GUEST EDITORIAL
Secondary insomnia: a myth dismissed

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Causal inference

To fully appreciate the meaning and implication of SI, one must recognize the critical distinction between SI and CI. Causal inference is what separates the two. SI asserts that stimulus A (a disease, disorder, or substance) causes event B (poor sleep), and causes is not a casual term. It requires all of the following:

  • 1.

    Stimulus A must precede event B.

  • 2.

    Variation in frequency, severity, or duration of A is closely mirrored in all dimensions by variation in B.

  • 3.

    In the absence of variation of A, B is

SI Concept Does Harm

The traditional concept of SI does harm. Once providers embrace the concept that A (primary condition) causes B (insomnia), it would be foolhardy to squander health care resources to treat the insomnia directly. Any sleep treatment gains would be cancelled by the primary condition refueling sleep disturbance. Motivated by beneficent intentions that are nonetheless misguided by invalid theory, health care providers have been inclined to deny treatment to people experiencing presumably absolute

Secondary depression

Morawetz5 published a paper in an obscure Australian journal that has received little attention. The study can claim only modest methodological rigor and the dependent measures do not constitute a robust evaluation, but the results are so stunning, the study is instructive. The author reports on 86 patients in his practice who presented with severe, chronic insomnia. About two-thirds of these individuals also experienced depression spanning the mild to severe range. He proceeded with a

Does secondary insomnia exist?

The answer is an unequivocal yes, but on a much more restrictive scale than has previously been believed. During acute onset of intrusive disorders such as cancer, depression, and pain, there appears to be a clear insomnia response in some individuals that does parallel the course of the primary disorder. And the presence or absence of this causal influence is often more obvious to the patient than the provider. Patients know when their sore back is disturbing their sleep, and these individuals

Conclusion

When plausible theory achieves broad audition, it may attain untouchable status and become highly resistant to revision despite mounting disconfirming data.11 Revered theory can become treasured mythology, and allegiance to mythology even among scientists, can be slow to fade. The interests of science and patient welfare are both served by dismissing the myth of SI.

Like traditional conceptualizations of SI I am criticizing, a fair number of the assertions herein have not been empirically

References (11)

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