by Patrick Quanten MD
Of all the conditions that make for human efficiency and well-being sleep is one of the most important. A whole array of symptoms may occur when human beings are deprived of sleep, ranging from the obviously increasing fatigue and irritability, to difficulties with concentration and coordination, and illusions and hallucinations.
Although the effects of serious sleep deprivation are not in doubt, it is difficult to define exactly what normal sleep involves and how much of it we actually need. We probably all know at least someone who is able to function perfectly well on three or four hours of sleep, whilst others who sleep for long hours never seem to obtain the maximum benefit from it and always seem to lack energy and vitality. So, how can we try and make sense of this?
Western science has focussed on the brain zones that are involved in day and night rhythm, and on the brain activity, as registered by an EEG (electro-encephalogram), during sleep. This established that there are two different brain wave patterns, identified as REM and non-REM. REM stands for rapid eye movement, indicating a state of absolute relaxation as measured in the body's musculature.
This type of research may establish that an individual is not getting enough REM sleep time. It may even show up low levels of certain neuropeptides (brain chemicals) that are known to induce sleep, such as serotonin and norepinephrine. It will, however, not deliver answers to the question why a person begins to suffer from insomnia, or why there is such a wide gap between the hours and quality of sleep on the one hand and the symptoms displayed by different individuals on the other.
But before we delve into the deeper background of sleep disorders and shed some light on the reality behind the obvious, I will give you a overview of the traditional way in which derangements of sleep have been categorised.
This word signifies want of sleep and is used popularly to indicate any impairment in the duration, depth or restorative properties of sleep. Quantitative precision as to what constitutes insomnia is impossible, because of the uncertainty as to the natural requirement of sleep and also its role in the economy of the human body.
Two classes of insomnia may be defined: one in which there appears to be a primary disturbance of the normal sleep mechanism, the other in which sleep impairment is secondary to another disease or condition.
The term primary insomnia should be reserved for those persons who throughout their lives have never enjoyed restful slumber, and in whom none of the usual symptoms of neurosis, depression, or other psychiatric or medical diseases can be elicited.
Severe insomnia is a frequent complaint of patients suffering from psychiatric disease. Also, vigorous mental activity late at night or excitement which leaves the muscles tense, counteracts drowsiness and sleep. Under these circumstances there is difficulty in falling asleep and a tendency to sleep late in the morning.
Sleeplessness is also commonly recorded in the histories of patients suffering from psychoneurosis and psychosis. Illnesses in which anxiety and fear are prominent symptoms usually result in difficulty in falling asleep and light, fitful or intermittent sleep. Also, disturbing dreams are frequent and may awaken the patient.
Disturbances in the transitional period of sleep
As sleep comes on, certain nervous centres may be excited to a burst of insubordinate activity. The result is a sudden start that arouses the incipient sleeper. It may involve one or both legs or the trunk, less often the arms.
Sensory centres may be disturbed in a similar way, either as an isolated phenomenon or in association with phenomena that induce motion. The patient may drop off to sleep, but be aroused by a sensation that darts through the body. Or a sudden clang or crashing sound disturbs commencing sleep. Sometimes there is a sudden flash of light or a sensation of being lifted and dashed to earth or of being turned.
Curious and at times distressing paresthetic disturbances develop during sleep. Everyone is familiar with the phenomenon of a leg "going to sleep". This is essentially caused by pressure on nerves in superficial places and a similar thing can develop during sleep. This condition usually lasts only a few minutes to hours, but if the compression is prolonged, the nerve may be severely damaged. Unusually deep sleep, as in alcoholic intoxication, renders the patient especially liable to sleep palsies, merely because the patient does not heed the discomfort of an unnatural posture.
Nightmares and night terrors
Awakening in a state of terror has happened to nearly everyone. Children are especially susceptible. Fever disposes to it, as may many other conditions such as indigestion. Nightmares differ from night terrors only in the greater intensity of the anxiety. In addition there is more vocalisation and motor activity, even to the point of running as if pursued.
Somnambulism and sleep automatism
This condition occurs more often in children than in adults. After being asleep for a time, the patient arises from the bed, walks about the house, and may turn on a light or perform some other familiar act. There is no outward sign of emotion; the eyes are open, and the sleeper is guided by vision. If spoken to, there is no response. Sometimes strange phrases or sentences are muttered over and over again. The following morning there is usually no memory of the episode.
Occasional abnormalities of the brain waves of the type seen in epilepsy tend to occur in epileptic patients during or shortly after the onset of sleep. Not infrequently an individual subject to grand mal attacks will have them only at night during sleep.
Nocturnal jerks of the legs are another troublesome symptom because they interfere with sleep night after night. This condition differs from the restless leg syndrome in that involuntarily movements occur.
In general there are three varieties of wakefulness.
One type is the inability to fall asleep. Individuals affected by this type have become more and more tense during the day and are unable to relax. After about 1 to 3 hours the individual sinks into an exhausted, deep sleep which continues throughout the night. For these patients any fairly quick-acting hypnotic (sleeping tablet) given 15 to 30 minutes before going to bed is useful in inducing and maintaining sleep.
The second type of insomnia is exhibited by patients who are able to go to sleep but who awaken in 2 or 3 hours and lose sleep in the middle of the night. They awaken during the period when sleep normally lightens, and some are alternately awake and asleep all the rest of the night. Often these are sick persons with a debilitating or painful illness which generates more pain and restlessness as muscles relax and leave painful areas unsplinted. In others, fever, sweats, shortness of breath, or other distressful symptoms develop and demand attention. Heavier and longer lasting hypnotics as well as appropriate analgesics (pain killers) are the drugs of choice here.
The third type is seen in patients who go to sleep promptly and sleep well most of the night, only to awaken too early in the morning. Most of these individuals are older persons who turn night into day. In this category also fall those individuals who are under great tension, worry or anxiety, or are overworked and exhausted. Heavy hypnotics and barbiturates are the drugs mostly used for this condition.
Is that it?
After all that research we now know that for the great majority of cases insomnia goes hand in hand with some other condition, be it a physical malfunctioning (pain, posture, etc) or a mental one (anxiety, emotional disturbances, psychosis, neurosis, psychiatric disorders).
We also know that, irrespective of what has caused the insomnia, there are three categories depending on what part of the night you are awake. It is these categories, not the cause of the insomnia, that determines the treatment prescribed. The physician's aim is to numb your brain during the specific waking period and he chooses the drugs accordingly.
All of this is set against a background of being unable to define insomnia or what quality sleep really is.
Sleeping, and more specifically, a total rest period has everything to do with the rhythm of night and day. As the day turns into night, the diurnal animals get ready for bed. Their internal clock is winding down and allows them to relax and eventually to fall asleep. This happens because their internal clock is attuned with the natural energies on which they feed. Within the 24-hour daily rhythm the energy levels are coming down late afternoon into early evening, in a similar way that during autumn life slows down and "beds" down in preparation for the winter. With the natural energy levels dropping, there is less and less activity, a growing tiredness and weariness, and an internal tendency to have a rest. Nature provides the perfect backdrop to a good night sleep, or more to the point, a complete rest. The only thing it asks of us is not to mess with it and to just let it happen.
The relationship between the kinds of sleep we are having and the way we feel afterwards is obviously more connected to the quality of sleep than to the number of hours we sleep. The fact that some people are perfectly all right with hardly any sleep at all and others are struggling with even more than a fair share of sleeping hours is indicative of an important individual factor. In other words, numbers and averages are no help to any individual who wants to understand the symptoms he or she is suffering from which include sleep disturbances.
In ancient cultures it has always been known that insomnia is the most typical sign of nervous distress. The ancients considered nerve impulses to be a kind of air travelling through the body, an energy that moves through the brain and the nerves, controlling both voluntary and involuntary functions. Derangements of this "air"-flow always involve some weakness, disturbance or hypersensitivity of the nervous system. Furthermore, nervous system disorders are also linked with mental disorders; the mind and nerves are directly connected to each other. Symptoms caused by this sort of derangement include nervousness, anxiety, ungroundedness, hypersensitivity and excess thought and worry. The sleep patterns related to these symptoms are difficulty in falling asleep, easily disturbed sleep, difficulty in returning to sleep once awakened. Dreams may be frightening, filled with flying, falling, nightmares, encounters with ghosts, etc. As causes for insomnia they list stress, anxiety, excessive thinking, taking drugs (prescription or others) or stimulants (coffee, tea, alcohol, sugar), too much travel, and overwork. These are the more specific causes, which should be added to the more general ones of malnutrition and poor digestion, inappropriate diet for one's constitution, lack of emotional nourishment, lack of routine in life, and frequent exposure to cold.
Here we have a sense that insomnia is not an isolated symptom, but fits right into an array of signs and symptoms that are the result of disturbed nervous energy. It makes a lot of sense then to approach the problem much more widely instead of getting lost in the different details, such as when one is awake, or whether or not one has nightmares. They are all expressions of the same underlying nervous system malfunction, albeit different expressions.
First of all, let me stress that all treatment should be individually adjusted. Just remember that no two people are the same and therefore it does not make any sense that all people should have exactly the same treatment. However, we can outline the main direction a therapy approach for insomnia will take for most people. We can also categorically state that a successful treatment programme will have to look at material, emotional and spiritual issues. But most people could start with the following:
- Diet should emphasize heavy nourishing foods, which include fresh dairy (full fat), whole grains and root vegetables. Coffee, tea and other stimulants, including stimulant herbs such as ginseng, chillies, turmeric, should be avoided. Warm milk with a little nutmeg can be taken an hour before sleep.
- Mental activity should be avoided in the evening, including reading, listening to loud music, watching stimulating films, etc. Sleep hours should be readjusted, so that one retires early (around 10pm) and rises early (by 6am).
- Warm sesame oil can be applied to the feet, the top of the head or forehead, or to the whole body, followed by a warm shower.
- Yoga or Tai Chi should be practised, but no aerobic or strenuous exercises should be done. Release all your worries and tensions of the day before going to sleep. The bed and the sleeping room should be a place of peace, comfortable, clean and well kept. Calming breathing exercises can be practised at the time of going to sleep.
- Western herbs that are useful for insomnia are valerian, skullcap, betony, hops, passionflower and camomile. One or two teaspoons of valerian powder in a cup of warm water is usually effective in mild conditions. Skullcap and other cooling nerviness are more helpful taken with the warmer ones, nutmeg or valerian, as their cold and light nature can aggravate the already existing imbalances.
There is no easy answer and there is no magic pill to ward off the ill effects of insomnia. As it is one symptom out of a whole collection indicating an imbalance in the way we live our lives, the only real long-term answer lies in making those all-important changes to our life style. Then and only then will the system change its habits.