Even a soul submerged in sleep is hard at work and helps make something of the world.—Heraclitus of Ephesus
What could be more dangerous than eating glass, swallowing swords, or snacking on casu marzu, a Sardinian rotten cheese riddled with maggots that can launch themselves 15 cm into the air at every bite?
The answer may surprise you. According to Guinness World Records, it’s…going without sleep.
After high-level consultations, the famous arbiter of the furthest limits of human endeavor decided against including a category for the longest period without sleep. The decision was made on the grounds that going without sleep for extended periods could prove more dangerous than some of the most extreme, life-threatening challenges recorded around the globe, including glass-eating, sword-swallowing, and consuming putrid milk products.
It was a sensible decision. Growing evidence of strong links between sleep disorders and serious health problems highlights the need for health practitioners of all specializations to explore and apply effective treatments for insomnia.
We’ve known for thousands of years how important a ‘good night’s sleep’ is to health. But it is only relatively recently that researchers have highlighted the dangers of too little, or disrupted, sleep.
In our search for underlying principles of healing and health, and in the belief that relatively small changes can result in large rewards, we have added these thoughts on sleep to this edition of Magic in Practice. The aim is to instruct and inform those who might be unaware of the cost of sleeplessness. Also, since we subscribe to Heraclitus’s observation that the sleeping mind is still at work below the level of consciousness, we also suggest some simple changes that can optimize sleep and help make something vastly better of the individual’s world.
Disrupted sleep patterns, insomnia, and simply ‘burning the candle at both ends’ can all have calamitous results.
According to a report by the Institute of Medicine of the National Academies, sleep disorders represent an ‘under-recognized public health problem’, and have been associated with a wide range of health problems, including hypertension, type 2 diabetes, depression, obesity, and even cancer.285
It has been estimated that 5- to 7-million people in the United Kingdom, and possibly 10 times as many Americans, may suffer chronic sleep disorders that may directly and negatively affect their health and longevity.
Most researchers agree that lifestyle factors, such as over-eating and lack of exercise, are driving the obesity epidemic. However, recent research involving 28,000 children and 15,000 adults suggests that lack of sleep may double the risk of becoming obese.
According to Professor Francesco Cappuccio, of the University of Warwick’s Medical School, a ‘silent epidemic’ of reduced sleep runs parallel to the obesity problem—a trend that has been noted in adults, as well as in children as young as 5 years.286
Lack of sleep, he believes, may trigger hormonal changes, including over-production of ghrelin, a known appetite stimulant, and reduction in the hormone, leptin, which suppresses the appetite.
Professor Cappuccio has called for more research into other possible mechanisms linking reduced sleep with increased chronic conditions in affluent societies.
Independent research at the University of Chicago Medical Centre suggests that suppression of slow-wave sleep in even healthy young adults significantly decreases their ability to regulate blood-sugar levels and increases the risk of type 2 diabetes.287 Researchers interrupted the restorative sleep stage known as ‘slow-wave sleep’ of a group of lean, healthy volunteers between the ages of 20 and 31. After only three nights of interrupted sleep, their sensitivity to glucose became significantly reduced.
While their bodies needed more insulin to cope with the same amount of glucose, insulin secretion did not alter to compensate for their reduced tolerance to glucose after only three nights of selective slow-wave sleep suppression. In that short time, the young, healthy subjects became clinically at risk of developing type 2 diabetes.
The University of Chicago researchers estimated this decrease in insulin sensitivity to be comparable to that caused by gaining 44 to 66 kg in bodyweight.288
Happily, though, the risk of developing type 2 diabetes can be significantly reduced with just three hours of ‘catch-up sleep’ a week.
Until now, it has been believed that sleep deprivation could not be redressed by weekend ‘lie ins’. Research by Dr. Peter Liu, of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), has demonstrated that men’s insulin sensitivity, or ability to clear blood sugar or glucose from their bloodstream, significantly improved after three nights of catch-up sleep at the weekend.289
‘We all know we need to get adequate sleep, but that is often impossible because of work demands and busy lifestyles,’ says Dr. Liu.
‘Our study found extending the hours of sleep can improve the body’s use of insulin, thereby reducing the risk of type 2 diabetes in adult men.’
Type 2 diabetes, the seventh leading cause of death in the US, affects nearly 26 million Americans and costs the nation an estimated $174 billion a year.
Obesity and type 2 diabetes, along with high cholesterol and increased blood pressure, are co-factors of the condition known as ‘metabolic syndrome’—also now linked with interrupted or inadequate sleep. One of the biggest studies yet carried out suggests that too little sleep can nearly double the conditions leading to heart disease.
A University of Pittsburgh School of Medicine study of 1,214 adults between the ages of 30 and 54 has demonstrated that both too little and too much sleep can trigger metabolic syndrome. Those who slept between seven and eight hours a night were 45% less likely to suffer these symptoms than those who slept fewer, or considerably more, hours each night.
Professor Martica Hall emphasized that the link with sleep had been established independently of other factors previously associated with metabolic syndrome, including smoking, over-eating, and lack of exercise.
Excessive, shallow, non-REM sleep may, at least in part, also explain the undisputed link between sleep disorders and depression. Recent studies have noted excessive REM in anxious and depressed patients. But, rather than causing insomnia, depression has been shown to follow periods of chronic sleeplessness. Both younger and older people are affected, and behavioral disorders among juveniles appear to have a direct link with short or interrupted sleep.290,291,292
Studies presented at the 19th Annual Meeting of the Associated Professional Sleep Societies (APSS) in Denver, and published in the Journal of Behavioral Sleep Medicine, give credence to the theory that insomnia could contribute to, or be a predictor of, depression, and that resultant and prolonged bouts of sadness, hopelessness, and loss of interest in life activities make patients less likely to recover. One study has shown that sufferers of insomnia were more than 10 times more likely to be still depressed after six months, compared with those not suffering from insomnia. The insomniac group was 17 times more likely still to be depressed after a year.
Treatment targeting insomnia is therefore likely to improve the recovery rate from major depression, the researchers conclude.
Groundbreaking research at Stanford University Medical Center suggests that melatonin, one of a class of antioxidant compounds produced during sleep, might be implicated in a suspected link between sleeplessness and cancer. When circadian rhythms are disrupted, less melatonin is produced, fewer free-radical compounds are mopped up, and the DNA of the sufferer’s cells may become more prone to cancer-causing mutations.
The researchers, led by Dr. David Spiegel, also propose a link between suppressed melatonin production and ovarian and breast cancer. Oestrogen prompts cancerous cells to continue proliferating. Shift workers and others with disrupted sleep patterns may produce less melatonin and more oestrogen.293
The second link lies with a hormone called cortisol, which normally reaches peak levels at dawn then declines throughout the day. Cortisol is one of many hormones that help regulate immune system activity, including the activity of a group of immune cells called natural-killer (NK) cells that help the body battle cancer.
One study found that people who are at high risk of breast cancer have a shifted cortisol rhythm, suggesting that people whose cortisol cycle is thrown off by troubled sleep may also be more cancer-prone. In past work, Spiegel and his colleagues found that women with breast cancer whose normal cortisol cycle is disrupted (peaking levels in the afternoon rather than in the early morning) have a lower survival rate. These women also slept poorly.
Spiegel also cites recent findings that night-shift workers have a higher rate of breast cancer than women who sleep normal hours. This is reflected in animal studies. Mice whose circadian rhythms have been interrupted show much more rapid tumor growth than normal mice.
These theories have since received strong support from a study, published in the British Journal of Cancer, which suggests that women who get by on less than six hours’ sleep have a significantly increased risk of breast cancer.294
Dr. Masako Kakizaki, who tracked nearly 24,000 Japanese women over eight years, has called the results ‘significant’.
Further analysis of the data revealed that women who slept an average of eight hours every night were 28% less likely to develop tumors.
Although some experts have dismissed the sleep-cancer link, two out of three recent cohort studies of sleep and breast cancer report a significantly decreased risk among long sleepers.295,296
Most medication, especially used over the long term, is inclined to produce side-effects. It is important that non-invasive, non-pharmacological interventions should be regarded as a first-line approach to all but the most serious sleep disorders. Here, we offer a few Medical NLP-based options we present to participants on Society of Medical NLP training courses. Although these are not intended as a full representation of the alternatives available, we suggest that readers experiment with the following underlying principles:
1. Reduce anxiety and allostatic load in the insomniac. This is probably the most important contribution a Medical NLP practitioner can make to dealing with sleep disorders.
2. Encourage the patient to tolerate each period of sleeplessness along with its accompanying anxiety, and to adopt a curious, observer stance (3rd Position). By shifting out of resistance to the condition and into the experience of detached ‘witnessing’, the patient will experience a spontaneous calm which often leads to sleep.
3. Practising the Relaxation Response (see Appendix A, pages 357 to 360) will, over a period of time, almost certainly improve sleep and other dysfunctional patterns. Since continued practice also leads to an increase in energy, ensure the patient does not do the technique too late at night.
4. Explore the conditions of previous times when sleep was deep and restful and elicit sub-modalities. Future pace the subject using these sub-modalities.
5. Rehearse restful sleep as follows:
i. Dissociate the subject by having her imagine floating out of her body and observing the developing signs of deep sleep.
ii. Elicit these from her (having the subject describe these changes profoundly alters the present state of consciousness), as well as suggest some she might have missed. Notice whether she follows by showing signs of deepening relaxation, pace, and validate (‘that’s right…’) in order to deepen the state.
iii. Have the subject reassociate into the ‘sleepy’ state and anchor to something which will inevitably occur at night (such as the head hitting the pillow).
Note: While talking to the patient, the following language patterns are particularly useful: Presuppositions, Nominalizations and Embedded Commands.
Richard Bandler focuses on internal dialogue when working with insomniacs. Most people who suffer from sleep problems talk to themselves in rapid, agitated tones. He suggests not changing the content of the internal monologue, but rather gradually slowing down the rate of speech, making the internal voice increasingly sleepy, punctuating it with long pauses and yawns.
Finally, the simplest of all techniques, based on the principle of paradoxical intervention, pioneered by Viktor Frankl: Frankl taught his clients to extinguish unwanted behaviors by deliberately practising them. This technique was later adapted and widely applied by Milton Erickson.
285. http://www.iom.edu/Reports/2006/Sleep-Disorders
-and-Sleep-Deprivation-An-Unmet-Public-Health-Problem.aspx
286. http://www2.warwick.ac.uk/newsandevents/
pressreleases/ne100000021440
287. University of Chicago Medical Center (2008, January 2) Lack Of Deep Sleep May Increase Risk Of Type 2 Diabetes. ScienceDaily. Retrieved November 4, 2008, from http://www.sciencedaily.com/releases/2008/01/
080101093903.htm.
288. Hall MH et al (2008) Self-Reported Sleep Duration is Associated with the Metabolic Syndrome in Midlife Adults. Sleep 31(5): 635-643.
289. Liu PY, et al “The Effects of ‘Catch-Up’ Sleep On Insulin Sensitivity in Men With Lifestyle Driven, Chronic, Intermittent Sleep Restriction.” Presented at ENDO 2013, 15-18 June, San Francisco. Link to paper: http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2013.DGM.3.SUN-782
290. American Academy of Sleep Medicine. “Insomnia Linked To Depression In Young Adults.” ScienceDaily, 3 April 2008.
291. American Academy of Sleep Medicine. “Insomnia May Perpetuate Depression In Some Elderly Patients.” ScienceDaily 4 April 2008.
292. JAMA and Archives Journals. “Child Sleep Problems Linked To Later Behavioral Difficulties, Study Shows.” ScienceDaily 10 April 2008.
293. Stanford University Medical Center (2003, October 1). Stanford Research Builds Link Between Sleep, Cancer Progression. ScienceDaily. Retrieved November 4, 2008, from http://www.sciencedaily.com/releases/
2003/10/031001060734.htm.
294. Verkasalo PK, Lillberg K, Stevens RG, Hublin C, Partinen M, Koskenvuo M, Kaprio J (2005) Sleep duration and breast cancer: a prospective cohort study. Cancer Res 65: 9595-9600.
295. Wu AH, Wang R, Koh WP, Stanczyk FC, Lee HP, Yu MC (2008) Sleep duration, melatonin and breast cancer among Chinese women in Singapore. Carcinogenesis 29(6): 1244-1248.
296. Pinheiro SP, Schernhammer ES, Tworoger SS, Michels KB (2006) A prospective study on habitual duration of sleep and incidence of breast cancer in a large cohort of women. Cancer Res 66: 5521-5525.