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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ALCOHOL AND THE BODY: ABSORPTION


So what happens to alcohol in the body? Surprisingly, absorption of alcohol begins almost immediately, with a very small amount being taken up into the bloodstream through the tiny capillaries in the mouth. But the majority goes the route of all food when swallowed: into the stomach. If other food is present in the stomach, the alcohol mixes with it. Here, too, some alcohol seeps into the bloodstream. Up to 20% can be absorbed directly from the stomach. The remainder passes into the small intestine to be absorbed. The amount of food in the stomach when drinking takes place has important ramifications. Alcohol is an irritant. It increases the flow of hydrochloric acid, a digestive juice secreted by cells of the stomach lining. Anyone who has an ulcer and takes a drink can readily confirm this. This phenomenon also explains the feeling of warmth in the tummy as the drink goes down. The presence of food acts to dilute the alcohol and therefore diminishes the irritant properties.

The amount of food in the stomach is a big factor in determining the speed with which the alcohol is absorbed by the bloodstream. The presence of food slows absorption. How quickly alcohol is absorbed depends on the total amount and the relative proportion of alcohol in the stomach contents. The significance of the rate of absorption is that it is largely responsible for the feelings of intoxication—thus, the basis for the advice to avoid drinking on an empty stomach. In addition to the impact of food in the stomach, the rate of absorption varies with the type of beverage. The higher the concentration of alcohol in a beverage (up to 50%, or 100 proof), the more quickly it is absorbed. This partially explains why distilled spirits have more apparent "kick" than wine or beer. In addition, beer contains some food substances that slow absorption. Carbon dioxide, which hastens the passage of alcohol from the stomach, has the effect of increasing the speed of absorption. Champagne, sparkling wines, or drinks mixed with carbonated soda give a sense of "bubbles in the head."

Meanwhile, on from the stomach to the pyloric valve. This valve controls the passage of the stomach's contents into the small intestine. It is sensitive to the presence of alcohol. With large concentrations of alcohol, it tends to get "stuck" in the closed position. When this pylorospasm happens, the alcohol trapped in the stomach may cause sufficient irritation and distress to induce vomiting. This phenomenon accounts for the nausea and vomiting that may accompany too much drinking. This "stuck" pylorus also may serve as a self-protective mechanism by preventing the passage into the small intestine of what might otherwise be life-threatening doses of alcohol.

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