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This presentation is a recast of a paper that I read before the Brooklyn Neurological Society in 1937. I shall endeavor to reformulate the meaning of insomnia in terms of certain ideas and fantasies observed in a number of analyzed cases. In this group of patients, sleeplessness predominated over co-existing symptoms. These patients claimed they would feel well if only they could sleep, and aside from the fear of not being able to sleep, they appeared to be living normal existences.
The designation of insomnia may perhaps be applied to a symptomatically restricted condition and is distinctly different from the sleeplessness which occurs from consciously perceived reality situations or from some frank neurosis or psychosis. Basically, anxiety is the exciting cause of all forms of sleeplessness. The manifestation of anxiety, however, differs when associated with repressed emotional factors from that associated with outer environmental situations. Insomnia in its more restricted meaning can be differentiated from general sleeplessness in that the insomniac is unaware of the deeper causes of his affliction. True insomnia persists over a prolonged period of time whereas general sleeplessness is frequently only of a transient nature. The insomniac belabors himself with many rationalizations of why he cannot sleep. He often fears losing his mind, doing some harm, or dying from exhaustion.
Insomnia has not been regarded generally as a separate neuro-genic entity even when it exists as an isolated symptom and is intractable. However, insomnia is such a specific symptom complex