Photo by AJ Colores on Unsplash.
It begins with a grim joke. ‘You do know you snore?’
What you don’t know is that the underlying cause is probably stealing your concentration, your memory, your dreams and your creativity.
‘It is very important to maintain regular sleep’, said Associate Professor Belinda Miller, who works at the sleep clinic at Melbourne’s Alfred Hospital. She has the same passion for sleep that artists have for their creative output.
‘Sleep is as important in life as good diet, regular exercise - regular sleep is very much part of that.'
‘The first thing with fatigue is that your concentration and memory is reduced and that is standard for all ages. Specifically, REM or Rapid Eye Movement sleep is important for memory consolidation.’
Memory is vital, but sleep disorders cut further, into our very identity. Most of our dreaming occurs in REM sleep, a phase of sleep that encourages us to dream vividly and has been connected to creativity.
If you are snoring or feel weighed down by lack of sleep, some personal detective work can help. Set a digital recorder going for a whole night and listen to your sleep on the computer next morning. You may hear yourself stop breathing, followed by silence, broken by an ugly gasping snort as your body reacts to the loss of air. How often? Every couple of minutes all night long is not uncommon.
The physiology goes like this: as you fall asleep, the muscles in your upper respiratory tract relax, and tissue falls inward to obstruct your breathing. Carbon dioxide is excreted into your lungs and builds up until chemical sensors are activated so you gasp, opening the airwaves and starting the process again. Ageing, obesity and smoking exacerbate the process and the details are variable.
It is called sleep apnea. Some people describe it as a tiny brush with death and very dangerous. Because REM sleep is comparatively light, and occurs when your muscles are most relaxed, it can also attack your capacity to dream which is a creepy assault on our imaginative selves. However, scientists are discovering how dreams occur in deeper sleep states, so it may be less threatening than we think.
According to Professor Miller, diagnoses for the condition are increasing. 'It may be more prevalent as obesity is one of the drivers of it, secondly it’s becoming more diagnosed as the community and medical people become aware of it.’
There are many reasons why doctors may suspect a sleep disorder. Besides mental confusion and the need for nanna naps, undetected sleep problems may be implicated in conditions like elevated blood pressure, respiratory disorders and weight gain.
The rolled gold diagnostic process is conducted during an overnight stay in a sleep clinic, with cameras, sensors and a respiratory mask. Patients can be sure of the diagnosis, which should find any underlying conditions. It is a strange, science fiction way to sleep, nested in wires, a recorder hanging off you, covered in patches, with a piece of plastic tubing across your snout, camera unblinking in your eyeline, but it works well enough.
Doctors will also send patients into the private system, to the growing range of storefront operations. Some will send people home with a monitoring system, which sends data to a clinic and provides advice without ever seeing the patient - an arrangement which Dr Miller deplores. They may also work through qualified sleep therapists who interview clients, interpret the data and offer a range of solutions.
Away from big metropolitan hospitals this may be the only option and it is pretty good. Sleep clinics anyway send their prescriptions out to the same external companies.
The most common solution is a continuous positive airway pressure or CPAP machine, which will create an instant $1500 or so vacuum in your wallet. There are several manufacturers like Siemens or Philips, and they all involve a pump, a heated hose, a water chamber and a mask. Most people end up with a full nose and mouth mask though the smaller nose gadgets seem appealing at first.
It feels as if the machine is pumping air into your lungs, but in fact it is simply maintaining positive pressure in the upper airways to keep them open. The system is electronically controlled to measure the pressure and synchronise it with your breathing, so it is a rhythmic mirror of your lungs. It is also designed to minimise coughing, which is an upper bronchial reflex activated partly by cold, dry air. So the machine supplements the warming and wetting process which goes on in your sinuses.
It is a startling addition to the nightly lifestyle. The pumps are quiet but its like flying a B52 into dreamland while cuddling a friendly octopus. Real life cuddling with partners is a tad inhibited as a result.
It doesn’t work for everybody and sleep experts may prescribe other solutions like surgery or a teeth mould. For some people apnea simply goes away. But many people feel as if they have woken up properly, alert, cognitively enhanced and haunted by the strange dreams they have been unable to remember.
The long biography of slumber
For Professor Miller, sleep is a lifetime issue.
‘In new-born infants, she explained, ‘sleep occurs for the majority of the time, which is eighteen plus hours out of the 24.’ Their sleep is simpler as their neural systems are relatively undifferentiated.
‘As they grow older they develop the more differentiated sleep paths we see in adults which is REM sleep and non-rapid eye movement sleep which is developing into increasingly deep sleep. As children move into adolescence and reduce the amount of sleep they have, they probably need eight or nine hours of sleep, and they have a lot of deep sleep and they have usually very consolidated sleep. As they get older the amount of sleep diminishes a little bit but even in old age we probably need about seven to eight hours sleep.
‘What happens with age is that the amount of deep sleep that occurs gets less, the amount of dreaming probably stays about the same, but people tend to have more broken sleep. And that seems to be a function of getting older.’
Disrupting these demands can be nightmarish. With babies, it’s the parents that suffer. But adolescents push themselves hard, relying on innate energy, and simply adapt to confusion and memory loss.
We all live to an innate circadian rhythm, which makes us sleep most deeply around 3am, wake in the morning and get sleepier in the afternoon. Young adults barely notice this, and can punch through to work effectively late at night, and seem to cope next morning.
But age is our enemy. As our total access to energy decreases, we are overwhelmed by those underlying rhythms.
The nanna nap
For Dr Miller, the nanna nap seems to be more of a curiosity. She acknowledged that it can be caused by broken sleep, and older people often get more tired during the day and nap in the afternoon. ‘But not everyone as they get older has nanna naps,’ she said, ‘but it does become a bit more frequent. Of the patients I see a proportion do have it but its by no means universal among the older population.
‘As we become older, fatigue becomes more of an issue and sleep may be disturbed by the normal changes of ageing which include arthritis or pain or getting up to go to the bathroom overnight, those sorts of things.’
Nanna napsters often associate the urge to sleep with food, and try to reduce the lunch time carbs to offset this need, but Miller doesn't see much of a connection. But I still wouldn't hire a lawyer who inhales three pork pies and bottle of Shiraz for lunch. It would be like expecting a sleepy-lizard to fight.
Insomnia and 'sleep hygiene'
Insomnia is distressing in itself and spirals out of control as we can’t sleep because we know we can’t sleep and it is so important to sleep to be alert tomorrow.
Professor Miller acknowledges the need to treat the problem on a cognitive level, to deal with the ugliness and frustration of insomnia. But she calmly points to ‘sleep hygiene’ as useful ways to counter-attack. Here is the list:
- no caffeine late in the day
- reduce alcohol consumption
- increase exercise
- regular sleep patterns
- increase light exposure in the morning and reduce it at night
- ditch the electronic screens
- reduce lifestyle stresses
‘Sometimes there is a short term factor which brings insomnia on,’ she said, ‘and that issue may have been resolved but the pattern continues. It can have a life of its own, and those patterns are very difficult to break.’
There is a secret biography of human life that is about ordinariness, which is much more fundamental than the public stories of promotions and toys and honour. Families and health are central, peace and quiet turn into goals, and cocoa replaces coffee at night.
We gradually learn to pop ourselves into bed at ten, eat sensibly, and try to walk ten thousand steps a day. All in the name of a good night’s sleep.