Fast Awake

Exploring the perverse attractions of insomnia.

In the 1990s, science fiction writer Nancy Kress envisioned a world where an elite few never had to sleep. Her Hugo and Nebula award-winning Beggars series posited a gene-therapy fix to sleep, dreamed up by gifted children let loose in a lab. The Sleepless were not only more productive but also more intelligent and emotionally stable while the sleep-dependent Beggars became an underclass of serfs.

Writer and video artist R.M. Vaughan also predicts a society that reveres lack of sleep, but his imagined future is yet more dystopian and in some ways has already begun. Vaughan has been cursed with insomnia since he was a small boy. That curse has come to define him as special, and he wonders how much of it was learned—a bid for attention perpetuated by a morbid attachment to complaining, one that he sees all around him.

“If the world around us is being run, ordered, financed and even entertained by people who are not sleeping well…,” he muses, “what kind of culture will we be sharing in the future?” In Bright Eyed: Insomnia and Its Cultures, Vaughan contends it will be a culture in which sleep deprivation is viewed as normal—and even desirable. When nobody can sleep, it is easier to face ourselves if we tell the world we do not need to.

The city that never sleeps has become every city and every home. Twenty-four hour urban bustle has been globalized, internalized and personalized, typified by the smart phone, which independently encourages late-night wakefulness. Beyond the addictive content of the internet and the intermittent reward schedule of email and Twitter pings, the smart phone’s screen emits blue-spectrum light, which travels into our eyes and hits the melanopsin receptors of our retina—the little-known third type of photoreceptor, after rods and cones. Those receptors send signals to our suprachiasmatic nucleus, a bundle of neurons in the brain that serve as a master clock. The signals say “Wake up—the sky is blue, so it must be daytime.”

Release of the sleep-promoting hormone melatonin is stopped in its tracks and all hope of slumber dies. The sad irony is that many of these smart phone–induced circadian interruptions happen when an insomniac rolls over in frustration to the nightstand to check the time on his or her smart phone. “We all carry sleepless cities around with us, in our pockets and bags, via our vast array of information-delivery devices,” writes Vaughan. “The city that never sleeps is inside us.”

Persistently lacking in this slim volume is any real awareness of the serious research already done on insomnia. A total of eleven sources grace the list of works cited, including such tangentially relevant works as Houdini, Tarzan and the Perfect Man: The White Male Body and the Challenge of Modernity in America. Subjective experience is notoriously unreliable as a form of psychological research, and when Vaughan wonders what the basis of his sleep problems are, the reader is tempted to suggest: Let’s just look that up—perhaps in the Journal of Sleep Disorders and Therapy. That might be a start on an evidence-based approach.

That is not to say Vaughan needs to take a medicalized approach. He roundly and rightly mocks the quackery sold to insomniacs and claims he has tried every pillow, every pill and every noise machine on the market. Trouble is, the best therapy for insomnia is not a pill at all; rather, the most effective treatment has been a round of cognitive behavioural therapy. In person or over the phone, a therapist educates the insomniac about sleep hygiene—keeping a dark bedroom, forgoing coffee at night—but also works to get to the bottom of perpetuating behaviour.

Often a sleep problem will start with an inciting stressor such as job loss or injury but continues for other reasons. The patient is instructed to keep a sleep diary and a consistent wake time even on weekends and, crucially, even after a sleepless night. But for cognitive behavioural therapy to work, one has to be serious about it, and Vaughan’s book places the locus of control squarely outside of the insomnia sufferer, in the surrounding cultural milieu. He refuses to believe that people can reliably implement best sleep practices, and so the most effective response is summarily dismissed.

For the author, though, insomnia problems are compounded by restless leg syndrome: the irresistible urge to get up and walk around, or at least move one’s legs in bed. It is painful and chronic, and is a truly intractable problem in medicine. Vaughan is not wrong to be despondent about his own prospects of near-term relief from sleep problems. It is just that his case is not representative of the rest of the sleep-deprived world.

The danger of relying on a single source—the author’s daily life—is that we come away with the impression that insomnia’s primary dangers are irritability and loss of mental acuity. While these may be the most salient and troubling symptoms for a young person, they are far from the most worrying if insomnia is as much of an epidemic as Vaughan asserts.

Let a healthy person sleep only four hours for three nights in a row and that person will function as a pre-diabetic. The glucose tolerance and insulin sensitivity will be severely compromised, and the blood pressure and heart rate will rise. Not just that, the concentration of leptin in the blood—the hormone that communicates satiety to the brain—will drop at the same time as the appetite-stimulating hormone ghrelin rises. The adrenaline in that person’s plasma as well as the stress hormone cortisol will be elevated. All of this takes a long-term toll on the body and contributes to obesity in our society.

You would not know that from the anecdotal approach taken in Vaughan’s interview with his celebrity friend Douglas Coupland. “Just because you maybe slept more when you were younger doesn’t mean you need it when you’re older,” asserts Coupland. “The most vibrant people I know get four hours of sleep a night. They embrace it and it seems to work.”

“Seems” must be the operative word, because four hours of sleep a night delivers a cognitive impairment equivalent to legal intoxication. On a couple of days of four hours of sleep, it is inadvisable to operate heavy machinery. In fact, far from Coupland’s claim that one needs less sleep as one ages, much of the cognitive decline we see in normal aging may be explained by the decline in sleep quality. The reason is that the prefrontal cortex, which coordinates executive functioning such as judgement calls, attention management and planning, is the most sensitive to sleep loss. A four-hour sleeper is not a vigilant driver, or doctor … or nuclear power plant technician.

If we are to have a less accident-prone, obesity-ridden and distractible society, we must face up to the cultures Vaughan describes, and then we must recognize that the solution is as close as our own bedrooms.