It is estimated that about 20 per cent of the normal population experience some form of insomnia at some time in their lives. The Australian Bureau of Statistics conducted a survey in 1983. They interviewed 465100 people at random and asked them if they had been taking sleeping medication in the last two weeks. They found that 3.6 per cent of those interviewed had been. Hence the problem of insomnia is fairly common. Consequently the manufacturers of sleeping pills are making millions of dollars out of insomnia.
But what is insomnia? The Oxford Dictionary states that insomnia means habitual sleeplessness. To the doctors, insomnia is only a symptom of underlying problems. Insomnia itself is not an illness. It is like a fever which is symptomatic of some underlying infection. If a patient has a fever, there is generally a cause for it. Both the fever and the cause should be treated.
However, there is a difference between fever and insomnia. Fever can be confirmed objectively by taking body temperature, and we can measure how high the temperature is. Insomnia is a subjective symptom and cannot be confirmed by measurement to assess how bad it is. Very often people complain that they never sleep a wink. Does this mean that they have the most severe form of insomnia? In other words, how reliable are people’s assessments of the severity of their insomnia?
With the help of the sleep laboratory we can now measure and objectively assess how much insomnia these people have. In Paris, Dr Betty Schwartz tested chronic insomniacs who insisted that they never slept. These people were monitored at night in the sleep laboratory. Since these people were convinced that they did not sleep at night, they agreed to press a button to signal that they were still awake whenever they heard a buzzer. It was found that, in most cases, they all had a normal sleep pattern on the EEG recordings. The buzzer sounded many times throughout the night, but none of these people pressed the button. These people, who insisted that they had insomnia, had in fact been sleeping soundly and could not hear the sound of the buzzer. In the morning, when they were questioned about their sleep, they still insisted that they had not been sleeping at all.
It has been reported that 95 per cent of healthy adults fall asleep within half an hour. Hence those who fall asleep within half an hour do not have insomnia. But is this true? People who fall asleep easily may wake up at 2 a.m. or 3 a.m. in the morning and fail to go back to sleep. This is called early morning insomnia. What about those that sleep and wake at normal hours, but wake up very frequently throughout the night. Do they have insomnia? And there are people who need only three or four hours of sleep without feeling any distress at night, and they function well the next day. They never complain of insomnia, but are they experiencing insomnia?
Insomnia is a subjective feeling and is influenced by many factors. The main component of insomnia is the distress felt as a result of not being able to sleep. People who say they are suffering from insomnia may in fact be getting enough sleep. But why do these people say they are not sleeping? It is because of the distress they feel when they are not able to fall asleep when they want to. These people who get enough sleep biologically and yet complain of insomnia, I call ‘pseudo-insomniacs’. ‘Pseudo’ means imposter, and I would like to discuss this under the following categories.
1) Feeling of distress
The difference between short sleepers and insomniacs is that the former sleep only a few hours at night, but feel well and function well the next day, whereas insomniacs invariably are miserable, feel distressed, became impatient of not sleeping, feel frustrated, and have little confidence in their innate ability to fall asleep even when they feel very sleepy. There are some people who can play cards all night without much sleep or attend wild parties well into the morning and yet feel no distress at all. However, these same people, when they are in bed and if they want to sleep and yet fail, will be so distressed and worried that they keep turning in bed and try all sorts of ways to make themselves sleep. Of course, the more they try to sleep, the more they cannot, which is the law of reverse effect. Hence they lose confidence in their innate ability to sleep and take sleeping pills.
(2) The expectation of more and better sleep
People are trained to sleep a certain number of hours a day when they are very young, and this magic number of hours stays in their subconscious, which has led them to think that a good sleep means sleeping eight hours or more. If they ever fall short of this, they become dissatisfied and distressed. They call themselves insomniac
(3) The facts of NREM sleep
As mentioned in chapter 9 on Sleep without Dreams, during NREM sleep there are no thoughts and no memory. The only way to convince ourselves that we have in fact been sleeping is either to remember our dreams or to look at the clock before and after sleep. NREM sleep is like general anaesthesia—there is a blank in our continual awareness. These pseudo-insomniacs do not remember their dreams. They are not aware that they have slept as no one can ‘feel’ NREM sleep. It is difficult to convince them that they have had a normal sleep, as they expect to feel something when asleep.
(4) Frequent awakenings in the night
In the sleep laboratory it has been shown that we normally wake up many times in the night. Most of the awakenings last only a few seconds and we fall back to sleep, not remembering them in the morning. If these awakenings last longer we feel distressed and, if they are all added up in the morning and remembered, we tell ourselves that we have had a bad night of broken sleep. The distress of lying awake in bed even for a few minutes will be remembered and exaggerated in the morning, even if there was actually many hours of sleep. This is the power of exaggeration when we are stressed.
(5) Natural insomnia sets in with age
As we grow older we need less sleep. Ian Oswald in Edinburgh reported an interview of 2500 people of different ages. Over 20 per cent of the elderly who were interviewed said they slept less than five hours each night. As we grow older we need less and less sleep. However, even if we need less sleep, we are not contented, as the distress of lying in bed and not sleeping is unbearable to a lot of us. In contrast, there are a lot of older people who are completely satisfied with only three to four hours sleep at night. They do not complain of insomnia and they do not take sleeping pills.
Hence a large proportion of people who think they have insomnia are in fact experiencing pseudo-insomnia. In fact these people are healthy, and if they are tested in the sleep laboratory they are found to have a normal sleep profile. They are imposters.
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