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To sleep or not to sleep

January 1, 2008
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If Shakespeare had suffered from a sleep disorder, his work might not have turned out quite so well. He'd have written more like me—in a state of unfocused, highly distractible drowsiness, and his affliction undoubtedly would have crept into the speeches of his protagonists. “To sleep, perchance to dream,” a bleary-eyed Hamlet might soliloquize with a yawn, “Ay, that seems unlikely.”

I'm not a good sleeper. In fact, I sleep very poorly. Actually, I'm the worst sleeper I know. Most mornings my wife inevitably chirps, “Did you sleep well?” and I respond to the question in the words of stand-up philosopher Steven Wright—No, I made a few mistakes.” I frequently jest that guilt and shame is what keeps me awake at night, but I wish it were that simple. Sometimes I work so hard to sleep that I have to get up and rest awhile.1

A friend of mine had often maintained with an insensitive level of hubris that between bedtime and the ringing alarm clock he had never awakened in the night. Not once. Ever. In his whole life. Then one morning I got the call. “Gary,” he said with a solemnity usually reserved for horrible news. “It happened. I woke up.” After 40-plus years of life, he had finally experienced—once—what happens to me multiple times every single night. He did the right thing to phone, though, because if he had shared that in person I might have slapped the melatonin out of him.

Anyway, I can't sleep. But I maintain it's not entirely my fault, that I'm just the latest genetic victim in a sad lineage of chronic insomniacs. All across this country, in the wee hours of most nights, I and any number of sleep-deprived family members will almost certainly toss off the covers and wander zombie-like around our respective homes or cells—perhaps consuming a bowl of cereal, watching some television, polishing the silver, or rearranging the furniture alphabetically. It's a curse. Nothing seems to wake us up like going to bed.

Which brings me to one particularly dreary night a couple years ago. As I lay on the couch in the glow of the TV at 3:14 a.m. trying to decide how many BeDazzlers to buy, I finally admitted I had a problem. So like thousands of desperate others before me,2 I trundled off to the hospital for a sleep study. A decidedly wide-awake nurse named Denise3 tenderly stuck electrodes all over my body in a manner I had formerly associated with capital punishment,4 then led me to my room.

The plan was clear, but flawed: Let's grab the guy who can't sleep in the privacy of his own home, cover him in wire, put him in an uncomfortable hospital bed, tell him he's going to be videotaped and watched all night by strangers, then perkily exhort him to “sleep well.” About two in the morning I finally sat straight up in fatigue and disgust, and immediately a soothing, otherworldly voice came through a hidden speaker above me. “Is everything okay in there, Gary? Do you need any help?” If it hadn't been so frightening, it would have been an almost spiritual experience.5

Somehow, though I don't remember ever falling asleep, enough data was gathered to prove I had sleep apnea,6 and I left the hospital with a shiny CPAP machine under my arm. For those of you who are unfamiliar with this apparatus, the name stands for Continuous Positive Airway Pressure, which is scientist-speak for “we're going to turn your throat into a wind tunnel.” Each night I slip the mask over my face and transform into a hybrid of Hannibal Lecter7 and an asthmatic Darth Vader. As millions of Americans have discovered, the device also works wonders for birth control.

But for all its aesthetic failings and marital risks, the CPAP has virtually cured my condition, mostly because I'm unable to sleep while it's attached to my face.8 It's a foolproof solution—if I can't sleep, I can't possibly die in my sleep. Unfortunately, although I don't seem to have sleep apnea anymore, I now have a bad case of CPAPnea, defined in the Physicians’ Desk Reference as “an inability to fall sleep while wearing a hockey mask attached to the wrong end of a vacuum cleaner.”

Still, things are looking up. I'm feeling better, more rested and refreshed, and I recently bid a tearful good-bye to my friends at Insomniacs Anonymous. But just when my own nighttime problems are nearing a solution, it looks like the entire healthcare profession may be developing its own sleep disorder.

Reputable research apparently has found higher rates of breast and prostate cancer among women and men whose workday starts after dark.9 Scientists suspect10 that overnight work is hazardous because it disrupts the circadian rhythm, the body's biological clock, and the World Health Organization plans to add night shift work to the official list of “probable” carcinogens.