okay welcome to another MedCram lecture we're going to continue with our
talk on insomnia so here I've got a graph that's going to describe what the
theory is in terms of insomnia and how people get insomnia this is a little bit
of a graph here to explain over a number of months to years how this could happen
and so we've got in red here this predisposing factors so what are
predisposing factors this is just the way you were made
it's your genetics it's your tendency to have anxiety it's something that's
pre-wired you can't do anything about it it's just there next one is the blue
which is the precipitating factor you can't control this either something just
happens in your life it's a you know either good stress or bad stress you're
moving away to college you're getting married you're getting divorced there's
someone that's born in the family that's own that died in the family so these are
major life events and these are the precipitating factors and then finally
these are perpetuating factors which we'll talk about these are the things
that we do to ourselves that are harmful in terms of our sleep hygiene and keep
us from having a good night's sleep so let's talk about this a little bit here
and the first graph that I want to talk about is called the pre morbid condition
pre more of it and what I mean by this if you can remember back to your
childhood this is how you were okay you could sleep we hope some people had
problems sleeping their whole lives but let's just assume here that you were
fine and so here is the pre morbid condition and this is just your genetics
this is just how you are used there's nothing you can do about it and this is
the contribution of your genetics otherwise known as predisposing factors
that's going to cause you to have a problem now you can see here this is the
summation of all the problem and it's well short of the threshold that's going
to cause insomnia the spline is the insomnia threshold so since you're below
the insomnia threshold you don't have insomnia now let's move on to the
next phase in your life and the next phase in your life is the acute insomnia
again you cannot change and so you have your basic set of inherent factors that
are part of you that either do or don't make you have a tendency to insomnia but
instead of just that now you have a major life stressors and that major life
stressors is has a high enough magnitude
okay that it actually goes over the insomnia threshold and as a result of
this you have insomnia okay this is normal people have this all the time
they've got a test the next day they have a major report that they have to do
they've got to go on a trip this is all part of life and sometimes it's
difficult to sleep in those situations can't prevent that okay but something
happens in some people they are well adapted and this insomnia acute factor
goes away they go right back to normal and they have good sleep however in some
people early insomnia something else happens here again is our predisposing
factors here as the stress still over the threshold but as the stress from
that insomnia starts to recede we unwittingly not on purpose
begin to add these perpetuating factors we'll talk about what those perpetuating
factors are very shortly but nonetheless we do it we add perpetuating factors
until finally we get to a situation unfortunately where we
have chronic insomnia okay it's getting good here now where again we have the
thing that we cannot change which is our predisposing factors and the actual
acute event may be very minimal in fact by itself it would be well below the
insomnia threshold but because we have these perpetuating factors because we
have unwittingly engaged in behaviors we continue in a situation where we are
still over the insomnia threshold if we could somehow figure out what we're
doing here and correct that we could be down here enjoying a good night's sleep
and so the rest of these lectures are dedicated to figuring out what that
stuff is and how to do something about it now notice I haven't talked about
sleep medication we're gonna talk about what the societies that deal with
insomnia recommends and let's talk about that very briefly before we end this
video and go on to the next for insomnia the general approach that I use in the
office first is to look for diseases that could cause the patient to have
insomnia so things like obstructive sleep apnea and look at our videos on
obstructive sleep apnea to get a better understanding about that we look at the
sleep hygiene so we review a list which we'll talk about and we talk about
stimulus control this is very interesting and we'll talk specifically
about stimulus control in the next couple of lectures it's only then after
we've done that that we still haven't made headway that we start looking at
behavioral therapy and then finally medication notice how far down the list
medication is for insomnia and yet if you look at television and commercials
you'll think that the first thing you should do if you can't sleep is
to take a sleeping pill let's talk about that and we'll move on to the next
lecture see you next time
you