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The linkage of wrong attitude and wrong reaction, a teal vicious circle, which should in this instance be understood quite literally as a steady increase in pain, climaxes in reaching for the sleeping pill. At this stage, however, the pill can hardly be effective except in significant dosage. And the problem sleeper who, at least subjectively, has spent many sleepless nights, has only the one dominating wish to be able to sleep, and wants the pill to have the effect of a sledgehammer and to have the effect of bringing about sleep at any price. So he

no longer considers whether a sleeping pill is healthy , or has side effects if it will only help. He is then neither particularly careful with the dosage, nor does he hesitate to have recourse to alcohol. Since the combination of sleeping pills and alcohol is particularly dangerous, it must be treated in detail in a separate section.

An underdose of sleeping pills has as disastrous an effect as too large a dose. Underdosage occurs mainly among persons who take advice from other problem sleepers and even try out then* sleeping pills either because their own medically prescribed pills no longer help or because they, despite being afraid of unfamiliar medication, start doctoring themselves without medical counsel. So they start with too low a dosage to be effective in aiding them to fall asleep or to make them less nervous and tense. Then, after having waited too long, they increase the dosage of sleeping pills by timidly taking another half-tablet, which again is insufficient to induce sleep. In this manner, intake and reduction of medication can almost be balanced out without ever achieving the therapeutic level that results in sleep, and the sufferer can "creep up on" two or more sleeping pills in the course of a night without ever falling asleep or eliminating his steadily increasing tension.

The feeling of exhaustion resulting from not having slept off too large a dose of sleeping pills is particularly acute on the following morning and lasts well into the day. It is certainly more unhealthy and strenuous than a sleepless night. Consequently it is necessary at this point to warn emphatically against the dangers of dilettantically prescribing sleeping pills for oneself. Every medication works in its own way, every person reacts differently to one and the same medication, depending upon his physical and psychic state at the time of taking it, and therefore requires dosage specifically appropriate to him and his state of health.

Those who have suffered from sleep disturbances

for several years often convey the impression of physical exhaustion and look pale and tired. Mentally, though, they are usually easily irritated and tense and often lack initiative, verve, and pleasure in planning their lives. These characteristics are still more pronounced among chronic users of sleeping pills. Such problem sleepers often manifest other vegetative symptoms such as nocturnal sweating, anxiety states, and an abnormally fast heartbeat, and frequently have a tendency toward depressive states. The typical pattern of their vacillation in mood shows them to be at their lowest point in the morning after having slept poorly and waked up too early.

Thus functionally disturbed sleepers reveal both types of personality. Some are the subdepressive cyclothymic type who can find no end to brooding, who pile up problems instead of eliminating them, who wall themselves in with their problems almost to the point of being crushed by them, whose initial response to any issue is negative and problematic, and who are unable to sleep because of their self-torturing thought processes. And then there is the other, hyperthymic personality type who is unable to sleep because of the excitement of pleasant anticipation, creative drive, and an abundance of ideas. While both types may experience the same degree of difficulty in sleeping, in the last analysis they differ from one another in their opposite evaluation of a situation based on their respective dispositions. The subdepressive cyclothymic type can feel ill from the awareness of having a sleep disturbance, while the other personality type experiences no suffering in connection with being a short sleeper and therefore comes to terms with the condition without any physical ill-effects.

The last dream phase before waking can also be decisive for the feeling of having slept well or poorly. This is true even though the person may be unable to recall the dream and regardless of the quality of sleep periods preceding the last dream phase.