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December 21, 2010
Most forms of DIMS fall into one or another of the categories I’ve just described; occasionally, however, I will run across cases that fit none of them. There is no doubt that the patients suffer from insomnia – they sleep less than they feel is right for them.
But when I examine them I am unable to discern any physical or psychological abnormality. Even the results of a sleep lab study may demonstrate no objective findings, by any of the usual clinical measurements, to indicate that sleep was disturbed, yet the patients insist that sleep was somehow unsatisfactory. Such patients are known as “short sleepers,” meaning that their sleep lasts less than 75 percent of the time considered average for their age group. Any symptoms they experience as a result of their sleep patterns are not directly related to their perceived insomnia. Rather, problems arise from their basic concern that they are somehow “abnormal,” that they should be sleeping differently from how they are. Sometimes these patients express the belief that there is a certain amount of sleep they “should” be getting—what I call the eight-hour myth. They may also feel lonely because they are awake during the early hours of the morning, or because there is relatively little support from our culture for people who do not fit the normal pattern of rest and waking. One short-sleeper acquaintance told me she would wake up hours before she had to be at work and do nothing except worry about her job. By the time she got there she was a nervous wreck. However, her life and her work improved tremendously when she began an early-morning hobby: writing. She is now writing a sequel to her first, unpublished spy novel.
Often a patient’s description of a sleep problem may initially suggest a disorder in initiating or maintaining sleep. As I’ve mentioned, however, careful attention to the patient’s sleep patterns, drug use, and medical history may help further differentiate the true nature of the disorder. Sometimes reassessment is mandated when the initial approach to therapy is insufficient or completely unsuccessful.