Sleep disorder
Dr. L.R. KHAN
Insomnia Disrorer
Insomnia is a disorder is a disorder of initiating or of maintainig sleep (DIMS). It may be
transient or persistent. In the latter case, the disturbance occurs at least three times a
week for at least 1 month and results in significant daytime fatigue or impaired social or
occupational functioning .
A brief period of insomnia most often is associated with anxiety,
either as a sequela to an anxious experience or in anticipation of an anxiety provoking
experience examination or an impending job intervie. In some persons, transient insomnia of
this kind may be related to griefreaction, reaction to loss, or almost any life change.
This condition is not likely to be serious, althoug it should be kept in mind that a psychotic
episode or a severe depresion may sometimes begin with and acute insomnia. Sepcific
treatment for this conditions in which the problem is most often difficulty falling
asleep rather than remaining asleep, and involbes two sometimes separable but often
intertwind problems somatized tension and anxiety, and a condtioned asscoative response.
The patients often have no clear complaint other than insomnia. They may not experience
anxiety perse but dischage it through physiologic channels. They maycomplain chiefly of
apprehensive feelings or ruminative thougts that appear to keep them form falling asleep.
Usually, these are not patients who experience specific fears or dreads as they fall asleep.
Sometimes , but not always, a patient describes how the condtionis exacerbated at times of
stress at work or at home and remits during vacations. Treatment of times of tish condition
is among the most difficult problems in sleep disorder. In pure cases where the conditioned
component is prominent, a deconditioning technique may be useful.
The patients are asked to use the bed for sleeping and for nothingelse, if they are not asleep
after 5 minutes in bed, they are instucted to simply get up and do someting else. Sometimes
actually changeing to another bed or to naother room is useful. In some cases where the
somatized tension or muscle tension is prominent, relaxation tapes, transcendenatl meditatio,
or practicing the relaxation response and biofeedback are occasionally helpful. Psychotherapy
has not been very useful in the treatment of this sort of