The Aword

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Insomnia Introduction

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Insomnia and fatigue are 2 sides of the same coin and are very common in arachnoiditis.

The illness seems not only to afflict our waking hours but also to be instrumental in depleting our sleep; reduced in amount and effect, we are unable to find the solace we so urgently need.

"To sleep, perchance to dream, aye, there's the rub" Shakespeare

"Sleep that knits up the ravelled sleeve of care
The death of each day's life, sore labour's bath
Balm of hurt minds, great nature's second course,
Chief nourisher in life's feast." Shakespeare, Macbeth.

"When you have insomnia, you're never really asleep, and you're never really awake"  from the film Fight Club based on a novel by Chuck Palahniuk.

"There is a gulf fixed between those who can sleep and those who cannot. It is one of the great divisions of the human race." Iris Murdoch , Nuns and Soldiers.

"There are twelve hours in the day, and above fifty in the night." Marie de Rabutin--Chantal

Famous insomniacs include Winston Churchill, Napoleon Bonaparte and Marilyn Monroe.

A workshop in Paris in February, 2001, entitled "Open your eyes to sleep" noted that there is an enormous gap between the number of sufferers with insomnia and those  actually treated: it is underdiagnosed and undertreated.

One German expert suggested that only 50% of people with insomnia are actually diagnosed.

Physicians tend to trivialise insomnia.

Insomnia is the experience of inadequate sleep: whether deficient in quality or quantity, or both.

It may involve:

  • difficulty falling asleep
  • difficulty staying asleep: frequent waking/ early waking
  • unrefreshing sleep

It is estimated that up to a third a patients seen by GPs have occasional difficulties sleeping with up to 10% experiencing chronic sleep problems. Prevalence increases with age and is more common in women.

Generally speaking, insomnia encompasses sustained problems in falling asleep, staying asleep, or having non-restorative sleep for over one month.

Someone who takes 30 minutes or more to fall asleep at night, or is up in the middle of the night for 30 minutes or more (this may be all at once or in short episodes) 3 times a week may be said to have a sleep problem that needs attention. However, there is considerable variability.

Some people think that we have fixed on 8 hours of sleep at night as an arbitrary figure to which we adhere blindly, and that if we consistently have less then we feel deprived even if no harm is being done.

As Dale Carnegie said,

" It's the worry that gets you, not the lack of sleep."

That may be true up to a point, for mild, intermittent insomnia, but persistent lack of sleep is a very different situation.

Stephen King, in his novel, "Insomnia", vividly describes the peculiar kind of torture that insomnia brings:

"He was tired, yes-more deeply and fundamentally tired than he had ever been in his life- but being tired and being sleepy, he had discovered, were sometimes poles apart. Sleep, that undiscriminating friend, humankind's best and more reliable nurse since the dawn of time, had abandoned him again."

"Then, shortly after three o'clock, that pleasant drowsiness began to disappear. It did not go with a champagne-cork pop but rather seemed to ooze away, like sand through a fine sieve or water down a partially clogged drain."

"That creeping sensory numbness and the erosion of his decision-making capabilities were not the only problems he had come to associate with insomnia; his short-term memory had also begun to slip."

"By four o'clock Ralph's bed had become hateful to him, as it always did when he realized he could put it to no good use."

"I'm so tired I can't remember my own name."

"I'd go to bed at ten, fall asleep around four, get up at seven, and drag myself through the day feeling like a bit player in someone else's nightmare."

"That long Thursday morning and even longer Thursday afternoon taught Ralph Roberts a valuable lesson: not to sneer at three or four hours' sleep a night simply because he had spent his entire life under the mistaken impression that he had a right to at least six and usually seven. It also served as a hideous preview: if things didn't improve, he could look forward to feeling like this most of the time."

" He went into the bedroom at ten o'clock and again at one, hoping for a little nap- even a catnap would do, and half an hour would be a life-saver- but he could not so much as drowse. He was miserably tired but not in the least sleepy."

"Ralph's sleep had shrunk to roughly three hours and he had begun to feel quite a little bit like something on a slide under a microscope."

"There were times (usually sitting in the wing-back chair at four-thirty in the morning) when he swore he could actually feel his brains draining."

There is a film called Insomnia due for release in which Al Pacino plays a cop who arrives in a northern Alaskan town during the period of the midnight sun, so that he experiences perpetual daylight. This wreaks havoc on his body clock and prevents him from sleeping.

As the story develops, events cause him increasing psychological pressure, which in combination with his lack of sleep, have profound effects upon his decision-making ability. The film portrays his insomnia as a physical representation of his psychological struggle.

There is no doubt that we underestimate the damage impaired sleep can do. Paul Martin, in his recent book, "Counting Sheep", says that:

"Sleep deserves much more attention in science, medicine, education, social policy and, most of all, in our everyday lives."

As he remarks, sleep is taken for granted,

"an inglorious example of familiarity breeding contempt."

It is only when we lose the ability to sleep, that we appreciate its value : after all, we are likely on average to spend a third of our lives asleep, around 25 years!

We spend more time sleeping than on many other activities, and unlike other activity, we cannot ?save time' by getting someone else to do it for us, and if we cut down too much, the effect on our waking hours can be disastrous.

As many car accidents are caused by tiredness as by drink-driving. We can do without food for longer than we can do without sleep.

Modern society as a whole is chronically sleep-deprived. Since Edison gave us light ?on tap', our waking hours are no longer tied to natural rhythms of daylight and darkness. 

The margins are blurred and our 24/7 world puts us on a treadmill it can be hard to escape.

However, sleeplessness is by no means a new problem. Medical literature from the 19th. Century shows that sleeplessness and ?stress' were recognised problems.

People with chronic illness encounter extra difficulties:

  • increased stress
  • pain
  • other symptoms
  • medication-related problems
  • altered sleep patterns