Understanding Sleeplessness by David N. Neubauer

Author:David N. Neubauer [Neubauer, David N.]
Language: eng
Format: epub
Published: 2011-02-17T05:00:00+00:00

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Understanding Sleeplessness

Although a life story easily can be reduced to a bare outline that can represent a compelling case of why someone might sleep poorly, a major strength of this approach is that it can emphasize the role of the individual. It is natural to sympathize with the concerns of the woman in the following case.

The Russian Worrier: Sasha, a 48-year-old woman, presented to the Sleep Center because of persistent nighttime awakenings. She had been born and raised in Russia, where she had been educated through an advanced degree in the clinical sciences. She was married and had two children doing well in college. She and her immediate family had immi-grated to the United States four years previously. She and her husband had secured job positions appropriate to their high level of training. She reported that she had had difficulty with her sleep during stressful times, mostly job related, beginning soon after she had moved from Russia. At the time of the evaluation, her sleep had been very disturbed persistently for six months, and she attributed this to her worries concerning her father’s health, as he was diagnosed with cancer at that time. Since he had remained in Russia, she would telephone him at what for her was the middle of the night. Most nights she was rather sleepy at her 11:00 P.M.

bedtime, and she would fall asleep quickly. However, she usually would awaken within two hours, at which time she felt rather anxious and would ruminate about assorted problems. If she was able to get any more sleep, it was repeatedly disrupted. She was out of bed for the day between 6:00

and 7:00 A.M. Throughout the daytime she felt fatigued and had difficulty concentrating. She was frustrated about her distressing nighttime experiences and her impaired functioning during the daytime.

Narrative explanation is abundant in Sasha’s insomnia history. Distress about her father’s illness, her nighttime telephone calls, and worry about her daytime performance all can be viewed as contributing to her disturbed sleep.

The following patient presented not because of current insomnia but rather because of fear of a recurrence of past insomnia. Life choices often affect insomnia; here, insomnia influenced life choices.

The Fear of Not Sleeping: Paula was a 30-year-old, married woman who came to the Sleep Disorders Center because of her worry about a return of insomnia, which in the past had been quite distressing for her. Her difficulty with insomnia had begun four years previously, after the birth of her only child, a daughter. At that time she had felt rather depressed and had experienced frequent tearful episodes. The depression disappeared 03 neubauer 95-186 7/23/03 12:19 PM Page 101

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within a few weeks, and soon after that the baby was sleeping well at nighttime. However, distressing sleeplessness continued. Paula’s obste-trician prescribed pentobarbital and then flurazepam, which usually was helpful and which she continued to take about once a month. Most nights she was able to fall asleep quickly at her 11:00 P.

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