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WHY YOU AREN'T GETTING A GOOD NIGHT'S SLEEP.

Like many of you I love a good mystery novel. Piecing together the clues, trying to discern the real culprit from the pretenders, has kept me awake on many nights as I struggled with the temptation to turn to the last page. In a way being a doctor is very much like reading a mystery: We never have as much information as we would like, and sometimes, just when we are absolutely positive that we know who (or what) did it, we get our biggest surprise. Some of you may have dreamed of being a doctor; I, on the other hand, have always wanted to be the next Dick Francis or Robert Ludlum. For now, however, I must be content with being a doctor. Unfortunately, doctors cannot turn to the last page to find the solution to the whodunit.

Instead, we must rely a great deal upon the information you- the patient or members of the patient's family-provide. This is especially important since in sleep disorders, unlike most other areas of medicine, there are no readily available diagnostic tests like the X ray to guide us. Thus the information furnished by the previous chapter's self-assessment is crucial to a doctor's diagnosis.

It is also important that we be precise in the definitions of sleep disorders. Only with this precision can we begin to eliminate some of the confusion that surrounds the subject and design a therapeutic approach that has a hope of succeeding.

Clearly, confusion does exist. In a poll conducted by Stanford University, 4.3 percent of respondents described themselves as "insomniacs." At first glance, this low number would seem to belie the statement I made in my introduction, that as many as one out of three people in this country experience difficulty sleeping. But numbers and surveys can be deceiving. In this case the same Stanford survey went on to report that 38 percent of the group also declared that they had problems with at least one of the following: falling asleep, getting back to sleep after awakening during the night, awakening too early, and daytime tiredness. Strange, isn't it? Few claimed to be "insomniacs," but many suffered from the very symptoms that define insomnia.

With that in mind, then, let me try to clarify the terms I'll be using throughout this book in order to establish what a sleep disorder is and is not. These definitions are based on a consensus of doctors and psychiatrists and are widely used in diagnosis and treatment.

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