PSYCHOLOGICAL CAUSES OF INSOMNIA

By far the most frequent source of insomnia is some form of mental or emotional disquiet. Since one primary biological reason for sleep is to provide the brain with a chance to rest, it is perhaps not surprising that one consequence of a troubled mind should be troubled sleep.

I must hasten to point out that in using such terms as "mental disquiet" or "psychological disturbance" I am not suggesting, by any stretch of the imagination, that people with insomnia are thereby crazy, or that their sleep troubles are "all in their minds." Quite the contrary. Insomnia is a very real, and very widely experienced, phenomenon. Insomniacs really do sleep less than other people, as measured not just by their own perceptions but clinically and scientifically in sleep laboratories. Nor do victims of insomnia have unrealistic expectations or beliefs about what constitutes a good night's sleep; studies have shown that insomniacs desire only the same amount of sleep as other people.

While it is true that insomnia is a feature of a number of severe mental disorders, including clinical depression, it may also appear when a psychologically healthy person's life is unusually stressful or tension-filled. Often people with sleep disorders have endured troubling situations over which they had no control—an unhappy home life during childhood, for example/ And the increasing pressure and pace of today's society adds to everyone's mental load. The primary purpose of labeling insomnia as largely psychiatric in origin is not to suggest that the disorder is illusory or that its victims are mentally disturbed but to call attention to the types of therapy that have the greatest chance of succeeding.

With that in mind, then, let me proceed to describe some of the behavioral patterns and mental attitudes that are frequently associated with insomnia. Perhaps you will recognize one or more of these traits in yourself or in a loved one who suffers from sleepless nights. If so, you will be better able to focus on the cause of the problem—the first step toward resolving it.

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PSYCHOLOGICAL CAUSES OF INSOMNIA: STUDIES INDICATING


Generally, studies indicate that patients with chronic insomnia report fewer positive experiences during childhood. This can mean a number of things. Perhaps their parents quarreled constantly or criticized harshly. Possibly there was violence or abuse in the home. There may have been few rewarding family relationships: no siblings, or too many lack of an extended family; little or no time to interact with parents due to conflicting or demanding work schedules. Perhaps the family moved often, making it difficult to find and sustain friendships or to establish one's role in a school or a community. In such cases, people often fail to develop a healthy sense of self-esteem. As a consequence, they find it difficult as time goes on to sustain healthy interpersonal relationships. They may also fail to develop adequate methods of coping with stress: in some cases, they may avoid confrontation rather than meet a problem or an opponent head-on.

One commonly found trait among insomniacs is their tendency to internalize their emotions. Perhaps as children they were discouraged from expressing their feelings or were ridiculed for their attitudes and behavior. In time, then, these people may have learned to suppress their feelings of anger or hostility or sadness—or even joy—either through habit or as a mechanism of defense against hurt or shame. Common wisdom and scientific research support the view that failure to express such feelings can result in physical as well as emotional consequences. Insomnia, as we are seeing, is one of them.

Emotional suppression is a vicious circle. To illustrate, let me relate an anecdote about a patient I'll call Howard. This thirty-eight-year-old man worked at two jobs in an effort to support his four children. Howard suffered from chronic gastrointestinal disorders—perhaps one reaction to the stress he felt. In one capacity, as an assembly-line worker at a leather-goods plant, he was called upon to stand for long, uninterrupted hours operating a drill punch. One day, plagued by diarrhea, he needed to leave his post virtually every hour. His boss, who had always been difficult to deal with, grew increasingly frustrated with each absence, since it disrupted the flow of work for the entire assembly line. Throughout the day, in the presence of other employees, the boss hurled insults and snide remarks at Howard, ridiculing his condition and mocking his perceived weakness. Howard confided to me later that he grew increasingly angry and had thoughts of violence toward the man, but he suppressed them since he depended so heavily on his job. Within a week Howard's condition grew worse, and he was fired for "laziness." The loss of income preyed on his mind, and Howard began to suffer a string of sleepless nights.

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