Allan, the owner of an electronics firm outside Boston, was an insomniac. Most nights it took him at least an hour to fall asleep; he usually got up several times during the night to go to the bathroom; and he always awoke, wide-eyed, before dawn. At work he felt jumpy and had trouble concentrating.
Allan had gone to his family physician about his insomnia, but the doctor only prescribed sleeping pills and offered some platitudes. He provided no real solutions to Allan's problem. Finally, a year of fitful sleep drove Allan to seek help from the sleep clinic at Brigham and Women's Hospital in Boston.
"When a problem interferes with an entrepreneur's productivity or in any way threatens the bottom line, he's ready to act," explains Dr. Quentin R. Regestein, director of the sleep clinic. "And he's not interested in symptomatic relief. He wants to get right to root causes -- and he usually does."
When doctors and patients talk about insomnia, they don't mean the occasional sleepless night everyone experiences. Rather they mean chronic difficulty in falling asleep (taking more than 15 or 20 minutes), awakening several times during the night and having trouble falling back to sleep, and, finally, waking up too early in the morning.
Today, about 40 clinics across the country study sleep and treat hundreds of people with chronic insomnia and other sleep disorders, such as narcolepsy (sudden attacks of sleep during waking hours) and sleep apnea (temporary cessation of breathing during sleep). Scientists have investigated the phenomena of sleep since the early 1920s, but it wasn't until the early 1950s that a big breakthrough occurred. "Graduate students at the University of Chicago began studying rapid eye movements during sleep," says Regestein, "and people began to realize that dramatic things were happening -- we weren't simply witless as cabbages while we slept."
Since then, scientists have attached electrodes to people's heads and done elaborate studies of the human nervous system during sleep. Yet, ironically, though the research on sleep and sleep disorders has grown increasingly complex, the factors contributing to insomnia remain remarkably mundane: going to bed at irregular hours, relying on sedatives, drinking too much alcohol, and consuming caffeine from such sources as coffee, tea, colas, chocolate, pain remedies, and even coffee ice cream. Caffeine disturbs sleep more than most people realize. Chemically related to amphetamines, caffeine can act for as long as 20 hours; a cup of coffee at breakfast may still be percolating in your brain at midnight.
"When people visit a sleep clinic, they expect to have a specialist delicately apply stainless steel instruments to magically exorcise their problem," says Regestein. "Occasionally we resort to that. But more often, the great high-priced expert says, 'Give up coffee,' and the patient says to himself, 'I paid for this?"
But treatments aren't as casual as they may appear. For patients like Allan, the clinic first obtains a detailed medical and personal history to identify conditions, practices, or habits that might be interfering with the ability to sleep well. Among the more common medical conditions are arthritis, peptic ulcer, migraine, angina pectoris, hiatus hernia, irritations of the esophagus, backache, and the effects of drugs used in treating hypertension.
Largely on the basis of the history and interview, the staff formulates a regimen for each patient. If the person isn't sleeping better within a specified period after dealing with the presumed causes of his or her insomnia, the staff digs deeper to uncover other possible physical or phychological causes. This outpatient approach has proved successful about 90% of the time, provided the patient sticks to the clinic's regimen. Typically, patients are seen every three weeks for a total of five visits.
Allan was like many of the entrepreneurs and corporate executives Regestein sees: "He ran instead of walked," explains the doctor. "When he got into bed he was still running, thinking about business problems. A guy like Allan has built-in amplifiers -- he's more awake to begin with than most other people. You take the amplifier and crank it up with caffeine and he's right off the ceiling."
Following the clinic's regimen, Allan gradually cut out caffeine and sleeping pills over a period of several weeks. Although the benefits of sleep-inducing drugs are unclear, the dangers are not. Known hazards include drowsiness during the day, "hangover," and habituation that gradually increases the patient's reliance on these drugs. Allan had begun to realize that the pills were no longer helping him sleep, and he was "dopey" for quite a few hours the next day, especially if he drank any alcohol at lunch.
Alcohol, especially four or more drinks a day, can contribute significantly to sleeplessness. Although alcohol may indeed help put you to sleep, it erodes the quality of sleep after the first few hours, causing you to toss and turn, possibly because of withdrawal. When a patient is having trouble sleeping, Regestein tries to get him to taper off and then cut out his drinking. Once he's sleeping well, if alcohol doesn't bring back his insomnia, he is allowed to drink again.
Because Allan was committed to work and willing to change his behavior in order to work with greater alertness and zest, he was not difficult to cure. "He gave up sleeping pills; he gave up coffee; he gave up chocolate ice cream," says Regestein. "You tell these CEOs, 'Do the following,' and, by God, they do it." Regestein believes most people are capable, if they make the effort, of figuring out what in their behavior contributes to insomnia. More difficult is eliminating those substances, habits, and practices. If they can't do so on their own, they need professional help.
"Insomnia is seldom overcome by a simple poly like counting sheep or taking a pill," Regestein comments in his book Sound Sleep (Simon & Schuster, 1980), written with James R. Rechs. However, you might give grandmother's old remedy -- drinking a glass of warm milk at bedtime -- a try. Some doctors theorize it works because of a substance called tryptophan, an amino acid found in milk; others call attention to the psychological effects, the pleasant condition associated with maternal care; still others believe it affects soporific hormones. "In a setting of ignorance," says Regestein, "appealing theories abound. More important than the reasons is that it works."
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