Persons mentioned in this article, apart from the author, are fictional. They bear no relation to any person, living or dead.
I hadn't had a great morning. I had flown into Lagos from Abuja on a particularly wet, August morning and the weather was as gloomy as it was unfriendly. As usually happens on such days, vehicular movement all over Lagos was as its most awkward, turning my trip to the mainland into an entire nightmare. As it were, therefore, by the time I arrived at my destination, my mood mirrored the foul weather to the point of exactitude. But all that went into a reversal the moment I stepped into the Penthouse office of the firm's Chief Executive Officer. I found her standing, facing the tall windows which afforded a panoramic and breathtaking view of the Marina. With hands clasped behind her, she stood statuesquely built at about six feet in a black trouser suit and low-heeled shoes. As she turned round to acknowledge my presence, the entire atmosphere, including my mood, was instantly transformed by her warm and enchanting smile. A stunning beauty by even the most exacting set of standards, Mrs. Daisy Davies was at a stage of physical perfection rarely achieved by any member of the feminine gender. Striding elegantly to the center of the room, she smilingly proffered a handshake and ushered me to a set of leather lounge seats set in a wall recess. Daisy Davies, at thirty seven, sat atop a multi-million dollar Real Estate concern, whose clientele ranged from the upper levels of government to the cream of the organized private sector. Evidently, she was as highly accomplished in business as she was in her looks and comportment. However, despite the obvious air of sophistication, beauty and glittering dividends that emanated from her, she had a problem.
"Doctor, I CAN'T SLEEP. I SIMPLY CAN'T GET TO SLEEP!"
"What exactly do you mean by that?" I asked.
"I haven't had any satisfactory depth of sleep in the past three months. It has made me very tense, and my output at work is dropping. If I don't resolve the problem in the shortest possible time, I will surely go mad. Please help me."
"Mrs. Davies, is this an isolated incident, or have you experienced such episodes in the past?"
"Frankly, Doctor, I have sporadically experienced sleeplessness since my university days, but the present episode is the worst."
After a moment's pause, I quickly realized this was a case that deserved my focused attention. And so began an intensive series of dialogue which lasted three consecutive days.
"Mrs. Davies, what you suffer from is technically termed insomnia, which far from being a benign, harmless condition, can actually cause serious dislocations in family life, corporate performance and domestic equilibrium."
She rolled her eyes skyward and said, "You can say that again, doctor. My husband is quite fed up, and the members of my board are almost giving up on me."
"Indeed, Mrs. Davies, insomnia can be quite a costly ailment. The most common forms of it are: difficulty with falling asleep, difficulty with staying asleep, difficulty with getting back to sleep after waking up at night and feeling drowsily tired on awakening in the morning, and this can extend into the rest of the day. Which of these applies to you?"
"I have experienced each of them, at some time or the other!"
"Insomnia is insufficient, disturbed and non-restorative sleep. In my practice, I now recognize three types of insomnia: Occasional insomnia of one to two nights, short term insomnia of three nights to two weeks or so, and chronic insomnia of longer than two weeks, or frequent episodes of this chronicity."
She smiled prettily and said, "I am guilty of chronic insomnia!"
I laughed. "Are you a lawyer, madam?"
"Yes, I am. How did you guess?"
"Mild legal language comes glibly to you. Now, on a serious note, chronic insomnia is a fairly common problem. Worldwide, it is estimated that about two percent of the general populace is afflicted with it, and of course, most of these people fall into the elitist class."
She smiled again, and quietly said, "The tragedy of affluence!"
I laughed. "I won't dispute that, madam!"
"Now, let us go into the causes of insomnia. Please note that everyone is subject to the occasional period of poor sleep. However, chronic, recurrent insomnia can usually be traced to specific causes. There is a physiological phenomenon called the "biological clock". We all have biological clocks deep within our brains, which control regular fluctuations in body functions, such as hormone secretions, temperature regulation and the sleep-wake cycles. The clock controlling sleep-wake typically cycles every twenty five hours. In some people, this 'normal' cycle can become abnormally shortened or prolonged."
"How very fascinating," she exclaimed, wide eyed.
"Other causative factors are what we call OTC or over-the-counter medications, which include nasal decongestants, cough syrups, diet pills and many others. Believe it or not, even sleeping pills can disturb the normal pattern of sleep activity in the brain, thereby worsening the very problem they are designed to alleviate. Of course, substances of abuse, such as alcohol, nicotine, caffeine and cocaine, can also disturb sleep patterns, and so interfere with sleep."
She looked horrified and scandalized at the same time. "Count me out of all these!" She declared.
"The abrupt discontinuation of certain medications, after weeks or months of regular use, can also cause insomnia. For example, people who have been on tranquilizers and pain killers can develop insomnia when they suddenly stop them. In fact, the withdrawal of long -term usage of sleeping pills can cause a well-known condition called Rebound Insomnia, and this can last for weeks."
"Another group of causes are anxiety, worry, depression and stressful life events. But perhaps one of the most significant causes of insomnia is the way one responds to one's inability to sleep. After not sleeping well for several days, many people typically become quite worried, frustrated and even depressed. This causes them to add psychological pressure on themselves to sleep, which in turn leads to increased anxiety at bedtime and this further interferes with sleep. This pattern precipitates what I've come to term the vicious cycle of "failure-worry-more failure-more worry," and once this vicious cycle is established, the sleep-failure pattern becomes self-perpetuating."
At this point, Mrs. Davies unfurled her long legs, which had hit her to been elegantly crossed, leaned forward in her chair, and looking at me earnestly, said, "Doctor, you have just described, to the finest point of detail, my problem. Bless your heart!"
With that, we concluded the first phase of our dialogue.
I arrived at her office at nine a.m on the second day of our encounter, and after instructing her executive assistant to ensure that we remained undisturbed for three hours, we ensconced ourselves comfortably in her wall- recessed lounge. I studied her carefully. This delectable and stunningly attractive Chief Executive Officer of an upscale real estate firm on the Lagos mainland, despite her outward signs of enviable worldly success, was afflicted by particularly distressing bouts of episodic, chronic insomnia, which she bravely attempted to live with behind a polished veneer of sophistication and a formidable intellect.
"Tell me, Mrs. Davies, how was your night? Did you sleep well?"
"I decidedly did not sleep well, doctor!"
"I would like you to relate your experience to me in precise detail. As an afterthought, and perhaps to simplify the entire exercise, permit me to ask you certain leading questions, since in that manner, we shall conveniently dispense with the wastage of valuable time on the irrelevant."
"That is perfectly alright with me," she replied, as she settled more comfortably into her seat.
"Did you try to 'will' yourself to sleep?"
"Yes, I did."
"Did you remain in bed, in the dark, all the while hoping desperately that blissful sleep would come?"
"Guilty as charged!"
"Kindly permit me to indulge in some legalese. I put it to you that, while lying there in the dark, you entertained a subtly unconscious, yet patently fearful expectation of failure in getting to sleep. Is this summation accurate?"
"Absolutely, doctor, absolutely."
Leaning forward in my seat, I gazed intently at her.
"Mrs. Davies, I'm afraid you belong to the category of insomniacs who have formed negative associations with their bedrooms, such as lying in bed, in the dark, for hours on end, literally learning to fear the very act of trying to get to sleep, and in the process, becoming negatively conditioned about success in this area. This unfortunate tendency is not unlike what men experience when they have an attack of erectile impotence."
"How very intriguing!" she said, in obvious fascination.
"Let me drive home certain unassailable and incontrovertible facts. The harder you try to make yourself sleep, the less success you will achieve. The more you worry about not sleeping well, the less sleep you will get. Tragically also, the longer your sleeping problem lasts, the more difficult it will be to correct, for the simple reason that, over time, you are likely to inculcate more bad habits, and more negative associations. It is equally important for you to know that the factors that precipitated your sleeping problem in the first instance may not necessarily be the ones that are responsible for its protraction. Furthermore, as you would no doubt have discovered by now, sleeping pills are rarely the answer to this malignant problem."
"Now, let us turn to remedies and possible solutions... "
"And about time too!" she interjected, flashing me her divine smile.
"First, let us establish just how much sleep is enough. From an understandably expert point of view, I would say that although this would vary from one individual to the next, the amount of sleep that is appropriate for you is that amount which enables you to remain wide-awake, alert and energetic throughout the day, and for most adults this will range between seven and nine hours, although some can feel awake and energetic on as little as four to five hours of sleep."
"Now, Mrs. Davies, based on an assumption that your experience over the years would have vacillated between episodes of occasional, short- term and chronic insomnia, I will be quite comprehensive in my coverage of possible solutions, so that you may be in a position to derive maximal benefit from our joint excursion, and so that you may also be able to counsel other people who may be afflicted with the same problem. You see, I always consider my coaching as "train the trainer programs."
She suggested a thirty- minute tea break, during which she regaled me with hilarious tales of her various boardroom battles in the years of her long climb up a corporate ladder that was dominated by age-old male prejudice and insufferable chauvinism. I felt her story ought to serve as potent motivational material for countless other young women, and encouraged her to write an illuminating book chronicling her experiences. She readily agreed with me, and promised to start work on it as soon as she had resolved her sleep difficulty.
"The first step in approaching sleep-related problems is to ask oneself certain pertinent questions: When did the problem begin? Is the problem mainly getting to sleep, staying asleep or both? Did the onset of the problem coincide with some medical problem, psychological trauma, stressful life event, starting or stopping a prescription of Over The Counter medication? Is one's sleep normal in other environments, such as a hotel or possibly another room in one's house?"
"The best way to deal with the isolated one night of sleep difficulty is simply to go to bed early the next evening. Refuse to make excuses for staying up late more than one or two nights in a row. Ensure that you complete your day-time tasks before going home."
She looked away guiltily and gave a short laugh.
"Do you, as a habit, take afternoon naps?"
"Yes, I do," was her prompt response.
"Well, I can tell you that, in your particular case, going to bed early would be infinitely better than taking a daytime nap, for while it may be validly argued that these naps can make you less tired during the day, they may make you less able to sleep at night.What is more, the habit can interfere with the re-institution of your normal sleep-wake cycle."
"I would advise against the use of caffeine to keep you awake during the day, or alcohol to assist in getting you to sleep at night."
"Tell me, doctor, why is it so important to avoid using these substances for those purposes?"
"Both of them alter the normal sleeping cycles in the brain and can lead to further insomnia, which can become long-standing. However, you can use sleeping pills to help you catch up on your sleep, as long as it's just for one or two nights, as longer use of such drugs can also disrupt the normal sleep patterns in your brain."
"Longer periods of insomnia, say for one to three weeks, are usually caused by stressful life events. This is short-term insomnia, and the repeated loss of sleep can lead to poor daytime output, irritability and a further decrease in one's ability to cope with stress, and this will in turn lead to anger, worry and frustration, which will further compromise sleep, ultimately instituting a vicious cycle. So, if suddenly, you are not sleeping well for several consecutive days, try to identify recent stressful events or conflicts in your life and try to resolve them as quickly as possible. Refuse to sweep them under the carpet. Don't ignore them, simply hoping they will go away. Address them vigorously and successfully, and you will find your insomnia fizzling away. The pre-eminent aim should always be to re-institute normal sleep patterns as quickly as possible, because the longer insomnia lasts, the greater the tendency towards bad sleeping habits. Now, sleeping pills may be quite useful here, as they are often preferable to allowing your body to be deprived of badly-needed rest for weeks at a time. However, you must limit yourself to no more than a week or two of use, and definitely under a doctor's supervision. Again, the goal is simply to restore normal sleep pattern as quickly as possible, and once this is achieved, the need for further medication will disappear. Please note that if you do have to use sleeping pills for more than seven days in a row, it is not advisable to stop their usage on an abrupt note. Ideally, you should gradually decrease the dose or frequency of use. As you can see, the therapeutic approach to insomnia of several days in a row is really quite simple: swift and aggressive intervention to quickly cure it and prevent long-term problems, such as the development of bad sleep habits and other negative associations. Do not wait for two to three weeks before deciding to act. If you have not slept for three days in a row, call your doctor!"
At this point, I decided we would adjourn for the day, as I did not want my client to suffer from information overload.
On the third and final day of our consultation, Mrs. Davies had to host an extraordinary meeting of her firm's board of directors, and this took the larger part of the morning. At noon, her executive assistant came to fetch me from the library where I'd closeted myself all morning. It was gratifying to know that even real estate firms repose some interest in an eclectic collection of books from a wide and varied spectrum, and given my proclivity towards, in the main, literature of a sublime slant of focus, that is saying a lot about that library's collection.
As we settled down to the day's tutorial, I asked my client if she had had a good night's sleep. She replied in the decidedly negative, although she did not, in the least, look like someone who had been deprived of badly- needed sleep.
I gazed thoughtfully at her over the rim of my mug as I sipped my tea. Maybe she took an elective course in 'composure,' I thought to myself as I couldn't help admiring someone who had the handicap of a long-standing sleep difficulty, and yet managed to look more refreshed than those who had their full sleep complement! Despite the glossy exterior however, I knew only too well that she was merely putting up a bold front, and must necessarily be feeling quite drained of energy.
"Having deployed so much time into learning exhaustively about insomnia in general, I think in your case I can comfortably entertain a diagnosis of chronic insomnia."
"I think I would readily agree with you," she replied, her brow creasing in a worried frown.
"We must always keep at the back of our mind that insomnia always has a cause. There could, in fact be multiple causes, and the ones that precipitated the problem may no longer be the ones sustaining it. We must consider the following probable causes: medical ailments that cause bothersome night-time symptoms, for example heart disease and thyroid disease. Psychiatric conditions associated with anxiety or worry often keep people from falling asleep, while depression often results in early morning awakening, or difficulty in remaining asleep."
"Certain commonly- used substances can also contribute to insomnia. Excessive use of caffeine to maintain daytime wakefulness can lead to withdrawal symptoms including headache and sleeplessness at night. Alcohol, on the other hand, is commonly used to help people get to sleep. Quite apart from leading to a dependency state, alcohol can also disrupt normal brain activity during sleep. Admittedly, its sedative and calming effect can help get people to sleep initially, but it tends to increase night-time awakening, and reduces Stage 3 brain activity which is needed for proper rest."
As she appeared eager to say something, I paused.
"On an intellectual level, I find myself quite interested in the role of negative conditioning and negative associations in the evolution of chronic insomnia. Can you shed more light on these?"
"Indeed, there is an ever present constellation of conditioned thoughts, feelings and behavioral responses that become associated with, especially, one's sleeping environment. You see, after protracted and unsuccessful attempts to sleep, your bed, or even the entire bedroom can become associated with your failure to get to sleep. Of course, insomnia-sustaining behavior, such as staying in bed for far too long when you can't get to sleep, can also aggravate the problem. An interesting validation of this theory is seen in the fact that people tend to finally get to sleep well in places that they don't normally associate with sleep, finding, for instance that they may not have trouble sleeping on vacations, or at a friend's home. They may even find it easy to take unplanned naps at their own homes, while trying to sleep at 'bedtime' remains a herculean task."
"There are other conditioned responses that lead to bad sleep habits. These include failure to adhere to a consistent sleep-wake schedule, trying to catch up on lost sleep over the weekend, thinking of work-related problems during the night, excessive time awareness or frequent clock-watching while in bed and exercising too vigorously too close to bedtime."
"To what degree do environmental factors influence sleep?" She asked.
"A safe, quiet and comfortable sleep environment is very important to anyone having trouble sleeping. If bothersome noise is a problem with you, see how you can get the human sources of such noise to cooperate with you. Such people may include your children, or even your neighbors. If minor noises disturb you, consider using a constant background noise to help you get to sleep. You might also consider using ear plugs. These are particularly helpful in coping with partners who snore."
"Also, time-watching could pose a problem for people who are trying to get to sleep. Looking at the clock every five to ten minutes while lying in bed, or glancing at the clock to see what time it is anytime you awaken during the night is unnecessary behavior that should be avoided, and to help you with this, you could consider keeping clocks away from your bed. Certainly, you should have no business wearing your wristwatch to bed. If, for any reason, you need a clock for its alarm, make sure the face of the clock is turned away from you. The essence is simply to ensure that you avoid focusing on time, or putting yourself under time pressure of any kind."
The pensive look on my client's face told me she might have been a victim of quite a few of the negative factors I had mentioned.
"Now, doctor, I am really interested in how one could possibly reverse the insomnia-producing effects of negative-conditioning and poor sleep habits."
"Mrs. Davies, these habits can be reversed, but it is important that right from the outset they are approached with a great deal of patience, since most established habits are difficult, but certainly not impossible to overcome. Take the creation of positive pre-sleep rituals for instance. You could try reading, a warm bath, listening to soft music or anything else that can help put you in a relaxed mode before going to bed. Another powerful strategy is to take to your bed only when you feel sleepy. This translates, roughly, to making sure that you do not use your bed for any other purpose than sleep. Refuse to do official work, or television watching on your bed. Do these things in another room, or on a desk, and when you finally feel sleepy, stop these activities and go to your bed. The beauty of this strategy is that it positively associates your bed with feeling sleepy."
"Another effective strategy is to 'avoid trying to sleep.' This is what I mean. The more you try to 'will' yourself to sleep, the worse your problem will become. Realize that sleep is not a task you must perform. It requires a relaxed, calm and peaceful state which usually means you are not willfully trying to do anything. Refuse to allow thoughts of work-place problems and projects clutter your mind. Save these for the daytime hours to which they truly belong, since, in any case, that is also when you can do anything about them. Try to think about stupid, inconsequential things instead. Do you know that it is much easier to change the focus of your thinking than to keep yourself from thinking at all?"
She raised her eyebrows, smiling quizzically.
"Is that so, doctor?"
"Join me in a little experiment, if you will. Think about goats roaming about in your village."
She nodded.
"Now, think about a quiet lake with a row boat floating peacefully on its surface. Wasn't that infinitely easy to accomplish?"
Smiling prettily, she nodded in the affirmative.
"One of the best ways to break an insomnia problem is the disciplined establishment of a consistent wake-up time, and to adhere strictly to it. If, for instance, you set your alarm for, say, nine a.m. every day, ensure that you vacate your bed at that time. Refuse to get up late at weekends. The disciplined establishment of a consistent wake-up time encourages your body and brain to adopt an equally consistent sleep-wake pattern, which will take over naturally on its own after a while."
"And now, I will offer you the icing on the cake." I said mysteriously.
'Are you due to go on a business trip anytime in the very near future?" I added.
"As a matter of fact, yes I am. Why do you ask?"
"You will discover the reason for that inquiry soon enough, madam!"
With that, I brought my three day encounter with the charming lady to a close.
A month later, I received this electronic mail from Mrs. Davies.
"Doctor, the most amazing thing happened! I had to travel to Accra, Ghana, to attend an international symposium on best practices. On arrival at my hotel, a well-appointed holiday resort, I had sat on the twin-bed and merely laid my head on the pillow for a moment of recuperation after my exhausting flight. And that was the last awareness I had of my conscious self. Six hours later, I sprang awake, still fully dressed! I was amazed! It had taken a change in environment to break my insomnia!"
This author is available for the delivery of seminars on SLEEP DISORDERS. He is also willing to write, not only more in-depth material on the subject, but can, additionally, write a novel centered on SLEEP DISORDERS, AND IS WILLING TO ENGAGE IN GHOST WRITING IN THIS REGARD.Companies that manufacture Tranquilizers may also advertise on his website. http://www.dryomigarnett.com/
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