|Clinical Mastery Mind/Body Attachment Theory Brain Science Future of Psychotherapy Challenging Cases Diets Wendy Behary Linda Bacon Mindfulness The Future of Psychotherapy Anxiety Couples Therapy Couples Clinical Excellence Attachment Alan Sroufe Narcissistic Clients Trauma Symposium 2012 CE Comments Ethics Community of Excellence Gender Issues William Doherty Men in Therapy David Schnarch Mary Jo Barrett Etienne Wenger Great Attachment Debate|
|Sleepless in America|
Making it Through the Night in a Wired World
By Mary Sykes Wylie
It's 3:00 a.m. Your eyes suddenly snap wide open and stare unblinking into the darkness. You try to remember the dream you were having, but it's gone, and anyway you're now as tightly tuned as a bowstring to the mysterious night noises of your house—pings, drips, rustles, hums, creaks—that send little electrical jolts zinging unpleasantly through your nervous system. You determine not to move, because that would be to admit you really are irrevocably awake. So you lie very, very still and clamp your eyes tightly shut again, though they fight back, quivering in the effort to reopen.
You're aware of a dull, inner pain in your lower left side, or up near your heart, or deep in your belly, or behind your right eye. How long have you had this pain? What does it mean? Cancer? Stroke? Heart attack? Just lie quietly, relax your muscles, breathe slowly from the diaphragm, watch your breath, you think to yourself. But your body doesn't want to lie still—a cascading series of itches, prickles, cramps, and aches build up to an unbearable restlessness.
So: roll over to the left, curl up into a fetal position, roll over to the right, stick one foot out from under the covers, roll back to center, straighten legs, bend legs, flex feet, stretch, yawn, scratch stomach, scratch upper back, rub eyes, drum fingers on covers, throw off covers, pull up covers, pound pillow, massage temples, crane head around to look at clock (3:13), try the breathing thing again.
By now, your hyperactive brain is in full gear, a gazillion neural networks churning out a kaleidoscopic vision of every awful moment of fear, loss, frustration, fury, humiliation, and failure you've ever had, going back to college, to 7th grade, to kindergarten. (Now is also a good time to relive the really grisly part of that horror movie you watched years ago, still lodged permanently somewhere between your amygdala and prefrontal cortex)
If you're lying next to someone, you listen resentfully to that person's deep, regular, innocent, animal breaths, hating him or her for not joining you in your night of sorrows. If you're by yourself, you might sigh, sit up, turn on the light, arrange the pillows behind you, and begin reading the book that you almost fell asleep over just a few short hours ago. But you can't concentrate very well—you feel exhausted and wired at the same time, preternaturally alert and jumpy, but with a deep, penetrating tiredness. After reading the same paragraph 12 times, you get out of bed, go into the bathroom, turn on a light, pee, and take a look in the mirror at your haggard face.
It's now 3:42, and you begin wandering aimlessly around your house like the undead, looking out different windows at the quiet nighttime neighborhood. You know with great, hallucinatory certainty that everybody in your community, your town, your state, everybody within four to six time zones, uncounted millions of people are all peacefully asleep—all except you. You, however, are wide, wildly awake, and absolutely, utterly alone.
Insomnia. Almost everybody has it at one time or another. Some poor souls live (or barely live) with it. It's hard to know exactly how widespread it is—prevalence rates are all over the map. As many as 30 percent of the population, or as few as 9 percent (depending on the source of the statistic, or how insomnia is defined, or what impact it has), suffer from some form of it at least some of the time. Critics maintain the higher estimates are overblown, partly by insomniacs themselves, whose suffering leads them to overestimate the time they spend lying awake (10 minutes of lying wide-eyed in bed feels like an hour) and by the pharmaceutical industry (that all-purpose villain) in order to sell billions of dollars in sleeping potions.
Chronic insomnia is linked to a multitude of physical and psychological ills: increased risk of cancer, hypertension, heart disease, obesity, diabetes, infertility, miscarriage, depression, anxiety, irritability, dementia, impaired cognitive and reasoning skills, lowered immune-system function, heightened awareness of pain, and who knows what else? Probably bunions, dandruff, and pinkeye. But while insomnia apparently contributes to, results from, or is comorbid with the ailments on this laundry list, why we get insomnia, which parts of the brain are most implicated, and how it actually hurts us, even what it is exactly, all remain largely a mystery, as does sleep itself. Thus researchers summed up a lengthy 2005 National Institutes of Health report on insomnia with deadpan succinctness: "Little is known about the mechanisms, causes, clinical course, co-morbidities, and consequences of chronic insomnia."
What's undisputed, however, is that sleep is as necessary to physical and mental health as air and water, and that, without it, we suffer—often severely. So, those annoying world-beaters, who brag about needing only four hours of sleep a night (the better to forge multimillion-dollar start-ups and do their Nobel Prize–winning research) are perhaps not being entirely candid. According to sleep expert Thomas Roth of the Henry Ford Sleep Disorders Center in Detroit, "The percentage of the population who need less than five hours of sleep per night, rounded to a whole number, is zero."
Yet if a vast conspiracy were afoot to create an entire civilization of insomniacs, it would operate pretty much the way our society does now. Over the past century or so—roughly coresponding with the invention and worldwide adoption of electricity—the average time allotted to sleep in the industrialized world has shrunk by as many as four or five hours. The average North American now sleeps about six and a half hours a night—even fewer for ambitious careerists on an upward trajectory—down from eight hours a generation ago and ten hours in the early 20th century. In fact, thanks to technology, particularly the Internet, there's nothing you can do during the day that you can't do at night. The glory of 24/7 is that, using our computers or TVs or cell phones, we can continue working, buying, selling, playing, communicating, gambling, managing our portfolios, following the latest news in Karachi, or London, or Santiago, or Shanghai without stopping for a time-waster like sleep.
Insomnia is exactly what the movers and shakers of our society want for us. The buzz-term used by advertisers and corporate honchos for the monetary windfall of our 24/7 lifestyle is the "attention economy," and there's a perceived need to increase it, which means finding ever-growing numbers of people (consumers) awake and aware of the proliferating Internet-mediated information sources (the "product") popping up on their screens, and ultimately buying something, somewhere, from someone. "The winners will be those who succeed in maximizing the number of Ôeyeballs' they can consistently control," writes Columbia art historian and social critic Jonathan Crary in the essay "On the Edge of Sleep." According to Crary's dystopian view of the 21st century, in a nonstop globalized economy where night never falls, sleep is a passive, useless occupation taking up precious time that might better be spent producing, circulating, buying, and selling. This is the kind of world that demands an endless supply of insomniacs for its economic lifeblood.
But never doubt capitalism's fiendish ability to take advantage of a market opportunity, whatever its origin. Even as massive entrepreneurial energies are expended on keeping people awake and entertained, countervailing commercial efforts are put forth to lull them to sleep. Besides the blockbuster sales of sleeping pills with soothing names like Ambien, Lunesta, and Sonata, the well-heeled spend more than $20 billion a year on an astonishing array of sleep paraphernalia, including herbal supplements, aromatherapy massage, reflexology, calming soaps and lotions, massage pillows and buckwheat-seed body wraps, Hungarian goose-down duvets, white-noise machines, and specialty mattresses that can cost from $5,000 up to $60,000 (yes, you read right—the $60-grand number is Swedish, filled partly with hand-selected horsehair, and takes 160 hours to make).
The Need for Sleep
Still, it's doubtful that any of these expenditures make much difference in sleep quality to the truly dedicated insomniac—he or she will just have spent more money on greater luxury in which to thrash around all night. Yet even the most desperate of us will fall asleep eventually because our bodies will make us. You can refrain voluntarily from eating until you literally starve yourself to death, but you can't willfully keep awake beyond a certain point on your own any more than you can command your blood to stop flowing. Even the few competitive "athletes" of voluntary sleeplessness who force themselves to stay technically "awake" for more than a couple of days (the Guinness record holder is an Englishwoman, Maureen Weston, who apparently went without sleep for 14 days and 13 hours in 1977), involuntarily fall into "microsleeps" of a few seconds to a few minutes without being aware of it.
But it was only in our own "enlightened" era, once the invention of electricity made bright, 24-hour lighting and sound amplification technically available, that sleep deprivation as a form of state-sponsored "no-touch torture" came into its own as an art and science. The Gestapo used it in Nazi Germany, the Japanese used it on POWs during World War II, the Chinese on prisoners during the Cold War and on dissidents to this day, the Israelis on Palestinian militants (and Palestinian factions on each other), the British on IRA members, the Pinochet dictatorship on subversivos, the police and army in Iran, Saudi Arabia, and Tunisia on their own alleged enemies—it's probably the rare country that hasn't used it at one time or another. The Soviet secret police called sleep deprivation a "conveyor belt," because prisoners were kept awake day and night by revolving shifts of interrogators who had at them until they signed the requisite "confessions." (One Russian dissident of the 1960s said interrogators bragged that after many hours of this treatment, they'd gotten his 14-year-old son to "confess" to writing the novel Eugene Onegin—actually written, of course, by Alexander Pushkin, an insomniac himself, and published in 1837).
Considering the horrible array of tortures widely used in hellholes around the world, people often find it hard to believe that simply keeping people awake really qualifies as torture, or even "enhanced interrogation," as our Interrogator-in-Chief calls it. But according to prisoners or detainees subjected to "sleep management," the antiseptic term used by Lt. Gen. Ricardo Sanchez, the former U.S. military commander in Iraq, the modern forms of tormentum vigiliae are indeed as tormenting as many far more draconian torture methods. "After two nights without sleep, the hallucinations start, and after three nights, people are having dreams while fairly awake, which is a form of psychosis," says John Schlapobersky, psychotherapist to the Medical Foundation for Victims of Torture, who was subjected to sleep deprivation in apartheid South Africa. "By the week's end, people lose their orientation in place and time—the people you're speaking to become people from your past; a window might become a view of the sea seen in your younger days. To deprive someone of sleep is to tamper with their equilibrium and their sanity."
In his book White Nights: The Story of a Prisoner in Russia, about being a POW in a Siberian labor camp during World War II, former Israeli prime minister Menachem Begin wrote that prisoners "subjected to extreme tortures had not cracked, but lost the will to resist with sleep deprivation. In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep, to sleep just a little, not to get up, to lie, to rest, to forget. . . . Anyone who has experienced this desire knows that not even hunger or thirst are comparable with it. I came across prisoners who signed what they were ordered to sign, only to get what the interrogator promised them. . . . uninterrupted sleep!"
Nonetheless, unforced insomnia that ends only in death, though very rare, does happen. Consider a disease called fatal familial insomnia (FFI). As described in The Family That Couldn't Sleep by D. T. Max, fatal familial insomnia is a genetic disease, first identified in the 1980s, in which prions—the same kind of mysterious, viruslike rogue protein responsible for mad cow disease and Creutzfeldt-Jakob Disease in humans—caused a rare, always lethal, condition characterized by relentless insomnia. Upon autopsy, the brain seems mostly normal, except that the prions have essentially scoured out the thalamus—a nodule still not well understood, which helps control the body's autonomic nervous system and natural sleep–wake cycles. The affected person experiences increasingly dire symptoms: worsening insomnia, profuse sweating, stiff neck, pinprick-sized pupils, sudden menopause in women, impotence in men, listlessness, tremors, uncontrollable crying, thrashing limbs, elevated blood pressure and pulse, loss of balance, dizziness, and emaciation, ultimately culminating in a state of chronic, agitated, hallucinatory stupor, alternating with ever-shorter periods of lucidity. No narcotic or anesthetic agent has any effect, and the end—generally around 15 months or so after symptoms first appear—is usually awful. Max describes one dying man "howling in the night, his arms and legs wrapped around themselves."
Almost nobody gets fatal familial insomnia, and yet, don't these symptoms strike a terrifying chord in the heart of anyone who's ever spent more than a few nights staring hollow-eyed into the darkness? The exhausted longing for sleep combined with the paradoxical inability to force yourself to "fall" asleep is maddening in that the harder you try, the greater your physiological stress, and the more awake you feel. The sense of existing in a surreal state, all nerves quivering as if expecting at any second that ominous knock on the door by the KGB or the Gestapo (or Homeland Security?), breeds anxiety and dread, an enveloping foreboding that something nearby is wrong and strange and dangerous.
With our poor night vision and relative helplessness before predators that growl and stalk the darkness, we have always felt, from our deepest hominid past, most vulnerable to harm after sunset: the "hour of the wolf" has more than metaphorical meaning. Night and death, sleep and death, have a long history of association. In The Iliad, Hades, the "Kingdom of the Dark," is also the kingdom of death, and it's during the night that the dead visit the living in the form of dreams. To be up and about in this land of the dead seems to be breaking a taboo, to be entering a forbidden borderland between waking and sleeping, living and dying, and risking unpleasant and unsought encounters with ghosts and specters, goblins and ghouls. And encounter them we often do, even if they originate in our own minds, haunting presences from our own lives. As an anonymous Japanese poet once put it, "the night offers toads and black dogs and corpses of the drowned."
The Literary View
Writers, past and present, have been no strangers to insomnia. An incomplete, ad hoc list of confessed insomniacs includes Charles Dickens, the Bront' sisters, Franz Kafka, Marcel Proust, Lewis Carroll, Ernest Hemingway, Mark Twain, Gertrude Stein, and Philip Larkin. Other possible sufferers were Sappho, Dante, Shakespeare, Cervantes, and Dostoevsky—all of whom wrote about insomnia as if they knew it all too personally. As you'd expect, insomnia is often paired with guilt, fear, and despair. In the Divine Comedy, adulterous lovers in the second circle of hell are kept perpetually awake by a "hellish hurricane, which never rests, drives on the spirits with its violence: wheeling and pounding, it harasses them. . . . Now here, now there, now down, now up, it drives them. There is no hope that ever comforts them, no hope for rest and none for lesser pain." (Lying awake at 4:00 a.m. listening to the winter wind howling and rattling the windows provides a reasonable facsimile.)
Probably Shakespeare was the master of characterizing insomnia as the wages of sin and guilt. Think of Macbeth's cry to himself after he's murdered Duncan: "Methought I heard a voice cry 'Sleep no more! Macbeth hath murdered sleep'—the innocent sleep. Sleep that knits up the raveled sleave of care." Or Iago, about Othello, whom he deceives into becoming jealous of the innocent Desdemona and murdering her: "Not poppy nor mandragora, Nor all the drowsy syrups of the world, Shall ever medicine thee to that sweet sleep Which thou own'dst yesterday." Or Queen Margaret, who curses serial killer Richard III: "No sleep close up that deadly eye of thine, Unless it be while some tormenting dream Affrights thee with a hell of ugly devils."
But in more modern times, a tradition has emerged linking insomnia, like madness and melancholy, not so much with guilt as with Faustian powers of creativity and imagination, and perhaps even the promise of immortality, not granted to dull slugabeds catching their nightly eight and a half hours. "There is a nocturnal personality, a nocturnal spirit, distinct from that of daylight and available only in solitude: hence the secret pride of the insomniac who, for all his anguish, for all his very real discomfort, knows himself set apart from others," writes Joyce Carol Oates in her preface to Nightwalks: A Bedside Companion. "Unable to sleep, one suddenly grasps the profound meaning of being awake: a revelation that shades subtly into horror, or into instruction," continues Oates, who's herself both an insomniac and a master of literary horror fiction.
In some literary works, the insomniac sets him- or herself proudly above the natural laws mandating sleep, but pays for this arrogance in a horror of madness, damnation, or death. At the end of Isak Dinesen's short story Night Walk, a guilt-ridden insomniac encounters an ugly redheaded man, who sits at a table and counts a pile of silver coins over and over. Repeating "with extreme arrogance" and "deep scorn, "I never sleep. Only dolts and drudges sleep,'" the coin-counter reveals himself to be none other than Judas Iscariot, who hasn't slept since the night he betrayed Jesus. Now, he's doomed to spend eternity alone with his demonic pride, his 30 pieces of silver, and his insomnia.
Vladimir Nabokov once called sleep the "most moronic fraternity in the world, . . . [a] nightly betrayal of reason, humanity, genius." He really did have it in for Hypnos, the ancient Greek god of sleep. In his memoir, Speak, Memory, he writes, "People in trains, who lay their newspaper aside, fold their silly arms, and immediately, with an offensive familiarity of demeanor, start snoring, amaze me as much as the uninhabited chap who cozily defecates in the presence of a chatty tubber [bather]. . . . I simply cannot get used to the nightly betrayal of reason, humanity, genius. No matter how great my weariness, the wrench of parting with consciousness is unspeakably repulsive."
Nonetheless, in Nabokov's novel The Defense, a chess master is so obsessed with his "chess life" in which "everything obeyed his will and bowed to his schemes" that he doesn't go to sleep at all, but devotes himself night and day to perfecting every conceivable chess strategy. In the end, he's horribly punished for his monomaniacal determination to win at all costs by an insomnia that drives him mad and kills him. Exhausted and reeling during a heated match, he falls into a delirious phantasmagoria of "twilight murk, thick, cotton-wool air," in which strange voices, lights, chess figures, ghosts, and shadows, snatches of landscape and architecture appear and disappear before "a wave of oppressive blackness wash[es] over him," whereupon he collapses and dies. In "Sleep," a surrealist story (surrealism, fantasy, magic realism, all lend themselves to insomnia, and vice versa) by Haruki Murakami, a woman, suddenly liberated from the need to sleep at all, finds herself becoming a tireless, perfectly functioning humanoid machine—entirely free of ordinary biological constraints, more energized, intelligent, self-confident, her consciousness expanding, expanding until . . . until her life explodes, literally, in terror and death. "I had imagined death as an extension of sleep. . . . Eternal rest. A total blackout," she thinks, on the way to her demise. "But now I wondered if I had been wrong. Perhaps death was a state entirely unlike sleep, something that belonged to a different category altogether—like the deep, endless wakeful darkness I was seeing now."
In our own culture, there's an eerie echo of this insatiable striving to rise above our stupid, beastlike, physiological need for sleep and become unflagging, bionic powerhouses. For some years now, a drug called Provigil has been marketed as an alternative to amphetamines for keeping people awake and alert without the screaming meemies that are often a side effect of Dexadrine and other forms of speed. Provigil was originally intended to treat people with narcolepsy, but 90 percent of all prescriptions now are written "off label" ($575 million worth in 2005) for travelers who want to avoid jet lag, night-shift workers and long-distance truckers, military personnel, people in high-stress jobs (those 15-hour-a-day junior lawyers bucking to make partner), and students pulling all-nighters (or just partying all night). "There is a multibillion-dollar demand from civilians who wish to sleep only when they want to sleep," Jonathan Moreno wrote in the November 2006 issue of Scientific American.
Provigil is only one of several such wake-up drugs in the research pipeline. The Pentagon's Defense Advanced Projects Research Agency (DARPA), which pioneered Internet technology in the '60s, is investing at least $100 million for research into even better wake-up-and-stay-up contrivances, including more powerful, side-effect-free drugs, focused magnetic waves, and light stimulus. "The more we understand about the body's 24-hour, clock the more we'll be able to override it," says Russell Foster, a circadian biologist at Imperial College London quoted by Graham Lawton in the February 18, 2006, issue of New Scientist. "In 10 to 20 years we'll be able to pharmacologically turn sleep off."
To anyone not enchanted with this forecast of perpetual, goggle-eyed wakefulness, who still values sleep and rues insomnia (which is most people, barring self-defined masters of the universe and Dr. Strangelove types), for anyone who still has some retrograde attachment to the idea of natural body rhythms, this kind of scientifically generated defeat of so integral a part of human biology as sleep is inherently abhorrent. But, it turns out, we've long been insulting our natural wake-sleep cycle—for well over a century anyway—simply by expecting ourselves to fall asleep precisely at 10:00 or 11:00 p.m., sleep solidly the entire night, and wake promptly at 6:00 or 7:00 a.m. There's now accumulating scientific and historical evidence that human beings, like many of our mammalian cousins, weren't meant to follow what we consider a "normal" wake-sleep pattern of two strictly segregated blocks of time—16 uninterrupted hours awake, 8 uninterrupted hours asleep.
In studies conducted at the National Institute of Mental Health during the '90s, psychiatrist Thomas Wehr and colleagues found that when research subjects were deprived of artificial light and restricted to a dark room for 14 hours a day (closely approximating the natural light-dark conditions of winter) for several weeks, their entire sleep pattern shifted dramatically. They didn't sleep solidly for 8 or 10 or 14 hours, but first lay quietly in bed for two hours, then slept in two sessions of about four to five hours each, separated by one to three hours of calm, reflective, wakefulness. Instead of having the stress hormone cortisol streaming through their bodies—like insomniacs have when they can't sleep—these subjects exhibited heightened levels of prolactin, the pituitary hormone that stimulates lactation in mothers and permits chickens to brood contentedly on their eggs, during their periods of nighttime wakefulness. Their brain-wave measurements at these times resembled a state of meditation.
Some researchers, including Ekirch, are apparently drawing the conclusion from this material that midnight or early-morning insomnia is possibly more "natural" than the pattern of eight hours straight sleep that we've come to expect, but often fail to achieve. Perhaps, the implication is, we ought to accept the reality of those hours awake and cultivate a better attitude toward the inevitable—we should accept and make friends with those wakeful hours in the middle of the night. According to sleep researchers, lying quietly and peacefully awake can be as restful and restorative as sleep. And it's undoubtedly true that expending much anxiety on insomnia just makes the problem worse.
But those gentle, midnight ramblings and tranquil musings of the bimodalists clearly have nothing in common with what we experience as insomnia, in all its tense, anxiety-haunted misery.
Anyway, we don't have the time for playing around with first and second sleeps and late-night contemplation and conversation—we've only got what we've got, which is usually a pitifully few hours after work, after dinner, after the kids are settled, after we've answered our e-mail, after we've made some calls, after we've paid some bills, after we've done some laundry, to get whatever sleep we can steal from what's left of the night. In obvious ways, we've long since abandoned the ancient habits and rhythms of our primordial ancestors, not only in our patterns of waking and sleeping, but of working and playing, mating and child-rearing, thinking and believing. We aren't likely ever to return to those old patterns—barring a worldwide catastrophe that sends those of us who survive back into paleolithic times. And we might not want to: the staggering scientific and social progress of the modern era probably owes a good deal to all those extra, artificially lit hours of wakefulness devoted to thought, study, research, invention, and production.
Mary Sykes Wylie, Ph.D., is senior editor of the Psychotherapy Networker. Letters to the Editor about this article may be e-mailed to email@example.com.
The following Networker U Courses related to this subject or author are available on this site:
Audio Home Study