"To sleep, perchance to dream. Ay, there's the rub."
- William Shakespeare
We are a nation in sleep deprivation. About 60,000 Americans each year are afflicted with insomnia. Approximately 30 percent of men and 40 percent of women cannot consistently get a good night of sleep. The situation gets worse as we age. If you suffer from depression, you are more likely to have problems sleeping. Over eight million doctor's visits per year are attributed to insomnia, and since the definition of insomnia does not include those who choose to get less than seven to eight hours of sleep each night, the picture is bleak indeed.
Our pace of life increases continually. Technology allows us to be productive 24 hours a day, seven days a week. We can do our banking or make airline reservations at any time - even 2 a.m.! We can eat; talk on the phone; listen to the radio; read; and drive - all at the same time! Multitasking is de rigueur. It is no wonder that sleep has become relegated to something we simply surrender to when we can go no more. We are malnourished when it comes to sleep, and it is affecting our health, our minds and our quality of life. It is unclear how many accidents are caused by lack of sleep, but it is quite significant.
As health care practitioners, we must always consider the role of sleep (or lack thereof) when working with our patients. Any type of deficiency, whether blood, qi, yin or yang, must be considered in the context of our patients' sleep habits. If there is not enough sleep, a true evaluation of the state of qi is unreliable until the sleep issue is dealt with.
When we are out of synch with our natural diurnal rhythms, our hormonal equilibrium becomes disturbed. Recent studies have shown a correlation with disruptions in melatonin levels and a decrease in resistance to cancer. Melatonin imbalances are associated with cancers of the breast, prostate, colon, rectum and uterus. Disruption of sleep can also affect cortisol and insulin levels. Syndrome X, the relationship of insulin resistance to serious chronic health problems, can be exacerbated by sleep deficiencies. Women who work night shifts have a documented higher risk of developing breast cancer than women who sleep at night. There is little doubt that if you skimp on sleep, you are building a castle on a frozen lake.
What is sleep? Modern research, which has relied heavily on EEG data, shows us that sleep is something of an enigma. Our general understanding of the purpose of sleep is that it is restorative. Paradoxically, in REM sleep, as opposed to the four stages of non-REM sleep, the brain uses more oxygen and glucose and is more active than during wakefulness! REM sleep is the primary time in which we dream. All mammals, with the strange exception of the anteater, have REM sleep. For some inexplicable evolutionary reason, we mammals need to dream. Deny us REM, and we deteriorate. Freud felt that dreaming was how our pre- and subconscious mind integrated and digested all of the phenomena we experience, but could not possibly be aware of, during each day. It is an organizing mechanism. We do this by creating a story - the dream. Tibetan Buddhists feel the dream state is no more real or unreal than the waking state. If we can learn to have lucid dreams - dreams in which we are aware of our dream while we are dreaming - we can perform spiritual practice while we are dreaming, and transcend the illusion that wakefulness and dreaming are separate. Interestingly, the only states of consciousness that can come close to REM are meditative states of consciousness. In other words, if you find yourself unable to sleep at night, the next best thing to do is meditate.
One cannot discuss proper sleep without examining the role of light. Circadian biologists, those who study the diurnal patterns of living organisms, have known for a long time that light (or lack of it) plays a crucial role in our daily cycles of sleep and wakefulness and the concurrent fluctuations of basal body temperature and hormones. Common sense also dictates that we should probably follow the sun, as our ancestors have done for millennia. There is a natural range for people, and those on either extreme are called "larks" and "owls."
The advent of artificial lighting has contributed to our ability to exploit these tendencies dramatically. It has been found that total darkness at night and exposure to authentic sunlight during the day greatly reduce the incidence of insomnia. Those who are deprived of the coming and going of the sun, people in institutions and those who work and play primarily indoors, are most prone to disorders of the sleep cycle. This is yet another affirmation that the farther we remove ourselves from the natural world, the more tangled the web we weave.
How to Promote Healthy Sleep Habits for Ourselves and Our Patients
- We must value sleep and not feel guilty about making time for it.
- Create an evening ritual and a fixed bedtime. We are creatures of habit, and our diurnal rhythm thrives on ritual and routine.
- Refrain from eating and drinking for at least two hours before bedtime.
- Slow down and do not screech to a halt. Make the last couple of hours before bed a gradual process of disengagement from activity and stimulation. Turn off all media (radios, televisions and PCs); perhaps go to candle light. Try not to have intense conversations before bed. Essentially, you are allowing the nervous system to unwind and prepare for sleep. We cannot simply go from 80 miles per hour to zero in 6.2 seconds.
- Treat yourself to a hot foot soak or hot bath.
- Take the day in review, in reverse. Try this: As the last thing you do before going to sleep, sit on the side of the bed and for exactly five minutes (not four, not six), mentally review the events of the day from the present moment back to the moment of waking that morning. By doing this review consciously, it enables the mind to enter into sleep more freely. One can keep a pad of paper and pen nearby so that if some crucial bit of information is revealed one can write it down, thereby freeing the mind from having to remember one more thing. This should become a nightly habit, as its affects are cumulative.
- Make sure the bedroom is dark and stays dark. If you have to get up at night to urinate, navigate to the bathroom in the dark. Most of us can negotiate our way in our own home without using light. If you must, employ no more than a night light in the hallway or bathroom.
- Wear warm socks to bed. Our core temperature drops almost a full degree Centigrade from evening to morning. Cold feet is one reason we wake in the night. Keep them warm.
- Keep all electrical devices, such as clock-radios, as far from the bed as possible. Keep those EMFs (electromagnetic fields) away from the place we are trying to spend about one third of our lives. Some folks even flip the breaker switches in their homes off at night, cutting the power completely.
- Find some sunlight in the middle of the day. In accordance with darkness at night, sunlight during the day promotes a healthy circadian rhythm. If you are in the northern reaches of the country, there are full-spectrum lights designed just for this purpose.
There are probably dozens of other helpful ideas for helping us prepare for sleep. These ideas are what I have found to be most critical. It is an affirmation of our biological heritage to take back the night and resume our rightful place in the order of things.
