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Persistent DIMS is a type of disorder that afflicts the patient for a month or more; as we’ve seen, this form of insomnia can last for years and is directly attributable to the learned behavior I’ve just described. For example, a patient may experience some kind of illness or emotional crisis that, among other symptoms, disrupts sleep. However, when the illness is cured, or after the crisis has passed, the insomnia may take on a life of its own and become the focus of the patient’s concern. He or she then perceives the insomnia as a distinct disorder in itself.
The insomnia thus hangs on long after the initial, precipitating cause has disappeared; the longer the pattern continues, the more entrenched it becomes. Just entering the bedroom and experiencing its sights, smells, and sounds can trigger feelings of unpleasantness. Frequently the patient will conduct some kind of inner monologue: “Oh God, it’s bedtime . . . another night of tossing and turning. I just know I’ll never get to sleep. I hate this ritual. . . .” In this way victims reinforce their insomnia on a nightly basis, until it has swollen into a kind of sleep phobia. The technical term for this kind of conditioned disorder is “psycho-physiological,” a combination of syllables that appropriately suggests the impact the mind can have on the way the body behaves. According to one study psychophysiological factors are present in about half of all diagnoses of DIMS.
By carefully eliciting the patient’s medical and psychological history, I find I can usually detect the conditioning pattern. Ruling out sleep disturbance stemming from medical conditions or psychiatric problems such as anxiety, fear, depression, or the form of neurosis known as obsessive-compulsive behavior, I begin to suspect that I am confronting a case of persistent DIMS. One key element in confirming the diagnosis is the patient’s absorption with the sleep process itself, to the exclusion of other mental or emotional concerns. Often he or she reports desperate and self-defeating efforts to obtain sleep, revealing in the process the degree to which a sleep problem is overanticipated.
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As a person becomes older his sleep pattern changes. He has many more awakenings throughout the night. His sleep is much lighter, and he rarely enters stages 3 and 4; instead these are replaced by a lot of awakenings and there is a kind of natural insomnia. However, most older people do not understand that they no longer need so much sleep. They feel distressed lying in bed alone at night, and some still want to recapture the feeling of ‘sleeping like a baby’.

My advice to the elderly is that we are becoming wiser and more respected as we grow older. We should be proud of our grey hair and hard-earned senior status in society. We should feel lucky that we have outlived our unfortunate associates. We are no longer babies, and do not need all that sleep anymore. We can relax and rest at night, and should keep ourselves more active both physically and mentally in the daytime. During the day, if we are inactive, we may have a lot of microsleeps. Microsleeps are brief periods of sleep activity which can be recorded on the EEG. These microsleeps last only a few seconds, but, if all these microsleeps during the day are added together, they will replace most of the need to sleep at night.

Many of my older patients regularly sleep three hours a night and have one hour of afternoon nap. They are all healthy and they function perfectly well in the day. They understand that they do not need all that sleep. It is sad to see older people, who biologically need only a few hours of sleep each night, extending their sleep time artificially with sleeping pills.

To summarise, the two different kinds of sleep, REM and NREM, alternate with each other, and we have a few sleep cycles each night. We used to think that sleep is passive and peaceful and mat if we dream a lot we have had a poor sleep. Now, with the help of the sleep laboratories, we know that we have at least four or five dream periods at night and at least one-quarter of our sleep is spent in dreams, although we cannot remember most of them. The other surprise is that it is normal to wake up in the middle of the night. These findings have dispelled the myth that good sleep means no dreams and no awakenings in the night.

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I have found that one of the greatest difficulties in helping people by this approach has been getting them to accept its simplicity. People always want the newest form of medical treatment. The modern trend in medicine is continually toward greater and greater complexity—more complicated instruments, more complicated tests, more potent drugs. We have come to associate complexity of therapy as an advance over more simple treatment. You can see my difficulty.

I am advocating a form of treatment that is simple in the extreme. But I will remind you that it is natural as well as simple, and that is why it is so successful.

A very aggressive young woman, a graduate in psychology, was openly contemptuous when I explained the way in which I proposed to help her. She gave me a superior smile, and said, “It will take more than that.”

I had great difficulty in persuading her to lie down on the couch so that I could show her what I meant. With a shrug of the shoulders, she said, “Oh well, just to please you!” I then spent sufficient time with her to be sure that she would capture a real feeling of relaxation. She did. This was the turning point. She learned to practise the exercises herself and did very well.

A writer of international fame consulted me because he was tense, disgruntled with himself, and had lost his creative ability. After considerable discussion of his difficulties, it seemed clear that the real problem was his inability to work caused by slowly mounting tension over the years. I explained how I could help him to be less tense and more at ease. However, he prided himself on his worldliness and his sophistication and from the outset was sceptical of my approach because of its inherent simplicity. He did the exercises, but he did them reluctantly, with a smirk on his face, as it were. He benefited to some extent, but I am sure his improvement would have been much more complete had he accepted the truth that we can often be helped most by basic methods which are themselves simple.

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