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The sleep-wake pattern is the first clue to a diagnosis of DIMS. In addition, the length of time a disorder has persisted—a few days? years?—is a significant factor in understanding the problem. All of us suffer disturbed sleep at some time or another as a normal response to grief, illness, or a major change in our lives. A long-term sleep disruption, however, may be the result of behavioral patterns learned in childhood. This kind of conditioned response accounts for perhaps a third of all DIMS diagnoses.Like other physicians I have noticed other patterns of behavior common to many insomniacs. They frequently report that, come bedtime, they feel increasingly tense and anxious. They begin to ruminate about the state of their health, their problems at work, or their personal relationships. Thoughts of death intrude. I’ve already mentioned that common but bizarre prayer “Now I lay me down to sleep”; the scientific literature on sleep contains reports of people who have been terrorized by this innocent prayer and its not-too-concealed threat that they might die before they awaken. One sensitive parent I know of rewrote the prayer this way: “In the morning when I wake, keep me again for thy dear sake,” thus effectively shielding her children from the association between sleep and death.In large measure, insomniacs are people who lack adequate means of dealing with stress, who tend to turn their emotions inward. Laboratory studies demonstrate that these thought patterns have physiological consequences in that they stimulate the autonomic nervous system. Heart rate, muscle tension, and body temperature may increase, making onset of sleep more difficult. In the morning these individuals feel worse than on retiring: tired, unrested, irritable. They drag themselves through the day feeling tense, unhappy, not fully in control.*108\226\8*

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