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Sleep is a necessary process of revving down. But what if you can't sleep?
Removing ourselves from the animal kingdom has granted us privileges not afforded to our mammalian friends. We can lie down and sleep without worrying about our safety, to a degree. Many animals, in the wild, sleep standing up; their joints lock in place when they doze off. So when they’re jolted by a predator on the prowl, they can run away.
Our struggles with sleep are more a matter of attitude. “There isn’t a right way to sleep, but there is a correct way of approaching sleep,” says Dr. Raymond Gottschalk, a sleep disorders specialist.
The first step is understanding that there are rhythms that guide us “to when we are the sleepiest.” Many of us spend our evenings doing things that interfere with our ability to sleep well. These activities can be “alerting" like playing video games, being exposed to bright lights, and consuming caffeine and alcohol, among others.
But, one other thing many of us are guilty of doing is working. “Sitting at a computer, late at night, trying to work” is a surefire way of disrupting your sleeping pattern.
“Sleep is a passive process, but it is something actively done by the brain.” - Gottschalk
The enemy of a good night’s sleep is effort. Trying to fall asleep is the worst thing one can do. Gottschalk claims that “if you insert any level of alertness into it, it’s not going to happen.”
Over decades, he has learned that most people’s problems with insomnia are due to the mind being too alert. “It’s not a sleep deficiency, but rather an alert overdrive.”
Quieting that hamster on the wheel is what its all about. Gottschalk recommends a laissez-faire attitude and uncoupling your angst about it. “If you can turn around and say ‘I don’t give a hoot about sleep,’ your odds are better.”
Now, 13-30% of Canadians suffer from insomnia. It’s often left untreated because very few doctors are qualified to treat an insomnia disorder.
The main reason, however, behind the recent massive increase in insomnia was COVID-19. Add that atop a never-ending list of worries already plaguing the sleep-deficient.
“We’re now on the precipice of a possible nuclear war. We’ve got climate change that is incredibly disturbing. We’ve got news media which fires up the people [and] polarizes them. There’s been this huge societal shift in attitude, behaviour and aggression. We’ve seen a massive increase on attacks against various minorities. It’s quite clear that people are unhappy. They’re worried. They’re frightened. They’re angry.” - Gottschalk
Gottschalk and his staff have experienced the increase in patients hurling abuse first-hand. He’s not surprised and believes “people have been given the opportunity to let go because they’ve seen their politicians do it."
Sleeping less or not being able to sleep doesn’t necessarily imply an insomnia disorder. One needs to have it for more than three months, and it needs to occur at least three times a week.
But some people are just short-sleepers. In fact, the amount of sleep one needs is biologically determined; in other words, it runs in the family. There are families of long-sleepers and short-sleepers. Gottschalk claims that there are “some people who only need four-and-a-half to five hours - they are fairly unusual. Maybe he or she is just a short sleeper.”
“We know that poor sleep is run in families." - Gottschalk
Another factor is obesity. Our American neighbours report an obesity rate of nearly 70%. But despite our best intentions to help people lose weight, only 2-3% of people can do so. Why? Gottschalk points to a biological concept called allostasis.
“If I give you four glasses of water to drink, you’ll urinate out most of those four glasses. Why? Because the body says “I don’t need any more fluid in me.” So, it keeps things the same. When you start losing weight, what is your body going to do? It’s going to say “I don’t like this.”
In theory, the stored energy is an advantage to the body. But if you didn’t know where your next meal was going to come from, why would you voluntarily give up on calories?
Before evolving out of the animal kingdom, losing calories could've meant starvation and death. So, our bodies like to hold on to energy (calories). Having easy access to food whenever we desire is still a relatively new concept from an evolutionary standpoint. Gottschalk doesn't have a difficult time "seeing how we’ve bred ourselves to be crippled with overweight.”
We might first notice excess weight in our stomach area. Eventually, our necks get fatter which, in turn, makes our tongues bigger. Then our airways get smaller, and, soon enough, a sleep apnea disorder is on the horizon as we can’t breathe properly. We also can’t walk properly and start crushing our joints.
Many patients don’t receive the right treatment for a sleep disorder because their physicians don’t want to spend time connecting the dots. Gottschalk has witnessed an evolution in the way doctors approach their patients’ issues since he started analyzing sleep in 1994.
Nowadays, he says, you're only allowed to discuss one medical issue each time you visit your physician.
“One issue per appointment” signs are plastered on the walls of doctors’ offices all over Ontario.
“You can’t say “I have a headache. But, my foot is also swelling up.”
Gottschalk professes that people “often tell you what’s wrong with them.” He harkens back to his days as a medical student in South Africa where he was “hammered by [his] professors to keep a medical history of each patient.”
The present-day ritual of visiting our family doctors for an annual physical alarms Gottschalk, who refers to it as an “annual chemical” instead. “Doctors just check your test results. ‘Oh your blood tests are fine; go home.’ No one touches you, examines you, or even speaks to you.”
They say “I’ve gone for my annual physical.” I say, "no, you haven’t. You’ve gone for your annual chemical.”
To know whether your doctor really cares about you, have a visit, and "you’ll see fairly quickly.”
"If you go to a doctor with a concern, and the moment you sit down, they’re writing a prescription and then trying to rush you out the door, [then you know.] As opposed to someone who looks you in the eye, and tries to figure out what’s going on with you. It's fairly simple!” - Gottschalk
