A Thousand and One Sleepless Nights - Opinionator Blog

All-NightersAll-Nighters is an exploration of insomnia, sleep and the nocturnal life.

In Ernest Hemingway%u2019s short story %u201CNow I Lay Me,%u201D Nick Adams, the writer%u2019s alter ego, stays up at night listening to the silk worms feeding on mulberry leaves outside his army tent in Italy. During World War I, Hemingway had himself developed insomnia so severe that he was afraid to go to bed with the lights out. And he struggled with sleeplessness the whole rest of his life, although this issue was often hard to separate from his other ailments %u2014 including severe depression, chronic alcoholism and diabetes. %u201CI myself did not want to sleep,%u201D he writes, %u201Cbecause I had been living for a long time with the knowledge that if I ever shut my eyes in the dark and let myself go, my soul would go out of my body.%u201D

When someone says %u201CI don%u2019t sleep,%u201D what exactly do they mean?

Sleep and death have long been intertwined, with the ancient Greeks creating a colorful genealogy to explain it.  Nyx, the goddess of the night, gave birth to twin boys: Hypnos (sleep) and Thanatos (death).  Hypnos fathered Morpheus, the god of dreams, who lived surrounded by opium poppies, the giver of dreams.   While there would be no Morpheus without Hypnos, the Greeks weren%u2019t very interested in sleep per se, but in its magical offspring: dreams.  They made pilgrimages to special %u201Cdream temples,%u201D where, after offering sacrifices and bathing in sacred waters, a healing deity would appear to them in sleep, curing whatever troubled them.  The Chinese believed in two different souls %u2014 p%u2019o and hun %u2014 that represented the physical and spiritual worlds.  The hun, which could separate from the body during sleep, often visited the land of the dead, where it brought back news of deceased ancestors.  According to Robert L. Van de Castle, in his book %u201COur Dreaming Mind,%u201D if the soul failed to return to the body before the dreamer woke up, %u201Cdreadful consequences would follow.%u201D

At the turn of the 19th century, insomnia was depicted as a horrible torture that often led to suicide. An 1888 article in The Washington Post explained that %u201Cit is a well known fact that loss of sleep, carried to [sic] far, will produce insanity.%u201D  It was believed that something called the %u201Cnerve fluid%u201D was produced at night, and if one didn%u2019t get a sufficient quantity of it, the nerves would become %u201Cabnormally sensitive and irritable %u2014 almost as if they were bare%u201D %u2014 and the victim would go crazy.

Though we%u2019ve come a long way in our understanding of sleep, if you asked an insomnia sufferer today to describe her symptoms, she might provide a similar account.  According to the National Center for Sleep Disorders Research, 30 to 40 percent of American adults experience intermittent bouts of insomnia over the course of a year. Ten to 15 percent report chronic symptoms.  That%u2019s a lot of irritable nerves.

But when someone says %u201CI don%u2019t sleep,%u201D what exactly do they mean?  If they have fatal familial insomnia, they are describing a situation that ultimately leads to death. There is no cure.  F.F.I. is caused by an accumulation within the thalamus %u2014 the part of the brain that controls sleep regulation %u2014 of abnormal proteins called %u201Cprions.%u201D   The disease usually begins between the ages of 40 and 60, and its first symptom is progressive insomnia.  Eventually the person falls into a coma, dying from the consequences of sleep deprivation.

Insomnia is a unique disorder in that the patient is also the chief diagnostician.

Since F.F.I. is extremely rare, most people who complain that they can%u2019t sleep usually mean that they do indeed sleep, but not long or deep enough.  Perhaps a job loss or divorce is to blame, and in such cases, the insomnia usually resolves itself with time.  When the insomnia is a symptom of underlying depression, a combination of therapy and anti-depressants can work.   Does the patient snore?  That could be a sign of sleep apnea, which can be helped with a breathing device or dental appliance.

Insomnia is a unique disorder in that the patient is also the chief diagnostician.  The American Academy of Sleep Medicine, which sets the clinical standards for the field, recommends overnight studies for all people with sleep complaints.  But what%u2019s the point of watching someone not sleep?   And if you%u2019re told you have insomnia, which you knew anyway, what can be done about it?   Often sleep doctors will prescribe cognitive behavioral therapy, which involves a set of %u201Csleep-hygiene%u201D rules, like avoiding stimulants and alcohol, regularizing bedtime and wake-up time, and using the bed only for sleep and sex.

While in theory %u201Csleep hygiene%u201D makes sense, in today%u2019s culture, which affords no time for relaxation, it%u2019s hard to put into practice.  We%u2019re on the computer at all hours and then we snuggle with our Blackberries. Our kids are even more hyperactive, texting way past their bedtimes, although today even the concept of %u201Cbedtime%u201D sounds quaint.  To compensate for being so tired in the mornings, they eat caffeinated foods, gulp energy drinks, and pop Adderall and Ritalin.   In recent years, the %u201Cwake-promoter%u201D Provigil has gained ground with college students as a %u201Csmart drug.%u201D  A 2005 national study, led by a University of Michigan research team, found that 7 percent of college students have used prescription stimulants for non-medical purposes over their lifetimes and 4 percent have used them in the past year.  In a sample of middle- and high school students, the illicit use of stimulant medication was 4.5 percent.   As the anthropologist Matthew Wolf-Meyer notes, %u201CIf a society can%u2019t rest, how can it sleep?%u201D

To combat what he calls our %u201Cculture of exhaustion,%u201D Americans spend nearly $24 billion a year on sleep-related goods and services, buying $5000 mattresses, 600-thread count sheets and high-end sound machines that simulate the surf or chirping birds.   By 2012, the market for insomnia drugs is expected to grow 78 percent, to nearly $3.9 billion.   But with sleeping pills what are we really getting?  They only provide an additional 11.4 minutes of sleep over placebo pills, and they interfere with memory formation, with the result that people sometimes forget how badly they actually slept. Some sleep doctors say, %u201CWhat%u2019s wrong with that?  If people perceive their sleep is better, they%u2019ll feel better.%u201D  But that strikes me as %u201CAlice in Wonderland%u201D logic: %u201CI wonder if I%u2019ve been changed in the night? Let me think. Was I the same when I got up this morning? I almost think I can remember feeling a little different. But if I%u2019m not the same, the next question is, %u2018Who in the world am I?%u2019%u201D

I can%u2019t think of anyone more dissimilar to the hard-boiled Hemingway than Michael Jackson, yet he too suffered from chronic insomnia.  One can only imagine the pressure Jackson was under rehearsing for a grueling world tour with the sadly prophetic title, %u201CThis Is It.%u201D  Over the years sleeping pills and other tranquilizers had lost their effectiveness to the point that he demanded that his doctor administer the powerful anesthetic propofol, which was later ruled a major factor in his death.   Jackson referred to it as his %u201Cmilk.%u201D  There%u2019s something terribly sad about someone wanting to sleep so badly that he%u2019d opt for a hospital anesthetic, rather than the old-fashioned sedative: a cup of warm milk.

But perhaps we%u2019re way beyond such homespun remedies.  We live in stressful times.  Some would say that%u2019s nothing new.  People have been searching for ways to induce what Shakespeare called %u201Cthe honey-heavy dew of slumber%u201D for as long as they%u2019ve been able to harvest medicinal plants.  A reference to opium poppy was found on Sumerian clay tablets dating back to 3,000 B.C.  We know little about the way prehistoric man slept %u2014 there are no sleep %u201Cbones%u201D for us to analyze %u2014 but as they huddled together in caves, they probably worried that giant bears would eat them.  Now we lie down on $22,000 hand-groomed horsehair mattresses and worry that underwear bombers will blow up our planes.  So tonight many of us will be wide awake listening to the silk worms on our high-priced sound machines, afraid that our souls will leave us, afraid that we have no souls, afraid that with each passing day, this is it.

Patricia Morrisroe

Patricia Morrisroe, a journalist, is the author of the forthcoming %u201CWide Awake: A Memoir of Insomnia.%u201D

Do we sense a theme - Sleep is overrated -

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