Insomnia at the Pinnacle of Power

We don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Insomnia was a problem for Mao ZedongWe don’t hear much about the sleep of presidents and prime ministers except for the hours they get: President Obama, 6; George W. Bush, 8: Margaret Thatcher, 4. Their personal habits matter little compared with the decisions they make and the work they do in office.

But Dr. Li Zhisui wrote about insomnia at length in his biography of Mao Zedong, The Private Life of Chairman Mao, suggesting that our leaders’ sleep (or sleeplessness) may affect their decisions and behavior more than we think.

Mao’s Stress-Related Insomnia

As Mao’s personal physician, Li was expected to give up all other duties to see to the chairman’s health and wellbeing. So he worked and lived in the ruler’s compound, observing him at close range and eventually becoming Mao’s confidant.

Li noted right away that Mao’s sleep was erratic. Anticipatory anxiety would keep him awake on nights before public events where he was to address the masses.

“Often he would get no sleep at all the night before the festivities,” Li wrote. “He was exhilarated by the crowds and their adulation, and his energy always carried him through the event, but he often caught cold afterward. Sometimes the cold would become bronchitis, and he would be miserable for weeks.”

A Possible Circadian Rhythm Disorder

But Li observed that Mao’s erratic sleep patterns seemed to be driven by internal as well as external factors. Mao was a night owl who tended to be awake when most other people were sleeping.

“His body refused to be set to the 24-hour day,” Li wrote. “He stayed awake longer than others, and much of his activity took place at night. If he went to bed one day at midnight, the next night he might not sleep until 3 in the morning, and the day after that he would not sleep until 6. His waking hours grew longer and longer until he would stay awake for 24, or even 36 or 48, hours at a stretch. Then he could sleep 10 or 12 hours continuously, and no amount of noise or commotion would wake him.”

This erratic sleep pattern would probably be classified as a circadian rhythm disorder today. It might be delayed sleep phase disorder, a diagnosis often given to night owls who prefer to be up at night and sleep in late in the morning. It might also be non-24-hour sleep-wake disorder, a problem often seen in people who are blind, who cannot detect daylight and whose body clocks—as a result—are not set to the 24-hour day.

Whatever the diagnosis, the problem may have been amplified by Mao’s unusual lifestyle. He spent most of his time indoors—in his bedroom, according to Li, where thick dark curtains blocked out the sunlight. Without exposure to sunlight, his circadian rhythms may have become desynchronized, a situation that could easily give rise to insomnia.

But Li felt Mao’s problem was partly organic, and that he’d simply been born with a wayward body clock predisposed to run on its own time.

Insomnia Affected Mao’s Behavior

People with sleep problems like Mao’s don’t usually have easy lives. Perennial lateness and poor performance interfere with relationships and jobs.

But Mao rose to a leadership position despite his strange sleep habits and, as Chairman of the Communist Party, he called the shots. Without regard for the sleep needs of his associates, he would call impromptu staff meetings at 3 a.m. On the spur of the moment he would order his whole staff to get up early to prepare for a 4 a.m. departure by train.

As disruptive as his strange sleep habits were to others, they were a source of great anxiety to Mao himself, Li said. Mao tried swimming, dancing, and walking to wear himself out, and he took up to 4 times the recommended dosage of powerful sleeping pills. But often, Li said, nothing worked.

Could there be a relationship between the tight-fisted control Mao insisted on exerting over his country and the lack of control he seemingly had over his sleep? What do you think?

Q&A: Should Night Owls Use Sleeping Pills?

Rob wrote to Ask The Savvy Insomniac complaining about insomnia and wondering if Belsomra might help.

Today’s blog post features his story and my response.

Rob wrote to Ask The Savvy Insomniac complaining about insomnia and wondering if Belsomra might help.

trouble functioning in the a.m. could indicate circadian rhythm disorder

I’ve had insomnia since my teens. Never could get to sleep before 2:30. And that’s when I’m lucky. Sometimes it’s 3:30 or 4.

I do everything I’m supposed to do. I work out at the gym every day. I have a few beers when I get home but that’s it. I use a blue light blocking app on my computer and anyway I’m usually off it by 11. But nothing I do changes the situation. I just don’t feel sleepy. No matter how sleep deprived I am, I feel wired.

When the alarm goes off at 7:20 I feel exhausted. Coffee doesn’t help. I fight to stay awake at the office and by the end of the week it’s a losing battle. Early morning meetings are the worst.

What saves me is being able to sleep in on weekends. That and sleeping pills. Ambien will sometimes put me to sleep by 1. So my question is: Do you think Belsomra could work for me?

Barking up the Wrong Tree

I’m no doctor, but I suspect that if Rob were to consult a sleep specialist, his diagnosis would not be insomnia disorder but rather delayed sleep phase disorder (DSPD). The symptoms he reports are classic:

  • a preference for going to sleep several hours later than normal
  • difficulty sleeping at more conventional times
  • feeling alert, not sleepy, at night
  • struggling to wake up and function in the morning
  • catching up on sleep on the weekends

Rob might not have a sleep problem if his work began at noon. But most jobs start earlier, and for people with DSPD, trying to function on a conventional schedule is a major ordeal. It can quickly lead to sleep deprivation and trouble meeting obligations. It limits prospects down the line.

A 25-Hour Circadian Period

We humans can’t choose our sleep time preferences. Whether you’re a night owl, an early bird, or somewhere in between depends on a mix of genetic factors. These preferences can be modified, though, and may also evolve with age-related changes.

Sleep experts have long suspected that people with DSPD have body clocks that run slow, taking longer to complete their daily cycle. While the average circadian period in humans is 24 hours 11 minutes, scientists have hypothesized that the period length in people with DSPD is closer to 25 hours.

The results of two recent studies confirm that circadian rhythms are quite a bit more delayed in people with DSPD than in normal sleepers:

  1. Investigators in Australia assessed study participants’ core body temperature rhythms over 78 hours and found that under conditions of a constant routine, DSPD patients’ temperature rhythms were delayed by about one hour a day. This suggests “that DSPD patients, on average, must advance their circadian rhythm by almost an hour each day to maintain stability of their sleep–wake cycle to the 24-hour world.”
  2. Using a similar, 30-hour study protocol, the same team found that melatonin secretion began almost 3 hours later in DSPD patients than in normal sleepers. While in normal sleepers the melatonin secretion began with a surge, in DSPD patients, it started out gradually.

No wonder people like Rob have trouble getting to sleep!

Therapies: Bright Light and Melatonin

The most effective treatment for night owls wanting to get to sleep sooner is not sleeping pills but rather bright light therapy. The light source can be the sun or a light box that disseminates light at 10,000 lux. Light exposure should occur first thing in the morning. The largest phase advances occur in sessions lasting for 2 hours.

Phase advances are also larger when morning bright light sessions are combined with a melatonin supplement taken late in the afternoon or around dinnertime. Combined with 0.5 mg of melatonin taken late in the afternoon, continuous exposure to bright light for 30 minutes early in the morning was found, in another recent study, to produce 75% of the phase shift that occurred with the 2-hour exposure.

But the bright light–melatonin regimen is not a cure for DSPD. Stop it and your circadian rhythms will revert to their natural cadence. This will also happen if you allow yourself to sleep in late on weekends. You’ll function best if you maintain the same sleep-wake schedule all 7 days of the week.

As for sleeping pills like Ambien and Belsomra, why assume the risks these pills confer when bright light therapy and melatonin supplements, which have few if any side effects, can work even better?

If you’re a night owl, have you tried bright light therapy and/or melatonin supplements? How have they worked?

Sleep at College: Here’s How to Get Enough

Off to college soon (or know of someone who is)? You’re probably looking forward to interesting classes, good friends, and the freedom to live away from the prying eyes of Mom and Dad. Heady prospects, all three! But you’ll also face some challenges. Getting enough sleep may be one.

But college life doesn’t have to be disruptive to sleep. By planning ahead, you can get the sleep you need whether you’re inclined to get up early or burn the midnight oil. Here’s what you can to do get a better night’s sleep away from home.

Make sure you sleep well at collegeOff to college soon (or know of someone who is)? You’re probably looking forward to interesting classes, good friends, and the freedom to live away from the prying eyes of Mom and Dad. Heady prospects, all three! But you’ll also face some challenges. Getting enough sleep may be one.

Sleep at college was a challenge for me: growing up in a quiet home, prone to occasional bouts of insomnia, I was unprepared for life in a dormitory. The dorm was a place where rock music and partying ruled—no matter that some of us had early morning classes. Often I struggled with insomnia. That I could see, the world was divided into two tribes: early risers and night owls. Living so close together was a pain in the neck!

College life doesn’t have to be so disruptive to sleep. By planning ahead, you can get the sleep you need whether you’re inclined to get up early or burn the midnight oil. Laura McMullen in US News & World Report recently offered advice on how to sleep well at college. Here’s mine.

If You’re an Early Riser

Especially if you’re a light sleeper or one who needs a solid 8 to 9 hours, you’ll need to be prepared to deal with unwanted noise at night. You can

  • Arm yourself with silicone earplugs
  • Use a device that creates white noise. Small fans work well, as do white noise generators that can be purchased online or at stores like Best Buy. My brother swears by his SleepPhones, also available online.

A bigger challenge for early risers may be negotiating with roommates for the conditions you need to get a good night’s sleep.

  • Be up front about the situation from the start. Tell your roommates you’ve got an early class and need the place to be quiet and dark by 11 p.m. Ask them please to text rather than talk on the phone, or to wear a headphone while watching TV.
  • If friendly negotiations don’t do the trick, then request a move–the sooner, the better. Ideally you’ll know of another person looking for an early-bird roommate or someone who’s likely to be considerate of your needs. If not, interview prospective roommates about their habits at night. Given a choice of location, avoid rooms near high-traffic areas like bathrooms and stairways.

If You’re a Night Owl

Noise won’t be such a problem if you’re naturally inclined to stay up late. But you may find that your sleep preferences are out of sync with daily life on campus. Your circadian rhythms are delayed, so you’ll tend to be sound asleep when early morning classes begin and you may not feel truly alert until much later in the day. (A young night owl I know claims he doesn’t really hit his stride until 6 p.m.)

To get the sleep you need and feel alert during the day,

  • Make strategic use of bright light. Light is your friend in the morning but a foe at night. When you get up in the morning, open the curtains and turn on the lights. Spend time outside if you can. In the evening, keep lighting low. Avoid computer screens and other light-emitting devices for an hour or two before going to bed.
  • Check with your doctor about using over-the-counter melatonin supplements. Taken around dinnertime, they enable people to fall asleep earlier than normal—at midnight, for example, rather than 1 or 2 a.m. (For details, see this blog or watch this video trailer.)
  • Schedule your classes later in the day. If you slept through 8 o’clock classes in high school, chances are you’ll sleep through early morning classes at college. You may be older, but circadian rhythms remain fairly consistent.

Arrange for active days and restful nights as best you can. If you still find yourself dropping off to sleep in class, catch some shut-eye in the middle of the afternoon. Ten- to 30-minute naps can do wonders for your stamina and put you on top of your game.

Q & A: Solutions for Sleepy Night Owls

A small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

Here are a couple ways she could shift her biological rhythms so that she feels like going to sleep earlier.

owl-headphonesA small business owner wrote to Ask The Savvy Insomniac to say that her problem was that she didn’t normally feel sleepy until around 3 a.m.

“When I try to analyze my sleep problems,” she wrote, “I feel I’m possibly confusing being a nocturnal person with insomnia. I’ve always wanted to stay up late. I feel like I’m about 3 hours behind the rest of the world. No matter how tired I am in the evening, I still can’t go to sleep till early in the morning!

“Sometimes just  knowing that I have to get up earlier than usual for a meeting or having to catch an early flight makes me crazy and not able to sleep. Then I try to regain what I lost in sleep the following morning. On some days I don’t get in to my office until 1 p.m.!” Other than take sleeping pills, she wanted to know, what could she do that would help her get to sleep at a reasonable hour?

An Inherited Trait

It’s no fun being a night owl when you have to march to the beat of a corporate clock. Getting up at 7 a.m. may be easy for those who fall asleep by midnight, but it’s much harder if you can’t fall asleep till 3. You’re a zombie at early morning meetings, spilling coffee and forgetting papers and keys, and then slogging through the day with what feels like a whopping hangover.

This inclination to want to go to sleep and get up late is not a matter of choice; one in 10 people are genetically programmed to experience what doctors call Delayed Sleep Phase Disorder, or DSPD. The body clock simply runs on a later schedule in people with DSPD. Here are a couple ways to shift your biological rhythms so that you feel like going to sleep earlier.

Bright Light Therapy

One is to expose yourself to bright light for a few hours right after you wake up, every day. Sunlight works best—but taking a walk or sitting by a window may not be in the cards if you have to get yourself ready for work or get children off to school.

Another option is to use a light box. While sitting beside a light box for two hours straight may not fit into your early morning routine, time with the light box can be interspersed with taking showers, getting dressed, making breakfast, and other early morning activities. The idea is to spend as much time by the light box as possible in the first few hours after waking up.

Melatonin Supplements

The other way to shift your biological rhythms forward is to use melatonin supplements. But taking melatonin according to the instructions on the label—an hour before bedtime—is not going to help. To get a sizeable phase-shifting effect, you have to take it around dinnertime. Specifically, 3 mg of melatonin taken seven hours before the time you actually fall asleep will give you the biggest bang for the buck, according to Charmane Eastman, director of the Biological Rhythms Research Lab at Rush University Medical Center, whom I interviewed last year. As is true of bright light, melatonin has to be used daily to keep your body clock from shifting back to its natural cadence.

A combination of bright light and melatonin supplements works even better than either therapy alone. Not being a night owl myself, I can’t speak from personal experience here. But research shows these therapies to be effective for a majority of night owls wanting to sleep more “normal” hours.

If you’re a night owl, does your work allow you to sleep in late, or have you had to adjust your sleep schedule to start work early? How have you done it?   

Larks and Owls Choose Different Careers

Being a morning person or a night owl is such a fundamental aspect of who we are that it appears to affect the majors college students choose.

For some 500 juniors and seniors who completed a survey at Penn State University, researchers found several correlations between their sleep habits and their chosen fields of study.

career options, choices, decisions“You can’t fight your body clock,” a colleague of mine once said, as we were talking about my mid-life career switch to journalism. I agree. I’ve always been a morning person, and a job that involved covering lots of public meetings at night would have made my sleep problem a lot worse.

Being a morning person or a night owl is such a fundamental aspect of who we are that it appears to affect the majors college students choose. For some 500 juniors and seniors who completed a survey at Penn State University, researchers found several correlations between their sleep habits and their chosen fields of study, according to a report in Huffington Post.

  • Nutrition majors tended to be morning people.
  • Students who majored in Management Science & Information Systems, or Administration of Justice, tended to be night owls.
  • Media students were the most sleep deprived, averaging over three hours’ less sleep a night than they wanted.
  • Speech Communication majors, on the other hand, tended to report getting nearly a full night’s sleep every night.

Why Does All This Matter?

“A mismatch of job time and biological time, as well as intolerance to partial sleep loss, can negatively influence peak job and school performance,” study author Frederick M. Brown wrote in an email following the conference last week. “It can become a stressor and increase on-the-job errors or accidents. Not only that, individuals who show strong aptitude for certain professions may be dissuaded from pursuing them in favor of following their preferred morning vs. evening activity routine.”

I empathize with Brown’s concerns. The mismatch of job time and biological time and partial sleep loss can cause real problems in people’s lives. But I’m not sure why he’s studying college students, who after all do have more choices than most of us and can take their natural sleep patterns into account as they’re making decisions that will affect the rest of their lives.

Surely it’s the ones among us who don’t have choices—the less educated, the poor, the unskilled—who, forced to work nights and do shift work, struggle the most with the problems Brown is lamenting. Shouldn’t we be devoting our research dollars to studying the impact of the unnatural sleep patterns they’re forced to adopt, and to helping them manage their sleep?

If you’ve routinely had to work during hours when you wanted to sleep, what was that experience like, and how did you cope?

Insomnia Is His Friend

There are those who, rather than fight insomnia, decide to embrace it. Los Angeles musician and sound artist Jean Paul Garnier is one. Garnier’s erratic sleep pattern inspired him to begin work on an eight-hour composition called “Sleep Map,” which he hopes one day will help others get a good night’s rest.

There are those who, rather than fight insomnia, decide to embrace it. Los Angeles musician and sound artist Jean Paul Garnier is one. Garnier’s erratic sleep pattern inspired him to begin work on an eight-hour composition called “Sleep Map,” which he hopes one day will help others get a good night’s rest. This week he told his story on the radio station KQED.

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Photo by Steven Cuevas, KQED

“I remember going back to when I was 5 or 6 years old being an insomniac,” he told reporter Steven Cuevas. “Because it’s been so long and I’ve fought against it for most of my life, I’ve been happier and my life’s been better since I decided to embrace it and work with it instead of fighting against it. So now, that’s just what’s become normal in my life and it works for me.” (For the full story, click here.)

A Night Owl?

This raises the question of whether Garnier is just naturally a night owl—a person whose body clock runs late, who stays powered up till the wee hours and then habitually sleeps till 9 or 10 a.m. While this may in part be true, to hear Garnier talk, his sleep is broken and completely unpredictable. Typically it comes in short bursts rather than in a single consolidated period. But now, whatever odd hours Garnier is awake, rather than lie in bed agonizing about it, he’s up in his sound studio composing.

I wouldn’t trade my now-more-regular sleep pattern for Garnier’s irregularity. Been there, done that, and it didn’t work for me.

All the same, I envy a guy who can marshal enough brain power to “layer isotonic tones” and create “ambient, ethereal music” at 2:22 a.m. In my case, my brain checks out somewhere around midnight. Not only is trying to do anything intellectual then impossible, but it hurts! Not to mention the achiness of my arms and legs which, on really bad nights, crave immobility. The idea of actually getting up and doing something—never mind being productive—is anathema! I’d rather kiss Newt.

On the other hand, if I had it in me to create beautiful soundscapes at 3 in the morning, I don’t think I’d resist departing from social norms and making peace with erratic sleep. In sleep as in our waking hours, we’re all different, and the consolidated sleep pattern held up as a model by sleep experts today is not for everyone.

What activities do you do when you’re awake at night?