“I go home dead tired. I fall asleep without any problem. The insomnia of the past few days seems to have disappeared by itself. I begin to understand something important: people who work hard don’t need sleeping pills to get their sleep. Those are for the rich, who don’t do anything from morning to evening. The usual war between rich and poor. “Cu avisuonnu nun cercacapizzu”- “When you’re tired you don’t go looking for a pillow.” This is called class conflict. Am I becoming a Communist? Don’t be ridiculous. It’s just the delirium of exhaustion.” –from Divorce Islamic Style by Amara Lakhous
The above quote was inspiring to me because it encapsulated some of my suspicions about the relatively recent pathologization of sleep. It’s a topic that comes up a lot in sessions with my clients, with colleagues, in popular culture, and I also have a complicated history with it. Why do so many people now struggle with “disordered sleep?” Is it a first world, or at least culturally and socially manifested condition? Maybe it’s something about psychologists, but everyone at our practice whom I’ve spoken to professes to have ‘sleep issues.’ these vary from person to person. One falls asleep fine but wakes up fully alert hours before she has to wake up and watches Netflix presumably until she falls back asleep or it reaches a reasonable time to actually get up. Another has issues on the other end of things, with falling asleep in the first place, although he is able to take a nap daily for 20 minutes at 2pm. Many take sleep aids, over the counter and prescribed. Some have participated in sleep studies to study their stages of REM sleep and circadian rhythms. We have a psychologist at our practice who specializes in sleep disorders, a potentially thriving field as it is so critical to mental and physical health.
I trace it back further. Lots of young children struggle with sleep or fight it. Napping is torture for some children and they will fight their body’s natural inclination for sleep even at night and despite their physical need for it manifested in yawns, emotional meltdowns, etc. I fought it as a child, past the point of natural tiredness –sending my body into the fight or flight mode, where adrenaline literally is activated to help keep you alert past your natural sleep state in case you hypervigilance is due to an environmental threat like a saber tooth tiger. Sleep became more complicated for me when I was approximately 6 years old. My dad retells this story of that fall, we were raking leaves, and I asked him what happened when you die. He said something along the lines of it being similar to sleep, but that he wasn’t entirely sure; no one was. As legend has it, I started to cry and ask if that meant I wouldn’t be able to see him anymore. I remember going to bed at night, without the distractions of light and sound in my room, my mind would drift to pretty tough, existential topics. I would try to prepare myself for death by thinking about what it would feel like. I remember trying to sooth myself by considering that I didn’t remember anything before I was alive, and that wasn’t so bad. Unfortunately that made the whole thing even scarier. It wasn’t only death I contemplated, but sometimes I would try to picture the universe expanding and tried to picture what that would be. That was terrifying too. Probably also terrifying for my poor parents, whose Dallas episodes or sleep were occasionally interrupted by a terrified and teary eyed child who couldn’t stop talking about not wanting to die.
Sleep is weird in a lot of ways. We spend our waking hours roaming around interacting, having some control over our thoughts and consciousness, reacting to environmental stimuli, making decisions, eating, drinking, emoting… Then, at a certain point in the day, usually the night portion, we lay down, close our eyes and essentially lose consciousness for a number of hours. We’re absolutely vulnerable and we’re okay with that. Anything could happen while we sleep, and we wouldn’t be aware of it until we awoke. And we lose total control of those neuronal pathways we build and run and recalibrate all day. They go off in every direction, according to some analysts, more specifically down those paths we spend the most time protecting and shielding from conscious contemplation to protect or egos. Like I said: weird.A weird concept at least. In practice, it’s such an essential component of life- this temporary break from it- where our brains and bodies can heal, recover, consolidate, and replenish. You would literally go insane or die if you were forced to stay awake. One study found people who sleep less than four hours per night are three times more likely to die within the next six years. So understandably, as a psychologist, I like to gauge the quality and quantity of sleep with my clients as it underlies so many adaptive functions.
A high school student in 1964 (of course…) experimented with sleep deprivation for 11 days and was still able to “function,” although he reported periods of extreme paranoia and hallucinations. A set of PETA-unapproved studies found rats died in 3-4 weeks when deprived of sleep. They developed skin lesions and failing immune systems that led to colonization of bacteria, that is normally only found in the digestive track, to the entire body. Obviously there are ethical implications for replicating this in human beings, but there is some documentation of a similar demise based on records from Nazi death camp experiments and executions by sleep deprivation from 19th century China. Sleep deprivation is also considered more hazardous than drinking when applied to driving. One study found drivers who had been awake for 17-19 hours performed worse than those with blood alcohol level of .05. So yes, brain functioning declines, our immune system struggles to keep up, and we feel cranky, emotional, lack impulse control and have slower reaction times. Cognitive function and memory are impaired. The frontal cortex, involved in speech, accessing memory, and problem solving, is affected. Sleep deprivation impairs the formation of nervous tissue and inability of the brain to renew and rewire itself properly. Stress is exacerbated and makes us more prone to depression and anger, not to mention physical accidents. Very sleep deprived people can go into bouts of ‘microsleep’ when they dozed off for several seconds without realizing it. Regular lack of sleep can hinder metabolism and hormone production in a way that is similar to the effects of aging and the early stages of diabetes.
Eye movement desensitization reprocessing (EMDR), is an interesting therapeutic technique, often used with trauma victims to overcome PTSD like symptoms. No one seems to really know how it works but basically it’s the induction of back and forth eye movements, alternating sound, or vibrations that is mean to stimulate both sides of the brain / bilateral stimulation. Hypothetically, in activating both lobes of the brain simultaneously, our creative and rational brain capacity is maximized and allows us to better resolve emotional disturbance and gain adaptive insights. More interestingly, this simulation mimics the spontaneous eye movement that occurs when we are dreaming and in REM (rapid eye movement sleep). Sleep is characterized by five stages that progress in a 90-minute pattern: the first four stages are called non-rapid eye movement (NREM) stages because there is an absence of the rapid eye movements that characterize the fifth stage of sleep, or REM. In a typical night of 8 hours of sleep you experience about five REM periods. Each REM period lasts longer than the last and we move from a 10-minute REM period at the beginning of our sleep to almost an hour of REM activity by the end of the night. REM sleep is when we have our most vivid and lucid dreams. If REM sleep is not reached, mental functioning deteriorates.
I’ve found I simply need to wear myself out in order to sleep at night. If I try to sleep before I am dead tired and struggling to keep my eyes open, my mind tends to drift relentlessly to upsetting and/or stimulating topics. Most of the time I don’t get the 8 hours I would love to. I do take some non-prescription sleep aids and have considered things like Ambien, but some of the freaky stories that have resulted make me hesitate. I find a day where I’ve done at least one thing I feel really proud about, exercised and eaten well, and hugged someone I love, tend to lead to the nights where I sleep most soundly.
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