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Donald C.


Hypnosis: An Alternate Approach to Insomnia

Insomnia, the feeling of inability to go to L'insomnie, cette incapacite de dormir ou de
demeurer endormi, est un probleme clinique qui se
sleep or to stay asleep, is a pervasive fait sentir un peu partout. Ce document traite de la
clinical problem. This paper examines the relation et des similitudes qui existent entre le
relationship and similarities between sleep sommeil et l'hypnose. On y fait part d'une etude sur
and hypnosis. Research on the study of des electro-encephalogrammes et un survol des
EEG patterns during hypnosis shows that textes sur le sujet demontre que bon nombre
many authors feel hypnosis is a waking d'auteurs considerent l'hypnose comme un
phenomene d'eveil. Les raisons pour lesquelles
phenomenon. Why hypnosis allows for the l'hypnose peut provoquer le sommeil demeurent
induction of sleep is not clear. confuses.
Primary and secondary sleep disorders Les troubles de sommeil primaires et secondaires
are classified. Primary disorders have an font l'objet d'une classification. Les troubles
autonomous function in the central nervous primaires sont d'origine cerebrale tandis que les
system while secondary disorders can result troubles secondaires peuvent etre causes par une
depression, de la douleur, de l'anxiete, un
from depression, pain, anxiety, lifestyle changement de mode de vie, etc. Les troubles
change, etc. Secondary disorders are most secondaires sont plus susceptibles d'etre traites, avec
likely to be improved by hypnotherapeutic succes, avec des methodes therapeutiques par
l'hypnose qui comprennent le relachement
techniques, which include progressive progressif et le renforcement du moi. Le sommeil
relaxation and ego-strengthening. (Can chez les patients qui ont de la douleur peut etre
Fam Physician 1982; 28:768-770). ameliore grace au relachement progressif et a
l'utilisation de l'anesthesie subjective de la main. Le
renforcement du moi est une forme de pithiatisme
qui peut resoudre les problemes d'insomnie relies au
stress et a l'anxiete.

Dr. Paterson practices family health food promotors) to overcome sleep).3 To the casual observer the
medicine in Sorrento, BC. Reprint hypnotized subject appears asleep.
the problem of insomnia. It seems ev-
requests to: Box 1000, Sorrento, eryone has a cure. Most doctors prob- There are many similarities be-
BC. ably recommend a pharmacological tween sleep and hypnosis: the subject
approach consisting of sedatives andmight describe the experience as
sleep-like. Often, when waking from
antidepressants. Sleepless physicians
INSOMNIA, loosely considered as themselves probably use the prover- sleep or emerging from hypnosis, the
the feeling of inability to get to bial night cap, brandy or wine. Be- person remembers little of what tran-
sleep or to stay asleep, is one of the havioral training counsellors rely spired during sleep or hypnosis. Some
most pervasive complaints in family parallels exist in thought processes.
more on changes in diet, reading, in-
practice.' It is associated with many Vivid dreams may occur in both
creased exercise and/or sex, counsel-
clinical entities, from infection and ling and various types of programs states. Sleep and hypnosis are inter-
chronic lung disease to hyperthyroi- such as biofeedback autogenic train-changeable; if the hypnotized subject
dism and depression. ing, and progressive relaxation.2 is left alone, or if specific suggestions
Many approaches to treatment have are given, he may pass into a natural
been taken by all kinds of practi- Use of Hypnosis sleep.
tioners (family physicians, psychia- The sleeping subject may some-
trists, social workers, psychologists, Historically, the term hypnosis times awake directly into a hypnotic
pastoral counsellors, chiropractors, derives from the Greek "hypnos" (to state rather than into a normal waking
768 CAN. FAM. PHYSICIAN Vol. 28: APRIL 1982
state, particularly if he has been in- instructions that are implicit and ex- anterior tibial muscles are frequently
structed to do so before going to plicit in most hypnotic inductions. affected, but quadriceps and iliopsoas
sleep.4 The precise state in which an When the subject relaxes in the awake muscles may also be involved. The
individual exists at any given time is state, alpha activity rises. electromyogram of the anterial tibial
extremely difficult to evaluate by ex- Hodge'2 referred to the hypnotic muscles shows a stereotype repetitive
perimental means. The subject's own contract as an initial agreement of co- myoclonic discharge occurring more
description of the experience ulti- operation between the hypnotherapist in the non-REM stage of the sleep
mately provides the main criterion for and the subject to provide circum- cycle than in REM sleep. The interval
determining his state. stances under which new behavior between discharges is usually 20-40
In 1979 Evans5 reviewed tech- would emerge, especially directed seconds. There is little evidence in the
niques for exploring cognitive activity towards the treatment of a problem, literature that this problem is treatable
during sleep, citing studies by Pas- such as insomnia. The alteration of by hypnosis.
kewitz6 and Dumas.7 In particular, re- the sleep pattern in insomnia is a Reynolds20 describes restless legs
searchers noted the relationship be- learned experience. As such, what syndrome as a disorder where the pa-
tween EEG alpha activity and was learned in producing the problem tient complains of numbness and tin-
physiology of hypnosis and sleep. can also be unlearned. Numerous sug- gling in leg muscles, associated with
The above studies examined alpha ac- gestions can be used, such as "double an irresistible urge to get up and
tivity (7-13 Hz) during hypnosis and binds" 13 to enhance the subject's co- walk. Most people experiencing this
sleep. Some investigators8 have sug- operation. The subject is given a discornfort get it as they are trying to
gested that there is a strong correla- choice of two actions, both of which get to sleep. Hence, it is distinctly
tion between increased alpha activity have the same result, e.g. "Would different from nocturnal myoclonus,
and hypnosis. According to Evans5, you like to raise your hand now, or and it is possible that hypnosis, par-
the paradox of alpha activity is that it after I count to three?" This tech- ticularly progressive relaxation, may
is greatest in the relaxed state and dis- nique improves the learning experi- be helpful.
appears with drowsiness, arousal or ence. As Hilgard'4 states, this is not a Secondary insomnia is an integral
difficult cognitive tasks. Evans4 has role-playing procedure "to please the part of another picture, not a primary
questioned the relationship between hypnotist". problem in itself. Insomnia of this
EEG activity and hypnosis, suggest- Finally, the mechanism by which a type can be:
ing that it be examined in two ways: subject shifts from the hypnotic state 1. a state in which the level of pain is
1. Do the subjects who are highly to the sleeping state is not known. too high, for example headache or
susceptible to hypnosis have different Why hypnosis provides effective joint pain.
waking brain wave patterns to those sleep suggestions is also not known. 2. a state in which the level of anxi-
who are not susceptible? ety is too high, for example phobias,
2. Does hypnosis alter brain wave ac- Insomnia Sleep Disorders stress or depression.
tivity? Insomnia sleep disorders can be di- 3. a disturbed level of awareness
Some authors6' 9 have suggested vided into primary and secondary which could emanate from internal
that alpha activity is probably not cor- types. Primary sleep disorders have sources such as thyrotoxicosis, drug
related with susceptibility to hyp- an autonomous function in the central side effect, prostatism with fre-
nosis. London, Hart and Leibovitz10 nervous system.'5 Secondary sleep quency, esophagitis, pregnancy. Ex-
compared EEG alpha activity in sub- disorders can result from causes such ternal sources could be too much or
jects with varied scores of hypnotic as depression, pain, anxiety, lifestyle too little noise, jet lag, shift work,
susceptibility. Their basic assumption change etc. Hypnosis seems to be holidays or culture shock.
was that both waking and hypnotic most effective in dealing with prob-
states are varied states of conscious- lems of a secondary nature.
ness. They also observed that people Reynolds'5 has suggested that pri- Therapeutic Approach
with both high and low susceptibility mary sleep disorders involving insom- Using Hypnosis
to hypnosis differ considerably in nia are of three types: Hypnosis serves a number of pur-
other psychological tests such as psy- 1. Sleep apnea syndromes poses in dealing with insomnia. The
chomotor coordination and rote mem- 2. Nocturnal myoclonus motor function of the central nervous
ory. They suggest that hypnosis has 3. Restless legs syndrome system is characterized by a triggering
no correlation with brain wave activ- There are a number of important clini- mechanism, which becomes more
ity. Subjects who are easily hypno- cal sub types of sleep apnea syn- complex as it proceeds peripherally.
tized paradoxically suffer few sleep dromes, which can appear from in- Hypnosis serves to simplify it, lessen-
problems. fancy to old age: ing its activity. The opposite is true of
Plotkin" investigated the possible 1. Upper airway obstructive sleep the sensory side of the nervous sys-
correlation between alpha wave activ- apnea tem, in which a large amount of data
ity in hypnosis and subjective experi- 2. Central sleep apnea is filtered to produce a smaller coded
ence of hypnotized subjects, but he 3. Mixed apnea amount of sensory information. Hyp-
found none. Clearly relaxation in- 4. Pickwickian syndrome nosis can increase this filter function,
creases alpha activity and perhaps as 5. Infant death syndrome making the subject less aware of in-
Evans4 suggests, investigators have Nocturnal myoclonus is character- coming sensory material.
been monitoring the EEG correlates ized by repetitive myoclonic move- 1. Hypnosis focuses attention on
of the ability to accept the relaxation ments of the legs during sleep. The problems that disrupt lifestyle.
CAN. FAM. PHYSICIAN Vol. 28: APRIL 1982 769
2. It is relaxing and can permit sleep emanate from the subconscious. They the College of Family Physicians of Can-
induction (for reasons unknown). serve as feedback for problem-solv- ada and the British Columbia Medical As-
3. It alters the physician-patient rela- ing. This is known as ideosensory ac- sociation. Kelowna, BC., Sept. 1981.
3. Wolberg LR Hypnosis. New York,
tionship and permits new learning to tivity. Harcourt Brace Jovanovich, 1972.
occur. 14 Autogenic training increases a per- 4. Evans FJ: Subjective characteristics of
4. It allows for creative gaps to occur son's awareness of changes that can sleep efficiency. J. Abnorm Psychol 1977;
in which there is a shift of habit pat- be induced in autonomic nervous sys- 86 561-564.
terns. There is a resynthesis of pre- 5. Evans FJ: Hypnosis and sleep: Tech-
tem functioning. The basic induction niques for exploring cognitive activity dur-
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other forms of psychotherapy. can be made more aware of these.19 lishers, 1979.
6. Paskewitz DA. Alpha Activity and its
The hypnotherapy approaches I Some insomnia problems-for ex- relationship to altered states of conscious-
prefer to use in treating insomnia are ample, jet lag or shift work-are rela- ness, in Edmonston WE, Jr. (ed): Concep-
auto-hypnosis, ego strengthening, tively simple and can be handled with tual and Investigative Approaches to Hyp-
a single session of auto-hypnosis nosis and Hypnotic Phenomena. Ann N Y
pain relief, hypnotherapeutic inter- Acad Science 1977; 296:154-161
viewing techniques, and autogenic training. Chronic depression is com- 7. Dumas R- EEG alpha-hypnotizability
training. plex enough to demand greater skill in correlations: A review. Psychophysiology
Basically, all hypnosis is auto- the use of more advanced hypnothera- 1977; 14:431-438.
hypnosis. The subject is taught how peutic techniques. A behavioral ap- 8. Schwarz BE, Brickford RG, Rasmussen
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to use hypnosis to fulfill his or her notically activated seizures, studied with
own needs. The extent of auto-hyp- hot tubs, sex, hot drinks, and regular the electro-encephalogram. J Nerv Ment
nosis training can vary from the sim- hours should be taken in correcting Dis 1955; 122:564 574.
ple to the complex, the simplest being the insomnia and hypnosis can be 9. Home MT, Wilson SK Alpha, biofeed-
used in addition. Hypnosis is most back and arousal slant activation, in Batty
progressive relaxation. Various com- J, Legewie H (eds): Human Factors: Bio-
plex trance-deepening techniques can useful when there is a high level of feedback and Behavior. New York, Ple-
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of an acute or chronic pain state, hyp- EEG alpha rhythms and susceptibility to
Ego strengthening is a concept in hypnosis. Nature 1968, 219: 71- 72.
which suggestion is used to improve noanalgesia and ego strengthening 11. Plotkin WB: On the self regulation of
the image the subject has of himself. may be helpful. Where anxiety and the occipital alpha rhythm. Control strate-
This can fall into two categories-the severely disturbed mental function are gies, states of consciousness, and the role
instructive and the permissive. British the principal problems, hypnosis is of physiological feedback. J Exp Psychol
best used as an adjunct to other treat- 1976; 105:6699.
authors17 tend to instruct their patients 12. Hodge JR- The contractual aspects of
by telling them that their situation will ment means or maybe not at all. I hypnosis. Int J Clin Exper Hypn
improve. Generally, the North Ameri- have not used hypnosis in the treat- 1976; 24:391-399.
can approach18 tends to be permis- ment of schizophrenia. 13. Haley J: Strategies of Psychotherapy.
I have found that hypnosis can be New York, Grune and Stratton, 1963.
sive, suggesting that things may 14. Hilgard ER: Divided consciousness in
change. used to modify patients' drug require- hypnosis: The implications of the hidden
Pain relief is offered by producing ments, for example analgesics and observer in hypnosis, in Fromm E, Shor
a suggestion of anesthesia in an ex- tranquilizers. Where the problem of RE: Hypnosis: Developments in Research
tremity such as the hand-a glove- hypnosis is due to environmental al- and New Perspectives. New York, Aldine
teration, such as travel, hypnosis Publishers, 1979.
like numbness that can be transferred 15. Reynolds CF.: Sleep and its disorders.
to any part of the body by suggestion. probably gives its greatest benefits. Primary Care 1979; 6:417-438.
This usually follows training in auto- Under these circumstances auto-hyp- 16. Rossi EL Psychological shocks and
hypnosis and imaging. nosis and progressive relaxation are creative moments in psychotherapy. Am J
The hypnotic interviewing tech- quite helpful. Clin Hypno 1973 Jul.; 16: 9-22.
17. Hartland J: Medical and Dental Hyp-
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While interviewing patients in hyp- Hypnosis: Therapeutic Approaches to Al-
1. Kroger WS: Clinical and Experimental tered States. New York, Irvington, 1980.
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which are equally subtle and which somnia, read before the Joint Meeting of Society of Clinical Hypnosis, 1973.

770 CAN. FAM. PHYSICIAN Vol. 28: APRIL 1982