the johns hopkins university press understanding sleeplessness perspectives on insomnia sep 2003

[...]... al., 1997) The presence of insomnia in baseline and follow-up surveys predicts the development of major depression The question remains whether the initial insomnia simply increases the risk of the depressive disorder or whether the insomnia is a prodromal symptom, the first sign of depression to come Nevertheless, these findings emphasize the importance of early recognition and treatment of insomnia People... decide whether they think that the underlying mental disorder (e.g., major depression) is causing the insomnia symptoms or whether the sleep disturbance is independent If the insomnia is judged to be integral to the mental disorder, then it must be decided whether the insomnia severity is sufficient to warrant the additional diagnosis The problem is complicated when insomnia is present and a new onset of... but uncomplicated insomnia as organic or nonorganic seems to be at the whim of the coder Generally, the insomnia entities and the distinctions among them are not well defined The ICD system is intended for worldwide use, and in many situations ICD coding is mandatory While ICD classifications may be valid in other medical areas, the insomnia organization does not represent a consensus understanding of... · Understanding Sleeplessness 18-year experience on the faculty at the Johns Hopkins Sleep Disorders Center illustrate different patient presentations related to the complaint of insomnia (The patient names have been changed to protect confidentiality.) The brief histories offer the salient features but not necessarily all of the negative findings in the cases Many of the examples are typical of the insomnia. .. organic and nonorganic etiology Among the nonorganic categories (codes 307.4x) are the transient and persistent disorders of initiating or maintaining sleep The transient category is associated with emotional reactions or conflicts, and the persistent disorders relate to anxiety, depression, psychosis, and conditioned arousal Other nonorganic choices include a phase-shift disruption of the 24-hour sleep-wake... many insomniac persons, it is the daytime effects that eventually bring them in for treatment Future research may help us better understand the processes influencing the perceptions of individuals complaining of insomnia who objectively demonstrate good sleep according to current sleep laboratory standards If the perception of poor sleep makes the person insomniac, what then makes the insomniac person... potentially influencing the sleep-wake cycle can be highlighted This chapter reviews the ambiguity of the term insomnia, the epidemiology of insomnia complaints, the consequences of this sleep disturbance, the primary treatment strategies, and the limitations of medical education on normal sleep and sleep disorders I explain the functions of sleep disorders centers and discuss the four perspectives as explanatory... and perpetuation would be expected Depressive symptoms often are associated with the presence of insomnia Clearly, depressive disorders almost always cause insomnia However, insomnia also may cause the symptoms of depression and increase the risk of new-onset major depression Retrospective and prospective studies of large-scale and well-defined focused populations support this conclusion (Ford and Kamerow,... Four Perspectives In considering the conceptual models used to explain insomnia, this book draws heavily on the approach elaborated in The Perspectives of Psychiatry, by Paul McHugh and Phillip Slavney (second edition, 1998) These authors explore fundamental explanatory models, and their relation to diagnosis and treatment, in the field of psychiatry Different disciplines and orientations within the. .. simultaneously The recognition that these perspectives are not mutually exclusive helps prevent the parochialism that has plagued the field of psychiatry in the past The result is greater integration in understanding and care of patients The disease perspective is category driven in the attempt to create patient clusters The ultimate goal is the definition of discrete diseases based on identifiable pathological conditions . iii © 2003 The Johns Hopkins University Press All rights reserved. Published 2003 Printed in the United States of America on acid-free paper 9 8 7 6 5 4 3 2 1 The Johns Hopkins University Press 2715. depression) is causing the insomnia symptoms or whether the sleep disturbance is independent. If the insomnia is judged to be integral to the mental disorder, then it must be decided whether the insomnia. nighttime sleep. The word insomnia is already vague when it refers to inadequate sleep. Attempts to expand the scope of the definition risk dilution of the concept and further confusion about symptoms