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Volume 10 No. 09
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Book Reviews

The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia

Frank M. Ralls, M.D.1,3; Swala K. Abrams, M.D.2,4
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine; 2Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM; 3University of New Mexico Hospital Sleep Disorders Center, Albuquerque, NM; 4University of New Mexico Psychiatric Center, Albuquerque, NM

Although insomnia has no doubt affected mankind throughout recorded history, it is believed that the term insomnia to describe this common sleep disorder did not come into use until 1623. Descriptions of that which we now call insomnia include references by Hippocrates and in ancient religious literature such as the Bible and the Koran, with phrases such as “sleep fled from him” and “they used to sleep but little by night” referencing this affliction. The word insomnia itself is derived from the Latin, “in” (i.e., not) and “somnus” (i.e., sleep). Insomnia pathogenesis varies widely, with etiologies that include medications, undertreated pain, mental disorders, circadian rhythm disorders, and poor sleep hygiene. Addressing this sensitive and challenging topic with patients is frequently difficult and many providers avoid the subject altogether, perhaps in large part because effective and lasting treatment can be elusive. Ancient Egyptians used opium for the treatment of insomnia, and there have been countless products, herbs, gimmicks, and medications advocated for this disorder over subsequent millennia associated with varying degrees of efficacy.

How far have we progressed in treating insomnia in the modern age? Recent data by Calhoun et al. (2014) indicates that one out of five young children and preadolescents have insomnia symptoms. Up until June, 2005 it had been estimated that approximately 30% of adults suffer from insomnia, but in that month a National Institutes of Health (NIH) State-ofthe-Science Conference added a diagnostic requirement for perceived daytime impairment or distress to the epidemiologic definition, resulting in a revised estimate of a 10% prevalence of adult insomnia. The American Psychiatric Association's Diagnosis and Statistical Manual of Mental Disorders (DSM-5) estimates that 6% to10% of individuals have symptoms that meet criteria for an insomnia disorder, which consist of difficulty initiating sleep and/or maintaining sleep and/or early-morning awakenings with an inability to return to sleep, as well as clinically significant distress or impairment in daytime functioning, and that is present at least 3 nights/week for at least 3 months. Untreated insomnia arguably impairs quality of life, functional ability, and contributes to medical and psychological pathology. The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia has long been a cornerstone in the diagnosis and treatment of this complex and multifactorial problem.

The Insomnia Answer was initially published in 2006 and was hailed by many at that time as a breakthrough resource that the lay public could use in order to appreciate the forces that cause and perpetuate insomnia. The book incorporates an approach that addresses the psychological as well as scientific underpinnings of the subject with the aim being to teach the reader how to get to sleep and stay asleep throughout the night without the use of medications. It does so by identifying the manifest origins and numerous contributing factors leading to insomnia so as to build the reader's fund of knowledge; such knowledge then serves to reinforce the reasoning behind the treatment strategies that lead to sustained benefit. Drs. Glovinsky and Spielman, both experts in the evaluation and treatment of insomnia, were among the first to take the understanding of insomnia to a new level by incorporating important concepts from the relatively new discipline of sleep medicine. First, the neurologic processes of sleep and other important aspects of the technical science of sleep medicine are presented in an easily digestible form for the lay reader: a basic understanding of how and why we sleep, circadian rhythms, and theories behind the development of insomnia help the reader obtain a broad grasp of the subject. The 3P behavioral model (predisposing, precipitating, and perpetuating factors) of insomnia is beautifully explained and serves to logically demonstrate to the reader how insomnia occurs acutely and how it may become chronic and self-perpetuating. The second part of the book addresses basic principles of good sleep hygiene and helps the reader understand the importance of developing appropriate sleep habits as well as the importance of sleep itself. Glovinsky and Spielman do a splendid job of guiding the reader step by step through the various treatments for insomnia such as relaxation training, stimulus control, and sleep restriction. The ever-important role of depression and the judicious and proper use of medication in insomnia are very well explained. Many important principles are reinforced through the presentation of easy-to-understand graphs, tables and question-and answer-forms.

The Insomnia Answer is well written, comprehensive, and up-to-date. It is written in a style that the average non-medical person can read and understand, meaning that it can serve as an excellent resource to recommend to the patient, potentially saving the provider from having to explain the same information during the usual all-too-hurried modern day clinic session. For the sleep medicine professional, it reinforces the impression that the basic principles of insomnia and its treatment have not changed since the book's initial publication in 2006. For some of us, it is a stroll down memory lane and for others it remains the same valuable resource it has always been in understanding and treating vital aspects of insomnia. We highly recommend The Insomnia Answer as a tool for helping the practitioner and patient understand the many complex forces that make treating insomnia difficult but also rewarding in terms of the positive effects that appropriate step-by-step therapy can obtain.


The authors have indicated no financial conflicts of interest.


Ralls FM, Abrams SK. The insomnia answer: a personalized program for identifying and overcoming the three types of insomnia. J Clin Sleep Med 2014;10(9):1041-1042.