General advice

Examples of general instructions : the "stimulus control"

Nb : Do not force against yourself : "understand before acting"

• Go to bed only when you "feel" you need to sleep (sleepy),
• Stop all intense physical activity one hour before going to sleep,
• Reserve the use of the bed only for sleep (no reading, watching TV, eat or laze around listening to the radio...)
• Get out of the bed or even the bedroom (at least 20 minutes) if sleep doesn’t come after 20 minutes;
• Get up at the same time every morning no matter how many hours of sleep you have had during the night;
• Have no nap during the day.

These guidelines, correctly applied, in "strongly motivated patients", some studies bring about up to 70% good results.

But it can happen that they have no result at all.
The inequality regarding sleep does that some good sleepers respect none of these instructions without any trouble and that others will have to discipline themselves during weeks before they find again trust and rest in their sleep.

The problem of insomnia cannot be summarized in showing and correcting behavioral errors.

In the same way, following a diet in order to become able to control weightgain on a long-term basis is sometimes not enough for some people who suffer of overweight.
The patient who consults is trapped in such a cycle that these "general instructions" have already been held in check by experience.
When it works without being understood and accepted, that type of "diet" doesn’t always allow the prolonged following of the instructions and the relapse reinforces the feelings of helplessness and guilt that are those of the sick person.
His/her feeling of being a victim is strengthened in a pattern of resignation (like in a subject who gives up a diet), and he/she increases his/her intake of sleeping pills.
It is the "yoyo" effect of treatments that are too fast and do not rely on sufficient knowledge.

Nb. The weight of the cultural and familial misunderstandings that we sometimes maintain towards our sleep often inserts a bias in the understanding of these instructions (a bit like an obese who would decide to supress the bread but keep the butter).
The nap is a very representative example to illustrate that misunderstanding. There exist a lot of prejudices as much in the people who are "for" as in those who are "against" the nap, which rely on their personal experience without taking the variability of the needs for sleep into account.
The nap should be used according to each circumstance and chosen in function of reasons based on knowledge and not according to a personal opinion of a "for" or "against" kind.

As De Fontenelle wrote, in 1687, in the history of the oracles, "that means that, apart from the fact that we do not have the principles that lead to the truth, we have others, which get on fine with what is wrong". (De Fontenelle. L’anecdote de la dent d’or, 1687)

The virtuous circle of recovering opposes to the vicious circle of insomnia

.... observe -> understand -> act ->observe -> understand -> act -> ...

The program of the caretaking must proceed in successive levels:
The duration of each stage depends on the quality of the doctor-patient relationship.

• 1st step: learn
  The definition of sleep and of its mechanisms of regulation
  Get familiar with the tools at disposal to observe and understand it.
  Definition of the individual sleep variations

• 2nd step: observe
  Determination of the somnological profile of the subject, during the interview (childhood, family, habits...) and with the help of the questionnaires.
  Observation of the "inventory of fixtures" and redefinition of the target.

• 3rd step: understand
  Reasoned analysis of the sleep/wake diary and thinking "like a scientist" for the identification and the interpretation of certain counterproductive cognitive and behavioral patterns (some learned people call it "socratic questioning").

• 4th step: act
  Choice of particular guidelines and experimental observation of the effect of the "somnications" on the diary...

  And... learn, observe, understand, act, and so on...

  Some follow-up consultations will be useful to make a synthesis of the positive and negative results. They result in the analysis of the problems, taking, thereby, the progress of the patient’s knowledge about sleep into account.

"Recovery or remission ?"

Insomnia often results from performances acquired "thanks to" out of the ordinary somnological abilities. The subject will always be able to have a sleepless night if the circumstances deserve it.
He/she will have recovered definitely if he/she keeps faith in his/her sleep, if he/she knows the consequences of that sleep debt and what he/she has to do in order to recover without causing chaos in his internal clock.
In the opposite case, the "old patterns" (panicking thoughts -> prolonged arousal -> wrong attributions -> counterproductive behaviors) risk to reappear.

The difference between the sick person and the good sleeper is of the same kind as the difference that exists between remorse and regrets. (See the end of the article about the personal management of insomnia)
The purpose of this website is to help everyone to become aware of that difference and acquire his/her autonomy regarding sleep.

\ offers an interactive sleep disorder screening test : "select the items for which you feel concerned" ... ... "your answers are compatible with the following problem(s)... you should discuss these questions with your doctor".