30-40% of adults experience one of several types of sleep disorders. Much of the industrialized world toils away with an oppressive and mounting sleep debt that rivals the burden on people’s health and life expectancy that the national debt exacts on people’s livelihoods. Disturbances of sleep include insomnia, or the inability to fall asleep and stay asleep when you want and for as long as you need.
But, the world of sleep disturbances includes a much wider and stranger array of maladies that go well beyond merely robbing people of adequate hours of sleep. For some, their sleeping extends far beyond the norm. Excessive sleep or hypersomnia can last 12-15+ hours daily. For others, structural obstructions in the flow of air (obstructive apnea) through the mouth and nose results in mini-awakenings dozens or even hundreds of times per hour, robbing the individual of restful slumber and wreaking havoc on their day-time routines. Circadian-rhythm disorders involve sleepiness that is out of sync with the schedules and routines of the external world of work or school. The body’s internal clock may not signal readiness to sleep until 3 or 4 in the morning followed by a noontime, or later, awakening. For them, obtaining sufficient hours of sleep isn’t the problem, it is the timing of when they obtain their sleep. Try coordinating that routine with that of your typical employer!
The Nightly Bazaar of Sleep's Bizarre Variations
Then, there are unusual sleep behaviors (parasomnias) that make their dreaded appearance in the dead of night. They include:
· dramatic sleep-walking that has individuals ranging considerable distances from their beds
· active but non-remembered food preparation followed by binge-eating behaviors
· people who engage in sex with an unwitting partner without being awake to the activity
· sleep terrors that make nightmares seem tame by comparison
· generation of twitches, spasms, jerks and more aggressive physical movements that can frighten or injure the party with whom the afflicted individual shares a bed, and
· sleep paralysis in which the individual is semi-conscious but remains physically paralyzed since the part of their brain that suppresses movement during dreams remains engaged and in control, preventing voluntary bodily movement
Insomnia - The Most Common Thief of Sleep
There are a variety of treatments for these various sleep disorders. Each addresses the multiple factors responsible for disrupting and dysregulating the “normal” daily transitions designed to guide us from wakefulness into sleep and back again. However, the remainder of this blog will focus on the treatments for the most common disorder: insomnia.
There is an old joke about a policeman who comes upon a man crawling on his hands and knees beneath a bright street lamp late at night. When told that the man has lost his car keys, the policeman enthusiastically joins in the search. When the search proves futile, the policeman asks if the man is certain that this is the spot where the keys were lost. The man replies that in fact, he’d lost them one block over. Befuddled, the policeman incredulously asks, “Then why are we searching here?” The man calmly replies, “The light is much better here!”
Common (and commonly misguided) Sleep Weapons
I think of this story when I think of the approaches most often taken to treat people’s insomnia. Our treatments focus on where the “light” seems to be shining brightest, which is on getting the person helplessly lying in bed to sleep. We have developed a range of classes of medication – anti-depressants, hypnotic anxiolytics, opiates, anti-convulsants, anti-psychotics, anti-narcoleptics, orexin antagonists – each of which targets different aspects of the complex brain-based networks that regulate our circadian rhythm (i.e., our sleep-wake cycle). All of them focus on what happens at night – not sleeping – when for a considerable number of people, what happens at night is the neurological and behavioral response to how their days are lived: Nights are the repository of the incomplete, insufficiently metabolized experiences of our days.
As I described in a previous blog (http://bit.ly/SleepingTime), sleep is a complex behavior that has evolved over thousands of generations in synchrony with nature’s daily and seasonal rhythms. Modern life has detached us from those rhythms in countless ways. One consequences is to be found in the proliferation of problems subordinating our sleep patterns to society’s dictates. A myriad of health problems follow (http://bit.ly/NoTimeToSleep).
The availability of pills to induce sleep is sometimes helpful, and may be necessary for some. But, for many, the reliance on pills not only generates medication dependence. It also reinforces the disconnection between people, their bodies, and their body’s built-in capacity to respond naturally and quickly to cues that emanate from nature’s various rhythms. For example, just one week spent living in the wilderness, where physical activities are regulated by the sun’s rising and setting and with intentional abandonment of, or access to electronic time-distorting gizmos and gadgets, will, for many, restore restful sleeping patterns. In short, modern societies artificial rhythms disrupt our lives by severing links not only to nighttime sleep, but to daytime meaning, purpose, and joy. The result, as Henry David Thoreau said is that, “The mass of men lead lives of quiet desperation.” His comment captures the lament I hear every day in my office as people, with and without sleep disorders, share stories relating their desperate searches to restore meaning, purpose, joy, and direction to their daily lives and relationships.
Unlike Thoreau, the majority of us are unable to retreat into life through sojourning by the banks of Walden Pond for several years. Surprisingly, however, many millennials are in effect doing just that as they choose to follow life paths that emphasize purpose and passion over dollars, status and other modern conventions. When we couple brain science with timeless wisdom, we find a set of established pathways by which days and nights can become resynchronized and restful sleep can be restored.
Re-Syncing Days & Nights for Better Sleep
What follows is a listing of steps (not in a prescriptive order) that guide you along those paths.
· Learning to Listen: We are afraid of not sleeping. When awake at night, we quickly engage strategies to “try” to sleep. Paradoxically, sleep only appears when we “stop trying” to sleep. Being awake at night has much to teach us. David Wolpe said, “We are best touched at night.” Night’s emotionally sensitizing influence, when coupled with silent, focused listening – not judging, but merely observing and noting – can bring into awareness recurring themes that spill over into our nighttime thoughts. We uncover yearnings, misgivings, hopes and unfilled dreams that cry for attention and action. Keep a notepad near your bed. If unable to sleep, sit quietly, just listening to the sounds around you and then, little by little, to the thoughts and feelings arising within you. Jot them down.
· Connect to Nature: Regular outdoor walks in parks, visits to arboretums, camping trips, outdoor picnics, star gazing, canoeing, or leisurely bike-rides all reconnect us to nature. Recent research (http://bit.ly/2pfkeuk) highlights measurable changes in our brains that occur when we spend time in “green” spaces. Levels of frustration decline, while feelings of excitement about, and engagement with life increase. These changes can mean we carry less baggage into bed with us at night, making deeper sleep more accessible.
· Replicate Nature’s Rhythms: Our senses are particularly attuned to light/dark cycles and the changes in sound and temperature that accompany them in the outdoor world. Hormone levels fluctuate in sync with those cycles, influencing mental clarity, energy levels, appetite, sleepiness, and more. As the sun begins to set, make your home reflect the natural world. Eat 2-3 hours before your planned bedtime and eat proteins vs. simple carb-rich foods, that your digestive system will “chew on” for a while, further inducing a sense of pleasant lethargy and satiety. Turn down house lights. Let in the advancing dusk and deepening darkness. Lower volumes on televisions or better yet turn them off. Play music that is peaceful, calming and soothing. Turn down your thermostat. Move more slowly. Become more physically and mentally still. These choices invite sleep to arrive with less fear and struggle.
· Reflect and Review: Make getting into bed the final act of a well-lived day. Reflect on the day that is ending. Spend 5-10 minutes reviewing anything – big or small – for which you are grateful. Basking in feelings of gratitude diffuses a sense of comfort, security and safety, all through you, which supports sleep as a process that can be both restful and restorative.
· Frontload Your Dreams: Establish the practice of noting the recurring themes of concern, worry, or challenge that are present in your days, which would otherwise simply spill into your nights. Then, select a concern from among the group. As your head lies on your pillow, make a request of your deeper mind: “Tonight, as I sleep and dream, help me to discover a solution, a direction, an insight about this concern or a way to release my fears.” Then, having passed the baton of self-responsibility to your sleeping mind, breathe into trusting that your tomorrows can and will be in good hands. For some, this involves prayer while for others, a more secular but spiritually infused approach works best.
· Botanical Approaches: For those who seek additional soporific support (natural sleep-inducing substances), investigate the benefits of GABA (quiets neural excitability), passionflower, L-theanine (amino acid with anti-anxiety benefits), Magnesium, Melatonin (the brain hormone that induces drowsiness and turns on the body’s “sleep mode”), Lemon Balm, Valerian Root, and Chamomile (especially in tea).
Audio Practice (above) to Re-synchronize Sleep Rhythms
This coming week, as you practice re-synchronizing your days and evenings to nature’s timeless rhythms, consider using this practice (provided above as a video link). It opens the door to sleep. It welcomes sleep’s arrival. It relaxes any lingering worries that now is the time for anything other than making room for deep, restful sleep.