Case Studies in Insomnia

If ever a book could be called timely, this is it. Sleep disorders medicine has made rapid advances in recent years. The field has attained growing respectability, with a textbook recently published, a congressionally man­ dated National Commission on Sleep Disorders Research, and a growing public awareness of the importance of sleep disorders. However, this rapid growth has made the discrepancy among certain components of the field all the more obvious. Thus, we find that patients who complain of insom­ nia are almost never in the majority of those seen in sleep disorders centers, in spite of the well-known fact that the prevalence of such individ­ uals in our society is by far the largest. Current articles on insomnia abound, but they tend to be facile recitations of diagnosis and impractical global recommendations for treat­ ment, without providing the essential details. Indeed, the clinical profes­ sions really do not know what to do about insomnia. This is reflected in a number of observations I have made in the recent past. For example, the majority of individuals who complain of insomnia take alcohol, aspirin, over-the-counter medications, hot baths, and a host of other nostrums, but rarely seek a physician. In the unlikely event that a physician is consulted, he is likely to prescribe a sleep medication but without any particular consistency, or any clear instructions on its use.