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Healthinmind/Mental 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: Desperately Seeking Snoozin' : The Insomnia Cure from Awake to Zzzzz by John Wiedman Say
Goodnight to Insomnia by Gregg D. Jacobs Links to related sites on the web:
Last updated 12/19/03 |
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