Health Disorders/Sleep Disorders
Primary Insomnia is the first and
best-known of the dyssomnias. To be diagnosed, the insomnia
must be present for at least a month and must cause the usual
significant distress or impairment. There are also
"exclusionary clauses;" it must not be a result of a
mental disorder or a medical (including substance-related)
condition. Insomnia is diagnosed more often among older people and
women than among younger people and men.
Most people with insomnia report difficulty in
falling asleep and in staying asleep, but a minority report simply
that their sleep is not restful. There is often a vicious cycle;
the less they sleep, the more they worry about not sleeping, and
the less they sleep. The lack of sleep can, in turn, lead to
irritability, frustration, poor concentration, and depressed mood
during the day.
Before Primary Insomnia can be diagnosed, the
examiner must be very careful to exclude "secondary"
mental or physical causes that might underlie the insomnia. The
worst offenders may well be prescription or non-prescription
medications used to induce sleep; these medications typically lose
their effectiveness and may produce a rebound effect after a few
uses, and may be very addictive. If a substance, even one as
commonplace as caffeine, is preventing sleep, Primary Insomnia
would not be diagnosed.
Many clinicians and many specialized sleep
clinics are adept at treating insomnia. The insomnia in many cases
has an environmental cause that can be eliminated; some people
drink coffee too late in the day, and stopping that habit may
reduce the insomnia. Exercise, like caffeine, should not be taken
too late in the day, but can be a great help to many people.
People with insomnia may profit from examining
their own behavior carefully and exercising good sleep hygiene.
Some examples of good sleep hygiene are seeking exercise and
avoiding stimulants, avoiding taking sleep medications or
daytime naps, not staying in bed longer than the number of hours
of sleep required, not exaggerating the amount of sleep needed,
and not using the bed for other activities besides sleep (no TV in
bed, reading in bed, eating in bed, and so on). Experts also
recommend that people with insomnia avoid excitement, especially
conflict, just before bedtime. Good sleep clinics have expertise
in these and other matters, in addition to specialized equipment
to analyze the precise nature of the person's difficulty.
An article in the Journal of the American
Medical Association indicates that behavior therapy alone can
be effective in treating many cases of insomnia. Dr. Jack Edinger,
the lead author, says that cognitive behavioral therapy could be
effective within six weeks, and the effects were still present at
a 6-month follow-up. Participants in the cognitive behavioral group
in their study reduced their wake time by 54 percent on average,
while patients in a relaxation group reduced their wake time by
only 16 percent, and those given a placebo sleeping pill reduced
their wake time by only 12 percent. A great advantage of the
cognitive behavioral approach is that there are no side effects or
danger of addiction.
The following books may be helpful:
Seeking Snoozin' : The Insomnia Cure from
Awake to Zzzzz by John Wiedman
Goodnight to Insomnia by Gregg D. Jacobs
More Sleepless Nights by Peter Hauri, Shirley Linde, Philip
Links to related sites on the web:
from the U.S. Food and Drug Administration
for practical information on sleep problems.
Although sleeping pills are not recommended as a solution, clicking
here will take you to a list of drugs sometimes used for
Last updated 12/19/03