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Comment by jamesrcole | Hacker News Reader

As someone who has a lot of sleep problems due to physical problems, I find it frustrating that insomnia seems almost always assumed to be always a psychological issue.

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I share that frustration. Also the assumption that increasing sleep time by 10% would be helpful - 10% of zero is still zero. My last marathon of chronic insomnia was 96 hours without sleep. Not being restless in bed, but just not sleeping at all. I'm about to start CBT for this but I'm skeptical, given that it's related to a medical problem for which I'm still awaiting treatment.

I laughed when he said he was helped by seeing his "bad" night was one hour less than his targeted 7.

I can go 4 or 5 days a week not going to sleep before 4 AM and I am at work by 7 AM. I can also go 3 or 4 days waking up every hour on the hour and take 20 or 30 minutes to go back to sleep.

Most people don't know I am that tired thankfully.

Every time I've looked back on a period when I've woken up every hour on the hour, I find that I was under untenable stress levels. Just a thought.

It's been since I was 15. I have gone through a sister and a son having terminal cancer and I don't notice a difference when I was in high stress or low stress. Just frustrating.

I got five hours last night, I'm grateful. I try to hide it from others but that's tricky when you can't stay awake at your desk :-}

Honest question... why not just get some sort of excuse to be able to sleep at those times when you are ready to sleep. Sure it might be during "working hours" but if that is when your mind decides it wants to sleep then for purely health reasons doesn't it make sense to seize that moment and sleep? Would you sleep for hours at that time or would you just wake up in an hour? Either way I can see scenarios where this could work.

I can sometimes get 20 minutes at work but there are few private places where this is possible. I got a 10 minute nap once and woke to find two very concerned people wondering if I'd had a heart attack or something!

If you haven't experienced insomnia it is, like most maladies, far more complex and difficult than you might imagine. Everyone has a suggestion or two, but it differs for each individual and has a multitude of causes (as I hinted, in my case a heart problem plus various complications from that, which I hope to get sorted soon).

That would be an awesome thing to be allowed to do. Outside of high workload Asian offices I haven't heard of sleeping during hours was anything but firing material.

Did you miss where the article says "In this way, unless exacerbated by physical causes — like sleep apnea or restless leg syndrome — insomnia is a condition of the mind that then infects the body. "

It's a minor aside in the second last paragraph of the piece. The rest of the article is written in a way the presents insomnia as a psychological matter.

For most people it is a psychological problem and for those people it was being unsuitably managed. Obviously that's not true for everyone.

CBT is also used in some patients who experience pain as a result of cancer.

Sometimes CBT is about fixing the problem; sometimes it's about helping someone cope better with a problem.

By and large it is a psychological issue. When it comes to physical problems, doctors focus on treating that instead of secondary symptoms like insomnia, so that's why when you present complaining just about insomnia, doctors initially assume a psychological cause.

Why are you treating this as an issue to do with "complaining to doctors"?

I'm saying that there seems to be a near universal assumption that sleep problems are psychological. In my experience, a lot of people will basically refuse to believe that someone has sleep problems due to non-psychological factors.

Out of curiosity, what physical condition causes your insomnia?

Musculoskeletal kinds of issues, involving a lot of inflammation and muscle spasm (this is a weirdly-named technical term, and not something where the muscles noticeably jerk). Unclear where it all originally came from, possibly from long-undiagnosed celiac disease.

Have you considered CFS/fibromyalgia? Your symptoms (including insomnia) are all very typical of CFS/fibro, but not celiac. Typically the cause is stress/burnout.

Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.

I think I have looked into those in the past, but it must have been quite a while ago. Something I'll try to look into again (once I get a bit of a break from phd work...)

I've had these problems all my life (or as long as I can recall), and for that and other reasons, I don't think it's stress/burnout.

I've read of people having a lot of musculo-skeletal and inflammatory problems due to celiac disease. I don't see what the "typical" symptoms have to do with anything -- they don't say anything about a specific case of a particular person.

> Regarding people not "believing" that your insomnia is physical rather than psychological: I think it's just that your symptoms are typical of a stress-related cause rather than an organic cause.

I do not believe that is the case. It seems to me that the majority of people believe such things can only be psychological in nature... it's like they do not want to believe it could be otherwise.

I also question what evidence people have for the idea that insomnia is primarily caused by psychological factors. It seems to be mainly an assumption. I'm sure there's been some medical studies, but I feel that the medical profession is also strongly influenced by this assumption, and I really wonder how much any studies have been able to properly factor in non-psychological factors as the cause of insomnia.

I see that osteomalacia can be a complication of celiac, but it should clear up once you fix the vitamin D deficiency. Have you actually been properly diagnosed with celiac and osteomalacia?

Having some kind of issue all your life doesn't necessarily rule out stress as a cause (assuming you don't mean "every day of my life", but rather "I've had this issue off and on all m y life"). Everyone tends to have slightly different responses to stress/burnout, which will likely remain the same for most of your life.

Anyway, I would certainly recommend looking into all possibilities. For me CFS due to stress/burnout seemed to be the most likely cause of my health issues, and making significant changes to my lifestyle completely resolved the issues. I'm not saying this is the case for you, just giving you an example.

I mean every day of my life (as far back as I can recall). Literally every single day.

I find it very difficult to describe the nature of the symptoms. There's definitely a lot more than the general description I gave.

Regarding celiac disease, I have no idea why you're mentioning osteomalacia, as that does not seem at all related to the symptoms I described.

I would really really like to get a biopsy for celiac disease, but the effects of gluten on me are too severe for me to presently spare the few months of eating gluten required for the test. Unfortunately I got given, and followed, poor advice -- to go off gluten for a few months and then reintroduce it and see the consequences. I wish I had gotten the test initially. Being off gluten has cleared up a number of fairly bad symptoms that I've had all my life, and my brother and his daughter also have similar issues with it.

The inflammation/muscle spasm stuff has generally improved after avoiding gluten, but seeing as it is a chronic problem and has gotten into the state it current is in, even if the gluten was the root cause simply removing it is, by now (it seems) too late to make those things simply go away. (...and it's complicated by damage to some joints and muscular weaknesses from it being chronic for so long).

In reply to DanBC:

> Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.

I agree. I didn't say otherwise.

They're not the reasons I gave.

> It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?

what? show me anything I've written that has dismissed "the pain felt from a purely psychological cause"

But it doesn't matter if there's a physical cause. We know that psychological treatments work for many people.

Offering a psychological treatment does not mean they don't believe you or that your problems are not real and distressing.

It's pretty stigmatising of you to dismiss the pain felt from a purely psychological cause - did you realise ou were doig that?

I spent two weeks in the hospital from my chronic insomnia once, anybody who tells me I just need to relax or stop reading in bed is about as helpful as someone who tells somebody with chronic depression to cheer up.

Not everything is in your head, and no amount of positive thinking will change that.

I think CBT is training your mind to work together with you. Some of the most important things in getting your mind to cooperate (to achieve a result like better sleep), is A) believing that you can, B) Wanting it, and C) Putting in mental effort to achieve your goal. No, it's not a panacea and not guaranteed, but the science* is clearly there.

* Science - It works, bitches! (XKCD quote)

CBT isn't "positive thinking" or "relaxing".

What was the cause of your insomnia?

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