Too Much Emphasis on Psychological Causes of Insomnia?

Gayle Green, in her book Insomniac, levels criticism at psychologists and psychiatrists who concentrate on factors such as anxiety, depression, and/or stress as causes of insomnia (characterized as "blaming the victim") at the exclusion of examining the contribution of physiology. Stuart Derbyshire, in his review of Insomniac, suggests that physiological explanations of insomnia, however, are flawed. Specifically, he writes: "…the idea that insomnia is the product of faulty neurobiology or hormones or something else is just a guess and a guess that could be horribly wrong in many different ways." Both author and reviewer acknowledge that more research is needed to better understand the causes of sleep disorders.

What are the arguments for and against psychological influences of insomnia? Physiological influences? Can current findings in sleep research shed light on the complexities of this disorder?

Read the Review

Why Can't You Just Go to Sleep?
By Stuart W. G. Derbyshire
      PsycCRITIQUES, 2008 Vol 53(52)

Comments

[Anna Van Der Post]

I am a research psychologist and author of 'Children and Teenagers with Aspergers'. I read the review of 'Insomniac' with great interest and would like to take issue with a number of points.

I think that the reviewer, Stuart Derbyshire, started from the false premise that insomnia is essentially a single condition. If I, and many others, have headaches which we cure by removing caffeine and using CBT, we could conclude that all headaches are caused by too much caffeine, faulty thinking and unrealistic life expectations which collectively make us unduly stressed. However, this dictum is clearly nonsense, as there is not just one type of headache or a single causation.

Ditto for insomnia. It seems ludicrous in the extreme to assume that insomnia is a single state. Derbyshire mentioned that he had trouble staying awake during the day throughout his sleepless episode. Lucky him that he got to feel sleepy and could, in theory, catch up on lost sleep. The really severe, life-long insomniacs are unable to sleep in the day when given a chance to nap. I struggle to achieve an average of 2 hours a night. I am rarely sleepy, even when relaxed, but I am dog tired. I am fixed in a state of wakefulness and I handle my lack of sleep far better than someone who can sleep, but is kept awake. Something is different in my brain which enables me to cope with a level of sleep that would reduce most people to a wreck within a week. Whatever I feel and whatever I am going through, whether blissfully happy, content, stressed, or miserable, my sleep pattern is just the same.

Derbyshire, seemed to dismiss or underplay other possible causes of insomnia because they are unsubstantiated hypotheses. Well, that is pretty much all there is. However, we must not forget that the view that insomnia is caused by stress, is also a hypothesis. It may be able to be shown that a percentage of insomniacs return to normal sleep patterns after conventional intervention, but how scientific many of these studies are is questionable. What about the insomniacs who fail to respond, those that have religiously followed the recommendations to the letter and have undergone extensive therapy. There are three responses to conventional intervention. Some, like the reviewer, return to normal sleep patterns. Others are less fortunate and enjoy some improvement but still have insufficient sleep to function optimally. Finally there is the group who fail to respond at all. Studies may be able to demonstrate improvement in a certain number of insomniacs, but it seems to me that most of the studies consider insomnia as a single condition. For example the reviewer had day-time sleepiness and had a single episodic experience; others have had life-long problems, some people can't get to sleep, others wake very early etc.

Hormonal influences, neurotransmitter and genetic abnormalities or brain differences all need to be thoroughly researched and eliminated before the psychological basis of insomnia can be supported. It seems to me that Derbyshire's belief system about sleep is based on anecdotal evidence and a theory which remains untested. Of course stress treatments have some success because some insomnia is stress induced. The cases that remain truly resistant to the standard treatments on offer are dismissed - this is sloppy science. Psychologists, who advocate emotional causes of insomnia, can always fall back on their trump card - either the patient is not committed enough or they clearly get some benefits out of being an insomniac. No more action is therefore needed. The psychological model is set up to always win.

Derbyshire should be fascinated by, and in awe of, how so many of us manage to hold down successful, professional careers and family lives in the face of such adversity and with a condition for which we receive NO understanding or sympathy. I found the comment that 'there is something childish about living life through an ailment' frankly insulting. I challenge/invite the reviewer to come and live in my house for a month, to sleep only when I do. At the end of a month let's see if he could still say that it is childish to live life through an ailment. I guarantee he would crack long before I would, then we would see who was the more grown-up.

I did not find Greene's book too long and in fact she stated at the outset that not everyone would necessarily want to read it cover to cover. It is written in a format that enables one to easily find areas of personal relevance or interest and to ignore the rest. I felt she covered all bases, and did not dismiss the current theories, but just felt that they were incomplete and failed to address those whose insomnia is not of a psychological origin. The brain is part of the body and as such can go wrong and when it goes wrong it can affect every aspect of our body and behaviour. It would be prudent to remember this. Epileptics were, after all, historically believed to be possessed and those with narcolepsy as attention seekers. Ignorance does not excuse bad practise.

For the true insomniac there is a lot to be 'cranky' about and I am not sure that the reviewer ever fully grasped this.

I LOVED THIS BOOK.

[Rackworld]

The word Insomnia originated from the Latin word Insomis meaning sleepless. To put it in a better way it is a condition where one is unable to obtain sufficient sleep. For me Insomnia meant feeling stressed, lost, sad and feeling worthless,trouble concentrating,irritability, increased risk of falls and accidents, and lower productivity..
Better Quality Sleep benefits to our mood, memory and concentration.