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Authors: Robert S. Rosenberg
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slept a wink since. Iâve already been to a nutritionist, understand this will be a life-long disease, and I worry. All night I pretend to talk to my husband while he snores away. Then I talk to my dead mother, and sometimes to God about whatwill happen to me. What will happen to my children? The pain is supposed to get worse over the years ⦠I need help. When I lie awake all night, I cry all day. My husband thinks I am going off the deep end, but I tell him it is just no sleep. No sleep and I cry. Thinking of my kids with no mom, I cry ⦠can you help me?â
Mariaâs case is a classic example of transient, or acute adjustment insomnia. Maria was so anxious over her medical diagnosis that she could not sleep. This had been going on for less than a month so it had not yet become chronic. Maria was smart to come to the Sleep Disorders Center early on in her lack of sleep. She had not yet developed sleep-preventing behaviors such as napping during the day, excessive caffeine intake to stay awake, or clock watching in response to her inability to sleep, to mention just a few of the symptoms that would develop if her insomnia persisted, as Allyâs had.
This is one of the situations where I provided a short-term use of an approved sleep medication. I gave Maria an initial two-week prescription for a sleep aid to use only if she was unable to fall asleep after several hours. Research has shown that restorative sleep does improve the physical and mental stressors Maria experienced. I also discussed sleep hygiene and bedtime relaxation techniques. I asked Maria to call me within two days to let me know how it worked for her. I also referred her to a therapist as it was obvious that more than just a sleep aid was necessary to help her cope long term with her diagnosis.
For patients like Maria, early intervention is incredibly important, which is why I let such patients clearly know that a short-term medication is step one of a larger coping process. If Maria continued to go without sleep, it was unlikely that therapy would be of much help. In fact, the acute condition was more likely to develop into chronicinsomnia associated with depression, a disorder which is very common in chronic pain disorders and much more difficult to treat.
Insomnia with Multiple Causal Factors
Tomâs primary care physician referred him to me for several reasons. Tom, an insurance agent who worked long hours, was overweight and had been waking up in the middle of the night for months. An inability to maintain sleep is a common symptom of insomnia. Tomâs doctor wrote in his records that he had been unable to stay asleep for at least four months, had trouble focusing at work, and had great fear of a heart attack because of his lifestyle. Tomâs wife had slept in a separate bedroom for some time due to Tomâs snoring, so there was no one to observe Tomâs awakenings or to verify any of his symptoms.
According to Tom, he woke each morning somewhere around 2:30 to 3:30 a.m. He reported waking up and feeling anxious. His mind would be racing and his thoughts frequently turned to work. In fact, he frequently took out his laptop and reviewed the next dayâs work. He was a smoker, and if working on the laptop did not ease his anxiousness, he would light up a cigarette, as it seemed to relax him.
After a while, Tom turned off the laptop and the lights to go back to sleep. It rarely worked. In fact, most of the time after waking at 3:00 a.m., Tom stayed awake in bed until 6:00 a.m. when he needed to get ready for work. Those early morning hours for Tom were grueling because of his racing mind.
His sleep habits on the weekend were no different except that he stayed in bed until 8:00 a.m. His anxiety rose in those early morning hours. His daytime mental abilities were foggy and unfocused. He was moody. Finally, Tom was so frustrated by the lack of sleep and the lack of results ofhis efforts that he dreaded going to the
Mariaâs case is a classic example of transient, or acute adjustment insomnia. Maria was so anxious over her medical diagnosis that she could not sleep. This had been going on for less than a month so it had not yet become chronic. Maria was smart to come to the Sleep Disorders Center early on in her lack of sleep. She had not yet developed sleep-preventing behaviors such as napping during the day, excessive caffeine intake to stay awake, or clock watching in response to her inability to sleep, to mention just a few of the symptoms that would develop if her insomnia persisted, as Allyâs had.
This is one of the situations where I provided a short-term use of an approved sleep medication. I gave Maria an initial two-week prescription for a sleep aid to use only if she was unable to fall asleep after several hours. Research has shown that restorative sleep does improve the physical and mental stressors Maria experienced. I also discussed sleep hygiene and bedtime relaxation techniques. I asked Maria to call me within two days to let me know how it worked for her. I also referred her to a therapist as it was obvious that more than just a sleep aid was necessary to help her cope long term with her diagnosis.
For patients like Maria, early intervention is incredibly important, which is why I let such patients clearly know that a short-term medication is step one of a larger coping process. If Maria continued to go without sleep, it was unlikely that therapy would be of much help. In fact, the acute condition was more likely to develop into chronicinsomnia associated with depression, a disorder which is very common in chronic pain disorders and much more difficult to treat.
Insomnia with Multiple Causal Factors
Tomâs primary care physician referred him to me for several reasons. Tom, an insurance agent who worked long hours, was overweight and had been waking up in the middle of the night for months. An inability to maintain sleep is a common symptom of insomnia. Tomâs doctor wrote in his records that he had been unable to stay asleep for at least four months, had trouble focusing at work, and had great fear of a heart attack because of his lifestyle. Tomâs wife had slept in a separate bedroom for some time due to Tomâs snoring, so there was no one to observe Tomâs awakenings or to verify any of his symptoms.
According to Tom, he woke each morning somewhere around 2:30 to 3:30 a.m. He reported waking up and feeling anxious. His mind would be racing and his thoughts frequently turned to work. In fact, he frequently took out his laptop and reviewed the next dayâs work. He was a smoker, and if working on the laptop did not ease his anxiousness, he would light up a cigarette, as it seemed to relax him.
After a while, Tom turned off the laptop and the lights to go back to sleep. It rarely worked. In fact, most of the time after waking at 3:00 a.m., Tom stayed awake in bed until 6:00 a.m. when he needed to get ready for work. Those early morning hours for Tom were grueling because of his racing mind.
His sleep habits on the weekend were no different except that he stayed in bed until 8:00 a.m. His anxiety rose in those early morning hours. His daytime mental abilities were foggy and unfocused. He was moody. Finally, Tom was so frustrated by the lack of sleep and the lack of results ofhis efforts that he dreaded going to the
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