation, Pharmaceuticalisation, and the Sleep Problematisation of Older Age in the UK


Most general practitioners try to address sleep with non-pharmacological methods- suggesting lifestyle adjustments, sleep hygiene, or brief self-help tools- first before considering medication. When hypnotics are prescribed, it’s often seen as a reluctant compromise. General practitioners are wary of habit formation, side effects, or simply not being effective long term. In addition, growing regulatory scrutiny over hypnotics (like benzodiazepines and Z-drugs) is pushing prescribers toward shorter courses and stricter criteria. All of this suggests a potential future shift towards “de-pharmaceuticalisation”. 

Current Insomnia Treatment Patterns

For a clinical diagnosis of insomnia, the characteristic difficulties with falling or staying asleep must meet specific frequency and duration thresholds. The symptoms are required to be present for at least three nights per week and must persist for a minimum of one month.

Diagnostic Criteria for Insomnia (Frequency and Duration)

A common issue for those with insomnia is developing anxiety about their inability to sleep. This anxiety increases physiological arousal, which in turn makes falling asleep more difficult, thereby reinforcing the anxiety and creating a self-perpetuating cycle.

Self-Perpetuating Cycle of Insomnia and Anxiety

Chronic insomnia is almost invariably linked with feeling overtired. Additionally, it often co-occurs with symptoms of depression, indicating a strong association between long-term sleep difficulties and mood disorders.

Association Between Chronic Insomnia, Fatigue, and Depression

A variety of factors can contribute to the development of insomnia. These include an individual's age, use of certain drugs, amount of physical exercise, mental state, and established bedtime routines.

Factors Contributing to Insomnia

For many college students, the inability to get the recommended 7–9 hours of sleep nightly is not a result of lifestyle choices like partying or studying late. Instead, it often stems from feeling overwhelmed and stressed, which directly interferes with their ability to fall asleep or stay asleep.

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