CHAPTER 16
Sally was a politician who didn’t particularly like being a politician. The constant scrutiny of her political actions by the media and her political opponents made her feel stressed, and made it hard for her to sleep—which in turn made her feel more stressed. She eventually realised that her lack of sleep was starting to affect her job performance as well as her life performance, so she decided to make some lasting changes to her life.
Have you ever tossed and turned for much of the night, churning over everything that happened the day before, or anticipating everything that might or might not happen tomorrow? Have you ever managed to blow every problem under the sun out of proportion at 3a.m.? Well, if you have, then you have experienced the singular joy of how unmindfulness impacts sleep. Poor old Macbeth had it bad, although it also took a few pretty unmindful decisions to put him in that situation in the first place:
Sleep is important. You’ve probably already realised that not getting enough of the stuff can lead to symptoms that can be as serious as those caused by not getting enough of our other basic physiological needs, such as food, water and laughter. Sleep is like many things that we often don’t really value until we feel that we’re not getting enough of them. Then, all of a sudden, we appreciate how important they are, and how they can make a big difference to our health and the quality of our life. Lack of sleep causes many physical and mental problems, and can lead to psychosis and even death. Sleep deprivation is even an effective form of torture. Lesser levels of sleep deprivation—often called insomnia—are also associated with health problems.
A decade-long research study of over 70,000 nurses in the United States produced a popular media headline: ‘Too little sleep—or too much—may raise the risk of developing heart disease.’ The study found that nurses who slept on average fewer than 5 hours a night were almost 40 per cent more likely to develop heart disease than were those who averaged 8 hours of sleep a night.[1] Medical science still doesn’t fully understand why we need sleep and the dreams that it usually includes, but it seems that sleep gives us a vital mental, emotional and physical de-bugging and re-charging, which we need to realise our full mental, emotional and physical potential.
Most of us take sleep for granted, just as we take breathing and interacting with others for granted. That’s as it should be because all of these things are natural, as well as good for us. Sometimes, however, our circumstances—and our thoughts about our circumstances—can get in the way of our natural ability to sleep. This can make our life a lot less peaceful and happy than it has the potential to be, and often we don’t even realise that something has gone wrong, or how. Sometimes we just get into a habit of not sleeping and just take it to be normal.
Interruptions to our sleep can be short term, such as when we’re studying late for an exam the next day, or even when we’re getting married the next day. Interruptions to our sleep can also be longer term, such as when we have a new baby to look after, or a book deadline to meet, or both, or if we’re working night shifts, or if we have chronic pain ... We may also have noticed that the harder we try to get to sleep the worse we make the problem. It can be a vicious cycle. As with stress, short-term sleep problems usually aren’t serious, but when they become long-term problems—habits—that’s when we really need to do something to restore our natural balance. Firstly, we need to recognise that we have a sleep problem, and that this has a cause and a solution.
Scientific studies have shown that most of us don’t get enough sleep. These studies include a large one undertaken on American adolescents, which showed that 80 per cent of them don’t get enough sleep—as recommended by the US National Sleep Foundation.[2] It has even been reported that people in our modern age sleep approximately an hour a night less than people did a century ago. This might simply be because our minds are more active and our bodies less active than they once were. Sleep deprivation can result in serious psychological and physical problems, and it’s far more common than we might think it is.
We can be suffering from sleep deprivation even if we don’t know we are. Waking up too early is a form of insomnia, as is waking up constantly, and just not enjoying good-quality deep sleep. Studies have shown that the sleep we get at the end of our sleep cycle is vital for achieving optimal mental alertness and memory performance, and this is something we can easily miss out on if we’re constantly relying on alarm clocks, or are otherwise prioritising something other than enough sleep, like being online late at night. If we want to upset our body clock and the hormone melatonin that regulates it, then that’s a pretty good way to do it.
The psychological symptoms of sleep deprivation include increased stress levels, concentration difficulties, memory problems, distractibility, irritability and lassitude. Lack of sleep is also strongly associated with an increased risk of depression.[3] The symptoms of sleep deprivation can resemble the symptoms of serious chronic physical conditions. Because it affects our immunity, physiology and hormones—such as melatonin—chronic and severe insomnia can greatly increase our chances of developing real and serious physical conditions such as heart attacks, strokes, high blood pressure, cancer, diabetes and obesity.
Lack of good-quality sleep also greatly increases our chance of having accidents. Studies have shown that driving while sleep deprived can be as dangerous as driving while drunk or drug-affected.[4] This suggests that there are thousands of road and other accident fatalities happening globally each year that are directly caused by fatigue. In 1979 a minor technical problem at a nuclear power plant in Three Mile Island, Pennsylvania, wasn’t resolved because an operator was fatigued due to sleep deprivation; the situation then worsened until it turned into a major nuclear disaster. Hospital medical interns are often seriously sleep deprived and this dramatically increases their risk of making diagnostic and drug-prescription errors. Contrary to what many of us might think—that we ‘get used to’ sleep deprivation, even if we’re shift workers or insomniacs—we don’t.[5] We just get used to feeling sleep deprived until we don’t notice it anymore.
When is inadequate sleep a problem? When we feel constantly tired, sleep at inappropriate times and when our lack of sleep affects our health or capacity to function.
Insomnia afflicts almost one adult in three in the modern Western world, with a greater proportion of women and older adults affected.[6] The causes of insomnia are varied, and can include physical problems such as sleep apnea, chronic pain or larger psychological problems. Insomnia and short-term sleep deprivation, however, are mainly caused by stress or a temporary increase in demands on our time. We do ourselves a disservice if we don’t look after ourselves—having too many stimulants such as coffee late in the day, or trashing our body clock with irregular hours, or sitting in front of bright lights (and computer screens) late at night, or not understanding a few principles of how sleep works. But the most important reason for our chronic inability to sleep properly—and the mental and physical problems that this can lead to—is going to bed with the agitated mind associated with stress. It’s far better for us to go to bed with something much nicer than stress, such as a warm cup of tea, or a good book.
The basic cause of stress in general is our habit of getting so fascinated with the lifelong running soap opera playing out in our minds—the daze of our lives—that we forget that we’re actually calm and peaceful beings, deep down. Our mental soap operas are actually just our idea of reality that our minds are addicted to. This is mindlessness and it’s not good for us.
There are treatments for insomnia that are based on classical conditioning. According to these approaches we should associate our bedroom with rest and not associate them with work, eating or entertainment. If we have trouble sleeping, we should either read with a low light or get up and go somewhere else and do something other than try to sleep until the next wave of sleep comes—this is so we don’t associate our resting place with our restlessness. Trying to sleep before the wave has come—they come about every 60–75 minutes and last for around 10 minutes—is futile and frustrating. Chill out until it comes and when it comes, don’t miss it. This principle can be taken further, to suggest that we don’t populate our sleeping room with things that we don’t associate with sleep, such as a TV. There are competing theories to this one, of course, which state that we should just stay in our bed and rest if we can’t sleep, because prowling around our house to distract ourselves from our sleeplessness can just add to our problems, such as by increasing our power bill.
Cognitive behavioural therapies are based on the idea that it’s the usual cognitive suspects—our negative, personal and catastrophic thoughts—that cause our sleeplessness: ‘I can’t sleep! I can’t do anything! I’ll probably develop a 40 per cent higher chance of heart disease by morning!’ According to these therapies we need to re-program our thinking habits to cure our sleep problems.
There is also a drug option for treating insomnia. In the days before modern medicine, some particularly desperate or innovative parents gave their infants spoonfuls of gin to help them sleep. Medical science has progressed from such barbaric and ignorant practices to a point where it can now offer the sleepless a wide range of modern equivalents to gin, including the benzodiazepines, the most common family of sleep medications. A serious problem with relying on medications, or gin, to help you or your family sleep, however, is that their efficacy tends to wear off after a few weeks, and the sleep that they help induce is of a lower quality than natural sleep. They also can be addictive and have unwanted side effects including poor health, memory and performance, and accidents. In the long run they can be as bad as the problem they were prescribed to treat. There are other remedies for sleep problems, including melatonin and natural therapies, which may be a little safer, but what makes more sense is to get to the heart of the problem.
The mindful solution to the problem of being sleepless in Seattle, or anywhere else, is to respond mindfully to the mindless circular thinking that can cause insomnia. It’s very easy for our habitual overactive, over-reactive, overwhelming mind to come up with a thought circus such as: ‘The clock just chimed again! That probably means that it’s about 3a.m. and I have to catch my bus for work in only four hours. Even if I got to sleep right now I’ll only get 3 hours’ sleep at best before I have to get up and start getting ready and I don’t particularly like the bus that I go to work on or the job that it takes me to and I’m sure I’d be happier if I stayed in bed, except I can’t sleep! I’ll undoubtedly therefore become psychotic as a result of my continual sleep deprivation and lose my job, which actually doesn’t seem that bad now that I realise I’ll soon be too psychotic to be able to do it or to get on the right bus!’
Familiar? W.S. Gilbert knew all about the mindless games that our insomniac minds like to confound their owners with, if we’re not mindful enough to recognise what’s happening and to realise that there’s always a conscious alternative. Gilbert described his own recurrent bouts of insomnia in 1882 in the wonderful Gilbert and Sullivan light opera Iolanthe. In doing so he created an accurate and funny word picture of what millions of other people have experienced before and since. This song incidentally is meant to be sung fast and then ever faster:
A mindful response rather than a mindless reaction to not being able to go to sleep can put the punctuation back into our thinking. We can recognise that we’re responding to what our mind sees as terrible problems mindlessly, when we lose our natural mental punctuation—the little pauses or moments of silence that make our sentences and life reasonable rather than desperate.
Mindfulness is a highly useful way of preventing and treating sleep deprivation because it simultaneously increases our awareness and our acceptance of what we’re aware of. This very effectively reduces the circling thoughts that can interfere with our sleeping and also our waking life, and helps us to get restorative rest even when we’re not sleeping.
Recent studies have demonstrated the value of mindfulness as a treatment for insomnia. A randomised control study in Minneapolis showed that mindfulness is clearly effective for improving sleep levels of people diagnosed with clinical insomnia.[7] A study in Chicago investigated mindfulness within the broader context of its being a promising new approach to emotion regulation and stress reduction, that has several important health benefits.[8] The results of this study showed that mindfulness is very effective at helping people with chronic insomnia to work successfully with their nocturnal symptoms and their waking consequences. Another study showed that the benefits of mindfulness for helping the sleepless sleep are maintained at twelve-month follow-up.[9]
The key to achieving a mindful response to sleep problems is to just be aware of our sleeplessness: to observe it without reacting to it; to accept it without comment or judgment. This will take practice because it is highly likely that we are well practised in being reactive and angry when we don’t sleep, which only activates our stress system, making the whole situation worse. We could even say that it isn’t our inability to sleep that causes the psychological and physical problems that sleep deprivation can lead to, but that the real problem is our worry about our inability to sleep. It may seem like a paradox, but mindfulness can help us to stop trying to go to sleep, which will make it easier for it to come when it’s ready to come.
If we practise mindfulness during the day—if we’re really attentive to the reality in front of our nose—then chances are that we will naturally also be mindful at night, and that we will therefore sleep better. If we practise rumination or worry during the day, then we shouldn’t be surprised to see it pop up at night. It’s also highly likely that if we develop greater mindfulness, then our life priorities will change and this will also help us sleep. As we become increasingly mindful we’re increasingly likely to prioritise peace, live a more balanced and regular lifestyle and to therefore enjoy more of it—right now, right here. This will work much better for us than will prioritising what gets in the way of peace, such as irrelevant ideas about how we’re going in life or in bed, or all the things we think we need to be happy, or about how we can improve things that don’t need improving, such as our natural ability to fall asleep.
We can practise mindfulness meditation on going to bed. We can also practise it at night when we don’t sleep or, if we’re really getting frustrated, get up and give our attention to something restful until the next sleep wave comes.
If our mind isn’t content with making us mindless and exhausted all day and wants to force us into night shifts as well—we shouldn’t fight it. We should just be gently aware of what our mind is trying to do to us, not for us, and not get caught up in its drama. We should just be gently aware of the thoughts in our mind, and not react to them. We should just be gently aware of the actual sensations in our body as we lie in bed. This will connect us with the reality of the present, and short circuit the unreality of our mindless day and nightmares. Above all, we should realise that we don’t only get rest from sleep; we can also get it by resting our minds while we are awake.
It seemed to Sally that the worse her sleeplessness became the less time she had to find a solution. She eventually asked one of the authors if he knew of anything that might help her sleep better and be less stressed. He gave her a simple mindfulness exercise to practise when lying in her bed late at night or early in the morning, thinking about not sleeping. The practice consists of concentrating for about half a minute on each of our five senses, one by one, and if any thoughts come just letting them come, and go, returning our attention to whichever sense we were attending to. This worked and Sally now sleeps well enough to do her new job well and happily.
Not so helpful
• Worry if we can’t sleep, or can’t get to sleep as quickly as we want to.
• Engage in unrestful activities such as TV watching or snacking where we sleep because this will condition our mind to associate our resting place with restlessness.
• Get so engrossed in some meaningless activity that we miss our sleep train.
Helpful
• Be mindful enough of our body and its needs to go to bed when we feel tired. We have periodic rhythms of sleepiness that we need to respond to rather than ignore.
• Recognise if we have a sleep problem, and realise that this problem has a cause and a solution.
• Practise a simple mindfulness exercise before going to sleep, such as being non-judgmentally aware of each of our senses for half a minute or so each.
• Practise mindfulness as much as possible during the day, so that by the time we get to bed we will have turned our practice into perfection, even if only slightly more successfully than we did yesterday.
• Consider the benefits of attending classes in mindfulness.
• Don’t worry about worry. If we’re tired enough we will eventually sleep. Most insomniacs sleep a lot better and longer than they think they do.
• Be patient and gentle with ourselves. Effective strategies will take four to six weeks to work deeply into our system.
• Seek help from a suitably trained health professional if we feel we need it.