Meredith Scanlan

“If you are fighting sleepiness during the day, it is likely that you have developed a variety of strategies to combat your fatigue. These might include caffeine breaks morning, noon, and night. You might keep yourself revved up with exciting work challenges or intense recreational activities. You might surround yourself with bright lights or loud music. You might be so enmeshed in a highly stimulating lifestyle that you are out of touch with your need for sleep.” A man named John R. Harvey, from the Allied Services Rehabilitation Hospital in Pennsylvania, unknowingly described my life perfectly. But I wanted to get in touch with my need for sleep, and I wanted to know how. And so it begins, a fascination and a devotion to a condition and a symptom referred to as insomnia… Is insomnia a curable disease?

Normal sleepers are satisfied and wake up with no complaints about their sleep or ability to fall asleep. They sleep on average eight hours a day. They have regular sleep habits, fall asleep and awaken at the same times every day, and never have to force sleep or fight it off. I may have only been born in 1985, but I have never met anyone fitting this description. A small percentage of sleep researchers claim that the average adult needs a minimum of eight hours of sleep every night. Other researchers give a range between 7-8 hours of sleep that an adult needs each night. Different people need different amounts of sleep; there is no normal amount of sleep. The truth is that the average American sleeps just under seven hours a night, and that rate has been steadily dropping since the development of the light bulb.

Sleep is, quite simply, a biologic necessity, a demanding human need that must be met by most of us daily, just like the need for food to eat, water to drink, and air to breath. Scientists have always known that everyone needs sleep, but none really understood what actually happened during sleep. It was generally believed that it was a time for the body and mind to relax and virtually shutdown. Only in recent decades have researches found out otherwise. With the development of new technology that allows researchers to measure the electrical activity of the brain (EEG recordings), scientists have discovered that sleep is a dynamic state of its own. Sleep is broken down into roughly five different physiological stages, or types of sleep.

The first few minutes before the body and mind start to drift into sleep are referred to as “relaxed wakefulness.” Brain waves, when awake and in this relaxed state, are called alpha waves. This is the gateway to the first stage of sleep, drowsing. This is the relaxed state found between waking and sleeping. This stage is identified by a slower brain-wave pattern called the theta wave, which interestingly also occurs when daydreaming (Jacobs). When a fellow student is dozing in a boring class, or perhaps when they are reading a lengthy report on sleep, they are often easily awakened and they claim to just be drifting off but not actually asleep. This is stage one sleep, a light sleep, but not regarded as a true sleep.

Stage two develops after a few minutes of stage one sleep. Stage two sleep is the first authentic sleep phase, and brain wave patterns exhibit sleep spindles and k-complexes (Jacobs). These are more or less surges, where the brain’s electrical activity jumps in a last attempt to maintain awareness. None the less, the outside world is calmer and more detached. This stage lasts between 30-45 minutes before it develops into the third and fourth stages of sleep.

The third and fourth stages of sleep are marked by very slow brain wave patterns named delta waves (Jacobs). This is when the body and mind are in a deep sleep and almost entirely shut off from the exterior world. Delta sleep is considered to be the time when the body is allowed time to recover (Hauri). There is no dreaming during these first four stages of sleep, called NREM or no dream sleep (Caldwell). Normally a person will undergo deep sleep for about 45 minutes and then they will go back into stage two sleep, wandering in and out between the three stages until they finally move on to dream sleep (Jacobs). Dream sleep is by far the most interesting stage of sleep, and yes, everybody does dream. It is commonly referred to as REM sleep meaning “rapid eye movement.” It is called this because we literally watch our dreams. During REM sleep, the brain and body display significant amounts of activity. Throughout the REM state, heart rates, blood pressure, and breathing rates escalate and become highly irregular during dreaming. Brain waves are similar during REM sleep to the brain waves found when awake. This is why REM sleep is also called paradoxical sleep (Jacobs). Sleep scientists call the time to the end of the first REM sleep the first sleep cycle, and the time from then to the end of the second REM sleep the second sleep cycle. A typical adult will return to REM sleep about every 90 minutes (and about every 60 minutes in infants). There are four to six cycles per night, depending on the length of sleep. The first REM period of the night is very short, lasting about 5 minutes, the second is about 10 minutes, and the third is roughly 15 minutes. The final dream of the night usually lasts for 30 minutes, but sometimes lasts an hour (Hauri).

Alright, sleep in humans is defined scientifically on the basis of particular brain- wave patterns. But what about animals? Some scientists seem to think that sleep, as opposed to rest or inactivity, is a relatively recent evolutionary development. Some researchers will insist that to have true sleep the animal must have the same types of brain waves that humans do, namely, slow-wave sleep and rapid eye movement. This is the equivalent to saying that before we conclude that an animal can think, it must have the human capacity for language. For this reason, some researchers have used more relaxed definitions of sleep in different species (Coren).

TYPICAL DAILY SLEEP TIMES FOR VARIOUS COMMON SPECIES OF MAMMALS

(Rounded Off to the Nearest Hour)

Source: Stanley Coren. Sleep Thieves. New York: Free Press Paperbacks, 1997, p. 42.

All mammals seem to show patterns of sleep. Animals that tend to graze like sheep, cattle, deer, etc… are always at risk from predators. Their only defense is to flee at the sight of danger. This is why grazing animals tend to only sleep for about 3-4 hours a day (Coren).

An amazing development in the realm of sleep is the very complex physical mechanisms that some animals use to get a little sleep. A fascinating example is the northern fur seal. This animal spends several days away from the shore on fishing expeditions. Sleep becomes a problem because this is an air-breathing animal. If it fell asleep it would sink to the bottom of the ocean and drown. In order to prevent this, the seal has developed a complex system. Its brain is structured like the human brain; two hemispheres, the left side of the brain controls the right side of the body and vice versa. The fur seal will gently flap its right flipper, using its left side of the brain, just enough to keep his little nose above water. Meanwhile the unused right side of the brain will rest. Then in about 20 minutes the seal will flip over and rest the other half of its brain! This mechanism is also found in some species of dolphins (Coren). Marine mammals in general have very peculiar sleeping habits. The Indus dolphin never stops swimming. If it did it would risk injury from strong currents and debris. Scientists were shocked to learn that this animal sleeps for seven hours a day. The trick is that it doesn’t sleep for seven hours all at once. It takes short naps, with the longest around 60 seconds and the shortest around 4 seconds (Coren).

Birds show sleeping patterns that are related to mammals, too. They have slow-pattern brain-waves and active REM sleep (except the owl must have some other indication of active sleep, as it can’t move its eyes!) The amount of sleep that birds get seems to be directly related to the amount of light in a typical day. As the days grow longer the birds tend to sleep less, although the minimum is not usually below 7 hours (Coren).

The complicated animals are reptiles and fish, lower end animals that do not have readable EEG patterns to suggest different brain-wave levels. These animals can be observed as being more so or less active. Their sleeping patterns suggest that anything that can be called “sleep” is active sleep, with almost no slow-wave sleep (Coren).

Many flying insects have active periods during the day and less active periods at night. Bees for example are very active during the day and calm at night in a hive where they become less sensitive to stimulation. Moths and sea slugs (however unrelated) also wedge themselves in places during the night, and do not move for several hours suggesting behaviors of sleep patterns (Coren).

Dr. Allan Rechtschaffen of the University of Chicago so elegantly put it, “If sleep does not serve an absolutely vital function then it is the biggest mistake the evolutionary process has ever made,” Well, the fact that sleep is as pervasive as it is, across so many different species and so many different levels of physical and neurological complexity, suggests that it is performing a useful and vital function. “Certainly, the complex procedures adopted by certain species to get some sleep and the fact that evolution is willing to sacrifice anywhere from 20-70 percent of the animal’s active life to this activity testify to its [sleep] importance,” (Coren). These seem to suggest that we may be risking grave harm to ourselves, from a biological perspective, if we ignore the evolutionary imperative to sleep and instead try to extend our active conscious lives…

There are ceaseless nights of tossing and turning, and opportunities deprived in slothful slumber. Sleep disorders are a major underlying condition in the United States in adults, adolescents, and children. Some are temporary and mild, others are terminal and tortuous, and the rest seem to fall somewhere in-between. Sleep Disorders can stem from inside the body or from conditions in the external environment (Fritz). There are four basic categories that the different sleeping disorders fit into: extrinsic, intrinsic, circadian, and parasomnias (Zammit).

Extrinsic disorders are those that originate outside of the body. Removal of these factor will result in a cure. Things like alcohol-related problems and diet-related problems fall within this category. Sleep disorders that develop within the body or arise from causes within the body are intrinsic. Narcolepsy, sleep apnea, restless legs syndrome, and certain forms of insomnia are intrinsic. Circadian sleeping disorders disrupt the “biological clock” reach to include jet lag and shift work sleep disorder. Parasomnias are clinical disorders that are not abnormalities for the processes related to sleep. These include things like REM behavior disorder, sleepwalking, and night terrors (Zammit).

Two of the more mild disorders are called Delayed Sleep Phase Syndrome (DSPS) and Advanced Sleep Phase Syndrome (ASPS). These syndromes are caused when the normal circadian sleep rhythm is out of alignment with the day (Harvey). The word circadian comes from a Latin word meaning “about a day,” and it refers to a persons synchronization of a 24-hour day (Fritz). People with ASPS have their circadian rhythm or their biological clock, set too early. They will often fall asleep too early in the evening, but they will wake up in the early hours of the morning around 3:00A.M.-4:00A.M. With DSPS, the sleep cycle is too late, and affected persons can not fall asleep until the early morning where they will sleep the normal seven or eight hours (Harvey). These syndromes are frequently found in the elderly, non-social types that spend a lot of time indoors, and shift-workers (Fritz). Treatments can come in the form of medicine aimed at setting a normal sleep schedule and rhythm, or a light technique where bright bulbs are replaced in the house to “trick” the brain into distinguishing daytime. The easiest, and least invasive method of treatment is turning the patients clock backward or forward by three hours every two days until a more normal sleep cycle develops (this usually requires temporary sleep loss) (Albert).

Nocturnal myoclonus, or periodic limb movements in sleep (PLMS), is a sudden, brief, shock-like involuntary movement caused by active muscular contractions. These are jerking movements that can occur every 20 seconds during the night. The incessant kicking may cause the patient to develop insomnia, but more frequently the spouse is the victim of insomnia (Wilson). Dopamine agonists and opiates are medications used in sever cases only, but prove to diminish the muscle spasms significantly so the patient has less muscle contractions that are less severe (Fritz).

Narcolepsy is an infamous neurological disease that is often chaffed at because of its peculiarity. Narcolepsy is caused by a brain abnormality that affects the neurotransmitters in the central nervous system (Fritz) that is likely genetically inherited (Harvey). This disease involves a paralysis that causes the narcoleptic to steep into a REM sleep at any given moment. Narcolepsy is marked by the sudden weakness of the face, neck, and sometimes body causing the person to crash to the floor. The attack can include an inability to move for several minutes, along with vivid and strange dreams. The attacks are seemingly random, but strong positive and negative emotions may trigger this paralysis (Harvey). The American Narcolepsy Association estimates that approximately one in a thousand people are affected with narcolepsy. Treatment is usually stimulant drugs and methamphetamines, however speed addicts are known to fake symptoms of narcolepsy to get access to these drugs, so it is very difficult for patients to get these prescriptions and the treatment they need (Fritz).

Restless Legs Syndrome (RLS) sounds like something that might be fun to have on the weekend, but in reality it can be an extremely painful experience. This syndrome is vastly misunderstood and most physicians don’t know how to diagnose it. Wittmaack-Ekbom Syndrome, as it is also called, has different levels of severity in each patient and in each attack (Wilson). A symptom of RLS is dysesthesia, a medical term used for a feeling that can’t be described. Some say it is a sort of creeping or crawling in the legs, others say it is a prickling or sharp prodding sensation; this can result in extremely painful tormenting. To relieve the pain people will jump, run, or walk around. When experiencing an attack a patient can become dangerously irrational in an attempt to stop the sensation – like jumping off a tall building or an urge to jump out of a moving vehicle. RLS is an important cause of severe insomnia because attacks often happen during the night in bed and patients are forced to move about losing sleep, which is why RLS is frequently called the sleep thief (Wilson).

“Sometimes people who are polite and normally well controlled during the day become aggressive and violent during the night because of REM behavior disorder,” John R. Harvey. REM Behavior Disorder is a subtle defect in the brain that normally causes paralysis during the dreams of REM sleep (Harvey). Sleepwalking to the extreme, a patient may act out the content of the dream causing harm to themselves and to others. REM Behavioral Disorder can often happen in children between the ages of four and twelve, however it is more frequent among men and can be treated with the drug Clonazepam® to help “ground” (Fritz).

Sleep apnea is a common condition in America that can sometimes require a major surgery. It is a transient cessation of breathing during the night (Harvey). This means that there a frequent episodes of stopped breathing that conclude with a large intake of breath. Sleep apnea is recognizable by loud snoring and wheezing or gasping sounds. This can repeat several hundred times throughout the night causing loss of sleep and insomnia. This could be caused by a malfunction in the part of the brain that controls breathing during sleep, but direct causes of apnea include obstruction of the airway due to enlarged tonsils and fat or extra tissue in the throat. Individuals with sleep apnea are likely to be overweight with high blood pressure, and sleep apnea puts a tremendous strain on the heart thus increasing risk of death due to stroke or heart attack (Harvey). Weight loss and avoiding sleeping on the back are two techniques that can eliminate mild forms of sleep apnea. However some need surgery to enlarge the airways. To do this, patients use a machine that uses air pressure to hold open air passages in the nose and throat (Fritz).

Since the days of September 11, and the War against Iraq, more and more Americans have reported sleeping problems. Forty-four percent of Americans reported trouble falling asleep, 48% said they had more awakenings, and 50% said they woke up unrefreshed (Benedict). A spot survey by the Pew Research Center after the attacks of Sept. 11 put the rate of total sleep problems at 33%, that’s one third of our country that is suffering from sleep deprivation!

Insomnia is a clinical disorder that assumes many forms and affects nearly 10 million Americans (Benedict). Sleep researchers and clinics all over the world have different methods for diagnosing insomnia which are boiled down to three systems of classification. One classifies how long the insomnia lasts. There are three types in this classification that are transient insomnia, short-term insomnia, and chronic insomnia. A second system determines what type of sleeplessness occurs: Sleep Onset Insomnia, Maintenance Insomnia, and poor sleep quality. Then there is the last system, which determines the causes of the insomnia as associated with psychological problems, medical problems, insomnia due to lifestyle, caused by poor sleep habits, environment, and primary insomnia (based on inherited factors).

Transient Insomnia is a very common form of sleep deprivation that almost everyone experiences from time to time. Transient Insomnia only lasts for one to two nights and it is usually caused by stress and outside influences (Jacobs). Sleeping in a strange bed or a hotel room, caffeine intake and diet, vigorous exercise at night, and daily stresses like worrying about an upcoming event, are all factors that cause mild sleeplessness (Cardinal).

Short-term insomnia lasts for four days to two or three weeks long. Stress or poor sleep habits can bring this on. Anxiety, saddened mood, or excitement about things like health, business, relationships, and lifestyle changes can bring on this insomnia (Cardinal).

Chronic insomnia is sleep deprivation that lasts for several months and even years. Sometimes it starts as early as adolescence and continues for years afterwards. Chronic insomnia is the most severe type of insomnia that can cause an array of health problems and psychological damage. In most cases it is clinically diagnosed, and medications, therapy, sleeping techniques and habits, or other treatment programs are needed to aid the patient to cure the insomnia.

Sleep-Onset Insomnia and Maintenance Insomnia are the two major types of insomnia. Sleep-Onset insomniacs have trouble falling asleep at night, taking a couple of hours to finally drift to sleep. The typical night might include going to bed at 11:00 P.M. then falling asleep around 2:30A.M. or 3:00A.M., and then waking up in the morning at the normal time around 7:30A.M. Maintenance Insomniacs don’t have trouble falling asleep, they have trouble staying asleep. Maintenance Insomniacs either wake up in the middle of the night and then can’t go back to sleep for several hours, or they wake up in the early hours of the morning around 4:00 A.M. and can’t go back to sleep. Then there is the third and less obvious type that doesn’t wake up at all during the night, but they are deprived of true sleep because they lack sleep quality. This type wakes up feeling tired, groggy, and unrefreshed because they do not sleep soundly through the night (Jacobs).

There is a considerable amount of doubt and controversy in determining the source and cause of a diagnosed insomniac. There are certain cases where there is a very obvious medical reason. Then there are also dubious, underlying psychological problems that are not easy to see at first. Sleep specialists can not agree on what all the causes are, nor can they necessarily say what any of the causes of insomnia are. Insomnia can be a symptom of another ailment, a condition caused by environmental factors, or an inherited disorder. It depends on the lifestyle and the chemical make up of the mind and body. Each insomniac suffers from their own slightly different version of sleep deprivation.