Karnac, 2017/Penguin, 2018
Reviewer Ben Gatty
“Weary with toil, I haste to my bed … but then begins a journey in my head”, writes Shakespeare in Sonnet number 27, before going on to foreground the need for sleep “to work my mind, when body’s work’s expir’d”. Sleep and the role of shut eye has long since intrigued the minds and works of the creatives: Fuseli’s 1781 painting ‘The Nightmare’ so captured the public imagination that different versions toured around sell-out audiences. The painting features a demonic incubus crouched on top of a woman in deep sleep, observed by a dark horse (a night mare). Sigmund Freud is reported to have had a reproduction of the image on the wall of his apartment at Bergasse 19; the first psychoanalyst sought to understand not only those who were mentally ill, but also the functioning of the everyday mind. So vital is the form of work enabled by sleep, the two books reviewed here tell us, that putting in our eight hours or so is effectively enabling the finest of elixirs. Step right up, step right up, for good mood, good skin, good sex – who wouldn’t want a sufficient dose of this stuff? But so too the texts illuminate the profound impact of insufficient sleep on both the well and the unwell, and how the two may overlap: if you also thought that your sleep shirking was no big deal, the texts parade such a list of terribles that poor sleep induces – diabetes, depression, dementia, premature death – and that’s just some of the D’s – that you’ll be having nightmares.
In terms of therapy for the more markedly ill, it is clear that sleep difficulties impact almost all of those who present with a significant diagnosable condition. At the outset of psychotherapy treatment I’m commonly struck by the deep unfairness that someone who is so in need of rest is deprived of it, with the unresolved ails of the day insisting on making their presence felt during the night. Bad sleep is both consequence and cause of many mental health difficulties. In terms of a consequence of mental illness, these books highlight the broad principle that, as we are more vulnerable at night, so wakefulness will be more present when we feel threatened, even if the threat is more social, or only decipherable as an internal state. That bad sleep can be causal for mental health difficulties is demonstrated by the fact that the amygdala, central to our brain’s processing of fear, is up to 60% more reactive when we have slept badly.
As Lee cites (p.2), at the extreme end of the spectrum poor sleep can be disastrous. It has been shown to be causal in large scale accidents such as the Chernobyl nuclear power plant disaster and Challenger space shuttle tragedies, along with numerous car crashes and medical blunders. Elsewhere, whilst the denial of sufficient sleep can be attributed to a form of refusal of our mortality, which is connected to the super-man notions of Eddison, along with successors who author mind-hack sites for would-be executives, perhaps a more profound explanation lies in our biology. Thinking from a neuro-biological perspective, our SEEKING system (Panksepp, 1998) is so primary within our instinctive moves that the many rich opportunities for further exploration offered up by the well-lit home, and even more by the internet, will be a struggle to resist, like being frugal when eating from a well-plenished buffet. Yet sufficient sleep makes so much more mind available that, perhaps, when thinking about the centrality of relationships and people’s relationship to themselves, we need to give greater space to foreground our relationship with our drives.
Coming from a Cognitive Behavioural perspective, the approach articulated by Lee has been shown to work well to reduce insomnia. As would reasonably be assumed, the virtue of the particular way of working suggested by Lee is dependent on both therapist and client. Certain types of clients will be more receptive to a learning based model, with particular benefit likely for those who are fairly conscientious when it comes to doing follow up practices between sessions. Perhaps a significant division between therapists is between those who prefer therapy texts to be fairly aligned to their own their frame of reference, or those who might be receptive to adapting elements of it into their general way of working. For the former group this book will only be satisfying if you tend to work with particular protocols and incorporate CBT ways of thinking. Yet if you subscribe to an alternative modality but like to consider how varied approaches might invigorate your own practice Lee’s could also be a useful text, and an encouragement to give greater primacy in treatment to sleep problems. Maybe a further distinction between therapists, or between different states of mind for the therapist, is the desire for texts that give us a summary of knowledge and a suggested way to apply it, as in Lee’s book, or those that have good potential to produce further thought and reflection on the given subject.
I tend to refer to Walker’s book as ‘why sleep matters’ which is telling, as the text is in a sense an impassioned plea to take the need for good sleep more seriously, although I found it to have the paradoxical effect of making me want to stay awake in order to read more. Walker’s different angles on the subject are grounded in his expertise as Director of UC Berkeley’s Sleep and Neuro-Imaging Laboratory. I found ‘Why We Sleep’ to be of particular value in helping me think further about the epidemic of poor sleep that is impacting at least half of the general population in Western nations, and seems to be affecting increasing numbers of people. Perhaps a good starting point when considering the way in which so many of us disregard our nature is the cult of ‘manly wakefulness’, a term coined by Thomas Eddison, inventor of the lightbulb. Prior to widespread electric light usage, given the cost of candles, people tended to spend most of the time that was dark resting, and vice versa. As Oxford University’s Robert Foster puts it: “we feel we can abandon four billion years of evolution and ignore the fact that we have evolved under a light-dark cycle”; indeed Dale Carneige, early 20th century self-help guru, stated that “we don’t know if we have to sleep at all”. The vogue for sleeping less in the 1930s is regarded as being significantly reflective of economic insecurity, while in the last decade or so a particularly notable embarrassment from the glitches of information technology has been how the blue light from devices has further constricted sleep for so many of us.
That many of the difficulties that lead someone to come to therapy are enlarged by poor sleep is an argument for treating bad sleep directly, either to clear the ground for further therapy, or to give the patient sufficient remedy for what troubles them. If we are specifically seeking to target sleep in therapy, then David Lee has written an excellent reference. Meanwhile readers who are particularly keen for a book to open up a play of ideas may get more from Mathew Walker’s insightful, and at times poetic, text.
Ben Gatty is is a psychotherapist, trainer and supervisor working as part of TfL’s Counselling and Trauma Service and in private practice. In his work he has worked with night workers and those in corporate settings who are affected by poor sleep.