Approximately one-third of all Americans report difficulty falling asleep or maintaining sleep, and perhaps one-half of these unhappy persons consider this to be a major problem in their lives (Mellinger and Balter, 1983). The general approach of this book has been to emphasize that the complaint of chronic poor sleep is often the expression of underlying pathophysiology (e.g., sleep apnea or nocturnal myoclonus) of which the patient is often unaware. In other cases, psychiatric disorders such as depressive illness are evident. In both of these conditions, a specific treatment is often available: for example, CPAP for sleep apnea or a tricyclic antidepressant for an affective disorder. In addition to these situations perhaps one-quarter of all patients seen for insomnia in sleep disorder centers have difficulties that are currently described primarily in psychological terms: persistent psychophysiological DIMS (disorder of initiating and maintaining sleep, or insomnia) and subjective DIMS complaint without objective findings (Coleman et al., 1982). In this chapter, we will describe these conditions and present some tantalizing findings that suggest their etiology. The use of hypnotics to treat insomnia has been discussed in Chapter 3; here we will present some nonpharmacological approaches.
KeywordsPlacebo Fatigue Depression Schizophrenia Assure
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