The Twilight Clinic knows all too well that Insomnia is a very common sleep disorder that affects many people. We all have suffered from insomnia at some point in our lives. It can be difficult to treat insomnia because it deals with many different variables. There are many causes for insomnia, and treatment needs to have a holistic approach. There are several models for treating insomnia. A very well-known and accepted model is known as the 3P Model.

3P Spielman Insomnia Model

The 3P Model is known by a few different names – the Spielman model, the three-factor Model, behavioral Model. As you can tell by the name, this Model deals with three factors: Predisposing Factors, Precipitating Factors, and Perpetuating Factors.

  • Predisposing factors include “biological factors” of the body that deal with sleep and wake, such as the “biological activation,” as discussed in a previous post. Other predisposing factors include “psychological factors” like worrying and the propensity to ruminate on things. Another predisposing factor is “social factors,” which can include things like your bed partner not having the same sleep schedule as you. This would also include circumstances that do not allow you to sleep your preferred schedule (shift work, taking care of a baby/child, school).
  • Precipitating factors include triggers that cause sleep disruption. Primary triggers could be from life stresses – both medical and psychiatric. Some people can pinpoint a major traumatic event in their life that caused their insomnia. However, some cannot.
  • Perpetuating factors include actions that someone does when trying to manage insomnia. These factors deal with what’s called “stimulus control.” These are wake activities in the bedroom, staying awake while in bed, and spending too much time in bed.

The 3P Model focuses more on the perpetuating factors. People with insomnia often spend way too much time in bed. They try to go to bed earlier or get out of bed later. They will often try and nap during the day. People do this because they hope it will allow them to sleep. It sounds good because you think it will help you “catch up” on the lost sleep. However, this is not the case. Little known fact, it can actually be very detrimental to sleep and worsen insomnia. The bed should only be used for sleep and sex until your insomnia has resolved. If you are awake and in bed, you should get out of bed if it’s been about 20 minutes (without looking at the clock). Once you are sleepy, then you can get back into bed. These techniques are related to what’s called “sleep hygiene techniques.”

Sleep Hygiene Techniques

If you have insomnia, the first step is to practice useful “sleep hygiene techniques.” These are specific behaviors that promote and improve sleep. These may seem very simple, but they do have a profound effect if you can do them. The key is consistency. It can be very difficult for people to change their behaviors. If you’ve had insomnia for a long time, it will not be an overnight fix.

Most of these recommendations to promote sleep are from the American Academy of Sleep Medicine:

  1. Keep A Sleep Schedule: Keep a consistent sleep schedule. Get up at the same time every day, even on weekends and during vacations. Set a bedtime that is early enough for you to get at least 7 hours of sleep.
  2. Do not go to bed unless you are sleepy
    • The 20 Minute Rule: If you don’t fall asleep after 20 minutes, get out of bed. This is very difficult to do because you are tired and the last thing you want to do is get out of bed.
  3. Bedtime Routine: Establish a relaxing bedtime routine, making it a nightly ritual that helps you fall asleep. Essentially, it is teaching your body it is time to sleep. 
  4. Sleep & Sex: Use your bed only for sleep and sex, nothing else. 
  5. Quiet & Relaxing: Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
  6. Bright Lights: Limit exposure to bright light in the evenings.
  7. No TV and No Cell Phone: Turn off electronic devices at least 30 minutes before bedtime. Screens emit a wavelength of light that will cause suppression of melatonin release from the brain. Some people can use “blue blocker” glasses to prevent this. This can help. However, if whatever you are watching on screen is too engaging, you will not be able to sleep.
  8. Light & Healthy: Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
  9. Keep yourself Healthy: Exercise regularly and maintain a healthy diet.
  10. Caffeine: Avoid consuming caffeine in the late afternoon or evening. 
  11. Alcohol: Avoid consuming alcohol before bedtime. 
  12. Fluids: Reduce your fluid intake before bedtime.
  13. No More Naps: Avoid napping during the day. If you take a nap during the day, you will take away from your sleep at night.
  14. Supplements: Consider natural supplements such as CBD or THC.
  15. Finding Your Center: Meditation and deep breathing techniques will help you relax and fall asleep.
  16. White noise: It can help to have soothing sounds such as nature sounds, ocean waves, and rainstorms to help you sleep.
  17. Relax Your Body: Take a hot shower or warm bath before bed.
  18. No More Snooze: When the alarm goes off in the morning, do NOT hit snooze. When you are up, get up and out of bed.
  19. Natural Sunlight: Make sure you get nice bright sunlight in the morning when you wake up.
  20. Know Your Sleep Schedule: If you tend to be more of a “night owl,” you might want to consider doing a night shift job so you can sleep during the day.
  21. Poor Fido: Don’t sleep with pets. This is tough for some, but it really helps.
  22. Therapy: Getting Cognitive Behavior Therapy for Insomnia is also an excellent and more pertinent solution.

If you’ve tried these things and are still having a difficult time, consider getting professional help. An evidence-based approach to treating insomnia is “Cognitive Behavioral Therapy for Insomnia” (CBT-I). It can take a few sessions to start seeing results. CBT-I is a holistic approach to insomnia, focusing on cognitive, behavioral, and psychoeducational interventions, which we will discuss in another post.

Contact Us For Sleep Study

I hope you found this helpful. Feel free to comment or leave a question. I hope you have a good night’s sleep! Twilight Clinic ensures that you can get a better night’s sleep when you need it. If you are interested in a Consultation or sleep study send us a message. That way, you can be on the road to a better night’s sleep.

Dr. James Davis,