Stop losing sleep over insomnia – it's natural to wake up in the night
23:12 GMT, 1 October 2012
Only a couple of decades ago, failing to get your prescribed seven to eight hours of uninterrupted sleep was considered merely a red-eyed nuisance.
Nowadays we are repeatedly warned that it constitutes a short cut to the cemetery.
The thought of losing a precious few hours will have us reaching for the medicine bottle or lying awake in the kind of stressy tizz that is guaranteed to keep slumber at bay.
Around one in three people complains of suffering from bouts of insomnia, according to the NHS
Medical experts keep sounding dire warnings of the consequences of lost sleep.
For instance, a recent study from Warwick University reported that people who sleep fewer than six hours a night are more likely to die before the age of 65 than those who sleep for longer.
If that were not enough to keep you awake at night, another study of more than 30,000 adults in the scientific journal Sleep found that fewer than five hours’ slumber a night can double your chance of heart attacks, strokes and angina.
The researchers, from West Virginia University, warned that sleep deprivation raises blood pressure, which increases the risk of artery damage.
Such reports are all the more worrying because periods of deprivation are often a natural part of our lives.
Indeed, around one in three people complains of suffering from bouts of insomnia, according to the NHS.
As a result, one in ten of us now regularly takes some form of sleeping tablet.
Last year, an astonishing 15.3 million NHS prescriptions were written for sleep medication such as zopiclone and temazepam, reports the Economic and Social Research Council.
Such drugs are not without their dangers. One early study published in
The Lancet warned that severe side-effects, such as memory problems and daytime grogginess, can create more problems than they solve.
Then last week came a worrying report suggesting that sleeping pills taken by more than a million Britons may significantly increase the risk of dementia.
One in ten of us now regularly takes some form of sleeping tablet
Pensioners who use benzodiazepines — which include temazepam and diazepam — are 50 per cent more likely to succumb to the devastating illness, according to a Harvard University study published in the British Medical Journal.
The researchers suggested this might be because some people who have trouble sleeping are suffering from brain changes that can lead to dementia.
But it may also be true that the drugs themselves interfere with neurotransmitters — chemical messengers in the brain — causing dementia.
But what if our use of these potentially harmful drugs was unnecessary
What if waking up several times a night and sleeping less than the prescribed seven or eight hours is perfectly natural
What if ‘insomnia’ is not really the massive problem we think it is
These are the controversial suggestions to emerge from two newly published books that challenge our widely accepted rules about what constitutes ‘healthy sleep’.
Their authors argue that the ‘eight hours uninterrupted’ rule is, in fact, a myth that was created to suit factory owners in the Industrial Revolution. Instead, our natural state is to have segmented periods of sleep that are nowadays thought unhealthy.
However, the ‘tyranny’ of the eight-hours message has meant that the many people who don’t conform to this end up suffering ‘sleep anxiety’, as David Randall argues in his book, In Dreamland: Adventures In The Strange Science Of Sleep.
‘We know we should be getting a good night’s rest, but imagine we are doing something wrong if we awaken in the middle of the night,’ he argues.
‘Related worries turn many of us into insomniacs and incite many to reach for sleeping pills or sleep aids.’
Much of the problem can be traced to the invention of the light bulb, says Randall, a senior reporter at Reuters.
‘Before this electrically illuminated age, our ancestors slept in two distinct chunks each night,’ he says.
‘The so-called first sleep took place not long after the sun went down and lasted until a little after midnight.
'A person would then wake up for an hour or so before heading back to the so-called second sleep.’
This forgotten way of sleeping was rediscovered by Professor A. Roger Ekirch, a historian at Virginia Polytechnic Institute and State University.
He identified historical references that pointed to this approach, among them a character in The Squire’s Tale, in Chaucer’s Canterbury Tales, who decided to go back to bed after her ‘firste sleep’.
There was also an English doctor who had written that the time between the ‘first sleep’ and ‘second sleep’ was the best time for study and reflection.
Professor Ekirch’s studies also unearthed a 16th-century French physician’s conclusion that labourers were able to conceive several children because they waited until after the first sleep, when their energy was replenished, to make love.
Their wives liked it more, too, he said. The first sleep let men ‘do it better’ and women ‘have more enjoyment’.
According to Professor Ekirch, people got out of bed during this interval and did household chores or visited family and friends.
There were other, more practical reasons for the habit. Records show that through the winter months, northern Europeans would spend nine or ten hours a day in bed, including time spent awake.
Recent studies suggest that the deep sleep obtained by napping for only 30 minutes can restore the brain to work more imaginatively and productively
The bed was the cheapest place to keep warm and was considered a place of rest as well as sleep.
Research suggests this wakeful cycle may indeed be our natural sleeping pattern when we are away from light bulbs, screens and other electronic distractions.
A study by the U.S. National Institute of Mental Health found that when people are deprived of artificial light they go to bed earlier, then wake up a little after midnight and lie awake for a couple of hours.
Once the study volunteers learned to stop worrying about their broken sleep, they started to enjoy their time in the middle of the night as a chance to relax — to think and reflect on their day just done, and the day to come, explained Thomas Wehr, a psychiatrist and research scientist who led the research.
Anthropologists have now observed a similar pattern in some contemporary African tribes.
The Tiv people of central Nigeria even use the same terms — first sleep and second sleep.
Blood tests conducted by Wehr suggest the waking time between first and second sleep may be highly relaxing.
During this period, his volunteers brains’ were found to have raised levels of prolactin, a hormone that helps reduce stress and is responsible for the relaxed feeling after an orgasm.
But in the industrialised world, our sleep habits are no longer driven by our individual or biological needs.
Instead they are cultural, designed to fit the schedule of capitalist society, suggests Matthew Wolf-Meyer in his new book, The Slumbering Masses: Sleep, Medicine And Modern American Life.
As he explains, we need to get up in time for the shrill of the factory whistle or the busy office, then stay awake through the dark to consume media entertainment.
Ever since industrialisation, eight continuous hours of sleep each night has increasingly been touted as optimal by medical and lifestyle experts, no matter whether our bodies agree, he argues.
The result is a ‘culture of exhaustion’ that has spawned a multi-million pound industry that offers us cures in the shape of drugs, special mattresses, lifestyle advice and high-tech sound machines that simulate waves or chirping birds.
‘If a society can’t rest, how can it sleep’ asks Wolf-Meyer, an anthropologist at the University of California, Santa Cruz.
He concludes that we must learn again to recognise the variety and limits of sleep, to have flexible expectations about it and to combat the damage that industrial control has had on our natural rhythms.
Fighting the entire capitalist system, however, is rather a tall order for those of us who barely ever get a decent night’s slumber.
But there are certainly practical things we can all do to help us sleep better and more naturally, rather than relying on pills.
We may try to join an emerging global trend for napping.
Though siestas are most closely linked with Spain and other Latin cultures, they were once popular throughout Europe, Africa and Asia.
Many state-owned companies in China still give their workers two hours for lunch. The first is used for eating, the second for sleeping.
Today, napping is being reinvented as ‘fast sleep’.
In Hong Kong, a mall in the shopping district of Causeway Bay has installed high-tech beds where executives and shoppers pay £15 to grab 20 minutes’ shut-eye in darkness lulled by whalesong.
‘It should not be considered sleeping,’ says Benjamin Lau, the entrepreneur behind the beds.
‘It is a place to re-energise, really.’
Meanwhile, employees at Google in the U.S. are allowed the chance to nap at work because the company believes it may increase productivity.
They may have good cause: recent studies suggest that the deep sleep obtained by napping for only 30 minutes can restore the brain to work more imaginatively and productively.
A NASA-funded study at the University of Pennsylvania has shown that volunteers improve their cognitive performance after as little as 24 minutes’ nap-time.
The more conventional approach to overcoming insomnia is ‘sleep hygiene’, which involves avoiding anything mentally demanding in the 90 minutes before bedtime and instead trying to wind down with a routine — for example, by taking a stroll followed by a bath, some reading and a warm, caffeine-free drink.
Experts such as Professor Adrian Williams, of the London Sleep Centre, recommend that we also ban all electronics from the bedroom.
This is because our brains mistake the light from screens as daylight, confusing our bodyclocks.
‘The standard rule of sleep hygiene is that the bedroom is for sleep and sex, and nothing else,’ he says.
But could ‘sleep hygiene’ actually be part of the problem
Another leading expert, Dr Guy Meadows, the director of The Sleep School in London, worries that this approach sets us up to become ever more anxious about being able to drop off if, for instance, that warm drink doesn’t work.
He thinks that tackling anxiety is the key. His advice is to be relaxed about the amount of sleep that you get — and to be accepting of any problems you may have at night.
Dr Meadows says that highly publicised medical concerns about insomnia mean ‘the cultural pressure for us to sleep has never been greater, while in our hurried modern lives the time available in which to sleep has never been so scarce.’
This pressure can turn an experience that we all have — short periods of sleeplessness due to problems such as pain, anxiety or noise — into a spiral of dread-fuelled wakefulness that turns into clinical insomnia.
‘Your conscious mind starts to worry about sleeping. That keeps you awake at night, and you get into a vicious cycle,’ explains Dr Meadows.
‘The stress activates ancient, survival-related pathways in your brain that keep you awake in case there is real danger around you at night.
‘Many of my clients say that they can spend the evening falling asleep in front of the television, but when they go to the bedroom, their hearts start racing.
'They are going to bed almost like a knight on horseback, fully pumped up in “fight” mode. It is the antithesis of sleeping.’
The answer, Dr Meadows suggests, is that we become far more relaxed about relaxing.
He treats his clients with an approach called ‘acceptance and commitment therapy’, which teaches them to calmly and objectively acknowledge their nocturnal worries, rather than either being wound up by them or trying to stop them.
He also encourages them to accept that wakefulness happens.
‘Getting up in the middle of the night to have a pee is not a disaster,’ he says.
‘Broken sleep is entirely natural and normal.’