The Elusive Sandman

Elizabeth Trattner

March 2009

Several years ago Hurricanes Wilma and Katrina blew through South Florida resulting in the loss of power for hundreds of thousands of homes; ours was one of the many families that had to endure the power outage for two weeks. Attempting to cope without electricity many of South Floridians were faced with the day-to-day challenges of cooking, bathing and general existence without the conveniences of microwave ovens, water heaters and alarm clocks. I was thankful at the time that I had been a girl scout as a child to help me prepare for the perils of camping. We were fortunate to be prepared with a small propane stove for cooking and plenty bottled water. Sure it was a huge inconvenience, but aside from a few trees I lost in my yard, things could have been a lot worse. The one thing that struck me from the entire ordeal, besides my daughter converting our bathtub into a swimming pool to cool off, was that my sleep, which has been inadequate since childhood, was amazing during those two weeks. What among the chaos in the aftermath of two hurricanes could have improved my sleep?

One of the chronic problems that most plagues Americans and westerners in general is insomnia. Our society puts a premium on our waking hours and has the tendency to underestimate the importance of a full night’s sleep. However, in today’s world, millions of people are besieged with insomnia and look for quick fixes instead of exploring the root causes of the problem. Rather than embrace nighttime we tend to attach a negative stigma through numerous associated evils such as the boogey man, monsters under the bed, dragons, bad guys, scary noises, shadows and other things. We let our minds wander from one element of stress to another keeping us up for hours or perhaps an entire evening. We are then forced to approach the new day without having benefitted from the regenerative powers that nighttime could bring.

Sleep hygiene is an afterthought to most people in the west. People stay up to all hours watching mindless television shows as a way of escape or to seek companionship while alone. We allow TV to distract us from our families, our responsibilities and our emotional dilemmas. Moreover, television, late night eating and keeping lights on at night, all contribute to restless and sleepless nights.

Not too long ago, there were no light bulbs and the end of the day signaled a time to begin winding down from a long hard day. People usually ate their evening meals earlier, consistent with the setting sun. This could have been anytime from 4-8pm depending on the time of the year. Following dinner there would be an hour or so of family time giving the body time to unwind and synch up with the body’s natural rhythm to prepare for sleep - then off to bed permitting a full nights rest before rising with the sun.

Returning to the hurricane story, I felt as if I was literally thrown back 200 years when there was virtually no electricity, and I was engaged in strenuous activity as people lived long ago. During the day my main focus was ensuring there was sufficient food and water for my family. I spent hours every day cleaning my property and removing heavy debris from the back yard. I was more consumed with the rituals of preparing meals for my family and neighbors than I would have been had I had the conveniences of a refrigerator and kitchen appliances. Our meals had to be prepared during daylight and once the sun went down, there wasn’t a lot to do with a bored 8 year old and my restless husband. We played card games by a flashlight and listened to a battery-powered radio. As if by magic, an hour or two after the sun set, the sleeping dust was scattered about my house and we slept like bears until the sun came up.

As a baby, my parents would find me playing in my living room in the middle of the night, which led to my being locked in my bedroom as my parents feared I would wind up down the street if left to my two-year-old devices. Shortly after that, an attempted robbery at my house at night left me afraid of everything dusk could bring. I became an expert at patrolling my house; double checking door locks and scoping out closets and under beds for anything that might go bump in the night and send me into cardiac arrest. Nighttime continued to be hard for me as I grew. As a young adult I developed asthma and the medications had turned me into a night watchman, struggling to shut my eyes and get some rest.

This past spring I was fortunate to participate in a medical rotation at the University of Arizona’s Center of Integrative Medicine. Somehow fate had left me with housing arrangements in Tucson encompassing a range potential nighttime evils. I was staying in a home situated in the middle of a mountain range, near total isolation, flanked by a wash on one side and a canyon on the other. Wild animals and snakes owned the night. One of the preceptors in our program was sleep expert Dr. Rubin Naiman, Ph. D. Having been faced with sleep issues since childhood, I arranged to meet with Dr. Naiman the day after I arrived. I figured a meeting with the good doctor might shed some light on why darkness was so daunting for me.

Dr Naiman told me I had to get in touch with the “shadow” - to embrace what I was most afraid of, night. The exercise of facing the night with no TV, no radio and no internet left me with sitting by myself alone in the darkness. Although I was petrified I slowly came to accept the night as an opportunity. Evening is a time to allow our minds and bodies to turn inward to our subconscious. I resolved to revel in the experience of a life time - participating in the medical residency, and I embrace the darkness. The first few nights were difficult, but in time I found the nighttime to be welcoming. While I accepted the isolation on all levels in the evening, I found myself to be me more awake and focused during the daytime. My sleep had improved dramatically; moreover I had gotten in touch and conquered the thing that scared me most: night.

Another valuable tool Dr Naiman explained to me was that exposure to early morning light and dusk help regulate sleep hormones in the body. This is why I slept so well during the hurricane. I had to take advantage of all available daylight hours to get work done. Insomnia is a 20th Century phenomenon that becomes more and more prevalent with advancing technology. Excessive lighting at night, evening shift work, evening computing, late-night pizza delivery and 24-hour convenience stores all serve to counteract the body’s natural rhythms. It’s no wonder people have trouble sleeping.

In Traditional Chinese Medicine (TCM) sleep occurs when the yang energy of the day folds into Yin - nighttime. Yin energy of the body is cooling and restorative. It is the time of day when our bodies turn inward and regenerate. This is the time we dream and explore the caverns of our unconscious mind. Conversely, daytime is yang, which is expansive. We expend the energy we have built up from the process of sleeping. Together, this is the cycle of yin and yang.

In order to treat insomnia properly, it is important to determine whether the symptoms are from a deficiency in Qi (energy) or from an excess of Qi. A deficiency of Qi is generally from the cooling aspect of various organ systems. An excess of Qi is usually caused by stagnant liver Qi (the energy that moves the body) transformed into fire or by the retention of food and turbid phlegm, which results in stomach disorders (eating too late at night before bedtime).

If the cause of insomnia is from deficiency of qi, the treatment consists of reinforcing or building Qi, replenishing blood and nourishing yin to eliminate deficient fire. The excess Qi conformations are treated by clearing the liver, purging fire, removing the retained food and phlegm, harmonizing the stomach and tranquilizing the mind.

To apply this concept to your everyday life try eating your last meal at least three hours before going to bed. If you are a hot excess type, you can cool your body down by avoiding hot and spicy food and drink. Avoid alcohol, coffee, chocolate any other stimulants, especially late in the day. Help circulate your body’s energy by working out or by gentle exercising. Build your body’s nutritive aspect by eating marrow based soups and stews, dark pigmented vegetables and fruits. Avoid overworking or over rumination as well.

In TCM we teach our patients that it is imperative to get to sleep before 11:00 PM. Any sleep before 11:00 PM counts for double the hours of sleep. So, if you were to get to bed at 10:00 PM, the hour between 10:00 and 11:00 would actually count as 2 hours of sleep. The energy of the liver and gall bladder picks up around 11:00 and if you’re not safely ensconced in restful sleep by then, you’re predisposed to experience poor sleep or insomnia until 3:00 AM.

An invaluable tool to help your brain unwind is meditation. Meditation helps the body create a sense of calm. Meditation can reduce stress, increase feelings of well-being, and improve overall health. It is of specific use to help one increase alertness, relaxation and reflection even in “waking” states. Meditation is best practiced during the day to help ease your sleep patterns at night.

Brain waves in meditation shift through various stages. The most common brain waves in meditation are alpha waves. These alpha brain waves in meditation basically promote changes in the autonomic nervous system that calm it. Regular contemplative practice of this type reverses the roles of the sympathetic and parasympathetic nervous systems. This lowers blood pressure and heart rate and lowers the amount of stress hormones in the body, as well as calming the mind. In experienced meditation practitioners it was particularly noted that gamma brain waves during meditation were especially high in the left prefrontal cortex of the brain. This area is often associated with decreased anxiety and fear, positive emotions, and a decrease in depressive feelings or symptoms. Theta brainwaves in meditation also invoke a deep sense of relaxation and also encourage creativity and make problem solving and memorization easier. Finally, delta brain waves in meditation are the slowest of all. Everyone experiences delta waves in deep sleep, but delta brain waves in meditation are said to help experienced practitioners access the unconscious mind.

Here are a few suggestions for instituting better sleep hygiene practices.

• Reduce nicotine, caffeine and alcohol use which can all interfere with sleep cycles.
• Avoid rigorous exercise 3-5 hours prior to bedtime.
• Avoid any heavy meals near bedtime.
• Maintain a routine sleep and wake schedule.
• Keep your bedroom dark, cool, and quiet.
• Position clock away from the bed; some clock watching is impossible.
• Establish a sense of psychological safety with your surroundings.
• Keep your bedroom free of television. Your bedroom should be a sanctuary.
• If you must watch television, try watching it in the early evening. This goes the same for the computer. Even a stimulating book can keep you up at night.

Practicing good sleep hygiene and keeping your body in sync with the rhythm of day and night can help your body cope with the ravages of CSS and give it an opportunity to get stronger and heal. By implementing just a few of the suggestions you should notice a great improvement in your sleep and how you function in the daylight hours.

For further information on Dr. Rubin Naiman you can visit his website: http://drnaiman.com/

Books and CDs by Rubin Naiman: http://drnaiman.com/goods/books-cds

The Sleep Advisor, a program for insomnia: http://thesleepadvisor.com/