Insomnia is one of the most persistent and depressing symptoms of psychasthenia. Patients suffer through sleepless nights, followed by bad days, and are so tired they don’t have the courage or will to react - their constant fatigue gives them an excuse to succumb to their illness. They place so much importance on sleep, and especially on how long they sleep, that sleep itself often becomes the main symptom of their disease. We’ve heard so many patients say, “If only I
could sleep, I’d get better.” This belief is more illusory than real. Certainly insomnia does make patients less capable of defending themselves, and more passive. But many patients sleep 10 or 12 hours a day, and still remain ill! We must accept the fact that getting rid of insomnia, as difficult as it is to put up with, does not guarantee a cure, and that it is the
quality of sleep, more than the quantity, that is the essential point. Sleep returns naturally as soon as there is some degree of improvement of other symptoms. However, since general improvement is sometimes slow in coming, we must look for ways to restore this essential function as soon as possible, in order to help patients to a more speedy recovery.
We will therefore explore the causes and describe the various forms of insomnia, and indicate possible forms of treatment.
Causes of insomnia
The basic, primordial cause is most often insufficient control, which takes on different aspects. Some patients can’t stop the flow of their thoughts; others suffer from some kind of phobia, for example an exaggerated sensitivity to noise, or even a fear of not being able to sleep.
Clichés are also a common cause. These do not prevent patients from falling asleep, but instead wake them up in the middle of the night, interrupting their sleep. We have seen patients suffer attacks of palpitations at the same hour every night. Sometimes, the memory of having been awakened on a previous night will repeat itself and keep
them awake for hours.
All these causes can be corrected through re-education. We can distinguish two main forms of insomnia:
1. Partial insomnia.
2. Complete Insomnia.
Partial insomnia is characterized by a kind of light somnolence which unfortunately does not give patients the feeling that have slept well.
In such cases, we advise patients to wake up completely, even a few times a night if necessary, and then to try and fall into true, deep
sleep by practicing the exercises we will describe a little later on. Another form of partial insomnia is when patients sleep deeply for one or more hours, but then wake up suddenly for no reason, and remain awake for a certain time. This is almost always due to a cliché, which must first be discovered, after which patients can concentrate before falling asleep in order to mentally set a more reasonable waking hour. When patients succeed in doing this, their insomnia is all
but cured. Hypersensitive hearing or phobias about noise interrupt sleep, but patients usually fall back to sleep as soon as the noise stops. In some cases, however, the phobia is strong enough to prevent patients from sleeping at all - they are so anxious about being awakened they can’t get to sleep in the first place. The most radical treatment for this consists of desensitizing patients to noise. There is another method: patients are instructed to concentrate on the source of noise as soon as they wake up. Such voluntary concentration will eventually cause the phobia to disappear. Complete insomniaThis is very often caused by a fear of not being able to sleep. This fear is so strong it can remain impervious to the most powerful sleeping pills. The best method we have found may seem a little strange, but it does produce results. It consists of getting patients to promise that they will resist falling asleep for a set period of time. They soon become
aware that if this instruction is really carried out, their anxiety
disappears, and they feel they can sleep. It is essential that patients keep their promise for the set time period,
and that they fight to stay awake. If their phobia reappears when they try to get to sleep, they must start again. Results will not be long in coming, and they will soon regain their ability to sleep peacefully. I have seen patients struggle with this method, not sleeping for one or two entire nights in a row. It takes quite some effort, but will always lead to success if they are sincere. Another form of complete insomnia is when patients do not sleep because they aren’t tired; they are not suffering from any phobias or clichés, their brain is calm but very awake, and they can rest without actually sleeping. This form is quite rare, and the exercises we suggest have hardly any effect, hypnosis being the treatment of choice in
We will not be talking about cases of insomnia caused by various organic problems, or by physical pain, since insufficient control does not affect these types. We can now move on the exercises most appropriate for regaining the ability to sleep. All the exercises are effective, since they all work to calm the mind and re-establish cerebral control. Some, however,
are designed for specific types of insomnia. The procedure we have termed “de-concentration” almost always
leads to sleep, as soon as patients are capable of producing a state of rest for a certain period of time. Patients concentrate on the number 1, then try to suspend their thoughts for as long as possible while progressively distancing themselves from the number
1. Any distraction or new thought is stopped by resuming concentration on the
Concentrating on the concept of calm and rest is also effective. A simple method is to concentrate on breathing, making it regular and pretending to snore a little, as if asleep. Visualizing the symbol of infinity (see page —) growing larger
and larger works well for some patients. A determined effort of will to fall asleep is sometimes effective, if
patients can dispel their doubts. To get results, these exercises require some training -obviously, if
patients are unable to concentrate, they will not be able to put them into practice. As for sleeping pills, we try to void them as much as possible. We are rarely forced to resort to them, and when we do it is only during
the initial phase of the treatment. The great disadvantage of narcotics is that patients are invariably in a passive state the following day, not to mention the dangers of addiction and harmful side effects.