Dream Along With Me
Sleep. What could be easier? You close your eyes, you dream, wake up. Simple.
Illustrations by Ron Braunagel
Drifting into unconsciousness hasn’t always been easy for me.
Some nights, I would wake up about seven, eight times. Not just in a peaceful, half-eyed, “I-wonder-what-time-it-is” stupor, but in a full body “I-slept-through-my-alarm” panic – even though my alarm wasn’t set to go off for several hours.
While my body would get up, my mind remained in a semiconscious state. I’d sleepwalk. I’d write incomprehensible notes to remind myself of things I needed to get done. I’d shower. Eat chocolate truffles. Move furniture. Sometimes I’d remember these things. Sometimes I wouldn’t. But the evidence was always there. Wet hair. Chocolate moustache. A chair on the couch. Notes that said: “Take out the mouse,” and “Revise the cat book.”
Friends who crashed on my couch overnight woke up to me screaming from the bedroom. One even thought I’d experienced something paranormal. In a sense, she was right: I saw a skull fall from the ceiling, bobbing right in front of my nose, suspended by a string.
Later, while sitting in physician Atul Khullar’s west-end office, I learn it was sleep paralysis with a side of hallucination – the results of sleep deprivation.
But the kicker comes next. “Pretty standard stuff,” he says, looking at my list of symptoms on a sheet of paper. According to Stats Canada, one in seven people over age 15 suffer from insomnia. And issues of insomnia and disruptive sleep affect most of Khullar’s patients at the Northern Alberta Sleep Clinic, where he specializes in problems that keep people awake at night. What I’ve described might seem strange to you or me, but not to him.
The clock watching and panic at night, says Khullar, are textbook symptoms of underlying anxiety or, simply, stress. And this stress, along with improper sleep behaviours, can result in parasomnia, which refers to abnormal behaviours like sleep terrors or sleep walking. “Patients will come in complaining of insomnia and anxiety is often a factor. They worry so much all day, it can carry over into their sleep,” says Khullar.
Khullar has eight years experience consulting across the country on sleep issues. He’s a University of Alberta clinical assistant professor and he’s provided sleep strategies for the Oilers and the Canadian Winter Olympic team over the years, helping athletes develop schedules and adjust behaviour so they can travel, compete and still get the best sleep possible.
Sleep is especially important for athletes during training and performance because heavy physical activity puts stress on the body and sleep helps the body to recover from the exertion. Without the right amount of sleep, they not only can’t focus on their goals, but physically won’t have the stamina to perform.
The challenge comes when athletes are constantly travelling and face irregular schedules, which can throw off their circadian rhythms. Circadian rhythms generally run on 24-hour cycle (or slightly longer) and it’s much easier to maintain a rhythm with a steady schedule. Like any high-stress career, being an athlete can be emotionally draining and Khullar suspects the incidence of anxiety in professional athletes goes largely unreported and could also potentially negatively affect sleep.
No matter if you’re an Olympic athlete wanting to improve your performance or a lawyer trying to make it through a work day without yawning, a lack of sleep doesn’t just affect your career. Long-term sleep deprivation is linked to heart problems, high blood pressure, diabetes, weight gain and depression. Some sleep problems like sleep apnea, when throat muscles relax or the brain doesn’t send adequate signals to the breathing muscles, can even be deadly. Basically, you need sleep to live. And you need a good quality sleep to live well, according to Khullar.
That means plenty of Rapid Eye Movement (REM), that is marked by accelerated respiration, heart rate and increased brain activity – it’s the time of night when people tend to dream and, for most adults, it happens every 90 minutes. There’s a general consensus among experts that REM helps restore the mind, while non-REM restores the body. Maybe restoration is even a euphemism, considering historical eureka moments resulting from a little REM – Paul McCartney dreamed up the melody to “Yesterday” late one night, Dmitry Mendeleyev saw a first draft of the periodic table in his sleep and Robert Louis Stevenson got the idea for The Strange Case of Dr. Jekyll and Mr. Hyde during a period of shut-eye.
But when you keep waking up due to a physical problem or anxiety, your body often isn’t asleep long enough to get enough REM. After a while, you can develop sleep deprivation and even night time hallucinations can result – ready or not, here REM comes.
I explain to Khullar my nightly routine. I like to watch a little TV; sometimes I read in bed. My bedroom overlooks a busy street with lights that flash through my blinds. I have a couple of clocks by my bed and I’m always worrying about the time and the amount (or lack) of sleep I’ll get. I go to bed late on weekends, earlier on weekdays, but still fairly late.
When it comes to sleep hygiene, as Khullar calls it, I’m the sleep equivalent of Pigpen in the Peanuts cartoons – I’m basically a mess. But, Khullar says, it’s not just about bad habits, it’s also about circadian rhythm. I’ve always considered myself a night owl; in the morning, I sluggishly hit snooze several times. But come night, my eyes widen, I turn up the music and I feel like going for a run.
Now, there’s even scientific backing to the night-owl claim, thanks to many studies that suggest our circadian rhythms may be genetically predetermined. Science published a study in 2007 claiming there was a genetic mutation (called After Hours or Afh) found in certain mice that suggests the existence of a 27-hour circadian cycle as opposed to the normal 24-hour one. In other words, those rodents love the night life as much as I do.
“There are many night owls out there who are trying to fit into the morning world,” says Khullar. Those late-night folks get their best, deepest sleep in the later hours of the morning, so it makes sense that they want to sleep in. It’s the reason I dream right before (or during) the ringing of my alarm clock.
Many factors can affect our circadian rhythms, but light is one of the main ones. Having light come into your bedroom when trying to sleep can also create problems. When there’s less light, the body gets tired because of melatonin, a hormone secreted by the pineal gland in the brain. Like nature’s sleeping pill, the natural substance is available in pill form at pretty much any drugstore. When used at the right time – Khullar suggests people take it a few hours before bed – it can help people to push their sleep cycles ahead. He suggests I take it.
The other concern Khullar brings to light (no pun intended) is my own concern. My worry about my sleep is actually making it harder to sleep – it’s a vicious cycle. The technique for combating this problem is called Cognitive Behavioural Therapy (CBT). “Insomniacs often tell themselves things like: ‘If I don’t sleep eight hours, my day is ruined.’ Instead of taking steps towards making their situation better, they do things like take naps, further disrupting their rhythm,” says Khullar.
The behavioural side speaks to the bad habits – staying up late watching TV, having a cell phone with text message reminders going off every few minutes, or having a room that’s too hot or cold. The cognitive side deals with how people actually think about sleep; rather than tossing and turning in bed, patients are encouraged to address their concerns by writing down worries and practicing relaxation techniques, like yoga or meditation.
Just to be sure he hasn’t missed anything, Khullar schedules me for an overnight study, a polysomnography. These tests have become so popular in recent years, there are even iPhone apps, allowing for at-home tests – though Khullar says they can only really determine how much a person moves, which is only one small part of the equation.
I wear a “Property of Alcatraz” t-shirt the night of the sleep study; it’s an unintentional commentary on the building’s Big Brother capabilities. The small room is empty save for a bed, a nightstand and the chairs where I sit with Jessica Pickett, clinical manager. The bed’s the focal point, right in the centre of the narrow space, and a camera leers over it, while auditory equipment will relay my every snore to a clinician in a room next door.
While the conditions are perfect for sleep – it’s pitch black with the lights out, it’s completely silent and the temperature’s just right – the lack of privacy would unsettle the heaviest sleeper. On plane rides, I always worry I’ll drift off and drool on the shoulder of a stranger. Amplify that worry a few times, and that’s how I feel preparing for a night at the clinic.
“We know when you’re sleeping; we know when you’re awake. Kind of like Santa Claus,” laughs Pickett, pointing at the camera arched over the bed. She has more than 11 years in the field and started working at the Northern Alberta Sleep Clinic this summer, where she’s responsible for analyzing data collected from overnight sleep study patients. It takes several hours to decode the pages upon pages of squiggles making up a patient’s sleep stages – Pickett marks down every time someone wakes up, every time he or she moves, every time there’s a respiratory issue.
It takes her about 40 minutes to connect me to so many electrodes attached to so many multi-coloured wires that I lose count. She uses a gooey substance to affix electrodes on all sides of my head, which she says will monitor my brainwave activity, showing the different stages of my sleep on a monitor in a separate room. She also tapes electrodes on my chest, which will determine breathing patterns, and attaches a few to the corners of my eyes, which will record my eye movement (an indication of REM sleep). A few more go on my arms and legs, the wires travelling to a box on the night stand. Pickett clamps a pulsing red light to my finger – it’ll monitor the oxygen saturation in my blood – and I feel like a marionette version of E.T. Pickett tightens a band across my chest, and places a breathing apparatus under my nose.
“Tell me about your sleep problems,” she says.
I explain some of the basics. Talk about the weird hallucinations, the panic attacks, the problems getting up in the morning. And I feel myself blushing – yes, she’s probably heard this and more, I tell myself. But it’s still embarrassing.
I’m wrong though; she’s not just heard it, she’s experienced some of it herself, which is why she’s so passionate about her job. Sleep problems have plagued both her and her family members for as long as she can remember.
Many members of her family – including her grandfather, father, mother and nephews – have had severe sleep apnea at various stages of their lives. “My grandmother said the neighbours moved away because grandpa’s snoring was just that loud,” she says. When she was younger, Pickett also had sleep apnea, and used a CPAP (Continuous Positive Airway Pressure) machine, which forces constant air through the breathing passage to prevent the throat from collapsing. After she had her tonsils removed, her sleep apnea went away, but she now sleepwalks when very stressed – including the night before my sleep study.
She recently moved from California to Edmonton. She’s adjusting to a totally new city, a new climate, a new job; and her mind’s way of adapting to the situation is to have a very active night life, even though she’s mostly asleep for it and locks her doors so she can’t leave her house.
I feel comfortable talking with Pickett about my sleep problems and I learn from her that the cure doesn’t come overnight. Literally. You need to work at it; it’s a matter of habits, but also a matter of regulating stress. Though for Pickett, it’s more difficult, since she often works during the night and sometimes during the day, which means her circadian rhythm is often affected.
But she’s happy her sleep apnea is no longer a problem. “People don’t realize how severe these problems can be – they affect all areas of your life,” says Pickett. And for those who think they or a relative have sleep apnea, there’s a simple, free take-home test, along with the more involved sleep study available at the clinic.
It’s 9:30 p.m. Time for bed. At least at the sleep clinic. I’d still be up for another three hours at home, but I crawl under the covers and blink, fake snore and thrash around, like Pickett asks. She needs to make sure all the equipment is working properly.
I’m half hoping I have an episode, so they’ll see a real example of a typical night. But I worry if I freak out and jolt out of bed, the electrodes will rip a strip from the back of my hair. Least of my worries, says Pickett. She’s right.
When I do wake up in the middle of the night, I’m eerily calm. I remember exactly where I am and what to do. I sit up and ask: “May I use the washroom?” The clinician races into the room, putting the box with the wires around my neck like a gaudy necklace.
Come six in the morning, I feel surprisingly rested. The results of the sleep study tell a different story. I slept, but my mind was on ready alert – maybe explaining how I knew where I was without any panic. According to the test, my mind woke up over 30 times per hour, which is a lot when compared to the five or six times experienced by most people.
“Keep in mind, you’re in a different place, and your sleep cycle means you’re not used to going to bed so early,” reassures Khullar. But just to rule out other factors, he also orders a blood test. The test shows that I’m deficient in vitamin D, which isn’t a surprise to Khullar considering our climate and the fact that most people in Alberta don’t get enough of the sunshine vitamin, even with it fortified into our milk. Turns out the sun regulates our sleep in more ways than one – the light from it helps regulate when we feel tired and without enough vitamin D (the sun’s the best source of it), people can feel lethargic, or even suffer from depression and Seasonal Affective Disorder.
I start taking vitamin D, calcium and magnesium as per Dr. Khullar’s suggestion and it really seems to work. Or, at least, I feel less sluggish. I still don’t have a flawless sleep, but there’s a marked improvement. When I do wake up in the middle of the night, I don’t obsess about how many hours are left for me to sleep. I make an effort to make less of an effort when it comes to worrying. I remember what Pickett had said: it won’t all be instantly better overnight. Some nights, I’ll sleep well, some nights, I won’t. But by the end of the week, I can still enjoy my weekend without sleeping through it.
Dr. Atul Khullar’s advice for sleeping like an Olympian
– Getting up at the same time is even more -important than going to bed at the same time; a schedule helps reinforce your circadian rhythm.
– Sometimes a light snack is OK before bed, but heavy snacks, caffeine and alcohol should never be consumed before bed. For those with acid reflux, food of all kinds should be avoided about three hours before bed.
– Get exercise, but not within a couple hours of bed because the increase in adrenalin will make it difficult to sleep.
– Keep your bedroom very dark, cool and quiet – light can trick your body into thinking it’s time to wake up.
– Keep the area around your bed clean, and free from clutter; it makes the room more comfortable and conducive to sleep.
– Practice relaxation techniques so that your mind is free from worry before bed.
– No TV or computer time within about a half an hour of bed – the light from the screen can throw off your body’s production of melatonin.
– Keep reading or TV to the living room, not the bedroom – it’s important for your mind to associate your bed with sleeping.
– Only go to bed when tired but allow about seven to nine hours for sleep.
– Sleeping pills are a last resort; those who are in severe pain or are severely sleep deprived may need them, but they do not get to the root of the problem, potentially masking other problems, and may not facilitate deep sleep.