Insomniac

  • Gayle Green
University of California Press: 2008. 520 pp. $29.959780520246300 | ISBN: 978-0-5202-4630-0

Californian professor Gayle Green has been an insomniac for 50 years. For her, insomnia has been an ordeal of suffering and anger, directed largely at medical professionals, sleep clinics and the providers of various potions, pills and other sleep aids. In spite of this, her informed insider's account of insomnia is a testament to how well we can apparently survive on far less than eight hours of sleep per night.

Although her inability to function is a message Green may want to convey, being a professor of literature we must allow her some poetic licence. After pouring out her woes, and pointing out that rats die without sleep and that insomnia may lead to all manner of ills, the book settles down to an interesting read. Green gives a fair reflection of how difficult life can be for insomniacs. Focusing on the United States, she interviews insomnia experts, tries out every conceivable sleep treatment and attends learned conferences on sleep disorders. Albeit from a personal viewpoint, she provides home truths and insights that many sleep researchers and doctors have lost track of; they would benefit from reading this book.

Claiming not to be depressed, obsessive or hypochondriacal, Green believes she has a genetic form of insomnia that leads to 'physiological hyperarousal' with additional hormonal underpinnings. For her, it is a physical condition and not 'all in the mind'. In my mind lingers the thought that “the lady doth protest too much”. Make of the author what you will, Insomniac is among the best books of its kind. Besides, there are millions of people just like her, seemingly beyond the bounds of modern medicine.

Insomnia is one of the few disorders that a general practitioner will allow a patient to self-diagnose. Credit: PRIVATE COLLECTION/JAMES GOODMAN GALLERY, NEW YORK/BRIDGEMAN ART LIBRARY

Insomnia is one of the few disorders that a general practitioner will allow a patient to self-diagnose. The patient may be rewarded with a short course of hypnotic drugs; but even the best of these medicines is unlikely to lengthen night sleep by more than 20 minutes, usually by quickening sleep onset by the same amount. This is not enough to improve daytime alertness, mainly because many sufferers are hyperaroused and constantly 'on the go' — that's why they can't sleep. Others, such as Green, report being tired all the time, which is different from sleepiness and the propensity to fall asleep.

This tiredness can be linked to insomnia, but both are usually symptoms of something more deep-seated. Treating the insomnia alone (by hypnotic drugs, for example) makes little difference and can be an expensive, frustrating and fruitless course of action, especially in the United States, where sleep induction is a billion-dollar industry. Many, like Green, then seek the solace and sympathies of alternative therapies.

Insomnia comes in many forms: difficulty in falling asleep, too many fitful awakenings or waking up too early. Although there may be obvious physical causes, such as pain and physical illness, for most other sufferers (especially Green) insomnia is more a problem of wakefulness intruding into sleep, rather than just bad sleep. To be more explicit, it is a 24-hour disorder in which persistent anxiety, anger or miserable notions, sitting constantly at the back of a person's mind, ruin the expectations of their next sleep. Clearly, the eventual cure must address this state of waking mind. It is pointless going to bed with these stresses.

Despite the author's fears, insomnia by itself in an otherwise healthy person is unlikely to cause depression or mental illness, unless these are quietly developing for other reasons. Most sufferers also sleep for longer than they realize, and sleep-restriction therapy can actually be useful in treating severe depression.

Worsening Green's plight are the questionable exhortations that we live in a sleepless society riven with 'sleep debt'. Deprived sleepers supposedly run the risk of obesity, developing metabolic syndrome (a combination of risk factors associated with increased cardiovascular disease, liver disease and type 2 diabetes) or worse. This idea is based on old and often misquoted arguments that our grandparents got, on average, nine hours of sleep every night, so we should do the same. This number is flawed. The original research was carried out 100 years ago and focused on school children, not adults. Since the 1960s, findings from the United Kingdom have shown that the average daily sleep has remained consistent at around seven-and-a-quarter hours.

Recent claims that inadequate sleep causes obesity mostly come from over-generalized laboratory and epidemiological findings. Acute sleep restriction — for example, four hours daily over six days — may produce metabolic changes, but few people can cope with so little sleep and the profound sleepiness that results. Even enduring less than five hours sleep a night for many years would result in only modest weight gain, on average about 1 kilogram per year. Insomniacs usually sleep more than this. Proving the possible corollary that one might lose weight by extending sleep would probably take years to accomplish; contrast this with the rapid effectiveness of exercise and diet.

Maybe Green should pause to be thankful about her life, her writing ability and even her sleep in her no doubt comfortable bedroom. The typical worker living a century ago would have toiled long hours and gone home to an impoverished, cold, damp and noisy abode, sharing a lumpy bed with the rest of the family, bed-bugs and fleas. Yet he probably slept quite well.