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.

*16\226\8*
Portuguese Italian Spanish English French German

ALCOHOL AND THE BODY: BLOOD ALCOHOL CONCENTRATION

In considering the effects of alcohol, several questions come to mind. How much alcohol in how much person? How fast did the alcohol get there? Is the blood alcohol level rising or declining? Let us consider each of these in turn. The concentration of alcohol in the blood is our first concern. One tablespoon of sugar mixed in a cup of water yields a much sweeter solution than a tablespoon diluted in a gallon of water. Similarly, a drink with 1 ounce of alcohol will give a higher blood alcohol level in a 100-pound woman than in a 200-pound man. In fact, it will be virtually twice as high. Her body contains less water than his.

The second factor is rate of absorption, which depends on the amount and concentration of alcohol in the stomach and how rapidly it is ingested. So quickly drink a scotch on the rocks on an empty stomach, and you will probably be more giddy than if you drink more alcohol more slowly, say in the form of beer after a meal. Even with a given blood alcohol level, there is greater impairment the faster the level has been achieved. Impairment is based on both the amount absorbed and the rate of absorption. Finally, for any drinking occasion, there are different effects for a particular blood alcohol level, depending on whether the blood alcohol level is going up or coming down.

Once in the small intestine, the remainder of the alcohol (at least 80%) is very rapidly absorbed into the bloodstream. The bloodstream is the body's transportation system. It delivers nutrients the cells require for energy and picks up the wastes produced by cell metabolism. By this route, too, alcohol is carried to all parts of the body.

Although blood alcohol levels are almost universally used as the measure of alcohol in the body, this is not to imply that alcohol merely rides around in the bloodstream until the liver is able to break it down. Alcohol is both highly soluble in water and able to pass rapidly through cell walls. Therefore, it is distributed uniformly throughout the water content of all body tissues and cells. For a given blood alcohol level, the alcohol content in the tissues and cells varies in proportion to their amount of water. The alcohol content of liver tissue is 64% of that in the blood; of muscle, 84%; and that of the brain, 75%. It takes very little time for the tissues to absorb the alcohol circulating in the blood. For example, within 2 minutes, brain tissues reflect accurately the blood alcohol level.

Now that we have explained how alcohol is taken up by the body and distributed to the body tissues, what are the effects, and how is it broken down and removed?

*18\331\2*