Sunday, August 14, 2011

Sleep here - no - how about here?

kw: book reviews, nonfiction, sleep, science, business

Sleep has become big business, or rather the lack thereof. Though there is a current fad of obstructuve sleep apnea (OSA) research and treatment, insomnia on the one hand, and enhanced vigilance on the other are the bread-and-butter of "sleep disorder" centers everywhere.

Coming from a long line of poor sleepers and non-sleepers, Patricia Morrisroe seems to have slept well when she was small, but it didn't last long. Of course, when you grow up and live in and around New York City, the City that Never Sleeps, you tend to live like the town lives, non-stop, go-go-go. It isn't just "shop until you drop", it is do anything and everything until you drop. Some people do well enough in this lifestyle, others don't. When she realized she was like a walking Zombie most days, Ms Morrisroe began to "do something about it." Being a writer by trade, she decided to make the quest meaningful, and possibly a bit lucrative, by writing about it. Thus we have Wide Awake: A Memoir of Insomnia.

She remembered life with a boyfriend whom she calls the Good Sleep Boyfriend (GSB), who is still a friend. His place seemed to have the right combination: quieter than most NYC apartments, comfortable bed, and she remembers sleeping pretty well there. Throughout the book, she remarks about one night or another that she gets plenty of sleep. But all too often, she gets an hour or two early on then spends the rest of the night awake.

Stories of the sundry casual horrors inflicted by Catholic public school nuns eventually prove a major part of the key. She has a worrying kind of personality, and anxiety is a big part of her wakefulness. Discovering that this is the case takes some doing, and then doing something about it is quite another thing. Early on, she tries a few sleep laboratories and medical interventions. The business side of things shows up, in spades. One person she interviewed is Dr. Gary Zammit, who runs the Sleep Disorders Institute in NYC and is a strong proponent of sleep aids such as Ambien or Lunesta. She has a long paragraph about his associations with the drug industry, sleep education organizations, and various clinical groups; he seems to be the poster child for conflict of interest. There is a ton of profit in helping the sleepy get some sleep.

There is, fortunately, a balancing view, by Dr. Charles Pollak, who has shown that "sleep aids" do not outperform placebos. Placebos (sugar pills offered in a comforting manner) do work somewhat, and usually by reducing anxiety. Throughout the book, it becomes clear that the face of modern society wears an anxious expression, including anxiety about being kept awake by one's worries. As an aside, I sleep quite a bit better on Saturday and Sunday mornings, probably because I don't have to face the office upon arising. And I like my job!

I don't know just how long her sleep research lasted. At one point she jokes to her husband about the "stories of 8,001 nights", which comes to 22 years, but this probably dates to her earliest insomnia as a teen. The time was substantial, for they traveled the world, including spending Christmas at the Ice Hotel in northern Norway, 125 miles north of the Arctic Circle. Trying to sleep in a smelly down bag on a block of ice doesn't seem to have been the right prescription.

Along the way she learned of military research into enhanced vigilance, and the new drugs and techniques being tried to enable soldiers to perform well on "extended missions" of several days, all without any sleep. A traditional army needs sleep as much as it needs good chow, but in modern battles the winners are typically those who can keep fighting while their enemies fall asleep.

It is well known that older people sleep less. It is not known whether they are harmed by this. In her travels, the author meets a number of elderly people who report that they don't sleep much if at all, and are glad of it because they have so much to do anyway. Can it be that a normal pattern is getting relabeled as a disorder? As America's Baby Boomers get into their sixties, they are certainly buying plenty of sleeping pills, and spending their money at sleep clinics. Of course, the Boomers are also getting obese, and OSA is a problem for many of them, one that does need to be addressed (By the way, OSA afflicts a goodly number who are not obese).

The author attended various conferences, of both doctors and alternative practitioners. One of the latter suggested she has to also try meditation, that it helps many. She does, and for her it is the single thing that helps the most. I was impressed while reading that Ms Morrisroe is not the kind to try something three or four nights before deciding if it works. She will try for a month or more. Her odyssey with meditation extends over a year, and is continuing, for it helps reduce her anxieties, and thus sleep the night, or even fall back to sleep when she awakens in the middle of the night. It is ironic that after traveling worldwide, she finds her answer two blocks from home at the local Y.

I personally could not meditate, at least not the Sanskrit way (Om mane padme Om. . .). It would kick off so many religious anxieties in me as to be counterproductive. But reducing anxiety has much going for it, and Jesus exhorted His followers, "Do not be anxious." I have many colleagues who work from home some part of the day, and a number who get their e-mail out of the way before coming to the office for an ordinary 8-hour day, then doing more work from home in the evening. It is like having two jobs! I've made it clear that I do not work from home, and I leave the company laptop locked in a cabinet in the office when I am not there. I think I get as much done as they do.

That is the takeaway message for me: be satisfied with what you can do in a normal day's time, and don't sweat the small stuff. For the author, it took a round-the-world tour to stumble over this. We can benefit from her experience. If meditation can reduce your anxiety, it is worth trying. If something else, then do that. I'm learning to look beforehand: will this make me worry more, or less? Can I do without the worry? When I sleep as well on an "office night" as on a weekend, I'll consider that a success.

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