In the summer it returns. Scandi-noir drama binge watching combined with forty-plus degree weather conspires to push my usual date with bed from 11:30pm to 1.00am and beyond. I writhe on sour, sweaty sheets, cursing politicians who deny the existence of climate change. In the less-known hours of the morning I surf my smartphone, stumbling across an article that describes my nocturnal activities as ‘sleep procrastination’.
For the past few months I’ve been frequenting chemist shops, buying Phenergan, a drowse-inducing antihistamine, or Restavit, an over-the-counter sleeping aid. I used to buy the night-strength version of Mersyndol, a heavy-duty painkiller that put me under like a knock on the head, but disconcerting palpitations accompanied the slide into sleep. Recently, while alternating between Phenergan and Restavit, I’ve had a couple of near misses on my bike riding to work. More to the point, I’m tired of living so much of my life through the fog of fatigue.
Insomnia for me is less a black dog than a yapping heliotrope one that’s kept me awake through the watches of the night for years. My sleep has been patchy, intermittent for most of my life; the supposed eight-hour norm is an unachievable ideal for me. I usually sleep like David in Six Feet Under – with a special pillow, earplugs, an eye cover and a mouthguard. I find it difficult to sleep with anyone else in the bed. I wake in response to noise, light – even a smell, like cigarette smoke, can rouse me. Chamomile tea, along with valerian, lavender oil, melatonin and relaxation tapes, have no effect on me. A yoga teacher once put a sandbag over my face during savasana (or corpse pose, the nap on the mat that traditionally ends classes) ‘to quieten the chattering Western mind’. Apparently she knew just from looking at me that mine wouldn’t shut up.
When I was in my twenties, I could easily wing the next day after a sleepless night and pass for normal after several nights of four hours sleep. But two decades later I’m weepingly, howlingly tired after a run of four-hour nights. I don’t think I’m depressed; nothing is worrying me in particular, except my inability to sleep.
Casting about for drug-free insomnia remedies on the net I discover an app, CBT-i Coach, developed by the US Department of Veteran Affairs for returning servicemen: if nothing else, advice about ‘weapons and sleep’ gives away its source. The CBT-i Coach’s main goal is to reset your biological clock, so you’ll sleep more regularly, by restricting your time in bed to certain hours (at night, of course). You log how long you actually sleep in a diary on the app. If you wake during the night, you’re to perform mundane tasks such as cleaning out drawers, making school lunches, shredding old bills and so forth, until you feel drowsy enough to return to bed.
I download the CBT-i Coach onto my phone out of a combined sense of curiosity and frustration. During my first week using the app, my sleep ranges from five-and-a-half to seven hours a night: a good score, by my books. Whenever the dog of insomnia yaps me into wakefulness, I rise dutifully to match unpaired socks, reorganise kitchen cupboards and cull junk jewellery until I can no longer stay upright. But halfway through the second week my time asleep drops below five, then four hours a night – at which point the app advises me to see a health professional.
I’m alarmed; the CBT-i Coach seems to have lost its potency already. Reflecting on the situation and my frequent relapses into insomnia, my experience is of forgetting how – then trying maybe too hard – to sleep. Perhaps what I need is someone who can help me remember how to fall asleep.
The hypnotist is fortyish with a genial, rumpled ‘dad-like’ persona. I can imagine him jogging up-and-down the soccer sidelines on a Saturday morning, although there’s an underlying intensity to his presence. I found him on the internet and was satisfied by his qualifications, and by online interviews, that he had some substance as a practitioner. He listens patiently while I explain that I’ve forgotten how to sleep.
Yes, I have tendencies towards anxiety and over-thinking that sometimes feed my insomnia, I tell him. Both my parents are (or were) poor sleepers; my father was addicted to Serepax for a while. I have memories of him consoling me with a mug of warm milk on finding me awake long after everyone else. But I’m not convinced that genetics, certain personality traits or my parents’ habits entirely explain my insomnia.
Losing the knack for falling asleep is an experience that extends back to my primary school days. Well I remember the delicious subversiveness of devouring a book at night, by torchlight in a tent of blankets. With the increasing routine and discipline imposed by school, I didn’t have as much time to satiate my imagination and desire for play as I would have liked.
‘There was so much activity in the world,’ the hypnotist says. ‘You didn’t want to let go of it.’
‘Yes, that’s it,’ I say. ‘I didn’t want to miss out on anything.’
I describe how, as a student throughout my twenties, I developed nocturnal habits that no doubt exacerbated my wayward sleep. After studying until nine at night, I would drop in on other ‘owl’ friends for a chat, or we’d have a meal and play pool on Lygon Street. Sometimes we’d wait until we got our ‘second wind’, then go on to a bar or a club. I usually went to bed at one or two in the morning then rose at ten or eleven to repeat the cycle.
The hypnotist says that what I experienced was ‘circadian rhythm shift’, which I’ve repeated with my TV-series binge watching during the summer heatwaves. Often when people try to reset their sleeping time, as I’ve attempted with the CBT-i Coach, they initially experience a period of reduced sleep, which could explain my run of four-hour nights. Eventually, they succumb to fatigue and sleep longer, more regular hours.
‘There’s a program in the States,’ he tells me, ‘where insomniacs aren’t allowed to sleep for several days and are goaded into waking if caught napping for a minute in order to reboot their body clocks.’
I wince. These techniques sound brutal, like something the CIA would apply as part of its interrogation procedures.
Routine is the secret, the hypnotist says. As the CBT-i Coach instructed me, I must maintain strict hours for sleeping. He will give me a relaxation track to play at my proposed nod-off time. If I’m awake half an hour later, I’m to do a bland activity of the sort advised by the app until I tire. Whatever happens, I mustn’t remain twisting in my sheets: bed becomes associated with people’s fears about sleeping. Nor am I allowed to look at computer or smartphone screens at night – bright light exposure reads as day to the brain – and I need to replace all fluorescent lighting with incandescent globes. Lying-in on the weekend to catch up on sleep debts is forbidden, and I’m not to nap (not that I’ve ever had any talent for daytime sleeping).
The session shifts gear. The hypnotist extends the recliner chair I’ve been sitting on and dims the lights, then launches into a rhythmic incantation about sleep while playing droning background music on his computer.
I’m entirely conscious of what he’s saying, but later I remember little of its content. Disparate images start flashing across my internal monitor. I see the faint grey, green spine of the West MacDonnell ranges, familiar to me from living for some years in central Australia. Then my father in his dark emerald dressing gown bringing me a glass of warm milk. Tears prickle behind my eyelids until I can no longer contain them and they seep out onto my cheeks.
My father has been dead for over a decade, but the memory of his kindness still has the power to draw emotion. That hypnosis has taken me back to childhood confirms my belief it’s when my insomniac habits started.
The hypnotist invites me to descend a staircase into a room, and I feel fear – terror, even – flooding my nervous system. I flash back to a night spent in the claustrophobia-inducing, windowless room of a catacomb-like youth hostel in Coober Pedy.
Fear is, after all, at the core of insomnia. Even if my insomniac habits have their origins in a restless desire not to go to bed just yet, I have become fearful of sleep itself.
A large, soft, white bed awaits me inside the underground room. The hypnotist instructs me to climb into it and to relax, limb by limb. I feel my left arm twitching involuntarily then my right leg starts.
The hypnotist issues some stern-sounding directives to keep the regular hours of sleep I’ve nominated. At the session’s end, he comments that I entered quite a deep state of rest. I have no idea how he can gauge this: perhaps my jerking limbs provided a sign.
‘Did you see me crying?’ I ask. ‘Does that often happen?’
‘Sometimes,’ he says. ‘Not being able to sleep is very frustrating.’
The first night after my visit to the hypnotist I fall asleep while listening to his relaxation track, but I’m pitched back into consciousness when a neighbour’s dog barks. I decamp to the living room – now appropriately dim and grotto-like with incandescent lighting – and read for a while before returning to bed, where I sink into heavy sleep.
The next morning I feel pleasantly alert, although I’ve only slept about five hours. My mind is sharper, my reactions are quicker throughout the day; perhaps this is how regular sleepers experience life. Any tension in my body – the familiar coat-hanger of taut shoulder muscles from computer work and cycling – dissipates easily. I’ve tried using relaxation aids before, including some from the CBT-i Coach, but none have had as profound an effect as the hypnotist’s.
I start looking forward to bed, craving the same deep sleep. But after a month my insomnia returns, like a virus that never quite goes away, and I stop listening to the relaxation track. I’ve been travelling frequently for work and I speculate that crossing back and forth between even small time zones has been enough to derail my newly established sleeping habits. Yet perhaps therein lies the problem: my sleep routine has become so ritualistic and finely calibrated that it’s difficult to maintain.
Indeed, I have some reservations about what might underlie the Pollyanna-ish mandates of ‘good sleep hygiene’ espoused by the CBT-i Coach and the hypnotist. In the recesses of my mind, I hear a sardonic voice saying ‘Oh, behave!’ in response to directives only to sleep in bed between certain hours, not to look at clocks during the night, to avoid bright light screen exposure of an evening and not to drink too much. Take control of your sleeping habits and it’s implied you’ll become a more normative and productive person.
Research challenging the naturalness of post-industrial, Western sleeping practices supports these druthers. In At Day’s Close: Night in Times Past, historian A. Roger Ekirch contends that people in pre-industrial Europe enjoyed two sleeps of roughly the same length at night, punctuated by ‘an hour or more of quiet wakefulness’ around midnight. During this interlude, Ekirch claims that most ‘probably never left their beds’, but instead prayed, chatted with their bedfellows, recounted dreams, reflected on events, and had sex. Some hardy souls rose for an early morning walk; Benjamin Franklin cultivated the habit of ‘taking cold air baths’ in which he sat reading or writing naked for up to an hour as a mental tonic.
Researchers at the National Institute of Mental Health in Maryland reproduced a similar pattern in an experiment attempting to simulate prehistoric sleep rhythms. Deprived of artificial light for several weeks, most subjects settled into a pattern of ‘broken slumber’: they ‘first lay awake in bed for two hours, slept for four, awakened again for two or three hours of quiet rest and reflection, and fell back asleep for four hours before finally awakening for good.’
The use of lighting to illuminate public places and streets in major European cities during the late eighteenth century, followed by the introduction of gaslight into nineteenth-century bourgeois homes, disrupted this pattern, delaying the onset of sleep and compressing the time available for slumber. ‘Heightened exposure to artificial lighting, both at home and abroad, altered circadian rhythms as old as man himself,’ Ekirch observes. Ironically, the standardised work hours ushered in for humanitarian purposes following the British industrial revolution cemented this shift: it was socialist Robert Owen who coined the slogan ‘Eight hours’ labour, Eight hours’ recreation, Eight hours’ rest’.
The idea of having two sleeps at night appeals to me. I imagine rising after midnight to join a confederate of double-sleepers; drifting to a local cafe where we might listen to music, shoot pool and engage in salon-style congress before returning home to sleep until waking at a reasonable time of nine or ten o’clock. Our conversations would be forgotten like dreams in morning busyness, although their contents would seep like vapours through our consciousness during the day.
Ekirch reminds readers, however, that pre-industrial Europeans fell asleep early not just because of the lack of lighting but because they were exhausted after hours of hard physical labour. Probably what my longing for two sleeps betrays is nostalgia for my student days, when I kept whatever hours I liked. Recently, I’ve noticed references to Ekirch’s ‘two sleeps’ surface regularly in ‘Brainpickings’-style cogitations about insomnia on the net: the authors of these articles often linger over the thought of having sex or scribbling in dream journals in the middle of the night. No doubt they too yearn for more flexible and hospitable hours for work and sleep. Add to the advent of electric lighting the now widespread use of computers and the popularity of the mobile phone – quite possibly every twenty-first century person’s most faithful bedfellow – and not only are the boundaries between night and day blurred, but also of home and work for many people.
Biologist Till Roenneberg claims that more than half the central European population currently suffer from ‘social jetlag’, carrying a significant sleep debt from working hours out-of-kilter with their natural body clocks. In Internal Time: Chronotypes, Social Jet-lag, and Why You’re So Tired, he explains that a range of different ‘chronotypes’ occur naturally: a preference for daily sleep at certain times directed by underlying circadian rhythms. The current work-day schedules of post-industrial, capitalist societies favour ‘larks’ – those with early chronotypes.
As an owl, the notion of social jetlag tallies with my experience; I’ve long scorned the dreary false virtue accorded to morning people’s habits. Yet appealing as I find Ekirch’s and Roenneberg’s theories, I have to ask myself whether the cultural constraints on sleep are the main trope at play in my insomnia or whether some underlying physiological processes might be involved.
My room at the Sleep Lab is nothing like what I expected: it looks like something from a budget motel. The furnishings are bland: it has lemon-coloured walls and bedding, grey carpet, simple office furniture and an overhead TV. A water jug and a couple of cream biscuits in a plastic bag on a table complete the effect. I’d been expecting a cubicle on a ward and hospitals, with their surfeit of noisy people and machines, would have to rank amongst the worst places to sleep. But I’ve often found cheap motel rooms sleep-inducing because their small size and banal interiors provide less-than stimulating environments.
My GP has diagnosed me with ‘chronic sleep deprivation’ – a term ominous enough for me to think I should take my insomnia seriously – and referred me to a medical specialist who has recommended a sleep study. The working hypothesis the specialist wants to test is whether I have ‘sleep state misperception’: a condition in which troubled sleepers consistently underestimate their time asleep, contributing to their anxiety about insomnia.
A phalanx of machinery beside the bed and the small green eye of a camera high on the opposite wall are the main giveaways that the room is being used for a sleep study. After I’ve had time to change into my pyjamas, a sleep technician, a jittery young man with the signature facial hair of his generation, comes to wire me up. He attaches two chest monitor bands – one below, one above my breasts – to measure breathing, and something like a peg to my left index finger along with nasal tubing to monitor the quality of oxygen I breathe. Then he sets about pasting and taping electrodes to my chest and legs, the pièce de résistance being a Medusa’s head of coloured wires.
‘What kinds of brain activity can the electrodes register?’ I ask.
‘Oh, they can measure all sorts of things,’ he says. ‘Dreaming in the frontal lobe, eye movement…you’re almost paralysed while you dream, with no bodily movement except for your eyes darting from side to side under their lids. If we weren’t paralysed, we would act out our dreams.’
The sleep study also tracks the various phases of REM (Rapid Eye Movement) and non-REM sleep, as well as slow-wave sleep activity or ‘deep sleep’. Sleep has four stages, three of which occur during non-REM sleep, the first of which is very light; the fourth stage is REM sleep when dreaming occurs. Slow-wave or deep sleep happens during Stage 3 non-REM sleep, and is thought to play a role in consolidating memories and brain recovery, although the boundaries between this phase and Stage 4 are unclear.
‘REM sleep is very important for processing emotions,’ the technician tells me. ‘The problem with teenagers’ grumpiness and oversleeping is that they stay up late, then their REM is cut short the following morning: they want to sleep in until 9am but they have to get up a couple of hours earlier than they’d like.’
‘Well, that’s me,’ I say, ‘the grumpy teenager who doesn’t get all the sleep she’d like.’
Once the technician leaves, I feel my chest straining with nervous tension against the monitor bands. I try to behave as I might normally, reading a book then channel-surfing news programs to settle my racing mind. I’ve been telling myself that I feel unexpectedly relaxed in the Sleep Lab’s neutral surroundings, but I’m not convinced I’ll sleep.
But sleep I do. I drift into slumber just after midnight, rouse for a toilet break around one, remain awake for an hour, wake again briefly before five and fade into fitful sleep. At six, the technician turns on the lights. I rise and slump over a breakfast tray, filling in a questionnaire about my sleep experience while I eat. In truth, I feel reasonably refreshed; it’s been a good night by my standards.
The questionnaire asks how long you think you’ve slept. I tot up some calculations on a serviette and write, ‘Five hours.’ It offers several descriptors to choose from of how you feel on waking. I circle: ‘Awake but not alert.’
I leave the Lab at 6.30am, a time when I’d usually be asleep, and drive home. On my way, I run a red light at a small railway crossing, an incident recalling similar instances I’ve had on my bike riding to work. I am indeed awake, but not alert.
‘Surprisingly you were pretty accurate with your assessment of the sleep study,’ the specialist says, sliding a stapled sheaf of papers titled ‘Overnight Polysomnography – Diagnostic’ across his desk towards me. He flips it open at a table headed ‘sleep statistics’ and circles a number with a blunt flourish of biro ink: the time I slept was five minutes less than my estimate of five hours. ‘So you don’t have sleep state misperception.’
I’m floored; I felt certain I was neurotic enough to suffer from something like sleep state misperception. My mind back-pedals to the careful calculations I made on a serviette over breakfast in the Sleep Lab. Perhaps my problem is that I’m my own polysomnograph, too keen an observer of every princess-and-the-pea type detail.
‘There’s no doubt,’ the specialist continues, ‘that you experienced periods of wakefulness.’
He gestures at the times I woke during the night on a graph. Otherwise, it seems I possessed ‘reasonable sleep architecture’ with ‘plenty of REM’ and ‘a good proportion of slow wave sleep’ – whatever all that means, but it sounds vaguely promising.
‘If the quality of my sleep’s not so bad,’ I say, ‘Is there anything I can do to extend or deepen it?’
The specialist stares intently at me over his reading glasses.
‘You can’t control sleep,’ he says. ‘Often what we find is that when some people try and predict and control their sleep, they’re maybe causing more harm than good. They’re doing what you’re doing…you’re monitoring it.’
‘Hyper-vigilance,’ I say grimly.
He thumbs to another section of the report: not only do I snore – an unedifying revelation in itself – but, more alarmingly, I have sleep apnoea.
The specialist keeps talking in his understated, fear-diffusing way. Apnoeas occur when the airways in the throat collapse, stopping you from breathing momentarily and resulting in reduced oxygen and frequent awakenings. They’re characterised not only by snoring but choking sounds, I later read; it’s a potentially life-threatening condition.
In an awkward sleight-of-hand the specialist produces a small black plastic box from underneath his desk. It looks a bit like a Geiger counter, with some tubing and a small rubbery mask like a pig’s snout attached. It’s a CPAP – continuous positive airway pressure – machine, which pumps oxygen through your nasal passageways to keep your throat open while you sleep. It’s often trialled with sleep apnoea patients for a month to see if it helps. While some find the oxygen treatment ‘soporific’, he says, others find it distracting.
But the specialist doesn’t want me to try the CPAP machine just yet. He thinks my sleep apnoea is only minor because my oxygen levels remained high and my heart rate was constant throughout the night. Instead he wants to see if applying cognitive behaviour therapy (CBT) with a sleep counsellor might address my insomnia, because I scored as having ‘a low grade anxiety disorder’ on a psychological questionnaire I took at an earlier appointment, ‘consistent with this hyper-vigilant – your word – sleep aspect.’
‘Is anyone Zen enough to get a perfect score of zero on these tests?’ I ask the sleep counsellor when I see him.
‘Look, anxiety is the new normal,’ he says. ‘Most of us have elevated levels of anxiety these days because we’re on such a tight drum about expectations to do things at work. Anxiety is about our capacity to deal with future events. We overestimate the threat and we underestimate our ability to deal with it. People have anxieties around sleep when they come to see it as a threat. Because if we don’t have enough sleep, we don’t function well.’
The antidote is, paradoxically, to stop worrying about sleep. The counsellor introduces me to a ‘go with the flow’ take on modifying attitudes and behaviours around sleep, which is much less regimented than others I’ve encountered through good hygiene approaches. He attempts to ‘tidy up’ my sleep by restricting my time in bed to between 12am and 7am. At first, I’m delighted at being given permission to stay up late, but I find this regime difficult to maintain as I become increasingly weary, one time falling asleep during dinner with friends. Eventually I’m so exhausted that I have a few solid nights’ slumber but, as with my experience of hypnotism and the CBT-i Coach, my sleep briefly improves then crashes, and I resume waking through the night’s far reaches.
The counsellor says I’m a classic case of someone with both sleep onset insomnia and sleep apnoea: the former can mask the latter, leaving apnoea to go undetected until a sleep study is performed. Sleep onset insomnia is associated with anxiety, and its sufferers often exhibit circadian rhythm disorder: their hours have switched to a later bandwidth and the trick is to shift them back. But those with sleep apnoea will continue to wake during the second half of the night, when most of the awakenings occur. In my case, I suspect that early onset insomnia has come to operate on a feedback loop with sleep apnoea: I fear bed because I won’t sleep throughout the night. The diagnosis also explains why I so often wake in the morning with a dry throat and experience fatigue well into the day. I remain sceptical about some of the norms pedalled around sleep, such as imperatives to rise early or to sleep for eight hours every night, and whether they’re much more than anxiety-provoking cultural packaging. But even after sloughing off some of my misperceptions about sleep, cultural and personal, its quality is not greatly improved.
I agree to undertake a CPAP trial. By that time, if someone had offered me a blow on the head to ensure a night’s sleep, I might have taken it. Sleeping with the CPAP machine is not as difficult as I expected: its hum is no louder than a computer monitor and the mask is lightweight. If I wake during the night, the machine’s soft, rhythmic blast of oxygen focuses my mind like meditation, encouraging me to succumb to the body’s processes.
It’s the vanity of the mind to think one can control such processes, as I attempted through various self-monitoring activities. Once you become too self-conscious about sleep it loses its involuntary nature. Indeed the degree of personal surveillance involved in writing an essay about insomnia may well have contributed to my hyper-vigilance and sleeplessness. Foucault has described the creation of a self that introspects its own truth accompanying the rise of confessional narrative practices. Sleep plucks at the fabric of the self, unravelling the strands of the fictions we create about ourselves during our waking hours. Insomnia on the other hand speaks of the old childhood fear of letting go of the world, of not being able to forget the hectoring ‘I, I, I …’ that keeps casting around for ways to quell the night fears baying at the threshold of consciousness. ‘Sleep, those little slices of death,’ Edgar Allan Poe writes, and if there’s a common theme underlying anxieties about sleep, it is perhaps that its transitory surrender of awareness reminds us too much of death.
For me, the diagnosis of sleep apnoea, with its unconscious death rattle, cemented that association. I was ready by then to settle for a ‘good enough’ night’s sleep, even if assisted by a machine. And it came unexpectedly in short, grateful draughts, prompting me to remember the cycle of breath and to loosen that child’s grip on the world that says no, I won’t let go, I’m too awake, too aware to sleep.
Image credit: Alyssa L Miller
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