SLEEPING/NOT SLEEPING

1. FAILING TO FALL

THE NARRATOR OF CHAUCER’S POEM The Book of the Duchess cannot sleep. As his fitful thoughts come and go, he lies awake. He hasn’t slept for so long, he fears he may die of insomnia. But what is the reason for his sleeplessness? “Myselven can not telle why,”1 he says. The English expression “to fall asleep” is apt because the transition between waking and sleeping is a gradual drop from one state of being into another, a giving up of full self-consciousness for unconsciousness or for the altered consciousness of dreams. Except in cases of exhaustion or with the aid of drugs, the movement from one world to another is not instantaneous; it takes a little time. Full waking self-consciousness begins to loosen and unravel.

During this interval, I have often had the illusion that I am walking. I feel my foot slip off a curb and fall, but before I hit the pavement, I feel a jerk and am fully awake again. I also watch brilliant mutating spectacles on my closed eyelids, hypnagogic hallucinations, that usher me into sleep. Sometimes I hear voices speak a single word or a short emphatic sentence. In Speak, Memory, Vladimir Nabokov tells about his own visual and auditory semi-oneiric phenomena. “Just before falling asleep I often become aware of … a neutral, detached anonymous voice which I catch saying words of no importance to me whatever—an English or Russian sentence.” He, too, had visions, often “grotesque,” that preceded sleep. Although hypnagogic hallucinations are poorly studied except in relation to narcolepsy, many people without that affliction report seeing pictures or just colors and shadows when they linger at the threshold of sleep. What distinguishes these experiences from dreams proper is awareness, a kind of double reality. As Nabokov writes of his images, “They come and go without the drowsy observer’s participation, but are essentially different from dream pictures for he is still master of his senses.”2

When I have insomnia, I cannot drop into this peculiar zone between waking and sleeping—this half-dreaming, half-aware state of words and pictures does not arrive. As Jorge Luis Borges observes in his poem “Insomnia”: “In vain do I await/ the disintegration, the symbols that come before sleep.”3 My internal narrator, the one who is speaking in my head all day long, refuses to shut up. The day-voice of the self-conscious thinker races along heedless of my desire to stop it and relax. Chaucer’s narrator seems to have a similar problem: “Suche fantasies ben in myn hede, / So I not what is best to doo.”4 And so, like many insomniacs before and after him, he picks up a book and begins to read.

I was thirteen when I had my first bout of sleeplessness. My family was in Reykjavík, Iceland, for the summer, and day never really became night. I couldn’t sleep, and so I read, but the novels I was reading only stimulated me more, and I would find myself wandering around the house with rushing fragments of Dickens, Austen, or the Brontës whirring in my head. It is tempting to think of this form of insomnia, the inability to fall asleep, as a disease of agency and control, the inability to relinquish high self-reflexive consciousness for the vulnerable, ignorant regions of slumber when we know not what we do. In On the Generation of Animals, Aristotle regards sleep as a between-world: “… the transition from being to not-being to being is effected through the intermediate state, and sleep would appear to be by its nature a state of this sort, being as it were a borderland between living and not-living: a person who is asleep would appear to be neither completely non-existent nor completely existent…”5 Sleep as nearer to death than waking or, as Banquo calls it in Macbeth, “death’s counterfeit.”

In sleep we leave behind the sensory stimulation of the outside world. A part of the brain called the thalamus, involved in the regulation of sleeping and waking, plays a crucial role in shutting out somatosensory stimuli and allowing the cortex to enter sleep. One theory offered to explain hypnagogic hallucinations is that the thalamus deactivates before the cortex in human beings, so the still active cortex manufactures images, but this is just a hypothesis. What is clear is that going to sleep involves making a psychobiological transition. Anxiety, guilt, excitement, a racing bedtime imagination, fear of dying, and pain or illness can keep us from toppling into the oneiric underworld. Depression often involves sleep disturbances, especially waking up early in the morning and not being able to get back to sleep. Weirdly enough, keeping a depressed patient awake for a couple of nights in the hospital can alleviate his symptoms temporarily. They return as soon as he begins to sleep normally again. On the rare occasion that I have had both a migraine headache and suffered from a whole night of insomnia, I have found that the insomnia appears to cure the migraine. No one understands how either depression or migraine are related to, or overlap with, the sleep cycle.

Chaucer’s insomniac reads Ovid’s The Metamorphosis. It does not put him to sleep. He gets very interested in it and spends many lines reporting on his reading. I read in the afternoons now, never at night, because books enliven the internal narrator to one vivid thought after another. No doubt my obsessive reading kept me up that summer long ago, but the permanent daylight of Reykjavík in June must have played havoc with my circadian rhythms, my normal twenty-four-hour wake/sleep cycle and, without darkness, my body never fell into the borderland that would carry me into slumber. When I look back on it, I think I was more anxious about not sleeping than about anything else I can name, and this is still often the case when I am seized with a fit of wakefulness. I am lucky it doesn’t happen often. It is bitter to hear the birds.

2. WHY SLEEP?

Waking and sleeping are the two sides of being. Aristotle put it this way: “It is necessary that every creature which wakes must also be capable of sleeping, since it is impossible that it should be always actualizing its powers.”6 This makes sense. We know that we have to sleep. We know sleeplessness makes us cranky, stupid, and sad. And yet, why we sleep, why we dream, and even why we are wakeful—conscious—remain mysteries. In The Meditations René Descartes asked if he could be certain he was even awake. “How often, asleep at night, am I convinced that I am here in my dressing gown, sitting by the fire when in fact I am lying undressed in bed!… I see plainly that there are never any sure signs by means of which being awake can be distinguished from being asleep.”7 Dreamless sleep gave Descartes a further problem. It followed from his cogito ergo sum that the apparent thoughtlessness of deep imageless sleep would mean an end to human existence. He was forced to postulate that both waking and sleeping states are conscious, even those periods when we don’t dream at all. John Locke found this ridiculous and came to the opposite conclusion: dreamless sleep is not part of the self, because there is nothing to remember, and personal identity is made of memories. Most of us accept the fact that although we may believe our dreams to be real events when asleep, upon waking in the morning in the same place, we can tell the difference between nocturnal hallucination and reality. But what is sleep and why do we need it? Who are we when we sleep? What exactly does the insomniac crave?

Until the middle of the twentieth century, most researchers agreed that fatigue led to reduced brain activity in sleep, that sleep was, by and large, a dormant state of mind. But this was proved wrong. In REM (rapid eye movement) sleep, brain activity compares to that of full wakefulness. Indeed, sometimes neural firing is more intense than when we’re awake. The old answer was: that’s because we’re dreaming. But the hard and fast equation between REM sleep and dreaming has been overturned, although the debates go on about exactly what this means. There are dreams during the non-REM phase of sleep as well. What waking consciousness is and what it’s for is also a mystery, although there are many competing theories. Does sleeping help consolidate our memories? Some scientists say yes. Some say no. Do dreams mean anything? There are people involved in dream research who say yes, Freud was essentially right, or right about some aspects of dreaming. Others who say no, dreams are mental refuse, and still others who say they have meanings but not as Freud thought they did. What is the evolutionary purpose of consciousness, of sleep, of dreams? There is no agreement.

If you keep rats awake, they die within two to four weeks. Of course, in order to prevent the poor creatures from sleeping, the scientists make it impossible for them to drop off, and whether they actually die of sleep deprivation or stress isn’t clear. Fruit flies and cockroaches perish without sleep. The putative record for a human being intentionally staying awake belongs to Randy Gardner, a seventeen-year-old, who remained awake for eleven days in 1965 for a science fair. He survived just fine but was a cognitive wreck by the end of his ordeal. As a volunteer writing teacher at the Payne Whitney psychiatric clinic in New York, I had many bipolar patients in my classes who had been admitted to the hospital during bouts of mania. A number of them told me that they had stayed awake for days, flying high as they had sex, shopped, danced, and even wrote. One woman reported she had written thousands of pages during her most recent manic phase. A strange illness called Morvan’s syndrome can cause people to remain essentially sleepless for long periods of time. In 1974, Michel Jouvet, a French researcher, studied a young man with the disorder who remained awake for several months. He was entirely cogent and suffered no memory impairment or anxiety. He did, however, have visual, auditory, tactile, and olfactory hallucinations every night for a couple of hours. He dreamed awake. Depending on their location, brain lesions can make people sleepy or prevent them from sleeping. They can also cause exceedingly vivid dreams or the cessation of dreaming altogether. Then again, people with no brain injury can experience all of these symptoms as well.

These admittedly random examples of sleeping and sleeplessness are all suggestive, and each one could feasibly become part of a larger argument about why we sleep and dream. Various understandings of both sleeping and waking consciousness depend on how the lines are drawn between and among the various states. Ernest Hartmann of Tufts University School of Medicine proposes a model he calls a “focused-waking-to-dreaming-continuum” which moves from the highly self-conscious, logical, category-bound, sequential wakefulness to daydreaming and reverie with their more fragmented, less logical, and more metaphorical thoughts to dreaming that is highly visual and much less self-conscious. This makes a lot of sense to me. The insomniac remains on the focused waking or daydreaming less-focused side of the continuum, unable for any number of reasons to let go. Hartmann shares with other researchers the conviction that dreaming is more emotional than waking life and that we make connections in dreams, often metaphorical ones, that are more creative than when we’re wide awake and working at some task. He does not believe dreams are random nonsense. Dreaming is another form of mental activity.

There is no place for dreamless sleep on Hartmann’s continuum, but that blankness might reside around the dreaming state. Gottfried Leibniz answered Descartes and Locke by arguing that not all thoughts are conscious. Some perceptions are too unfocused and confused to enter our self-reflective awareness. He argued for a continuum of perception from unconsciousness to full self-consciousness; therefore even deep, dreamless sleep is part of what and who we are. Leibniz died in 1716, but his insight remains startling. We still may not know why we sleep or wake up, but we know that both states are part of a dynamic, changing organism. Long after Descartes, Locke, and Leibniz, the French philosopher Maurice Merleau-Ponty wrote in The Phenomenology of Perception (1945): “The body’s role is to ensure metamorphosis.”8 Surely, that is exactly what we do when we move through the various stages of being wide awake and concentrated to the piecemeal musings of reverie, to sinking drowsiness, to sleep and dreaming, or to sleep with no dreams at all.

3. GOING UNDER

I remember a lamp that stood on the floor in the opened doorway to the bedroom where my sister and I slept. My mother put it there every night so the darkness would never be total. This is an old memory and around it are the usual fogs that dim recollection, but the light offered the hope that blackness would not snuff out the visible world entirely during my anxious transition to sleep. Bedtime rituals for children ease the way to the elsewhere of slumber—teeth brushing and pajamas, the voice of a parent reading, the feel and smell of the old blanket or toy, the nightlight glowing in a corner. For the child, bedtime means double separation, not only from wakefulness but also from Mother and Father. I wonder how many glasses of water have been fetched, how many extra stories have been read and lullabies sung, how many small backs and arms and heads have been rubbed in the past week alone in New York City.

In the “Metapsychological Supplement to the Theory of Dreams,” Sigmund Freud wrote,

We are not in the habit of devoting much thought to the fact that every night human beings lay aside the wrappings in which they have enveloped their skin as well as anything which they may use as a supplement to their bodily organs … for instance their spectacles, their false hair and teeth and so on. We may add that they carry on an entirely analogous undressing of their minds and lay aside most of their psychical acquisitions. Thus on both counts they approach remarkably close to the situation in which they began life.9

Children are even closer to that beginning than we adults are. Night looms larger because time moves more slowly—a child’s day represents a much larger percentage of life lived than it does for the middle-aged parent. The mental capacities of little children do not include the rationalizations grown-ups use to explain to themselves that a fear is unjustified. The three-year-old does not yet live in a world of Newtonian physics. Not long ago, I saw a film of a psychology experiment in which young children worked hard to get their oversized bodies into toy cars.

Sleep resistance, bouts of insomnia, nightmares and night terrors, crawling into bed with parents in the middle of the night are so common among children it seems fair to call them “normal.” Infants, of course, are notorious for refusing to sleep and wake on command. The exasperated parent can now call a counselor who, for a fee, will come to your house and address your baby’s “sleep issues.” As far as I can tell, these interventions are directed more at exhausted parents than at the welfare of children. They consist of behaviorist techniques that “teach” the offspring to give up hope for comfort at times inconvenient for her progenitors. The message here is an early-life version of self-help. The truth is that a baby develops through the reflective exchanges he has with his mother (or what is now called the “primary caregiver”). Essential brain development that regulates emotion takes place after birth, and it happens through the back and forth of maternal-infant relations—looking, touching, comforting. But there is also an intrinsic alarm system in the brain that the neuroscientist Jaak Panksepp calls the PANIC system. All mammals exhibit “distress vocalizations” when they are separated from their caretakers. They cry when they’re left alone. As Panksepp writes, “When these circuits are aroused [PANIC system] animals seek reunion with individuals who help create the feeling of a ‘secure neurochemical base’ in the brain.”10 Harry Harlow’s famous experiments with rhesus monkeys demonstrated that isolated baby monkeys preferred inanimate “terry cloth mothers” to hard wire ones that provided them with food. The animals raised in isolation became anxious, timid, maladjusted adults.

I am not saying that “sleep training” creates psychiatric problems. No doubt many sleep-trained children grow up just fine, but I am saying that sleep training is counterintuitive. When your baby cries, you want to go to her, pick her up, and rock her back to sleep. If anything has become clear to me, it is how quickly advice about raising children changes. In the early twentieth century when the dictates of behaviorism reigned supreme, experts on child care advocated strict feeding and sleeping regimens and discouraged parents from playing with their children.

I couldn’t bear to let my baby cry in the night, so I didn’t. For years I read to my daughter while she drifted off to sleep, her fingers in my hair. As she grew older, I continued to read to her and, after I had said good night, she would lean over and switch on a tape of Stockard Channing reading one of the Ramona books by Beverly Cleary. The tape had become a transitional object—a bridge between me and sleep. D. W. Winnicott coined this term for the things children cling to—bits of blanket or stuffed animals or their own fingers or thumb—that occupy a space between the subjective inner world and the outside world. These objects are especially necessary at bedtime when, as Winnicott writes, “From waking to sleeping, the child jumps from a perceived world to a self-created world. In between there is need for all kinds of transitional phenomena—neutral territory.”11 I vividly remember my sister Asti’s ragged blanket she called her “nemene.” One of my nieces used three pacifiers— one to suck and two to twirl. How she loved her “fires.”

There is no reason we should expect young children to enter the nocturnal darkness of sleep and dreams without help. Parental rituals and transitional objects serve as vehicles for making the passage and, indeed, to a child’s ability eventually to comfort himself. Freud was surely right about the strangeness of preparing for bed and about the fact that the human mind is undressed in sleep. The so-called executive part of the brain—the bilateral prefrontal cortex—is largely quiet, which probably accounts for the disinhibition and high emotion of many dreams. It is not always easy to go to the region that lies beneath wakefulness, to relinquish the day and its vivid sensory reality. And for a small child the most vital part of that reality is Mother and Father, the beloveds she must leave behind as she drops into the very private land of sleep.

2010