Tossin’, Turnin’ and our obsession with ZZZs
I kicked the blankets on the floor; turned my pillow upside down…went to the kitchen for a bite…I jumped back into bed it was the middle of the night…
So sang Bobby Lewis in 1961. Just as Baby Boomers were on the threshold of their teens, Lewis’ Billboard chart-topping song, Tossin and Turnin, trumpeted the frustrations of sleeplessness. Did it herald the future struggles of Boomers and subsequent generations?
Sleep can be strange and somnambulistic. Restful and fitful. Peaceful and restless. Friendly or fearful. You may at times be in a dreamer’s paradise, at other times haunted by demons—filled with hallucinations or dreadful creatures. Visions and visitations. Revelations. Night terrors.
Numerous polls and studies show insomnia is rampant in our nation. Its myriad consequences are only now beginning to be documented. But what on earth is keeping us up at night?
Sleeplessness can bring scourges that reach into all aspects of our lives. Sleep aids including Ambien, once considered a panacea, may actually be dangerous to many who rely on it. And technology—long touted as making life easier—has invaded our bedrooms to become a nocturnal menace, as screen time increasingly equates to hyper-awareness.
Why is sleep so crucial? Are insomnia’s medicines worse than its sufferings? Is technology both a hindrance and a help? Can dispensing with pajamas and sleeping nude bring on the slumber? What about counting sheep? Desperate times call for desperate measures.
“Each night, when I go to sleep, I die,” said Gandhi. “And the next morning, when I wake up, I am reborn.”
Unfortunately, that’s not everyone’s experience. It’s estimated that well beyond 50 million Americans suffer with sleep disorders. In one decade, 1999-2010, office visits for sleep problems rose 30 percent and prescriptions for sleep medications rose 200 percent, according to the American Psychiatric Association.
A 2013 international sleep survey found that Americans get 30 to 40 minutes less sleep than people in most other major developed countries; 43 percent of Americans admitted in a 2013 Gallup poll that they would feel better if they got more sleep. The recommendation of the National Sleep Foundation is 7 to 9 hours for anyone over age18. In 1942, 84 percent of us met that standard; in 2013, only 59 percent did. Is the culprit insomnia, or something even deeper?
Yale professor Dr. Meir Kryger, a nationally renowned sleep research authority, calls insomnia a national epidemic. “Fifteen percent of Americans have chronic insomnia,” he tells Coastal Connecticut magazine. “That means three to four nights a week for a period of six months, many of us are experiencing sleep loss.”
In a report published in the March 2014 issue of the journal Sleep, Dr. Rachel Salas of Johns Hopkins’ Neurology Department, said “chronic insomnia has a prevalence of up to 15% in the general population and is a major public health problem.”
“Sleep, those little slices of death—how I loathe them,” said Edgar Allan Poe.
Our bodies go through daily cycles engrained from evolution, called circadian rhythms. Sleep is programmed into these rhythms. As a restorative function, quality sleep primes us to think and function to our highest potential. Lose enough of it and we kind of start to, well, lose it.
In our hectic society, some take pride in getting by on little sleep. Madcap finance guru Jim Cramer boldly proclaims that four hours is sufficient. Prominent people throughout history— Leonardo da Vinci, Margaret Thatcher, and Thomas Edison, to name a few—also were also light sleepers. Edison worked 18-hour days and reportedly thought sleep was a waste of time. In 1921 he wrote, “We are always hearing people talk about ‘loss of sleep’ as a calamity. They better call it loss of time, vitality and opportunities.”
“Is sleep for wimps?” That is the headline of a blog on psychologytoday.com by Yale’s Dr. Kryger. “It now seems to be macho to not sleep,” he says. “It’s similar to being drunk. Twenty-five years ago it was considered macho by some to get drunk. Now it’s heavily frowned upon.” We need to take the same approach to insomnia, he says, because the effects can be just as debilitating. “Many people just don’t know how important sleep actually is,” Kryger says.
The movie, The Machinist, portrays a sleep-deprived man who has a workplace accident resulting in his co-worker losing an arm. It’s a stark depiction of the consequences of the condition. Sleeplessness is rich theme mined by Hollywood, as evidenced by films from Al Pacino’s aptly named thriller, Insomnia, to the Brad Pitt drama, Fight Club. One reason for the popularity is certainly that so many in the audience can relate.
But the repercussions of inadequate sleep are numerous, well documented, and in no way entertaining: they include irritability, slower reaction time, mistakes, and quick tempers. Job performance suffers when one’s thinking and motor functions are impaired. Most seriously, daytime drowsiness is causing accidents and fatalities. A November forum entitled, Asleep at the Wheel: A Nation of Drowsy Drivers, sponsored by the National Highway Transportation Safety Administration, cited disturbing numbers: 5,000 to 7,000 lives lost each year due to daytime drowsiness. An alarming 37 percent of people polled admitted nodding off behind the wheel. That’s every third vehicle.
It’s well established that sleep loss is cumulative. Losing two to three hours a night over two weeks has been compared to drunkenness. Yale’s Kryger says even if people sleep six hours a night, “after about two weeks, their brain reacts as if they hadn’t slept at all. They have microsleeps and lapses, which are dangerous: If a person falls asleep for just one second while driving 60 miles per hour, the vehicle will have traveled 88 feet.”
Inadequate sleep may be literally damaging our brains. Recent research at the University of Pennsylvania “shows disturbing evidence that chronic sleep loss may be more serious than previously thought and may even lead to irreversible physical damage to and loss of brain cells.”
Sleep loss has many causes. Perennial contributors include stress from jobs, home life and relationships, finances, mandatory overtime, shift work, and depression. We’re OD’ing on caffeine as coffee, Red Bull, and 5-Hour Energy Drink consumption skyrockets. But the modern world injects a new and increasingly prevalent cause—our expanding digital lives.
Technology has become an addictive interrupter of sleep. In our 24/7 culture, nearly everything is “on” all the time. Sleep interferes with our unending drive to not miss a beat. We crave to know all, in real time, fearing we’ll miss something.
Our smartphones are ubiquitous; they’ve become veritable switchboards directing us through life. We crawl into bed with them to text and email. The nightstand isn’t close enough, so we tuck them under our pillow. Yale’s Dr. Kryger says he’s had patients who held their phone in their hand while asleep.
There’s scientific reason why hanging in the cyberworld shuts out dreamland. To our brain’s circuitry, darkness means it’s sleep time. When our eyes are exposed to light, the brain receives signals to stay alert. Expending thought energy keeps all systems switched on.
It’s not only cell phones: laptops, tablets, and TVs all over-populate bedrooms. And it’s not just e-devices per se. Many electronics use blue light, which a team of Harvard researchers found to be especially problematic. They found that melatonin, the brain hormone responsible for our natural sleep cycle, is greatly suppressed by blue light.
Upon my pillow, breeding many woes —
Save me from curious Conscience, that still lords
Its strength for darkness, burrowing like a mole
So wrote John Keats in his poem, To Sleep.
A common complaint of insomniacs is not so much trouble falling asleep but staying asleep. Waking after two to three hours is routine. But falling back asleep is another story. Sufferers often report an overactive mind as the culprit—thoughts that jump randomly from one worry to another. Metaphysical author Carlos Castaneda called it “internal dialogue.”
This curious affliction is just now being examined.
Dr. Annika Norell-Clarke, a clinical psychologist at Orebro University in Sweden, calls it “vicious cycles which in turn cause sleep deficit and daytime suffering.” In her dissertation entitled, I Think, Therefore I am Sleepless, Norell-Clarke uses the term “racing mind,” describing it “as being mentally alert whilst in bed; planning, evaluating and worrying, and not being able to stop one’s thought activities.”
This subject is also being researched by Dr. Salas at Johns Hopkins. She tells Coastal Connecticut that the condition is analogous to “the light switch that is always on and they just can’t turn it off. Or, they’re like a car that’s always running, all the time.”
The brains of chronic insomniacs may be wired differently, Salas says. Her study of insomnia patients found they have increased excitability in their motor cortex, a primary control center of the brain. “Now evidence is showing more and more that insomnia is not just a nighttime disorder,” she says. “It’s really 24/7.”
For some, there is fear of darkness or nightmares. Surrealistic apparitions overwhelm. For hypnophobiacs, the notion of going to bed is frightful. Filled with anxieties or prone to frequent nightmares, they dread the coming of sleep.
Art reinforces such fears. The quintessential surrealist, Salvador Dali, seemed to have a unique talent for portraying this in works like Dream Caused by the Flight of a Bee Around a Pomegranate One Second Before Awakening. Fierce raging lions, claws and jaws open for attack, and a rifle with bayonet are suspended over a woman in repose.
How does one combat the insomnia curse? Dr. Dominic Roca, director of Sleep Medicine at Stamford Hospital’s sleep center, says waiting for the sandman is a mistake. “You don’t want to lie in bed looking at the ceiling tossing and turning because if you do that, you become more frustrated. I generally tell people that if you’re in bed for more than 20 to 40 minutes awake, get out of bed, go somewhere else, do something relaxing.”
Dr. Norell-Clarke echoed this approach. She tells Coastal Connecticut, “Try to break the thought process by getting out of bed briefly and stay in another room for a while, but not something that requires a screen close to one’s face, as this stimulates parts of the brain that are associated with alertness rather than sleepiness.”
Nineteenth century poet Elizabeth Akers Allen tenderly expressed the yearning of insomniacs in her poem, Rock Me to Sleep:
Make me a child again just for tonight!
Kiss from my forehead the furrows of care
None like a mother can charm away pain
From the sick soul and the world-weary brain
Not having that option, any purported nostrum is worth a try.
We’re shelling out millions for magic pillows, white-noise machines, meditation classes, melatonin, and herbs. Prescription medications proliferate. Sleep centers are booming, numbering nearly 3,000 with estimated revenue of $7 billion in 2015. Connecticut has several.
Spending on prescription sleeping pills exceeds $2 billion; three-quarters of a million on over-the-counter options. It’s certainly helping people, but what is the tradeoff?
A 2012 study by Scripps Health Clinic found nearly a five times “higher risk of death and a significant increase in cancer cases from ingesting sleeping pills. Even among patients who were prescribed 1 to 18 sleeping pills per year, the risk of death was 3.6 times higher.”
Case in point: When Congressman Patrick Kennedy smashed his car into a concrete barrier near the U.S. Capitol in 2006, he claimed disorientation from residual Ambien. Ambien was successfully used as a defense by a man accused of mass-murdering eight people in a North Carolina nursing home in 2006, getting him reduced charges. Incidents became so widespread that the FDA in 2013 recommended Ambien’s dose be cut in half.
But Ambien’s reputed sexual aphrodisiac properties may make it too alluring for many. Its hypnotic effect can reportedly reduce inhibitions, leading one of Tiger Woods’ girlfriends to brag about “crazy Ambien sex.”
Sleepers in art are often depicted in nude, idyllic slumber. Paintings like Giorgione’s Sleeping Venus exude sexuality while in blissful repose.
Dr. Michael Breus, who bills himself as the nation’s sleep doctor, touts the benefits of sleeping nude. Sans pajamas improves circulation, which in turn promotes healthy skin. With a partner, the skin-to-skin contact stimulates more oxytocin release, reducing blood pressure and anxiety. And nude keeps you cool—some studies link insomnia to being too warm.
And then there’s sex. It’s well established that chemicals and hormones activated during sex induce calm. Orgasm releases serotonin and prolactin. Serotonin precedes the release of melatonin. Prolactin induces drowsiness.
While cell phones get a lot of blame, free apps tout somnolent effects. DigiPill lets you prescribe your own hypnotic audio pill. Relax Melodies has an array of sounds like ocean surf, a crackling campfire, and wind chimes.
Both Yale’s Dr. Kryger and Stamford Hospital’s Dr. Roca mentioned a new prescription med called Belsomra. It interacts with the brain chemicals that regulate the sleep-wake cycle, the first drug to do so. Roca says, “It is a new insomnia medication that is derived from the research on narcolepsy. There’s data showing that it improves and helps people sleep better.”
Still, Yale’s Kryger says sleeping pills are overprescribed and over-relied on. “Most doctors aren’t spending enough time to find out why the patient has insomnia. They’re not treating the cause,” but rather the symptom.
In our harried lives, it may seem expedient to treat sleep as a problem that can be solved. But evidence is growing that demands digging deeper rather than treating surface symptoms. As Shakespeare wrote in Macbeth, “Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life’s feast, and the most nourishing.”