North & South – June 2019

NORTH & SOUTH| JUNE 2019| 85

different.Itmaybeassimpleasthe

brainfillingintimebetweenthebrief

awakeningsofnormalsleep,perceived

aswakefulnessbysomeonepredisposed

tothisformofinsomnia.”

SleepDeprivation

Insomniaandsleepdeprivationare

oftenconflated,saysLeschziner– but

theyareopposites.“Ifyoustudysome-

onewhoissleepdeprivedinthesleep

lab,theydozeoffveryquickly,and

whiletheyareawaketheyperform

poorlyintestsofvigilance.Instark

contrast,‘shortsleep’insomniacswill

behyper-vigilant,andwilltake longer

tofallasleepinthelab.”

HealthRisksofInsomnia

Whentheriskofconditionssuchashigh

bloodpressure,Alzheimer’sanddiabe-

tesareanalysedinpeoplewithinsom-

nia,saysLeschziner,thosewith“prop-

erlymeasured”shortperiodsofdeep

sleephavehigherrates,whilethose

sleepingsixhoursormorehavenoin -

creasedriskatall.Highbloodpressure

anddiabetesmayturnouttobelinked

tochronic,measurablyhighlevelsof

stresshormones(elevatedby-products

ofthesecanshowupinurine)thatcause

anintensestateofanxietycalledhyper-

arousal,preventingsleep.Thisisnot

sexualarousal,buta corrosiveformof

alertness, nervousness and vigilance.

historiesoftenrecorda happyending.
Thedoctorisa patientlistener,dogged
detective,andcomesacrossasanhonest
reporterofhisowntreatmentstrategies
andmistakes.Eachcasehistoryis
revealing,notonlyaboutthepatientand
thesciencebehindtheirproblem,but
also,inanalmostaccidentalway,ofthe
kindly,drolldoctor-writer.
“Aftera fewmorenightrides,Jackie
gavehermotorbikekeystoherlandlady
forsafekeeping,andlatersoldit.Shestill
missesherBSA250.‘Brilliantbike!You
canhearthatcomingformiles.’I tellher
it issurprisingthatit didnotwake her
up. ‘It is, isn’t it?’ she says.”

Can’t Sleep?

• Roughlya thirdofadultsreportperi-
  odsofpoorsleep,makingit byfarthe
  mostcommonsleepdisorder.About
  onein 10 adultshasinsomniaserious
  enoughtomakethemtiredandirritable
  duringtheday.Itcanbea signofan
  over-activethyroidgland,a sideeffectof
  medication,orofissuessuchasanxiety
  ordepression.Thelinkbetweensleep
  andmentalhealthis poorly understood,
  saysLeschziner.


• Youmightwellbegettingbettersleep
  thanyouthinkyouare.Eventhosewith
  severelybrokensleepcanactuallybe
  gettinga normalamountofrestorative
  deep(stage3)sleep.“Weareoftenun-
  reliablewitnessestoourownsleep.”


• True“shortsleep”insomniacsoften
  haveelevatedmarkersofstresshor-
  monessuchascortisolandadrenalin
  intheirurine.Thesehormonesindicate
  “fightorflight”stressandfearprocesses.
  Symptomscanincludea racingheartand
  dilatedpupils.Thesepatientsareliterally
  terrifiedoftheirbedroom.“Importantly,
  thesechangesarenotseeninpeople
  withinsomniawhoaregettinga reason-
  ableamountof[deep]sleep.”

SleepStateMisperception

“Itisincrediblycommonafter[asleep
study]tohear“Isleptterriblythat
night”,althoughthestudywillshow
a decentnight’ssleepofsevenhours.
Thepersonisadamanttheyonlyslept
anhourortwo.Somethingaboutthe
way this person experiences sleep is

HENRY FUSELI: OIL PAINTING ‘THE NIGHTMARE’- 1781. GETTY IMAGES.

HowMuchSleepisEnough?

“Thisquestion,”saysLeschziner,“is

similartoasking,‘Whatisthenormal

heightfora 10-year-old?’IfI lookat

mydaughter’sclassphoto,thechildren

rangeinheighthugely,butallofthem

arenormal.Likewise,thereisa range

ofnormalsleeprequirements.Itde-

pendsonyourgenes,andthequality

ofyoursleep.Therightamountofsleep

isthenumberofhoursneededforyou

towakeuprefreshed and not sleepy

duringtheday.”

SleepTrackers

Ifyouaresleepyduringtheday,orneed

tocatchupintheweekend,youare

probablynotgettingenoughsleep,and

Leschzinersuspectsyouwon’tneed

a sleeptrackertoknowthis.“These

devicesareatpresentrelativelyinac-

curate.Applyfivedifferenttrackersto

yourarmandyouwillgetfivewidely

divergingestimatesofyoursleepdura-

tion.Ifyouarealreadyworriedabout

yoursleepbecauseyouhaveinsomnia,

thenconstantlytrackingyoursleepcan

intensifyyourobsessionwithyoursleep

andmaketheproblemworse.”Formost

people,hesays,sleepis a subjectiveex-

perience,anda trackertellingyouthat

yousleptpoorlywhenyouexpectedto

betoldyousleptwellcan“initselfhave

profoundeffectsonyour own percep-

tion of your sleep”. +

Englishneurologistand

sleepphysicianDrGuy

Leschzinerusesthis

18th-centurypainting

byHenryFuseliinhis

lecturestoillustrate

theterrifyingstate

called“sleepparalysis”.

Thisisa failuretowake

completelyfromthe

sleepstateassociated

withdreaming(REM

sleep),whilethemuscle

paralysisofsleepisstill

switchedon.Thereis

oftena “senseofbeing

pinneddown,havinga

weightontheirchest,

theinabilitytomove,

accompaniedbydeeply

disturbingvisionsof

people or ghosts...”