Recently I wrote about the different ways of viewing the problem of insomnia discussed in my book "Understanding Sleeplessness: Perspectives on Insomnia." I described the motivated behavior and dimensional perspectives in my last entry. Here I'll write about the life-story and disease model views.
It's natural for us to search for meaning by trying to explain things, and that includes why we have certain problems, such as difficulty sleeping. There is a type of logic in the stories we create. We might explain insomnia as the result of an upsetting experience, a work schedule change, or a habit of drinking coffee after dinner. In other words, insomnia may make sense because of something we've done or something that has happened to us.
With the disease model we try to explain insomnia in relation to biological functioning. The disease model considers clusters of symptoms that might represent particular disorders. From this point of view, insomnia might be viewed as one feature of a mood or anxiety disorder.
Difficulty falling asleep is a characteristic of the delayed sleep phase syndrome. Some people have insomnia as a disorder that is not obviously caused by another disorder. The ultimate goal of the disease model approach is understanding the underlying biological cause of a symptom.
The motivated behavior, dimensional, life-story, and disease model perspectives all may provide valuable insights regarding a patient's sleep problems. None of them is the single right answer; rather, these four points of view complement each other. In addition to helping us understand insomnia, these types of reasoning are used in understanding many different psychiatric problems. That is the subject of the book "Perspectives of Psychiatry" by Paul McHugh and Phillip Slavney.
More points of view should help doctors highlight the different possible ways they can help their patients. Someone with an anxiety disorder may also have an advanced sleep phase "early bird" tendency and feel distressed about family problems. Addressing all of them probably will be the best solution for the insomnia.
