For six months, I have had a problem sleeping, and now, no sleeping tablet seems to help. My doctor has suggested a psychiatric evaluation. Is that a good idea?
The simple answer to your question is a most emphatic yes. You should, to the extent possible, accept the professional opinion of the expert you have chosen for yourself, unless you choose to seek another professional opinion from yet another expert.
This general point having been made, we must look at you and your case to better understand why we got to where we are. It has been six months since the problem started and you have, like most people do, started to self-medicate, before consulting the doctor. This habit of self-medication is most understandable and since insomnia is a common often self-limiting condition, it would be absurd to expect that each time one loses sleep for one or two nights, the first port of call is the psychiatrist. There are simply not enough doctors to treat insomnia of this type. That you have had the condition for six months means we are dealing with a more serious condition.
Similarly, and as your doctor has, in my view correctly pointed out, six months without a diagnosis and treatment for insomnia seems a rather long time, and your doctor is telling you, that the inability to sleep might be due to many, sometimes complex reasons, and in such instances, only the expert can make the correct diagnosis and hopefully find the correct treatment.
Your doctor might also be telling you that what you have been doing by buying over-the-counter sleeping pills could lead to addiction, which might end up creating a new, and possibly more serious medical condition. Many people become addicted to many different drugs because of buying them without first consulting a doctor.
In yet another possible scenario, the doctor might, without being explicit, be telling you that your drinking is getting worse and that the high blood pressure and liver problems you are showing, are complications of excess alcohol use, in your case, driven by insomnia and self-medication with alcohol.
The reason for the referral to the psychiatrist can be highly tortuous and personal and you must get all the answers you deserve from your doctor. Only he can give you the answers to the questions that might be going on in your mind.
Going back to the basics and attempting to understand what the psychiatrist might find out when you see him, the entire process starts with a detailed history, in which he tries to understand why you are unable to sleep, and indeed when and why the problem starts he will ask you.
It might for example be that this is not the first time and that you have suffered from insomnia many times in the past. It is indeed possible that at times of personal stress, like examinations or family illness, you have had problems sleeping.
It might also be that this is the first time of such a condition and that you have now, for the first time developed a major depressive illness that demands care as a medical condition and not simply the treatment of the symptom of insomnia. This determination is critical to your treatment.
Some people are unable to sleep because of Post-Traumatic Stress Disorder (PTSD) which might follow a traumatic experience such as a road accident or domestic violence. Still others are unable to sleep because of financial or marital problems while others stay up at night worrying about their children.
Others, in particular the elderly, stay up because of painful joints or other medical conditions including thyroid diseases that make the heart beat very fast. Different psychiatric disorders including depression and anxiety announce their presence with insomnia as does schizophrenia and the abuse of certain substances including coffee and miraa.
The situation is made more complicated because the doctor must establish the ‘type’ of insomnia he is presented with that is for example, the inability to fall off to sleep is more often associated with anxiety while losing sleep at 2-3 am is more common in depressed patients.
As you can see from the forgoing, telling us that you have a sleep problem means very little because the possible causes of lack of sleep are so many and so different for different people. It is therefore no wonder that your attempts at self-medication have not yielded any benefits and hence my agreement with your doctor that a visit to the psychiatrist might be a good idea.
