Sleep In Heavenly Peace----long

[Guest guest]

Pasting in a copy of a sleep article I wrote in case it may help

some of you with sleep problems. It was based on current research at

the time, but I have not kept up with the sleep literature, so not

sure if there are any signficant additions to treatment at this

time. This is copyrighted material, so you may read but not print.

Barbara

SLEEP IN HEAVENLY PEACE

(Copyright Modern Maturity 1995)

" Blessings on him who first invented sleep. It covers a person,

thoughts and all, like a cloak. It is meat for the hungry, drink for

the thirsty, heat for the cold, and cold for the hot. "

What Cervantes, author of Don Quixote, didn't add: But woe to those

who can't!

Sleep--that mysterious but natural state that cushions our nights--

is not an act of the will like turning a doorknob. It's more like

inviting a guest over, oiling the latch, then waiting for the door

to open. The best we can do is invite sleep in and hope it will

oblige.

The harder we hope for sleep, the less likely it will appear.

Worrying about lack of sleep, says Dr. Hauri, Director of the

Mayo Clinic Insomnia Program, typically results in even less sleep.

But that doesn't stop an estimated one third of the adult population

from tossing through sleepless nights, mentally stringing each tick

of time into one more worry bead.

Even before all-night television, 24-hour supermarkets, and swing

shifts, nocturnal unrest was common. " Nights of misery have been

assigned to me, " mourned Job in ancient times. " When I lie down I

think, 'How long before I get up?' The night drags on, and I toss

till dawn. "

" I'm so glad to see daylight, " says Roene Schonberg, 71-year-old

grandmother with chronic insomnia. Her problem began twenty years

ago when she and her husband Don moved from Minnesota to Kansas. " We

left a big house, a big yard and garden, animals to care for, and

lots of exercise and things to do outside, and came to an apartment

with none of those things to do. Instead, we had lots of interaction

with people. " That move, along with the inactivity, disturbed her

normal sleep patterns, Roene believes.

Nine months later the Schonbergs moved again, this time to assume

responsibility for her elderly parents. " Caring for Mom and Dad was

quite confining, " Roene recalls. " It kept me in the house most of

the time. There again, I was without exercise, plus being on call in

the night. These circumstances helped establish the pattern, I

think. "

When she can't sleep, Roene prefers activity to tossing and

turning. " I do all kinds of things in the night. I bake cookies, I

mop floors, I sew. I listen to the radio or read. I've even tried

boring books, but they don't put me to sleep. "

Grandparents, college students, baby boomers--60 million people of

all ages complain of transient or chronic difficulty sleeping,

according to the 1992 National Commission of Sleep Disorders. For

half of these individuals, the problem is severe, especially women

and older adults. But how much sleep is enough? What do we really

know about the process of sleep?

Experts talk about sleep " architecture. " Like a carefully designed

building, sleep is a multi-level process that cycles every 90-100

minutes between two distinct states: REM (rapid eye movement) sleep

when dreaming usually occurs, and non-REM sleep when the brain treks

through four different stages. Healthy sleepers fall first into non-

REM sleep.

" Going to sleep is like going down a stairway, " explains Dr.

Hauri in his book, No More Sleepless Nights. " You start down into

stage 1 sleep with your thoughts drifting, but you don't feel

asleep. Then you go down the stairway to stage 2, and your brain

starts putting out waves called sleep spindles and K-complexes. Then

you go into deep stage 3 and 4 delta sleep. "

Ahhh, says your body, as delta waves lap your brain and blood floods

every muscle fiber. During brief REM intermissions, however, much of

your blood abandons its restorative job in the muscle, rushing

instead to your brain as dreams spill out saw-toothed waves. Not to

worry, though. Researchers believe that REM sleep bestows benefits

too, allowing learning and memory to gel.

With enough REM and non-REM sleep, then, theoretically a professor

could walk six brisk blocks to his 7:30 a.m. Symbolic Logic class

and deliver a flawless lecture. What happens to this professor when

insomnia intrudes?

" If I were in a wheelchair, I could function academically, " said a

philosophy professor at a hearing for the National Commission on

Sleep Disorders. " But with sleep deprivation from insomnia, there

were times when I tried to read one of my own books to lecture from

and found it difficult to assimilate the material. I was dealing

with a lifetime of intellectual impairment. I was a basket case. "

The effects of sleep fragmentation are well documented. In a study

reported in Psychophysiology, eight adults who were awakened for two

consecutive nights at ten-minute intervals were unable to perform

math addition and vigilance tasks much better than subjects who had

no sleep. Imagine then the serious disability imposed by ailments

like sleep apnea (momentary lapses in breathing) or periodic limb

movement disorder (involuntary muscle jerks) that awaken the hapless

victim up to 400 times per night.

Even garden-variety insomniacs report fatigue, short attention span,

slow reflexes, fuzzy thinking, memory gaps, impaired judgment, and

irritability. In an investigation of 100 chronic insomniacs, 39%

reported less productivity at work; 30% felt they had lost some

ability to achieve their goals; 17% said they were more likely to

lose their temper.

Midnighters also report frequent colds and viral infections.

Research confirms that a flu virus, for instance, stays longer in

the lungs of sleep-deprived mice than rested mice. Sleep loss may

also alter mood. " If I don't get enough sleep, " says Roene, " the day

seems several shades darker. My mind sees through dark glasses. "

Decision-making is harder too, she adds, especially when shopping.

Like stock market losses, sleep debts accumulate. Poor sleepers

stagger from day to day under government-sized deficits. It's not

surprising, then, that some insomniacs perceive the problem as an

illness. But sleeplessness is a symptom--like a drippy nose. And

before treating any symptoms, a good scientist looks for cause.

--Emotional stress accounts for more than 50 percent of

sleeplessness, estimates Dr. Hauri in an interview for Mayo Clinic

Health Letter. Depression, anxiety, panic attacks, phobias, and

obsessive-compulsive disorders create disturbed sleep patterns.

Early morning wake-up, for instance, is typical of depression, while

anxiety usually strikes at bedtime. Even when they catch some zzz's,

anxious sleepers get less deep delta sleep and feel less rested.

Major stressors like deaths and births, promotion and retirement,

marriage and divorce can spark insomnia. So can bent fenders. Or a

noisy neighbor. Sleeplessness that begins with a single incident may

linger long after the stress resolves, a disorder called conditioned

or " learned " insomnia.

--Physical illness and the accompanying symptoms--like pain, nausea,

fever, shortness of breath--often trouble sleep. Parkinson's

disease, Alzheimer's, hyperthyroidism, migraine, angina,

fibromyalgia, and asthma are common sleep busters. Sleep is severely

fragmented for rheumatoid arthritis patients, according to a study

published in Arthritis-Rheumatology. In fact, some medical

conditions worsen during certain stages of sleep, or simply when the

patient lies down. Pregnant women sleep lighter and less

efficiently. Hot flashes and night sweats rouse menopausal women.

Certain drugs, such as cortisone, act as central nervous system

stimulants, sending the patient to bed as high-strung as a power

line. Beta blockers, theophylline, Aldomet, Prozac, caffeine, and

nicotine are common offenders. Alcohol, sly dog, may initially

relax, but later it plagues the sleeper with frequent awakenings.

Aside from illness, normal aging changes sleep patterns. Senior

citizens collect less delta and REM sleep, more awakenings, and less

time asleep.

--Poor sleep habits--like an irregular bedtime, frequent naps, or

weekend sleeping in--can scramble your body's normal sleep-wake

cycles. Other popular bad habits: Late-night television. Arguing in

bed. Pineapple danish at midnight, which trains your body to wake up

hungry. Yes, insomnia often becomes a tangle of cause and effect,

cemented with habit.

What's a sleepless person to do? Many Americans seem to accept the

problem as an inevitable part of a hyperactive lifestyle, but more

are seeking help. One physician survey estimates that sleep

complaints generate 3.3 million office visits per year. And

complainers often exit with a prescription.

But for chronic insomnia (two months or longer), pills are not the

answer. " Taking sleeping pills is like borrowing money from the

bank, " cautions Dr. Hauri. Besides masking the real causes, he

explains, benzodiazepines and other soporific drugs exact a pay

back: rebound insomnia, which in turn encourages addiction.

Currently, sleep experts focus on retraining insomniacs to sleep

well without drugs, and many report success.

--Stimulus-control therapy, developed by Dr. Bootzin to

counteract learned insomnia, abolishes tossing and turning. The

rules: Go to bed only when sleepy; if unable to sleep after 15 or 20

minutes, go to another room and do something relaxing until sleepy;

repeat this process for any night awakenings; get up at the same

time every morning; do not nap. This method requires discipline, but

the payoffs are good. In a few weeks, most patients demonstrate

dramatic improvements maintained at six-month follow-up.

--Sleep-restriction therapy works for insomniacs who try to make up

for lost sleep by spending too much time in bed. (The longer they

stay in bed, the worse they sleep.) Initially, patients must curtail

downtime to six or less hours, going to bed later and getting up

earlier. Once this short night becomes 90% sleep efficient, time in

bed expands by 15 minutes per week. The journal Sleep reports one

case history where this method enabled a depressed patient with

chronic pain to boost average sleep from 2.5 hours per night to 6

hours.

--Light therapy, a promising development in sleep research, can

reset an out-of-sync body clock. How? When light enters the retina,

it travels via the nervous system to the brain where it influences

the body's biological clock--a freckle-sized clump of cells. While

bright sunlight is useful, experts who treat insomnia usually rely

on timed artificial light of at least 2500 lux. With morning

exposure to light, evening insomniacs sleep quicker and deeper.

Exposure to bright light in the evening lengthens sleep for those

who wake up too early.

Besides these three therapies--which require professional

supervision--here's what you can do for yourself to get more of that

peace-on-earth kind of sleep:

--Think of night as friend, not foe. Insomniacs often approach a

dark room with a bed the way a soldier approaches a war zone:

fearful, but determined to win. Actually sleep is more like a

surrender, says author Frederick Buechner in Whistling in the Dark,

a laying down of arms.

--Deal with worries before bedtime. " I slept but my heart was

awake, " wrote Solomon in Song of Songs. How to shush those night-

blooming thoughts? Dr. Hauri suggests setting aside a half hour of

daytime to mull over problems, jotting down possible solutions. Or

try writing your angst into a daily journal.

--Establish a relaxing bedtime ritual. Insomniacs usually need more

wind-down time than a toothbrush-pajama routine allows. Roene and

her husband take turns reading to each other from the Anne of Green

Gables books. Other options: listen to quiet music, knit, drink

soothing herb tea, or try relaxing exercises like head rolls, body

stretches, or a do-it-yourself head massage.

--Exercise regularly. Studies confirm that people in good physical

condition sleep quicker and deeper. To get the most sleep perks,

exercise five or six hours before you tuck in. Why? The initial rise

in body temperature induces a corresponding drop by bedtime, sending

your body a sleep signal. A warm bath in late afternoon effects a

similar temperature swing.

--Eat to sleep. Dietrich reportedly ate sardine and onion

sandwiches to help her sleep. But most experts recommend a bedtime

snack of complex carbohydrates to induce drowsiness. Warm milk with

its tryptophan content is another favorite. In an MIT study, the

volunteers who ate bananas and English muffins won the sleep race.

In another study, an evening meal that included tabasco sauce and

mustard markedly disturbed the sleep of six young males, who stayed

awake longer, woke more frequently, and got less delta sleep.

--Check your nutritional status. One menopausal woman who began

taking a calcium supplement to prevent osteoporosis got an

unexpected bonus: no more night awakenings, which had plagued her

for ten years. Calcium's calming effect on the central nervous

system is well-known to researchers. B-12 and folic acid help some

poor sleepers, but aggravate the problem for others.

--Fine-tune your sleeping environment. Sleep cool, say the experts,

between 64 to 66 degrees. Noise, light, pressure, heat, cold,

drafts, humidity, or a restless spouse can rob sleep. To discourage

clock-watching, keep the alarm under the bed or in a drawer. Check

your mattress and pillow for comfort, but don't fuss too much. After

all, for centuries people slept well on the floor.

--Keep a sleep log. Every morning jot down the time you went to bed,

how long it took to fall asleep, number of night awakenings, total

time awake, total time asleep, morning wake-up time, plus an

estimate of how well you slept. Every evening complete a day log,

noting meals, naps, exercise, job or family stress. Then compare the

two logs, looking for clues. Dr. Hauri believes insomniacs should do

their own detective work. " Even if you have a crazy, far-out hunch,

test it, " he says. " Many times, your intuition and hunches are

right. "

Sleep clues can be obvious or ultra subtle. Several years ago when

Roene spent half of January with her son and his family in Vermont,

she slept well every night. But when she went home, the insomnia

returned. What made the difference?

" They live in the woods, " Roene explains. " There were no street

lights or house lights, no car sounds or people noises outside.

There were no social visits or concerns outside that house. It was

just Steve, Debbie, the baby and I. "

And every day, country-sized snowflakes fell. " I love the snow. I'd

go out and walk in it, " she says. " It was cold, but refreshing. "

The story illustrates just how sleep-sensitive we humans are. If

Roene had visited Vermont in July, for instance, would she have

slept as well? Are certain landscapes more sleep-friendly? In any

case, snow and good sleep have much in common: Softness. Pattern.

Depth. Accumulation. And the slow drifting down through silent

nights.