Confessions of an insomniac

When it began for me, I can’t remember. What I do remember is the following scene, played at various times throughout my youth:

“But I can’t sleep!” I’d protest as my parents tried to wrestle me into bed at what they called a decent hour, meaning any time before 1 am.

“Nonsense,” said my father, “of course you can. “Everyone knows how to sleep. Why, even animals know how to sleep. Just close your eyes, relax, and you’ll get sleepy. It’s the most natural thing in the world, sleep.” My father was a normal sleeper, and to the normal sleeper, sleep is “the most natural thing in the world.”

“But Daddy, I can’t! I don’t know how!”

“Well, you get all wound up. Now if you’d only listen to your mother and go to bed earlier…”

My father was a doctor, an old-style family practitioner who carried a black bag and delivered babies at home, one of a heroic, vanished breed. But that didn’t mean he knew a thing about sleep. Sleep had no part in the medical school curriculum at Yale in the 1930s. Sleep has little part in medical curricula today, when doctors get an average of one to two hours instruction in sleep disorders. The advice he gave me is a version of the advice I’ve been hearing ever since: you’re stressed out, you’re anxious, you’re depressed, you have poor habits, if you only wouldn’t stay up so late… Take a hot bath, drink a glass of warm milk, don’t let it get you down.

We hear a lot of cheer-up-it’s-not-so-bad advice: “Don’t worry about it—you probably just worry too much.” “You probably just need more exercise—try yogi” [that’s not a typo]. I have tried yoga. I swim three times a week and walk on the days I don’t swim.

The well meaning advice that is always useless

When people can see a problem, they can understand and empathise. But when a condition is invisible—and when it goes on and on for no apparent reason—it calls forth a lot of dumb advice. Friends of mine who live with chronic pain, headache, back pain, arthritis tell me they also get advice like this. And insomnia is not easy for us to talk about.

“Oh, you know, a bad night,” I say to a colleague on one of my walking-into-walls days. “Why, Gayle, what do you have to lose sleep about? You’ve got no problems,” says my colleague, eyebrows raised. If I’d been up with a bad tooth or a sick child, that’s something he would understand. If I just plain ‘can’t sleep’, that’s weird.

“Toughen up, get a grip”­—we hear this from friends, family, and doctors. “Nobody ever died of insomnia” is something else we hear a lot. [Actually, that may not be true: insomnia puts us at higher risk for depression, alcoholism, suicide, accidents, hospitalisations; although we may not drop dead of it the next day, it may be cutting years off our lives.]

Some of the least helpful advice I’ve heard comes from the ‘experts.’ “Insomniacs may be naturally short sleepers who are unaware of their lessened need for sleep,” wrote a Stanford researcher in 1993. “Their notion that they need more sleep is an ‘erroneous assumption.’” “Worries by such insomniacs about a ‘lack of sleep’ are unjustified,” says British researcher James Horne, who is himself, as he told me, a good sleeper: insomniacs “just need to be reassured that their sleep is sufficient, despite what they believe in this respect.”

Trust me, if I were a short sleeper, I’d know it by now. I have known such people. I’m not one. I’m a person with a normal seven-hour sleep need, trapped in a body that seems to think I’m someone else.

The invisible problem of insomnia

It’s no surprise that insomnia is not taken more seriously, since sleep itself is not. This is a 24 x 7 culture where “sleep is for the weak,” “you snooze, you lose.”

And yet humans are programmed—or most are—to spend a third of their lives in sleep. Researchers still can’t tell us exactly why we need sleep, but they do know that we need it. They can see what happens when we do without. Studies show that sleep deprivation compromises immune function, ratchets up the stress system and creates hormonal imbalances that predispose us to weight gain and diabetes.

I can tell you what sleep deprivation does to me. It hollows me out, eats me away, takes me apart. These are terms I heard from the insomniacs I talked to while writing my book Insomniac—comatose, spaced out, running on empty, nobody’s home, zombie, zomboid, zombied out—such words describe our feeling that our souls and spirits have taken leave, only our physical shapes are left stumbling around, as in that old movie The Night of the Living Dead.

Lose sleep, lose your ‘self’

When you lose sleep, you lose the better part of yourself. Creative thinking is one of the first things to go, along with mood. Researchers who give sleep-deprived subjects tests that require flexibility, the ability to change strategy and generate unusual ideas, find these capabilities impaired. Neuroimaging shows that the frontal cortex, the seat of “higher order” mental abilities [sometimes called the frontal lobes], is most affected: it doesn’t light up, as it does in the scans of people who’ve slept well. This is the most recent addition to the human brain, in evolutionary terms; on this, the so-called executive functions depend—selective attention, problem solving, decision making, organisation, judgment, reason, abstraction, language. This is where humans are thought to form their sense of who they are, the seat of self-awareness; this is where the self resides. And this is what’s most clobbered by sleep deprivation.

The dreams we miss

When your sleep is as broken and truncated as mine, you’re deprived of REM [rapid eye movement], the sleep stage where we have the most vivid, memorable dreams. Something in nature wants us to dream, since between a quarter and a fifth of sleep is normally spent in REM. That’s six or seven years of a 90-year life. And when we’re deprived of REM, the brain tries to make up for it; there is rebound, an increase in the amount and intensity of REM.

Nobody knows exactly what dreams are for, but recent research suggests that they’re associated with learning, the laying down of new neural pathways and reinforcing of old ones. And the learning that’s at stake here is much more than the French phrases we try to cram into our memory on a flight to France: it’s about extracting meaning from the world around us, making sense of our experiences, making judgment calls, negotiating a delicate situation with a colleague, say, or heading off a divorce. Anything that undermines these processes compromises our ability to deal with our lives.

Sleep repairs your life

If lack of sleep takes us apart, sleep puts us back together again, knits up the ravelled sleeve of care. On days when I wake up after seven or eight hours of sleep [which almost never happens without medication, alas], I’m all there, mended in mind, body, and mood. My head doesn’t ache and my heart doesn’t pound and my skin’s not parched and my eyes don’t sting and tear, and the world comes into focus. I can face the book I’m writing, the classes I’m teaching, the stacks of papers on my desk and floor. I know what goes where and how it fits together, and I have energy to take it on.

It’s ironic that sleep is sometimes feared as the loss or disappearance of the self, when it may actually be the way we become most fully ourselves, our most creative, intelligent, and alive. You might even say: I sleep, therefore I am.

There are many ways people come by insomnia, many routes to this place. Some insomnia is inborn and genetic, some is hormonal, brought on with menopause, and some is conditioned—i.e., we go through a stressful period and then it settles in. But much is simply not understood. People are differently endowed in the sleep department, as in all other departments.

I wrote Insomniac to find out what is known about insomnia, and to hear from others who live with the condition about what they’ve found that works. There are plenty of experts who are ready with glib advice, but we are the ones who live in our bodies—we are the ones who can say what works. So read widely, go on the web, learn all you can—the web is a goldmine of information [misinformation, too, of course]—and find out what people say. Then try things out for yourself, being careful, of course, and knowing that someone else’s experience with a method or medication may not be yours. There’s no one-size-fits-all solution; there is only what you can cobble together that works.

This was first published in the October 2014 issue of Complete Wellbeing.