Pedram Navab - Sleep Reimagined: The Fast Track to a Revitalized Life

SLEEP REIMAGINED

The Fast Track to a Revitalized Life

DR. PEDRAM NAVAB, FAASM

For Stephen N. Brooks, Rafael Pelayo, and Anstella D. Robinson, for mentoring me during my early years at Stanford and showing me the cool side of sleep medicine.

When I let go of what I am, I become what I might be.

LAO TZU

We dont see things as they are, we see them as we are.

ANAS NIN

There is between sleep and us something like a pact, a treaty with no secret clauses...

MAURICE BLANCHOT

T HROUGHOUT MY 16 YEARS AS A SLEEP MEDICINE specialist, this is what Ive learned: For your sleep (and life, depending on whom you ask) to fall apart, it doesnt matter if you were just married, discharged from the hospital, won the lottery, or diagnosed with a serious illness. Insomnia can happen in an instant. It can develop gradually. It can even be innate and exert its influence on you as a child. It can happen in the best or worst circumstances, whether youre rich or poor, whether youre living in an opulent home or a tiny apartment. Poor sleep doesnt discriminate. It can happen to the best of us.

All of us have experienced at least one night of abysmal sleep. Conservative estimates reveal that 10% to 30% of adults live with chronic insomnia. Whatever the percentage, it is evident that this is a problem for many of us, and a chronic one at that. Rest assured, though, I have an optimistic outlook, and I believe that even the worst sleep can be reversed. It may not be easy, and it may take some time, but it will improve. It is with this aim that I undertook to write this book: to share the wisdom that I have gleaned from the tens of thousands of patients Ive treated over my years of practicing sleep medicine. But it is more than that. It is also a philosophy of sleep, an outlook that not only applies to sleep but also to the various aspects of our lives. Sleep is a continuum, and what you experience in sleep will also segue to your waking life, for good or bad. When individuals sleep better, then hopefulness extends to their waking lives, as well. They feel more in control, and control is powerpower to change and power to not allow obstacles to hinder their goals.

The impetus for this book, then, was to attempt to offer treatment to the millions of people who suffer from poor sleep in a practical, entertaining, and easy-to-understand format, whether this poor sleep is characterized as insomnia, a circadian-rhythm disorder, sleep-disordered breathing, or something else. (Well get to all these conditions later in the corresponding chapters.) Although there is a myriad of sleep disorders in what is considered the diagnostic bible of sleep medicine, The International Classification of Sleep Disorderseverything from parasomnias to sleep-related eating disorder to sexsomnia to restless-leg syndromethis book is designed for those individuals with insomnia or its great imitators. After all, insomnia is the most common sleep disorder, and, as such, will take precedence in this book. Next to sleep-disordered breathing, which well discuss in Chapter 6, insomnia is the most common diagnosis I continue to evaluate at my sleep clinic. And it is the most distressing because it is felt more palpably than the resta living hell or a zombie nightmare, as most of my patients describe it.

In writing this book, I was reminded of the title of the French electronic-music project M83s album, Hurry Up, Were Dreaming. This book is in fact not about dreaming, although the title of the album can extend to sleep insofar as were all concerned about sleeping: sleeping faster, sleeping more, and sleeping better. This book is all about sleepspecifically, poor sleep that can be improved. But the title of the album is appropriate for our purposes to emphasize that sleep cant be hurried; it takes its time, and if you attempt to hurry sleep, it can actually slow down and exert its stubbornness. Performance anxiety can set in, and insomnia can take over in a most monstrous fashion. Sleep is a natural process, and to exert external pressures on it will simply backfire, as we may have all learned firsthand throughout the years. Rest assured that the techniques well use in this book will place some pressure on sleep, but its pressure that is innate and not external or foreign to the system. We may have heard the saying pressure makes diamonds, but in sleep, being under such pressure will not demonstrate its restorative potential; rather, it will show its destructive potential. Sure, we may have to work to fine-tune our sleep, but it should never resemble real work. Real work does not beget good sleep; in fact, working at sleep is anathema to getting good sleep. In this book well return to this concept, again and again.

I continue to remember the ending sequence of the great American drama series The Waltons, which aired from 1972 to 1981. I was a child then, but I still remember the lines at the end of each episode when everyone appeared to go to bed at the same time each night and say their goodnights. The sequence would sound like this: Elizabeth: Good night, John Boy. John Boy: Good night, Elizabeth. Good night, Daddy, and so on and so forth until every one of the parents, grandparents, and 7 kids had said their goodnights.

During my training as a sleep specialist, I would always reflect on how inaccurate this depiction was, that sleep was not this artificial or imposed. No one family could make its members sleep at the same time, no matter how hard they tried. In fact, the harder one tries to sleep, the less successful they will be. But to see this scene played over and over again for almost a decade reinforced in me the notion that sleep should be uniform, that everyone could sleep at the same time each and every night. (As a child, when I couldnt sleep, I would always blame myself. I thought that I somehow wasnt doing something right, that something was wrong with me. As a sleep expert, I now know better.)

But sleep is not uniform. It is different things for different people. For insomniacs, it is a chore or dread, as most have come to call their albatross. Most insomniacs treat their bed as a painful bed of nails because that is how psychologically uncomfortable it is for them. They are overstimulated when they attempt to unsuccessfully sleep in their beds. Well tackle this issue with our first case, Laura, who loathed her bed after a traumatic incident but was drawn to it like an opium fiend.

This book is a little different from most sleep books. Sure, it will cover the essentials of what one needs to know about sleep and how to treat insomnia and its imitators. It will show you how to think about sleep so that it doesnt feel like a category of its own, separate from ones waking life. But it is also a book of narratives, a literary book of sorts, based on the actual experiences of patients whom Ive seen over the years that exemplify the various sleep conditions at their most elemental. These stories are distilled to the conditions that patients of mine actually experienced, so that readers can identify with the sleep disturbances and the treatments that real people successfully underwent. Each story is rooted in patterns and symptoms that I have witnessed in my patients throughout the years. I undertook to write these stories to make it easier for you to recognize and relate the sleep concepts I discuss in a concrete and personal way.