Up all night: The science of sleeplessness


The science of sleeplessness.

by Elizabeth KolbertMARCH 11, 2013

Some people can’t go to sleep until late; others can’t sleep in. Both suffer “social jet lag.” Illustration by Nishant Choksi.

Nathaniel Kleitman, known as the “father of modern sleep research,” was born in 1895 in Bessarabia—now Moldova—and spent much of his youth on the run. First, pogroms drove him to Palestine; then the First World War chased him to the United States. At the age of twenty, he landed in New York penniless; by twenty-eight, he’d worked his way through City College and earned a Ph.D. from the University of Chicago. Soon after, he joined the faculty there. An early sponsor of Kleitman’s sleep research was the Wander Company, which manufactured Ovaltine and hoped to promote it as a remedy for insomnia.

Until Kleitman came along, sleep was, as one commentator has put it, “a huge blind spot in the science of physiology.” No one bothered to study it because it was defined by what it wasn’t—sleep was a state of not being awake and, at the same time, of not being comatose or dead. (It’s unclear what exactly attracted Kleitman to this academically marginal topic, but it has been suggested that it fitted with his own marginalized background.)In one of Kleitman’s first experiments, he kept half a dozen young men awake for days at a stretch, then ran them through a battery of physical and psychological tests. Frequently, he used himself as a subject. As a participant in the sleep-deprivation experiment, Kleitman stayed awake longer than anyone else—a hundred and fifteen hours straight. At one point, exhausted and apparently hallucinating, he declared, apropos of nothing in particular, “It is because they are against the system.” (Asked what he meant, he said he’d been under the impression that he was “having a heated argument with the observer on the subject of labor unions.”) In another self-administered experiment, Kleitman spent six weeks underground, in Mammoth Cave, Kentucky, trying to live according to a twenty-eight-hour day. (He found that he could not.)

In the early nineteen-fifties, Kleitman’s research was sponsored in part by Swift, the meatpacking company, which was interested in finding out whether feeding babies a high-protein diet would make them sleep more soundly. It was at this point that he—or, really, one of his graduate students—stumbled onto a great discovery. Casting around for a dissertation topic, the student, Eugene Aserinsky, decided to hook sleepers up to an early version of an electroencephalogram machine, which scribbled across half a mile of paper each night. In the process, Aserinsky noticed that several times each night the sleepers went through periods when their eyes darted wildly back and forth. Kleitman insisted that the experiment be repeated yet again, this time on his daughter, Esther. In 1953, he and Aserinsky introduced the world to “rapid eye movement,” or REM sleep. Another of Kleitman’s graduate students, William C. Dement, now a professor of psychiatry at the Stanford medical school, has described this as the year that “the study of sleep became a true scientific field.”

The discovery of REM sleep led to the elaboration of a whole taxonomy of sleep. In Stage 1, the brain emits what are known as theta waves, which are slower and more regular than the waves emitted by a brain that’s awake; in Stage 3, it emits delta waves, which are even slower and have a much higher amplitude. (A person can be woken from Stage 1 sleep by a slight noise; by Stage 3, he might sleep through a loud crash.) Primates, marine mammals, birds, even fish have their own sleep patterns. Mouse lemurs, from Madagascar, snooze for more than fifteen hours a day, but only an hour of this is REM sleep. Bottlenose dolphins sleep with half their brains; this prevents them from drowning. Thrushes catch up on sleep by taking “catnaps” of less than thirty seconds apiece.

New technologies have made the study of sleep cheaper, easier, and less intrusive. In 2003, one expert in the field announced the “dawn of the golden age of sleep research.” Since then, hundreds, perhaps thousands, of academic papers have been written on topics ranging from “sleep problems among Chinese school-aged children” to the “sleep behavior of the wild black rhinoceros.” Currently, in the United States alone, more than two thousand sleep clinics are in operation. All of which raises the question: If this is sleep research’s golden age, then why are we all so tired?

Of the many ways that things can go wrong in bed, sleep troubles are probably the most prevalent. According to a 2011 poll, more than half of Americans between the ages of thirteen and sixty-four experience a sleep problem almost every night, and nearly two-thirds complain that they are not getting enough rest during the week. The National Academy of Sciences estimates that fifty to seventy million Americans suffer from a “chronic disorder of sleep and wakefulness.” The results are dangerous as well as annoying. A recent study by the Centers for Disease Control and Prevention revealed that almost five per cent of adults acknowledge nodding off at the wheel at least once during the previous month. The U.S. Department of Transportation has determined that what might be called D.W.D.—driving while drowsy—causes forty thousand injuries a year in the United States and more than fifteen hundred deaths.

Our collective weariness is the subject of several new books, some by professionals who study sleep, others by amateurs who are short of it. David K. Randall’s “Dreamland: Adventures in the Strange Science of Sleep” belongs to the latter category. It’s a good book to pick up during a bout of insomnia.

Randall begins with an account of his own sleep problems, which include laughing, humming, grunting, bouncing, kicking, and, on at least one occasion, sleep-walking into a wall. He considers a range of possible explanations for the national exhaustion—too much light, too much warmth, too much avoirdupois—and finds them all compelling. The electric light bulb has made darkness optional, eliminating the enforced idleness that used to begin at sunset. Modern mattresses and bedclothes trap the heat that the body gives off as its core temperature drops each night. Obesity increases the chances of developing sleep apnea, a condition that combines choking and waking in an exhausting, sometimes life-threatening cycle. For all these reasons and more, Randall anticipates a bright future for the emerging field of “fatigue management.” One sleep expert he interviews predicts that “fatigue management officers” will soon be as common at major corporations as accountants. Like time, sleep, it turns out, is money.

Perhaps the most provocative claim that Randall has to make about sleep is that we’d all be better off doing it alone. Research studies consistently find, he writes, that adults “sleep better when given their own bed.” One such study monitored couples over a span of several nights. Half of these nights they spent in one bed and the other half in separate rooms. When the subjects woke, they tended to say that they’d slept better when they’d been together. In fact, on average they’d spent thirty minutes more a night in the deeper stages of sleep when they were apart. Randall cites the work of Neil Stanley, a sleep researcher at the University of Surrey, in England, who likes to say that there’s only one good reason to share a mattress.

“The Slumbering Masses,” by Matthew J. Wolf-Meyer, takes a more polemical view of what might be called the “sleep question.” Wolf-Meyer, an assistant professor of anthropology at the University of California at Santa Cruz, spent four years interviewing just about everyone involved in sleep research: physicians, technicians, patients, members of patients’ families. He concludes that what Americans have come to think of as sleep problems are mostly just problems in the way Americans have come to think about sleep. “Normal sleep is always pathological sleep, or at least potentially so,” he writes.

Wolf-Meyer refers to the practice of going to bed at around eleven o’clock at night and staying there until about seven in the morning as sleeping “in a consolidated fashion.” Nowadays, adults are expected to sleep in this manner; anything else—sleeping during the day, sleeping in bursts, waking up in the middle of the night—is taken to be unsound, even deviant. This didn’t use to be the case. Until a century and a half or so ago, Wolf-Meyer observes, “Americans, like other people around the world, used to sleep in an unconsolidated fashion, that is, in two or more periods throughout the day.” They went to bed not long after the sun went down. Four or five hours later, they woke from their “first sleep” and rattled around—praying, chatting, smoking, or making love. (Benjamin Franklin reportedly liked to spend this time reading naked in a chair.) Eventually, they went back to bed for their “second sleep.”

Wolf-Meyer blames capitalism in general and American capitalism in particular for transforming once perfectly ordinary behavior into conduct worthy of medication. “The consolidated model of sleep is predicated upon the solidification of other institutional times in American society, foremost among them work time,” he writes. It is “largely the by-product of the industrial workday, which began as a dawn-to-dusk twelve-to-sixteen hour stretch and shrank to an eight-hour period only at the turn of the twentieth century.” So many people have trouble getting enough sleep between eleven at night and seven in the morning because sleeping from eleven to seven isn’t what people were designed to do.

Till Roenneberg, the author of “Internal Time: Chronotypes, Social Jet Lag, and Why You’re So Tired” and a professor of medical psychology at the Ludwig Maximilian University of Munich, also blames the modern workday for our general drowsiness. But Roenneberg sees this not so much as a by-product of industrial capitalism as a quirk of human physiology.

Each of us has an internal clock, or, to use Roenneberg’s term, a “chronotype.” Either we’re inclined to go to bed early and wake up at dawn, in which case we’re “larks,” or we like to stay up late and get up later, which makes us “owls.” (One’s chronotype seems to be largely inherited, although Roenneberg notes, not altogether helpfully, that the “genetics are complex.”) During the week, everyone is expected to get to the office more or less at the same time—let’s say 9 A.M. This suits larks just fine. Owls know they ought to go to bed at a reasonable time, but they can’t—they’re owls. So they end up having to get up one, two, or, in extreme cases, three hours earlier than their internal clock would dictate. This is what Roenneberg refers to as “social jet lag”—each workday, owls fall asleep in one time zone and, in effect, wake up in another. By the time the week is over, they’re exhausted. They “fly back” to their internal time zone on weekends and sleep in on Saturday and Sunday. Then, on Monday, they start the process all over again.

For larks, the problem is reversed. Social life is arranged so that it’s hard to have one unless you stay out late on Friday and Saturday nights. But, even when larks have partied till 3 A.M., they can’t sleep in the following day—they’re larks. So they stagger through until Monday, when they can finally get some rest.

According to Roenneberg, age also has a big influence on chronotype. Toddlers tend to be larks, which is why they drive their parents crazy by getting up at sunrise. Teen-agers are owls, which is why high schools are filled with students who look (and act) like zombies. Roenneberg advocates scheduling high-school classes to begin later in the day, and he cites studies showing that schools that delay the start of first period see performance, motivation, and attendance all increase. (A school district in Minnesota that switched to a later schedule found that the average S.A.T. scores for the top ten per cent of the class rose by more than two hundred points, a result that the head of the College Board called “truly flabbergasting.”) But, Roenneberg notes, teachers and school administrators generally resist the change, preferring to believe that the problem is insoluble.

The Sleep Disorders Center, in Albany, New York, is housed in a nondescript office building in a nondescript office park not far from Route 90. It’s about an hour’s drive from my house, and not long ago I decided to check myself in. I have trouble sleeping from 11 P.M. to 7 A.M., and I thought that, in the spirit of self-experimentation, it might be interesting to find out what was going on. I was told to report to the center one evening at eight. When I arrived, a receptionist showed me into a room not unlike what you’d find at a Holiday Inn. She handed me a consent form and advised me to go to the bathroom to change into my pajamas. In the bedroom, a camera on the ceiling was going to film everything I did.

The center was having a busy night, and for a while I was left on my own. I entertained myself by reading some pamphlets I’d picked up on my way in—“Drowsy Driving,” “Sleep & Depression,” “Narcolepsy and You.” At around 10 P.M., a technician came to fetch me. She measured my head from various directions—front to back, side to side—and began attaching electrodes: three on the back of my scalp, two on each temple, three more on my chin, two on each leg, and two on my chest. Each electrode trailed a color-coded wire, which got plugged into what looked like a backgammon board. Some rubber tubes were stuck into my nose and mouth, belts were wrapped around my chest and waist, and an oxygen monitor that emitted an eerie red glow was taped to my index finger. I and the wires and the backgammon board got into bed. The technician plugged the board into a data logger and attached two more wires to each of the belts. Then she wished me good night.

One of the great riddles of sleep is why we do it. Clearly, any animal that could get preyed upon is better off being alert, and even predators, when they’re snoozing, are losing time that otherwise could be used searching for victims. Yet sleep has a very long evolutionary history. It’s hard to measure a fruit fly’s brain waves, but even insects, which have been around for some four hundred million years, appear to need shut-eye. (Drosophila melanogaster, when they’re tired, creep away from their food, crouch down on their abdomens, and remain immobile for up to two and a half hours at a time.) In the nineteen-eighties, Allan Rechtschaffen and Bernard Bergmann, both, like Kleitman, sleep researchers at the University of Chicago, performed what is now considered to be one of the classic experiments in the field. It showed that rats, when totally deprived of sleep, would, after two or three weeks, drop dead. But Rechtschaffen and Bergmann could never figure out the precise cause of the rats’ deaths, and so, they wrote in a follow-up paper in 2002, even “that dramatic symptom did not tell us much about why sleep was necessary.” Rechtschaffen has observed that “if sleep doesn’t serve an absolutely vital function, it is the greatest mistake evolution ever made.”

What followed lights-out at the Sleep Disorders Center was, predictably enough, not sleep. (Imagine for a moment going to bed in a fuse box.) Every time I moved, I got tangled in a wire. My legs itched where the electrodes were attached. At one point, I scratched one of them off; the technician, who was monitoring my many data streams, immediately showed up to plug it back in. I decided that, since I was doing this more out of curiosity than clinical need, I could take the tube out of my nose. The technician disagreed. She showed up again and told me to put it back in. I imagined someone watching the videotape of me tossing and turning in the darkened room. I wondered how you could even make a videotape of someone in a darkened room: what would there be to see besides dark? I fell into the familiar rut of worrying about not being able to sleep, which made sleep seem only that much more elusive.

Finally, after what felt like several hours, I conked out. The next thing I knew, the technician was back, telling me it was time to get up. It was 6 A.M. I was desperate for coffee, but apparently sleep centers don’t believe in providing insomniacs with caffeine. I knew there was a Starbucks out by the Albany airport, about a ten-minute drive away. As I groggily made my way toward it, I thought of the “Drowsy Driving” pamphlet tucked in my bag. “There is no substitute for sleep,” it warned.

A few weeks later, I returned to the center to get my results. Dr. David Palat, a pulmonologist who works on sleep disorders, told me that a technician had scanned the data I had generated that night—nowadays, of course, sleep data are recorded by computer, rather than on a ream of paper—and had analyzed the information so that it could be presented in a series of tables. He handed me a six-page printout. The tables indicated that the night had not gone as badly as I had thought. It had gone a lot worse.

The first table showed that I’d spent six hours and forty-two minutes in bed, of which I had slept for four hours and two minutes. But I hadn’t lain awake for nearly three hours and then dropped off, as I’d imagined. A graph, known as a hypnogram, traced how I’d cycled from wakefulness through each of the sleep stages—1, 2, 3, and REM. A good sleeper’s hypnogram looks like sets of facing staircases. It traces a steady descent from wakefulness to REM sleep, then an ascent to a lighter sleep stage, then another steady descent, a pattern that gets repeated three or four times in a night.

My hypnogram looked like the Manhattan skyline. It turned out that I’d fallen asleep within about ten minutes of getting into bed. But, after only a minute or so, I’d woken up for about fifteen minutes. I fell asleep again and woke up, fell asleep again and woke up, fell asleep a fourth time and then remained awake for nearly an hour. Even when I’d felt that I’d finally conked out, I had kept waking up, for a mind-boggling total of a hundred and forty-one times. Most of these awakenings—a hundred and eleven—were brief, under fifteen seconds. The tables also showed that I’d stopped breathing eight times, which, Palat assured me, was not unusual, and had experienced seventeen “periodic limb movements,” also not uncommon. In his comments, Palat had written that my “sleep architecture” suggested “difficulty with sleep maintenance.” He advised me not to go to bed until I was sure I was tired; not to stay in bed when I couldn’t sleep but to go read in another room; and to eliminate alcohol.

In the weeks since, I have tried to follow Palat’s recommendations to the extent possible—I figure two out of three isn’t bad—and it would be nice to be able to report that I’m sleeping better. In fact, now that I’ve gazed on my hypnogram, nights are, if anything, harder. Sleep is vital, and sleep is a mystery. As Randall writes toward the end of “Dreamland,” the more you know about it, “the more its strangeness unnerves you.” ♦

About bambooinnovator
Kee Koon Boon (“KB”) is the co-founder and director of HERO Investment Management which provides specialized fund management and investment advisory services to the ARCHEA Asia HERO Innovators Fund (www.heroinnovator.com), the only Asian SMID-cap tech-focused fund in the industry. KB is an internationally featured investor rooted in the principles of value investing for over a decade as a fund manager and analyst in the Asian capital markets who started his career at a boutique hedge fund in Singapore where he was with the firm since 2002 and was also part of the core investment committee in significantly outperforming the index in the 10-year-plus-old flagship Asian fund. He was also the portfolio manager for Asia-Pacific equities at Korea’s largest mutual fund company. Prior to setting up the H.E.R.O. Innovators Fund, KB was the Chief Investment Officer & CEO of a Singapore Registered Fund Management Company (RFMC) where he is responsible for listed Asian equity investments. KB had taught accounting at the Singapore Management University (SMU) as a faculty member and also pioneered the 15-week course on Accounting Fraud in Asia as an official module at SMU. KB remains grateful and honored to be invited by Singapore’s financial regulator Monetary Authority of Singapore (MAS) to present to their top management team about implementing a world’s first fact-based forward-looking fraud detection framework to bring about benefits for the capital markets in Singapore and for the public and investment community. KB also served the community in sharing his insights in writing articles about value investing and corporate governance in the media that include Business Times, Straits Times, Jakarta Post, Manual of Ideas, Investopedia, TedXWallStreet. He had also presented in top investment, banking and finance conferences in America, Italy, Sydney, Cape Town, HK, China. He has trained CEOs, entrepreneurs, CFOs, management executives in business strategy & business model innovation in Singapore, HK and China.

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