Sleep, beautiful sleep

kw: book reviews, nonfiction, sleep

What a way to start the year! with a book about sleep. Michael McGirr, a former Jesuit priest, and a victim of sleep apnea, writes about sleep and sleeplessness from a few unique perspectives in his book Snooze: The Lost Art of Sleep. I read the book hoping to re-connect with this lost art, but found instead a travelogue, a book of "what" but not "how".

There is no table of contents and I didn't count as I went, but I reckon there are upwards of a dozen chapters. Each is titled by a time and a year (or a few related years), thusly:

10:45pm

[2004]

in which chapter he writes of his diagnosis of sleep apnea and the invention of the CPAP machine, and about his marriage to Jenny who loved him anyway (this after he left the Jesuit order), or

2:15am

[2007BC]

riffing on Jacob son of Isaac, one of history's celebrated sleepers, he of the dream of angels on a ladder, but one who nonetheless complained to his father-in-law,

… by day the heat consumed me, and the cold by night, and my sleep fled from my eyes.

He writes of Edison, who was too busy inventing to sleep; of Florence Nightingale, who slept little but spent some 3/4 of her life directing matters worldwide from her bed; and of coffee and its use to ward off sleep, so much so that Balzac, who fueled his amazing literary output with sixty cups of coffee daily, died of caffeine poisoning at age 51. Balzac might have lived a lot longer on half the coffee, and while writing less daily, his total production might have been even greater.

I am reminded of Alfréd Rényi, who said, "A mathematician is a machine for turning coffee into theorems," a quote usually attributed to Paul Erdős, and tangentially of Leonardo da Vinci, who is said to have kept to a regimen of three hours and 40 minutes of work followed by a 20-minute nap, day in and day out (that comes to two hours in each 24-hour period). I read about one man who tried working on this schedule and did so for a few years, but then gave it up because he ran out of things to keep him busy. I guess to keep Leonardo's schedule you have to have Leonardo's creativity. I wish McGirr had included these also in his travelogue of sleep and its variations, but he did not.

Regardless, his own studies of sleep, restful or not, led him in many directions, including into those antonyms of caffeine, the various sleep-inducing drugs, from Benadryl^® to Ambien^® and beyond. During a hospital stay, a nurse gave me two Benadryl^®, which worked well. My father used a prescription sleep aid that turned out to be a double dose of diphenhydramine in one pill; the exact equivalent of taking two Benadryl^®, but a lot more costly. But the more recent drugs induce sleep by messing with the normal sleep cycle, which can put you into a deep sleep without the total sleep paralysis needed to keep you from acting out your dreams. Lots of sleepwalking (and sleep driving, etc.) incidents are known, some with fatal results.

In the last chapter, he writes that reading in bed can help us drowse, but only if we are reading off of printed paper. The reflected light from a page with dark ink does not inhibit melatonin production. The light from a computer of phone screen has a different quality, and does so interfere.

Overstress is a primary enemy of sleep. We need a certain amount of stress to keep life interesting, but overwhelming, chronic stress just burns us out. Some folks respond with depression and may take to their beds, sleeping much or most of the day. Most of us have trouble getting to sleep, wake too early, and feel tired much of the time. While a few chapters of Snooze address chronic insomnia, a broader affliction is that many of us get some sleep each night, but never seem to get enough. Many, many of us have an experience like mine.

During the last ten or so years of employment at DuPont, I seldom slept more than four hours nightly. For some of that time, I was also on one or another medication to address my bipolarity, but they didn't do much so I learned to cope with it unmedicated. During those medicated periods, I usually napped up to two hours daily, so you could say I had six hours of sleep, but not in one installment. However, without medication with a sleep-promoting side effect, four hours was it. No naps. I had work I enjoyed a lot, a congenial boss (the last 8 of the 10 years), and even told my boss I might work until I was 75. But when the company declared a retirement incentive, I retired at age 66.

After retirement, two important things happened. Within a few weeks, I was sleeping 6-7 hours nightly, and over about half that first year I lost 15 pounds. I remember looking back one day, and saying to myself, "I didn't realize the level of stress I was under!" I had also been using a lot of "cold caffeine" (Pepsi Max), up to a liter daily.

Now that four more years have passed and I am over 70, I get 5-7 hours of sleep, and if I wake early I simply get up, read my Bible a while, have breakfast, then have a morning nap for another hour or two. There aren't a lot of conclusions to draw from that. I am thankful that, though I snore some nights (not all), I don't have apnea; I have part time work that keeps some structure in my life, but is incredibly less stressful than any job I had before; I practically eliminated caffeine, using caffeinated cola only for driving alertness on road trips.

You'll have to look elsewhere for advice and information on how to sleep longer and better. For an enjoyable survey of how humans have been sleeping, or not, Snooze is the book for you.

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.

More on sleeping the weight off

kw: dieting, news, sleep

A bit more accurate information has been released about the Annals of Internal Medicine article regarding sleep deprivation and weight/fat loss. The study is termed a "crossover" study, meaning some participants slept the longer hours the first weeks and the others did so the latter weeks. That was not made clear in earlier news items. This is a key point, because it removes one possible cause of confusion. Please see my post this morning for the rest of what I said about it.

Sleeping the weight off

kw: news, dieting, sleep

The article is titled Dieting? More Sleep Helps Burn More Fat. It is one of about 700 news articles on this topic in the past day or so that are based on a study reported in Annals of Internal Medicine (I would link to the article, but it is embargoed until the issue goes on sale).

Ten volunteers on a low-calorie diet spent four weeks confined to a lab. For two weeks, they slept about 8.5 hours nightly, and for two they slept 5.5 hours. The key finding? During the latter two weeks the volunteers lost twice as much lean mass (muscle) and half as much fat, as compared to the first two weeks. The total loss each two-week period was the same, about 3kg. One more effect was that during the low-sleep weeks, the subjects reported feeling more hunger, and they had raised levels of ghrelin, a "hunger" hormone that also causes fat retention. It is not stated whether the study participants had the opportunity to exercise while confined to the lab.

Naturally, I find this upsetting. I have been reducing by dieting all Summer, and have so far lost about 12kg. I sleep very little, but that has long been true. A "good night's sleep" for me is 6h, and 7h is superb. I haven't slept an 8h night in thirty years.

In the article linked above, they do mention a few questions the study raises. Primarily, how does amount of sleep affect metabolism in general? But my key question is not raised, not only in this article but in a few others I perused: What was the effect of reducing sleep during the latter half of the experiment, rather than the other way around? The experiment needs to be repeated with low sleep first and more sleep later, to ferret out the effect of sleep from the effect of already having lost some weight. It is known that during a period of weight loss, the level of ghrelin rises.

It is necessary to distinguish correlation from causation. Based on this study and on what else is known, we cannot yet draw a conclusion that sleep deprivation was the primary cause of the shift from fat loss to lean loss during the study. I was very disappointed to find that the study had no control. The author of the article, Lynne Peeples, quotes the conductors of the study, who state that more and larger trials need to be performed to answer the questions this study raises. I heartily agree. A properly controlled study needs at least these four groups:

• Sleep a lot, get lots of exercise
• Sleep little, get lots of exercise
• Sleep a lot, lay around
• Sleep little, lay around

Of course, you'd need at least six volunteers in each group, to generate adequate statistics. Come to think of it, double the number of groups: half of each group needs to be people who have been exercising habitually, and half couch potatoes, and these need to be distinguished, so it is really an eight-group experiment.

Hoo, boy! Things proliferate. For each possible confounding effect you want to control for, you have to double the number of groups! For example, the same eight groups could be split according to

1. Get plenty of sleep or get too little, all 4 weeks,
2. Sleep lots 2 weeks then too little 2 weeks versus sleep too little the first 2 weeks, then sleep a lot, and
3. Exercise or not.

If we add the factor of those who habitually exercise or not, that makes sixteen groups. I'll stop there. The doctors have their work cut out for them to determine what is causing what!