Insights into Insomnia: 12 questions and answers about insomnia

Ways to Sleep Better

Doctors maintain that sleeping flat on your back, on a low pillow, is the best of all positions. It enables the blood to circulate freely and for sufferers from migraine headaches Is especially recommended because the flow of blood to the brain is eased. In the morning the sleeper will awaken refreshed and with a clear head.

However, if you are fatigued from physical work, it is better to sleep on the left side. Studies have shown that usually it is the right side of the body that is over-strained and in this position those muscles most affected will find greatest relief.

If suffering from indigestion, sleep flat on your belly. Also good for those insedentary occupations and whose abdominal muscles are flabby. The weight of the body exercises a beneficial, mechanical effect on the bowels. If your liver bothers you, sleep on your right side. You will keep it warm, the ligaments will be more relaxed and the gall overflow will improve.
Question: What is the reason for insomnia?

Answer: First, let us define insomnia: it is not the disappearance, but a disturbance of sleep. Reports in the press that some individuals do not sleep at all should not be taken seriously. As has been shown by prolonged investigations with encephalo-graphic registration of the state of sleep, no human being can do without sleep altogether.

Of course, different people require different amounts of sleep in order to feel physically rested and to maintain their normal capacity for work: some sleep four or five hours, while others sleep between eight and ten hours a day. Peter the Great and Napoleon, for instance, never slept longer than five hours a day, while Edison managed with only two hours. All three, however, preserved a wonderful capacity for work.

Now about the reasons for insomnia. Quantitative and qualitative disturbances of sleep are invariably the result of illness, above all affecting the nervous system. A smaller proportion of insomniacs have experienced cranial or cerebral injuries, or both, or organic brain diseases such as encephalitis. In the main, however, insomnia is a complaint of neurotics.

Neuroses, that is, malfunctions of the nervous system, can be caused by prolonged conflicts, involved situations or various forms of excessive strain on the nervous system.

Many factors in modern society provoke neuroses, an unfortunate consequence of which is disturbed sleep. The slogan of the twentieth century seems to be: maximum information per unit of time. The result is information overload, which either causes or aggravates a neurotic condition.

Question: Why does insomnia most frequently affect those engaged in mental labour?

Answer: Information overload is a strain on this category particularly. If the mental worker is incapable of processing the whole mass of information he needs for his work he develops an inner conflict which produces nervous overstrain with all its consequences. A complicating factor is lack of exercise.

In our time, it must be added, automation is taking over jobs previously performed by physical labour. This means considerable mental strain and concentrated attention on the part of the worker. So, information overload coupled with muscular underload is becoming increasingly troublesome for this category, too.

Question: Do sleep disturbances depend on age?

Answer: Most insomniacs are elderly people. They have trouble falling asleep and frequently wake up in the middle of the night or before dawn. Nevertheless, elderly people make fewer complaints about undersleeping. It affects young and middle-aged people worst of all.

Question: What are the modern concepts of the cerebral mechanisms of sleep? Obviously, without understanding them, it is not possible to understand the reasons for sleep disturbances.

Answer: That's true. Before trying to find the scientific explanation of disturbed sleep and giving scientific recommendations for prevention and treatment of insomnia, one must know what is going on in the brain during sleep and what is the purpose of this state, in which man spends one-third of his life. All the more so since in the past 15 or 20 years brain physiologists have obtained new facts of primary importance, which require rethinking on the state of sleep, as well as on a whole series of general propositions concerning the activity of the brain.

The main conclusions reached by sleep physiologists are as follows. In its essence or physiological mechanisms, sleep is not a uniform condition but is made up of at least two phases: sleep without dreams ("slow" or "orthodox" sleep) which produces slow waves on the electro-encephalograms, and sleep with dreams ("fast" or "paradoxical" sleep) in which case the electro-encephalograms reflect a state close to waking. Fast sleep is accompanied by quick movements of the eyeballs, sharply depressed muscular tone and dreams. It is, so to say, waking turned inwards.

During the night fast and slow sleep form cycles alternating four or five times a night. Every cycle begins with a phase of slow sleep which leaps into a phase of fast sleep. Fast sleep sets in 60 or 90 minutes after man falls asleep and its consecutive periods grow longer toward morning. Altogether, fast sleep accounts for some 20 per cent of the night's sleep.

The two phases of sleep differ sharply in their manifestations, mechanisms of emergence and sensitivity to different medicinal preparations.

Question: Is it true that sleep is an inhibited condition of the brain cells and that insomnia is caused by the stimulation of the brain's nerve cells?

Answer: Facts obtained in recent years disprove the hitherto widespread view that sleep is a state of inhibition spreading to vast numbers of neurons or at least a quantitative prevalence of inhibited neurons over stimulated ones. Sleep appears to be a specific activity of the brain, the significance of which, so far, remains largely unclear.

It has been suggested that the onset of sleep has something to do with the limit of the brain's information capacity, the so-called short-term memory. While man is asleep the information stored during the day apparently undergoes distribution: one part of it goes into long-term memory, another into the current activity programme, and what is useless goes out. But so far this is only a hypothesis.

Question: Can sleep cure illnesses or complaints?

Answer: At one time scientists really thought that sleep had curative effects and could be used as a method of treatment for nearly all diseases. This hypothesis stemmed from the idea of sleep as a form of protective inhibition, but this has been disproved by many newly obtained facts.

What then explains the beneficial "unloading" effect of sleep, which removes emotional stress in difficult cases?

To date there is no final answer to this question, as the purposes of the processes taking place in the brain during sleep remain unknown. It may be assumed, however, that a major role in this effect of sleep is played by further processing and distribution of the day's information.

Question: What is the mechanism of night sleep in insomniacs?

Answer: Thorough encephalo-graphic research reveals that insomnia may be caused by different changes in the structure of night sleep. Sometimes its cycles do not have the deep phase of slow sleep, sometimes there is a prevalence of fast sleep with dreams and frequent awakenings. Finally, the overall duration of sleep, or only the phase of fast sleep, may be reduced.

Multiple investigations of night sleep have led us to the conclusion that even those who complain about only two or three hours' night sleep, in fact sleep five or six hours. And, it must be remembered, in unfavourable circumstances at that, with electrodes attached to their bodies!

Question: Which is better for the health: sleep with dreams or without?

Answer: Everyone has dreams but not everyone remembers them. Dreams are a distinctive form of periodic psychic activity, which is vital to the normal functioning of the brain. If man is deprived of fast sleep with its dreams, he will develop mental disturbances. There are many instances to prove this.

Question: Are regular hours of sleep important and at what times is it best to go to bed and rise?

Answer: Sleep distribution obeys the inner rhythms of the organism, which are related to its many individual properties. A close study of these properties has led to dividing mankind into "skylarks" and "owls". The "skylarks" are early risers and work well in the morning and before dark. The "owls" go to bed late and wake up late and work best in late hours, too.

So no one can say when it is best to go to sleep and get up.

But the study of individual peculiarities of sleep may reveal interesting possibilities. Since the peaks of working capacity of "skylarks" and "owls" are different, perhaps it would be good for these two categories to work and study at different hours?

Timing working hours to coincide with peak work capacity might well offer major economic benefits.

Question: What are the commonly practised methods of treatment for insomnia?

Answer: It is not insomnia but the source disease, normally the neurosis, that needs treatment.

Incidentally, insomniacs erroneously believe that sleep must necessarily last a long time. That gives them a fear of undersleeping and sleepless nights. This fear, aggravating their tense condition, in itself prevents them falling asleep and sometimes causes persistent sleep disturbances.

The most justified method of treatment in such cases is psychotherapy, which takes different forms. Neuroses call for comprehensive treatment. Psychotherapy alone is not enough.

At the beginning of the XX century Pavlov came to the conclusion that sleep was inhibition - a slowing down designed to protect brain cells from overwork, exhaustion and death. With the invention of the electroencephalograph, new facts came to light which led scientists to do some rethinking on the question of sleep.

Dr. Pyotr Anokhin, Dr. Alexander Wein, Dr. Lev Latash and other russian scientists, upon analysing and summarising their observations, have come to the belief that sleep is an activity of the brain other than inhibition.

When we really know what sleep is scientists will be able to give recommendations for prevention and treatment of insomnia.

The following interview with Dr. Wein and Dr. Latash, leading russian neurophysiologists, may be of interest to at least one in four readers: for one-quarter of the world's population are insomniacs.
Question: How do you look upon sleeping pills?

Answer: On the whole, positively. But we believe that the doctor's usual examination is not enough. Thorough electrophysiological investigation of night sleep in order to discover structural defects is also required.

Regrettably, doctors so far have no sedatives at their disposal that can control different phases of sleep. They all ease the process of falling asleep but suppress the phase of fast sleep, which, we repeat, is necessary to keep the brain working normally.

Taken once, this side-effect is negligible. Taken regularly, sedatives at first suppress the phase of fast sleep. Then the brain gradually adapts and the phase of fast sleep is restored to the needed proportions.

If the user, for fear of developing a habit, cuts them out, his brain begins to develop excessive amounts of fast sleep. This aggravates his condition, intensifies the sensation of insomnia and sometimes - still worse - produces nightmares. Fast sleep takes some four to six weeks to get back to normal. The sufferer must wait patiently. However, if exhausted by several sleepless nights, he again takes the sedative and feels unable to do without it, then he becomes a sleeping pill addict.

But worst of all, some people resort to sedatives frequently but irregularly - at intervals of two or three days. In this case the brain only begins to adapt itself to the adverse aspect which prevents fast sleep, when the interval rapidly intensifies fast sleep. The result is constant wearying dreams and an acute feeling of sleeplessness.

That is why we categorically object to self-treatment: only a doctor should prescribe sleeping pills and dosage.

But the best thing to do is, without turning to the doctor for assistance, to try to regain the ability to sleep long and profoundly in natural ways. A beneficial effect is exercised by physical work outdoors, sports and hiking trips. Sometimes it is enough to settle down to a strict daily routine that includes a frugal supper, a walk and a warm shower before bedtime, and sleeping in a well-aired room.

Question: Many doctors recommend autosuggestion to insomniacs. Does it help to normalise sleep?

Answer: It certainly does. Many people develop what is known as sleep rituals: reading and a definite position of the body when falling asleep. Firmly established, these rituals become positive factors and constitute a form of auto-psychotherapy, that is, autosuggestion, which does a lot of good to the patient. However, there is no point in developing such habits artificially.

Another form of this method, as we see it, is also most productive and consists in controlling muscular tension, respiration frequency, heart contractions and temperature of the skin. In a word, what we mean is autogenous exercises that help remove inner tension, which, more often than not, causes prolonged, agonised expectation of the onset of sleep.

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