Sleep: a whimsical god

"Sleep is a whimsical god: when you call upon him it makes you wait". Whoever spent at least one sleepless night in his life cannot forget this quote by Alexandre Dumas. To fall asleep it is necessary to "let go", to give up the control over one's body and one's mind, a completely incompatible experience with anxious searching and waiting tensions of who actively looks for it without being able to find it. This is one of the worst insomnia tricks: it feeds itself. After a few sleepless nights, in fact, the confidence in one's ability to fall asleep diminishes drastically while developing a form of anxiety that anticipates the imminent failure; the focus on sleep produces thoughts of fear of not being able to fall asleep, which increase in frequency as night approaches. Anxiety creates the need for controlling all the variables that come into play when it is time to go to bed and develops rituals that negatively influence the subject's quality of life (need to go to bed always at the same time, to eat only specific foods for dinner, etc.). Sometimes this thinking habit grows to the extent of filling up completely the person's mind, even during the day. All these factors promote and perpetuate the disorder, leaving behind a deep sense of helplessness in relation to sleep, rest and other aspects of our life.

Yet insomnia is not considered a disease in itself: besides a couple of exceptional cases, it is not but the symptom of a psycho-physical discomfort, which denotes the real cause of the disorder. In episodic forms the origin is often to be found in a concern, a test, changing one's job; all can generate a sleepless night. Even daily stress can provoke insomnia, like a fight with the big boss!

On the other hand, more persistent forms of insomnia can be related to physical illness or psychic disorders, like anxiety and depression. The latter can have many diverse effects on sleep: there are depressed patients who spend all day in bed because they find relief from their disease in the silence of sleep. Others experience difficulties falling asleep or they wake up often times, without being able to reach a sound sleep. This happens particularly in cases of depressions after mourning or experiences of abandonment, like the end of a marriage or being left by a loved one.

Insomnia, as a symptom, has to be treated with after a differentiated diagnosis, in order to consider the possible organic and psychological causes at the source of the disorder. The cure cannot avoid a careful medical evaluation of the eventual illnesses which can be the cause the symptom. Once these causes can be safely excluded, one should consult a psychologist who can evaluate causes of a psychological origin.

Often the cure involves the intake of hypnotic drugs. These drugs have the advantage of quickly eliminating the problem, giving an immediate relief to those who have not been able to sleep regularly for a long time. They, nevertheless, present two disadvantages: addiction – when one stops taking them the problem comes back – and tolerance – after a certain period of time one needs to increase the dosage to keep the effects. They can give side effects such as torpor, vertigo and a progressive slowing down of the cognitive abilities during the day.

Psychotherapy is, instead, less immediate but gives more lasting results, because it deals with the roots of the causes that produced insomnia. In clinical practices a patient is frequently subjected to both treatments: pharmacological and psychological. This way one can combine the positive effects of each therapy. Comparative studies show that this combination gives best results as opposed to a treatment which involves only one of the two, especially during the first two weeks. Results in a solely pharmacological treatment often disappear at the time of stopping the drug.