Dear Ann Landers,
Your let-ter is strong testimony that experience is the best of all teachers. I find it interesting that 90 per cent of the letters I receive pertaining to in-law problems are complaints against the mother-in-law-not the father-in- law. And 80 per cent of the mother-in- law beefs are against the husband's mother-not the wife's. Insomnia Insomnia is defined as a temporary, or chronic, loss of sleep. The definition comes from the Latin in, meaning "not," and somnus meaning "sleep"-so, "not sleep." In general, temporary sleeplessness is usually caused by some transient physical condition or emotional upset. Chronic sleeplessness may be caused by persistent physical disorders, or more often, deep-seated psycho-logical difficulties, or a combination of both. Insomnia is one of the sleep disorders that has been studied extensively at leading universities and medical centers in facilities called "sleep labora-tories." Electroencephalogram (a machine that studies brain waves) tests during sleep provide an understanding of both the normal and the abnormal variations. Insomnia should be looked at against other factors that may affect sleep, such as season of the year, climate, social customs and occupation. People who change work shifts may have difficulty adjusting to a new sleep schedule. There are three levels or stages of sleep depth distinguished in the normal variations of human sleep. Stage One is a very light sleep which is a transi-tion between waking and sleeping. This represents about 5 to 10 percent of the total sleep period. Stage Two is medium deep sleep and represents about 50 to 70 percent of the total sleep period. Stage Three, called delta sleep, or deep sleep, repre-sents somewhere between 0 and 25 percent of total sleep. Stage Three (delta stage) is frequently subdivided into two stages so that it may sometimes be called Stage Three and Stage Four. One normally enters the deepest sleep pe-riod or delta sleep about a half hour to an hour after the onset of sleep. As the night goes on, there is less delta sleep, and more of Stage Two sleep. Delta sleep declines with age, so that many elderly people who are in good physical shape will complain of being relatively light sleepers. There is very little delta sleep after the age of sixty. Now, alternating with normal sleep (which is technically called non-REM sleep) in about ninety-minute intervals through the night is a separate state which is called paradoxical sleep. This is called the REM state (REM stands for Rapid Eye Movement). This period of REM sleep which alternates with normal sleep accounts for about 15 to 30 percent of the total sleep period. In theories of sleep and the studies that try to confirm them, REM sleep in-volves a time of psychological recovery for the sleeper. It parallels delta sleep, which is a period for physical recovery. This is just a theory, but it proposes that REM sleep is a period for psychological repair and reviewing of psycho-logical and emotional processes during the day. It involves the consolidation of memory. It has been proven that dreams dissolve within five to ten minutes after REM sleep, unless one awakens from REM sleep and immediately fixes the dream in his waking memory by trying to remember it. What this means is that someone who remembers a dream has actually awakened from REM sleep and fixed that dream in his waking, conscious memory. Not all people need the same amount of sleep. Many healthy adults can get along without any ill effects on three hours of sleep a night. Others need ten or twelve, and feel tired and irritable when they get less than ten to twelve. Therefore, insomnia should be defined only as it relates to an individual. A person has insomnia if his inability to sleep for as long as he needs to inter-feres with efficient daytime functioning, regardless of how many hours he gets. Short-term sleep losses are only of concern with certain medical conditions such as epilepsy, where the lack of sleep will lower the epileptic seizure threshold; or in those whose jobs require attention such as air traffic con-trollers and persons working with highly technical and dangerous equipment. The most common complaint about insomnia is difficulty in falling asleep. Frequently people become more and more concerned and approach sleeping periods with anxiety, which almost always assures another sleepless night. For those who have occasional nights when they have difficulty falling asleep, I recommend a hobby, reading or some form of quiet relaxation. Some in-somniacs would do well to catch up on back work rather than spend hours rolling and tossing. Occasionally a sleeping pill will help; but for the most part, sleeping pills are virtually useless when taken on a continual basis. Most are ineffective after ten days of chronic use, although occasionally, some will show potency up to a month. Actually, for those who use sleeping medication on a regular basis, depriving them of the drugs for a night or two causes a REM rebound which may produce nightmares and disturbed sleeping patterns. Usually se-vere and continuing insomnia may be caused by conditioning. It may have started during a crisis in one's life, such as an impending divorce, following a death, etc. It then continues because one establishes a pattern of sleeping poorly and expects to sleep poorly. To correct this situation, the person should be taken out of his conditioned setting. Frequently these people report that they sleep better on vacation than at home-the reason being that they are out of a conditioned setting. This is called behavior modification, and in-corporates the following instructions: One should not take naps during the day and should try to stay awake even when feeling sleepy after meals. One should try eating lightly during the evening meal since many of the chemi-cals in food induce a certain amount of sleepiness. This leads to "cat naps" rather than to a full night of sleeping. One should avoid stimulants like coffee and tea and cola drinks (all contain caffeine) or at least restrict them to the earlier part of the day. Essentially: (1) Go to bed when you feel sleepy. (2) If you do not fall asleep within ten or fifteen minutes, get up, get out of bed and leave the bed-room and go into another room, and do what you feel like doing until you feel sleepy again. This process of returning to bed as often as necessary until you fall asleep should be repeated until such time that you fall asleep in-stantly when going to bed. Every effort should be made to avoid oversleeping in the morning. What will happen is that after three or four nights of a sleepless or a disturbed rou-tine, the patient will fall asleep on the second or third attempt and will gradu-ally relate to the bedroom as a place for sleep, rather than sleeplessness. Many individuals who have had high anxiety about falling asleep will fall asleep almost anyplace other than their bedrooms. They will fall asleep in front of the television, they will fall asleep reading the newspaper, etc. For these individuals, relaxation techniques, such as the practice of tran-scendental meditation, are useful mechanisms. Occasionally a sleeping pill may help to reduce the anxiety, if it does not lead to chronic use. For some individuals, situational factors, such as overstimulation, excessive work demands, emotional problems, or chronic tension, will lead to chronic insomnia. Some insomniacs have been encouraged to exercise before going to sleep. In certain instances, this merely sets up an arousal pattern and stimu-lates them to a point where they cannot fall asleep. For such individuals, a quiet relaxation period of reading or drinking a glass of warm milk would be the better approach. Most patients with sleep onset problems show a combination of physical and emotional problems. Fragmented sleep (sleep in which an individual may frequently get up at intervals during the night) occurs in a variety of forms of depression and the remedy is to treat the underlying depression- usually with psychotherapy and antidepressant drugs. Many people get trapped into taking medication because they think they are not getting enough sleep, when, in actuality, they need less sleep than other members of their family. Certain types of physical illness, such as hy-pertension and cardiac disease, frequently will cause difficulties with insom-nia or fragmented sleep. There is another sleep disturbance in which an individual sleeps the entire night but wakes up exhausted in the morning. This is related to a condition which is called sleep apnea-usually associated with people who snore for extensive periods during the night. Their pattern can be described as follows: they snore, then they stop breathing and gasp for air; they resume loud snor-ing, then they breathe heavily again. The breathing interruptions are so brief that the patient can't remember them, but it does leave him exhausted and fa-tigued in the morning. Actually, the patient wakes up momentarily many, many times during the night. Such conditions are treated by a drug or, in a recent series at Stanford, by making a small hole in the trachea which is plugged during the day and which allows the patient to breathe more effec-tively at night. In summary, insomnia is a symptom usually of an underlying emotional problem such as depression or anxiety; sometimes it is situational and tran-sient-which means it passes. It may also be related to certain physical conditions, all of which should be explored. Most of all, one should remember that the usual sleeping medica-tion does not help after a period of time and may keep a person locked into a pattern which, on rapid withdrawal, will cause nightmares, teeth-grinding and other symptoms related to the disturbed sleep pattern. credit: Harold M. Visotsky, M.D., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Northwestern University Medical School; Di-rector, Institute of Psychiatry, Northwestern Memorial Hospital, Chicago, Illinois. BED TROUBLE DEAR ANN: My husband dared me to write you this letter. Our problem is not unique. It is one shared by thou-sands of women. My kids won't let me sleep days and my husband keeps me up nights. I'm tired all the time. He's a restless sleeper, thrashes around continuously, takes his half of the bed out of the middle, wraps himself in the blankets and leaves me shivering. I've begged for twin beds but he insists the double bed is the cornerstone of a happy mar-riage. What do you suggest? BEAT BEVERLY

DEAR BEAT,
The double bed may be the cornerstone of a happy marriage, but exhaustion could be the tombstone. Tell your husband the average per-son spends one-third of his life in bed. It's an undisputed fact when THAT third is happy, the remaining two- thirds is considerably more pleasant. Since he is a restless sleeper, yet he obviously wants you "near" I suggest twin beds (separate mattresses and box springs) placed smack together and use a single headboard. It will look like one large bed, but actually it's two- each with its own set of sheets and blankets. Intercourse (Painful) (Dyspareunia) Physical and psychological factors may cause dyspareunia-painful inter-course-in both sexes. Since the condition is much more common in women than in men, we will discuss only dyspareunia in women. In some virgins, the hymen (maidenhead) may be intact and unstretched. The first few times intercourse takes place there may be pain or even slight bleeding as the hymen is stretched or tom to accommodate the penis. A very few women have tough hymens which need minor surgery. Burning, itching or aching pain in the vagina during intercourse often is caused by failure to lubricate. The production of lubricating materials in the vagina can be compared to an erection in a male: Without it the woman is not ready either physiologically or psychologically for intercourse. Failure to lubricate can occur when the woman has little or no love, affection, respect or trust in her sexual partner or believes he feels none of these for her. Inade-quate lubrication may also result from fears (for example, of becoming preg-nant) and from the aging process. Using a lubricant such as K-Y jelly or foam (available in drugstores) is often helpful in relieving a lack of natural lubrication. Lack of lubrication after the menopause is a common symptom due to inactivity of the lubricating glands. Bacterial and fungal infections may also cause this type of vaginal pain. Douching after intercourse is popularly believed to be a hygienic practice that will help prevent infections. Actually, douching usually does more harm than good because it destroys the natural ecology of the vagina and increases its susceptibility to the growth of harmful bacteria and fungi. Women often get fungal infections after being on antibiotic therapy. The antibiotic kills the bacteria and the fungus grows wildly. Persistent bacterial infections of the vagjna may also result from anal inter-course if the penis is inserted into the vagina after being in the rectum. The incidence of this type of infection can be decreased by either refraining from vaginal intercourse after anal entry or having the male partner wash his penis well before inserting it into the vagina. A common cause of pain in the pelvis is deep thrusting. This problem can be remedied by informing the partner, who should then proceed in a less vig-orous and more gentle manner. When pain during intercourse results from scars of injuries received during abortion, childbirth or violent rape, surgical repair is the appropriate treatment. Endometriosis is one of the most common causes of deep pelvic pain with intercourse. It is always worse just before or after a period and is not too difficult a diagnosis for your doctor to make in his office. Some women complain of painful intercourse after hysterectomy. Although physical causes should not be ruled out, this pain is frequently caused by fear that the sex drive and orgasmic response will decrease or disappear. On the other hand, some women enjoy sex more after hysterectomy because they no longer worry about pregnancy. Many women who have undergone radiation therapy will experience pain during intercourse due to a shrinking of the tissues. Since painful intercourse has a variety of causes, some of them physical, a counselor's first step should be to assist the woman in obtaining a thorough physical examination, including sexual history. If no physical cause can be found, counseling should be sought The pain may be caused by the desire to avoid intercourse. This means there is an emotional problem which needs ex-ploration and ventilation if the woman is to have a satisfactory sex life. credit: John S. J-ong, M.D., F.A.C.S., F.A.C.O.G., Associate Professor of Ob-stetrics and Gynecology, Rush-Presbyterian-St. Luke's Hospital; attending physi-cian, Rush-Presbyterian-St. Luke's Hospital, Chicago, Illinois. Introductions When I was growing up (back in the Stone Age, of course) I was taught a few basic rules about introductions: A child or teenager always stands when introduced to an older per-son. When introducing one person to another one should present the younger (or less important) person to the other. Example: "Johnny, this is my grandmother, Mrs. Jones." "Prince Philip, may I present my laundress, Ruth Smith." A woman when meeting a man for the first time does not wait for him to extend his hand. She extends hers. Well, there's a lot more to introductions than that-as my readers have taught me. Here are a few examples of what I mean: dear ann: Many years ago an uncle of mine served in the capacity of lieu-tenant governor for about five weeks. He was appointed to complete the unfinished term of the lieutenant governor who died. My husband, when he introduces me to friends, invariably says, "Meet my wife-the niece of the former lieutenant governor of the state." This embar-rasses me and I become very uncomfortable and wonder what others must think. How can I cure my husband of this tasteless habit without humiliating him before friends? He's extremely sensitive, annoyed dear ann: It's one of the ironies of human nature that the most sensitive people are generally insensitive to the feelings of others. Tell your husband, in private, of course, that you are perfectly content to be introduced as his wife and it's unnecessary to drag your uncle in by his heels to build you up. As for what your friends think-they think exactly what you think they think, that your husband is an insecure clod who feels the need to impress people even if it means using a slightly fraudulent device.