Teen Insomnia




Insomnia, and teenage insomnia, might seem to be a modern problem, but they have been causing anxiety for centuries.

'The subject of sleeplessness is once more under public discussion," read the editorial in the British Medical Journal. "The hurry and excitement of modern life is held to be responsible for much of the insomnia of which we hear; and most of the articles and letters are full of good advice to live more quietly and of platitudes concerning the harmfulness of rush and worry. The pity of it is that so many people are unable to follow this good advice and are obliged to lead a life of anxiety and high tension."

It could have been written to mark Sleep Awareness Week, which started yesterday, but in fact the paragraph above appeared back in 1894. It shows that despite our fears of living in a caffeine-boosted "sleepless society" - in which insomnia is one of the most common complaints in GPs' surgeries - anxiety about our sleeping patterns has been with us for centuries.

According to the BMJ, the cure for teenage sleeplessness was more mental than medical. Different remedies suited different people, even if they were opposites: hot baths versus cold baths, hot drinks versus cold drinks, walks versus sitting around and "steady but monotonous counting" or "the more difficult feat of thinking about nothing". But such sensible advice has always been overshadowed by our wish for a pharmacological quick fix.

One of the oldest potions was the herb valerian, named after the insomniac Roman emperor Publius Licinius Valerianus, who advocated its use throughout his empire. Although it had only a modest effect, the influence of its patron meant it became the drug of choice for sleepless Romans.

It was several hundred more years before a genuine knockout drug became popular: laudanum, which was taken, especially in Europe, until the late 19th century. It was also called "tincture of opium", as it comprised a mixture of opium, alcohol and sugar. Byron, Shelley, de Quincey, Coleridge, Poe and even William Wilberforce were "opium-eaters", using the drug not just as a sleeping aid but also for pleasure or to feed an addiction. By the time of the Victorians, a "fix" was cheaper than a shot of gin or wine.

The problem - which continues to trouble us today - is that the more that more people, including teens, find such substances effective, the more they become over-reliant, or even dependent, on them. When coupled with a celebrity endorsement - such as the Emperor Valerian's - take-up could be rapid. Cannabis, also freely available in the 19th century, was thought more dangerous than laudanum in treating sleeplessness, until it became known that Queen Victoria had been prescribed it by her personal physician, Dr J?R Reynolds, to "assist sleep during menstrual cramps". In 1890, he reflected in an article for The Lancet, that cannabis was "one of the most valuable medicines we possess for treating insomnia".

This was a time well before Freud and his contemporaries, when the mind was largely ignored by physicians. None of the remedies for sleeplessness involved anything along the lines of what one might call psychological therapy, even though stress and a troubled mind were well known to be a common basis for insomnia, as reflected in the BMJ editorial. Fortitude and a "stiff upper lip" were expected of patients. Emotions, according to the prevailing medical opinion, affected the body, in particular the cardiovascular system, so treatments for "emotional problems" often involved targeting the heart and blood.

This further explains why teen insomnia, despite its link with stress and anxiety, still continued to be viewed, up until the early 20th century, as a physical disorder. Most of the treatments that did not involve drugs were aimed at counteracting insufficient bloodflow somewhere in the body, but there were contrasting opinions as to how to do this.

One school of thought believed that insomnia was caused by too much blood in the head, which could be reduced by the body being propped up. Another held that sleeplessness meant there was too little blood flowing, which could be fixed by sleeping with raised feet.

By the 1890s less addictive drugs had been discovered, among them paraldehyde, chloral hydrate, sulphonal and potassium bromide, which seemed to provide real "cures" for insomnia. Invigorated by this new armoury, the increasingly active British Medical Association, established in its current form in 1874, campaigned against what it called "secret remedies" and forced the removal of opiates, cannabis and cocaine from tonics and non?prescription medicines.

By now, physicians were responsible for prescribing most drugs to teenagers, and the old-style apothecaries had become pharmacists. As a result, medicine became even more influential in dealing with insomnia, which was becoming attributed not so much to the mind but to "brain dysfunction" - that is, it was at last seen as a physical illness brought on by stress, but there was still little regard for tackling the underlying cause. It became "medicalised" to a greater degree: patients could be diagnosed as insomniacs, rather than simply belittled for lacking moral fibre.

In a way, this is the situation that persists today. Like the new drugs of the 1890s, sleeping tablets are effective as part of an initial treatment, but are not a complete solution. After a few weeks of taking a pill, whatever it is, few people will see their sleep increased by more than 20 minutes, or the time they take to fall asleep reduced by more than 15 minutes. Similarly, pills are unlikely to improve alertness in the daytime, especially if sufferers are already over-active while awake. However, many of these medicines help by acting as tranquillisers: in reducing our underlying anxiety, they make us feel more relaxed as we lie waiting to go to sleep, and perhaps lead to greater contentment the next day.

Arguably, though, half of the benefit from any modern sleeping pill, be it prescribed or just bought over the counter, is due to a placebo effect. Belief in any treatment acts as a powerful therapeutic tool, just like buying a new mattress or having your bedroom feng shui'd. This is because the secret of conquering insomnia in teenagers is peace of mind at bed-time: too many sufferers forget that insomnia is typically a "24-hour disorder".

The real cure usually comes with professional counselling, and in understanding and dealing with our waking worries beyond the insomnia. Sleeping tablets can be a helpful bed partner, but after a few nights, the best tablet might be the one that sits on the bedside table gathering dust. Knowing it's there, just in case, is almost as good as swallowing it - although that might not be much consolation for the drug companies. from http://www.telegraph.co.uk




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