The Times of London, September 3, 2006
Sleeping in class is welcomed
Napoleon Bonaparte may have advocated six for a man, seven for a woman
and eight for a fool, but for a growing army of insomniacs even six hours’
uninterrupted sleep is a luxury. Sleep is as vital as water, more essential
than food, but for one in five of us it is as elusive as fairy dust.
Young professionals with a Starbucks habit, a BlackBerry addiction and
a demanding boss are prime candidates as sufferers, but it is a condition
that cuts across all ages and classes. Baroness Thatcher, Charles Dickens,
Oscar Wilde and Scarlett Johansson have all suffered from sleep disorders.
Finding the cure has become big business.
UK-wide, about 1m of us regularly swallow sleeping pills. Since the launch
in 1998 of modafinil, a stimulant that allows people
to get by on just four hours a night, sales have hit £330m. It may
sound like the stuff of nightmares, but scientists are now working on
a version that cuts the number of hours’ sleep needed to just two.
Our desperate search for the big sleep is leading us into bizarre territory.
Marriott Hotels has started to pump “sleeping odours” through
its air conditioning. Companies such as Leo Burnett and Procter &
Gamble have installed egg-shaped snooze-pods in their offices for executive
power naps. In America, shopping malls are introducing daytime siesta
cells for worn-out shoppers. Ewan McGregor is one of a number of Hollywood
stars who recently contributed a lullaby to Unexpected Dreams, a CD for
insomniacs by insomniacs.
Sainsbury’s and Waitrose stock sleep-inducing milk, taken from
cows when their melatonin levels are at their highest in the night. Add
in the homeopathic and herbal remedies, the lavender oils, the special
beds, the iPod pillows and the relaxation tapes and it is clear that there
is nothing lethargic about the sleep industry.
Now clinical psychologists at Glasgow University’s Sleep Research
Laboratory have devised a novel way of giving slumber- deprived Scots
a passport to the land of nod. They are establishing the first night-school
classes in teaching people how to sleep.
“Nowadays we see a lot of people with stressed lifestyles,”
says Professor Colin Espie, author of Overcoming Insomnia and Sleep Problems
and director of the university’s sleep laboratory. “Epidemiological
studies show that 8% to 12% of the adult population have a diagnosis of
sleep disorder and 20%-25% have a complaint about their sleep.”
From next month, sleepless in Shettleston and kipless in Kelvingrove
will be able to sign up for an eight-week course on sleep, its nature
and its management through the university’s department of adult
and continuing education. It is based on a programme of cognitive behaviour
therapy and sleep restriction techniques devised at the sleep laboratory,
which the psychologist Marina Malaffo, who runs the course, says has a
70%-80% success rate.
Malaffo shows me around the sleep laboratory in the neurosurgery department
of Glasgow’s Southern General hospital, where Big Brother-style
cameras film the behaviour of the inhabitants of four specially prepared
bedrooms and feed images through to a control room. Here, two night staff
monitor the brain activity of the patients, who are wired up to portable
machines.
Patients sleep for two nights at a time in windowless, air-conditioned
and bland bedrooms. Malaffo explains that there must be nothing in the
room to stimulate the patients. “We keep the temperature between
18C and 21C, which is the best for sleep,” she says.
Women are more prone to insomnia than men, as are people who suffer from
anxiety. But for insomnia to strike, there also has to be a trigger or
stress point, such as an illness, leaving a job or having a baby. “Most
people go back to normal sleep patterns after such an event, but some
don’t,” says Malaffo. They tend to reinforce the problem by
worrying about it or adopting “messy sleep” habits.
An insomniac, according to Malaffo, is somebody who takes more than 30
minutes to fall asleep or is awake for more than 30 minutes during the
night at least three or four times a week, with a subsequent negative
impact on their daily lives. If it lasts more than six months, it is deemed
chronic.
“It is not normal to be sleepy during the day, and if you are doing
so with no obvious reason, it should be treated as pathological,”
says Espie. “But the lack of awareness in the helping professions
means that a lot of things go undetected.”
Janette Stobbart, from Glasgow, who works as a planner in the National
Health Service, developed insomnia four years ago at the age of 49. “I
was blaming it on the menopause,” she says. “I just felt my
body had forgotten how to sleep. I had also recently moved house and job.
I was sleeping very badly for three or four nights every week. This went
on for years. If I managed to get to sleep before 3am I could cope, but
some nights I didn’t sleep at all. It was really quite debilitating
and my whole life became geared around not sleeping.
“I tried everything, including cutting out caffeine, using lavender
oil and drinking the milk from the cows milked in the night.” When
it got to the stage that Stobbart, who is divorced, started to get sore
eyes and developed a rash through lack of sleep, she went to her GP. She
was one of the lucky few and was referred to the sleep clinic in March
this year to take part in a clinical trial.
“I slept at the sleep lab for two nights,” says Stobbart.
“That was dreadful. I had such a bad first night I didn’t
want to go back. I was wired up and there had to be a light on. I don’t
think anybody could sleep in that. It was the sessions with Marina herself
that changed my attitude and helped me get back to sleeping properly.”
The first two courses, which cost £52, start on October 11 and
are limited to 20 people per class. A third course is scheduled for next
January. “There are a lot of myths about sleep,” says Malaffo.
“Take the idea that we all need eight hours’ sleep. We’re
all different. I know I need around seven hours. There is no point in
me trying to get eight hours. If I do, I mess up my sleep patterns.”
Mrs Thatcher famously needed only five hours. “So did Hitler,”
says Malaffo. “Most people on five hours would feel pretty dreadful.
They cope, but it does depend on the individual.”
The techniques used by the clinic are counterintuitive. Insomniacs who
don’t fall asleep within 30 minutes are urged to get up and do something
boring in another room until they feel sleepy again. If they are awake
for more than 30 minutes in the night they should get up. Lie-ins are
forbidden. “If you are only sleeping six hours, we advise people
to only be in bed for six hours,” says Malaffo. “We say don’t
do anything in bed apart from sleep and sex. People who don’t sleep
well tend to do a lot of other things in bed. They eat, watch television
or phone. It’s very important to re-establish the link between bed
and sleep.”
Despite the fact that it is an internationally renowned centre, the sleep
laboratory is not funded to offer a service to the general public. Espie’s
primary work is research. He is acutely aware, however, of the need for
a service. The typical person he sees in his trials has had insomnia for
10-15 years and has tried everything. Private treatment can cost hundreds
of pounds. Despite the fact that he cannot offer a service, Espie has
had 150 referrals from GPs in the past few months.
“It’s well nigh impossible to even get a basic diagnosis
of a sleep disorder in Scotland,” says Espie, who is a member of
the American Academy of Sleep Medicine. “We’re miles behind
the US in this. It’s frustrating when you know you’ve got
cost-effective ways you can help people.”
He believes treating insomnia could prevent some mental illness. “Sleep
disturbance is by far the most common indication of mental health disturbance
and insomnia is an independent risk factor for developing other mental
health problems, such as depression. There is a great emphasis in the
Scottish executive on preventative strategies. In the mental health field,
managing sleep disturbance is the equivalent of diet and exercise in physical
medicine.”
Espie believes that for £250,000 he could train health visitors
and nurse practitioners in the west of Scotland to disseminate the techniques.
Greater Glasgow Health Board is assessing the situation.
“We’re not talking millions. I don’t want to build
an edifice to sleep, but I think they are worried that it is so common
they would be inundated,” he says. “If you don’t have
a service, you don’t have a waiting list and you don’t have
political problems. But the question is: What price misery?”
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