What’s more, study of EEG tracings can help us monitor the way a patient is responding to treatment. Many antidepressant medications serve to suppress REM sleep—in fact, REM suppression may be one of the mechanisms by which such drugs work. (Interestingly, depressed patients also show improvement when they are deprived of REM sleep merely by being awakened at those points in the sleep cycle.) A patient who experiences REM sleep immediately after dropping off is thought to be responding poorly to antidepressants and may need to try a combination of drugs. Similarly, some patients who may respond better to electroshock therapy tend to show much shorter onset of REM sleep than others. Perhaps in the not-too-distant future physicians will be able to diagnose and categorize a patient’s illness and prescribe appropriate therapy primarily on the basis of EEG sleep records.
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I’ve also found that some insomniacs use their disorder as a mechanism to avoid certain issues or obligations in their personal lives. One of my patients, a thirty-six-year-old man I’ll call Jim, had experienced difficulty falling asleep for nearly ten out of the twelve years he had been married. While his wife usually went to bed by 11:30, Jim would stay up for hours, finding a number of tasks, such as balancing the checkbook, that had to be done before he could turn in. He was convinced that he suffered from some kind of “chemical imbalance” that simply prevented him from enjoying normal sleep patterns; he believed that a prescription for sleeping pills was all he needed.
During one discussion, however, Jim made a casual remark to the effect that the birth control method he used was celibacy. To my surprise, I discovered that he had intercourse with his wife no more than half a dozen times a year. On further probing I learned that Jim suffered from deep-seated fears about his sexual performance, which apparently stemmed from some thoughtlessly facetious remarks his wife had made shortly after they were married. Eventually, it seems, his fears were transformed into a behavior pattern that kept him from going to bed at the same time as his wife, in order to avoid confronting the issue of sex and exposing himself to the risk of what he perceived as “further ridicule.” After some encouragement and therapy Jim discussed these feelings with his wife, who, I am happy to say, cooperated by reassuring him about his sexual desirability and performance. At last report Jim’s sleep pattern—as well as his sex life—has returned to nearly normal.
As you can see from this example, Jim subconsciously used his insomnia as a means of avoiding sexual confrontation. Similarly, other patients blame sleeplessness for poor performance at work or use it to minimize expectations people might have of them or to avoid risk of failure. Still others find they can avoid family or social obligations by using their chronic fatigue as a constant excuse.
In some cases, of course, DIMS stems not from psychological causes but from a true organic abnormality, such as a disruption in the nervous system responsible for controlling breathing. Complicating matters is the fact that such organic insomnia  often mimics the symptoms of psychological insomnia, especially when the problem is one of interrupted sleep. Organic sleep disturbance seldom results in premature morning waking—an example of why a detailed understanding of an individual’s sleep pattern is so important in diagnosis. To reiterate, however, a psychological element will be found in most cases of insomnia.
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Waste products excreted by these mites, which are mainly proteins, are the main substances to which allergic people react. Each mite excretes about 20 of these pellets every day.
These pellets, minute in size, continue to cause allergic symptoms even after the mite is dead. A female mite lays 25 to 50 eggs and a new generation is produced every three weeks.
There is a direct relationship between the number of mites in the house dust, the degree of allergy and the symptoms of asthma. Tests done with extracts made from the laboratory cultivated mite (D. pteronyssimus), showed that all individuals who had positive reactions to the mites also reacted to house dust extract. “We have not yet seen a case in which a patient reacted to house dust and not to this particular species of mite or vice-versa,” says Dr Voorhorst, the researcher who discovered mite as the cause of house dust allergy.
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