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Even the term for this form of sleep disturbance indicates that it concerns difficulties in the psychic reaction to events, experiences, or thoughts. Here, too, there are nuances of what is "still normal," for even a healthy sleeper can react to aggravating experiences by not sleeping without at once being a problem sleeper.

The line of demarcation to the abnormal is only reached or even overstepped when the extent of sleep disturbance no longer bears any relation to the cause and when this situation starts to become a permanent condition.

These sleep disturbances, as already mentioned briefly, also have an element of predisposition, or of heredity. Psychoreactive disturbances in falling asleep are often found among persons who brood and mull over their own moods and the moods of others to the point of becoming depressed. These disturbances are also found among persons having a tendency toward periodic depressive states (cyclothymic personalities). Truly pathological depressions (endogenous psychoses) that have come into being independently and without perceptible external cause are not at issue here; they are merely a characteristic symptom.

Sleep disturbances among such cyclothymically disposed persons originate in their tendency toward brooding and self-criticism and in their being inclined toward depressive reactions to experience (Schulte). They are not able to shut things out or set aside the day’s experiences. They inwardly cling to all events. An added difficulty is that they frequently reach their low point of mood in the morning, similar to persons suffering from genuine depressive states. They therefore register their difficulties in sleeping particularly acutely in the morning, which accentuates their feeling of not having slept their full round.

The widespread discordant lifestyle of our modern world is characterized by insufficient physical exertion, overstimulation, the overrating of speed and accomplishment, and neglect of the realm of feeling. All these factors aggravate psychoreactive disturbances in falling asleep. Relaxation, often sought only as a means toward increasing efficiency, takes its mental and physical toll also.

Although the precise consequences to sleep resulting from this sociocultural factor cannot be documented with figures, it is certainly not to be underrated.

Some tangible causes of this form of sleep disturbance are unfinished tasks, unsolved problems, or problems whose solution is unsatisfactory and therefore cannot be accepted, resulting in their being "worked on further" during the night. Particularly tenacious sleep difficulties are also caused by guilt feelings, real or seeming neglect, improprieties—in short, by a bad conscience. But a lack of sleep in this instance can have its positive aspects, because reflecting on such problems during the night can possibly lead to their temporary resolution. It is possible to come closer to the solution of many problems and to plan changes in attitude. The same holds for thinking things through, for which there is often during the day too little time, too little peace, and possibly a lack of distance from the problems. After a night of taking inventory and making important decisions, the person's inner security and clarity of judgment may make him able to cope with real tasks and problems. Efficiency on the following day is astonishingly little affected, perhaps even increased, and the subjective feeling of not having had sufficient sleep Is remarkably slight.

Such "productive" encroachment on sleep, however,

is typically transitory. Such an encroachment only becomes a real sleep disturbance when the disproportion between cause and subsequent reaction steadily increases, when the process of reflecting during the night is not productive, or when it becomes fruitless repetitive brooding that is merely self-torture. If the psychoreactive disturbances to falling asleep were caused by unsolved problems and passing concerns, they can be eliminated by finding a solution to the conflict situation as quickly and as consciously as possible. In this case, the sleep disturbance can in fact be a kind of cleansing process. It is often worthwhile, instead of lying in bed and thinking about matters in the dark, to get up, turn on the light, and write down one's thoughts, which are often particularly concentrated and incisive at night. The consciousness of having written down the solution rather than having to retain it consciously brings relief, relaxation, and greater peace.

Psychoreactive disturbances in falling asleep caused by very serious events such as sudden death, professional misfortune, dead end psychological or material situations constitute the few exceptions when temporarily taking sleeping pills is justified. However, if longer lasting conflicts possibly having their origin in the personality structure of the person are involved, sleeping pills are not a solution, and systematic psychotherapy must be sought.