It was Shakespeare who wrote “O sleep, O gentle sleep, nature’s soft nurse, how have I frightened thee that thou no more will weigh my eyelids down and steep my senses to forgetfulness?” The renowned bard was beyond doubt reflecting the plight of thousands of insomniacs around the world. In a lighter mood we have this from Thomas Aquinas: “Sorrow can be alleviated by a warm bath, a glass of wine, but more than all… by a good night’s sleep!”
Disturbed sleep is among the most frequent health complaints physicians encounter. Millions of people suffer from a sleep disorder which can affect daytime functioning and mental health. The average adult needs seven hours of sleep. Teenagers need more but fail to get because of social pressures to stay up late, coupled with early school times , television viewing, video-gaming, social media, texting and smart-phone use. Few lucky adults get away with just two to four hours of sleep at night without taking hit on daytime performance. God bless them!
Insomnia has many causes: psycho-physiological factors, psychiatric conditions, drug abuse, painful medical conditions and neurological disorders. What makes the predicament of an insomniac worse is the anticipation of a poor night’s sleep. The sufferer is so anxiety-ridden as bedtime approaches that he sets off a dismal vicious cycle.
The cornerstone in the treatment of insomnia is “cognitive behavioural therapy” where a trained therapist uses techniques to reduce excessive worrying about sleep and reframes faulty beliefs about insomnia. The therapist also uses relaxation techniques and meditation to reduce autonomic arousal, intrusive thoughts and anxiety. Depression which is a frequent cause of insomnia is classically associated with early morning awakening, but it can also interfere with the onset and maintenance of sleep. There are a number of drugs for treatment of insomnia like anxiolytics and antidepressants. But because of habituation and side-effects they should be used only under advice from expert psychiatrists. A psychiatrist in the midst of his pressing schedule must show kindness and compassion towards the victim. I, for instance, was lucky to have Dr Rajendra Hegde who was available for me day and night. He would hold my hand, embrace me, pep me up and inculcate hope and optimism. But, family support is also important. My wife and children would often go without sleep to see that I would get a few restful hours. Many special persons also stood by me.
It is sad that all over Goa we find “counsellors “who have little knowledge of counselling and are totally unaware that depression is a result of changes in brain chemistry. When Dr Adélia Costa, now in her eighties and retired, the doyen of Goan psychiatrists, started her psychiatric practice in Goa, after graduating with flying colours from Lisbon, there was a virtuous priest, Fr Sávio Gama, who would prove to be a hurdle of sorts to her. More than once, I know, he had the impertinence of writing to Dr. Adélia: “Such and such patient of yours has come to me… I told him to stop your medicines… he suffers from “demonic possession”. Although I am not aware of the outcome of his victims, I know of many sufferers who are kept in bondage for long by these so-called “healers” and never break free from their sorry plight. Not that I do not believe that God works miracles. But this business of “demonic possession” is being stretched too far (even as the Church itself treads cautiously on this nebulous area).
In my own case, sometime ago, I went to a lay “counsellor”. As I sat before him I soon realised that he was unstudied and his questions were off the mark. In the end, as if seized with divine inspiration, he opened “at random” a page of his pockmarked Bible and gave me a quotation of the Old Testament, so frightening, so unsettling! Needless to say, I still have nightmares when I think of my unfortunate encounter with him. Vis-à-vis the frightening “curses” of the Old Testament, my life’s philosophy is simple: “God himself bore our sins in his body on the cross, so that we might die to them and live for righteousness. By his wounds we have been healed.”
Here are a few tips on the latest research about sleep: a) Waking early on work days may harm metabolic health and trigger obesity and heart disease b) Insomnia may set off insulin resistance and diabetes c) Long nights, lazy days, could send you to early grave c) Sleep disturbances exacerbate dysfunction in Alzheimer’s. A source of great concern nowadays is the online access to sleeping tablets. Alarm bells have also been sounded as college students reveal that prescription stimulants and anti-anxiety medicines are easy to find on campus.
To round up let me say that, as far as sleep and insomnia are concerned, it’s important that we do not compare ourselves with others. Every human being is unique. Some get satisfied with two hours of sleep, others with four. Life must go on despite occasional suicidal thoughts with expert help always at hand. The old dictum holds true: “A clean conscience is the best pillow.” Sadly, however, in a complex subject like insomnia, things do not always work as above. It is widely known that politicians, rogues and marauders sleep like a log. Life’s paradox, isn’t it?
(Dr. Francisco Colaço is a seniormost consulting physician.)
