Editor's message

Journal of Family Practice, Sept, 2004 by Lois E. Krahn

People cannot obtain sleep of satisfactory quality and quantity for many reasons. Some patients describe getting inadequate sleep dating back as far as childhood. The mechanism of longstanding primary insomnia of this type remains unknown, although several theories have been proposed. For some patients, insomnia can extend throughout the lifespan from childhood to aging. For other patients new factors such as changing sleep-architecture patterns, medications, life transitions, and sleep-hygiene issues, such as spending too much time in bed, can complicate getting high-quality sleep.

Physicians often face time pressures when seeing patients. Taking a sleep history that potentially reaches back to childhood sleep patterns may seem dispensable. However, when a secondary cause of insomnia is not clearly present, understanding the duration and severity of primary insomnia requires a careful assessment of the patient's sleeping patterns and lifestyle over time. Detailed questioning then permits the clinician to develop a multimodal treatment plan that addresses the attitudes, behaviors, and physiologic factors that can play a triggering or perpetuating role in this complex medical problem.

In the third issue we are pleased to feature contributions from:

* Dr Peter J. Hauri, who describes the paradoxical hyperaroused state observed in some patients with insomnia, often recognized only after a detailed history is obtained.

* Dr Max Hirshkowitz, who places sleep architecture in a useful context for practicing clinicians.

* Dr Roger J. Cadieux, who discusses several issues related to sleep in the geriatric age-group.

Lois E. Krahn, MD

Associate Professor and Chair

Department of Psychiatry and Psychology

Mayo Clinic Scottsdale

Scottsdale, AZ