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: HOWARD’S SLEEP PATTERN

Financial pressure caused Howard to work doubly hard. The added strain of a difficult boss exacerbated his gastrointestinal disorder, which, ironically, made the boss even harder to deal with. The escalating conflict led to Howard's termination, which in turn led to increasing financial pressure and, ultimately, to insomnia.

Obviously a complex case such as Howard's could not be resolved overnight. Merely advising Howard that he should have told his boss off or channeled his hostility into some constructive activity would have served no purpose. In the course of our conversations, however, this patient began to realize that he had been carrying a huge emotional burden by himself. Somewhere along the line he had been taught that to complain or ask for support from another person, especially his wife, was a sign of weakness which would mark him as unfit to support a family.

I explained to Howard that suppressing emotions has the unpleasant, and potentially dangerous, consequence of stimulating that part of our nervous system, the autonomic system, which is responsible for our unconscious activities such as heartbeat and breathing. We might feel anger and want to lash out at someone. If we trap that energy within, however, our bodies must find a way to expend it; they do so by increasing the activity in the systems not in our conscious control, including those regulating muscle tension and the constriction of blood vessels. Such activity tends to reach its peak at the end of the day, with the result that it disrupts our ability to sleep.

With encouragement, Howard began to communicate more openly with his family. As a result several things happened: ways were found to cut back on expenses and reduce the financial pressure to some extent. His wife took a part-time job, something she had wanted to do anyway but had not acted on for fear it would threaten Howard's position as breadwinner. Recently Howard reported that while things are by no means easy, by letting his family know the realities of his situation he discovered a previously unknown dimension of their love and support. His insomnia, I should add, has abated considerably.

Howard's story illustrates another factor of sleep disturbance: Its appearance is often connected to the occurrence of stressful life events. Such events can produce anxiety or depression and can cause us to ruminate about the situation in a cyclic and increasingly frustrating pattern. When people begin to have disturbed sleep, they also begin to worry that they won't get enough rest. In other words, ironically, they lose sleep worrying about whether they are going to lose sleep. Unless they realize that this pattern exists, either through their own efforts or with professional help, such people will continue to suffer.

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