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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SLEEP DISTURBANCES — CAUSES AND CONSEQUENCES: CONDITION OF THE BED

The importance of the condition of the bed is confirmed the moment one lies down on an unfamiliar hotel bed, when even a healthy sleeper can pass a sleepless night. Is there such a thing as an ideal bed? If so, what kind?

There are two medical opinions on this topic. One is the orthopedic approach, which is concerned with the proper position of the spine. The other is more concerned with circulation, since heart patients, persons susceptible to circulatory disturbances, and older persons feel oppressed, anxious, and experience shortness of breath if they lie in as flat a position as the spine requires. Their sleep may improve if a wedge-shaped bolster is used or if some other elevation is provided. On the other hand, persons having back pain and symptoms of slipped disks, who have difficulty in sleeping because they do not know which position permits them to be most free of pain, a firm, flat surface is recommended. Often a board placed under the mattress is an effective measure.

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