When it comes to insomnia, comparative effectiveness studies reveal that sleep medications aren't the best bet for a cure, despite what the commercials say. Several clinical trials have found that they're outperformed by cognitive behavioral therapy.
Note that fighting insomnia is implied in the title, as the only alternative. The need to fight insomnia, however, may be regarded as a cultural, as opposed to a natural, need. If you were living in the jungle, you would need to stay awake, or to sleep, for quite different reasons, and on an entirely different schedule, than you need to do if you have a job with regular hours. A personal pet peeve is the cavalier use of evidence. While it lends an air of credibility, the resort to claiming evidence conjures up the well-known quagmire of claims and counter-claims to be found in other studies. My personal situation vis-a-vis sleep allows me to follow the old Zen maxim, from The Tao of Physics by Fritjof Capra:
When Po-chang was asked to define [sic] Zen, he said, "When hungry, eat, when tired, sleep." Although this sounds simple and obvious, like so much in Zen, it is in fact quite a difficult task. To regain the naturalness of our original nature requires long training and constitutes a great spiritual [sic] achievement.
Because I no longer have to show up at a given time every business day, or take care of my personal business in my "off" hours, I now enjoy flex-time in terms of my daily sleep routine. (I am writing this at 3:00 in the morning). One of the great luxuries in life is never having to use an alarm clock. Amongst other influences in my developmental years, the sleep-work patterns of Thomas Edison, who took catnaps around the clock, and R. Buckminster Fuller, who flew around the world so frequently that he was in his own time zone, convinced me of the arbitrariness of our society's agreed-upon norm. Further, research on historical sleep patterns, and those in other cultures, reveals that two periods of sleep per night, with an interim waking and socializing period, as well as siestas during the afternoon when it is hot outdoors, may be more natural than one extended snore. Experiments in underground environments, where people typically revert to a 25-hour circadian rhythm, reinforced my suspicion that the medical establishment's standards for healthy sleep are societally skewed.
For most working stiffs, eating when hungry may be feasible, which opens another whole can of worms, that of eating disorders, which probably exceeds the scale of sleep disorders, and renders my choice of a can of worms inappropriate, or at least unappetizing. Sleeping when tired, however, is beyond the pale for most of us who have a day job. Or are working the night shift. But the fact that the world of work is organized around a cultural meme left over from our agrarian past — rising with the dawn and bedding down after dusk — does not make it natural. The invention of the light bulb did not make wakefulness possible after dark; it just made it a lot more visible, more tolerable, and widespread.
As an aside, I thought it telling to leave the typos [sic] in the quote, suggesting that this online excerpt from Capra was either re-keyed in, or the original publication was not adequately proofed. This is an example of another Zen idea, that the mark of imperfection makes for true perfection.
But more germane to my point about sleeplessness or insomnia is, who says it is not part of our original nature? Who are we to say? The motivations behind those who are promoting cures for it are self-serving, which undermines their implied assumption, that it is a problem to be fixed.
Another expression that has entered the vernacular is sleep hygiene, as a part of cognitive behavioral therapy:
C.B.T. for insomnia (or C.B.T.-I.) goes beyond the "sleep hygiene" most people know, though many don't employ — like avoiding alcohol or caffeine near bedtime and reserving one's bed for sleep (not reading or watching TV, for example). C.B.T. adds — through therapy visits or via self-guided treatments — sticking to a consistent wake time (even on weekends), relaxation techniques and learning to rid oneself of negative attitudes and thoughts about sleep.
A bundle of other memes that go unchallenged underlie Frakt's testimonial, e.g.: identifying mind-altering substances to avoid; compartmentalizing our body's functioning; clock-time consistency as a good thing; therapy as an answer; learning and applying techniques to any identified problem; and mind control to avoid negativity. Each of these can be challenged in its own right, as to whether they are legitimate or not. But here we do not have the space to consider each, and do it justice. One more is that there is a way to quantify any identified problem, in order to understand, and thereby fix, it:
My sleep log also helped me be more objective. Many nights I might have considered "bad" — and fretted over — were ones in which I got only one hour less sleep than my target of seven hours. Recognizing that's not really so bad helped me relax, and relaxing helped me get more and better sleep.
This knee-jerk tendency to rely on things measurable is exemplified by the phrase more and better — a more concise and fitting summation of the American Dream would be difficult to conjure.
This idea of cognitive behavioral therapy is so appealing, that it clamors for closer examination. In Zen, we recognize that fundamental change is not, and cannot be, a matter of intentionally changing our mind, just substituting pleasant thoughts for unpleasant ones. At best, this would be a kind of mental drug, masking the pain, instead of confronting it. The problem is deeper than that, in that our mind is not subject to intentional change, as long as we are following its dictates defining the kind of change that is desirable. We are only muddling about on the surface.
In another NYT article, A New Therapy for Insomnia: No More Negative Thoughts, by Roni Caryn Rabin, we learn that insomnia can be parsed even further:
My problem isn't falling asleep – it's staying asleep. This particular form of torture has been dubbed "sleep-maintenance" insomnia. Call me a high-functioning sufferer: I'm usually O.K. once I've had my morning coffee. But I worry about the long-term health ramifications of losing sleep.
Again, the social balance beam of losing versus gaining. How is sleep something we can lose? For that matter, how can we "lose time"? But that's another can of worms. And again, the caffeine. But further:
What I like about C.B.T.-I. is that it's very no-nonsense. It's focused on problem-solving. You won't find any soul-searching about the deep psychological reasons you can't sleep at night, just a lot of good information that will challenge some of your assumptions about sleep.
But the problem-solving does not expand to challenge the assumption that we need to sleep when we think we need to, and can solve that problem in a no-nonsense, problem-solving way. All very logical and no soul-searching involved. Tidy. And again, with the measurable dimensions we think we can control:
Get up and out of bed at the same time every day. Don't sleep in more than a half-hour on weekends, even if you are sleep-deprived (Sorry, I know that hurts).
The breezy tone and sympathetic style with which these articles are written is another tell, that they are, after all, meant to sell the newspaper or online subscription, and to promote the career of the journalist. All well and good. But how effective are the approaches they are endorsing? Further:
But the key element of Cognitive Behavioral Therapy is cognitive restructuring, which challenges you to reframe negative ways of thinking that can become their own self-fulfilling prophecies. So if you're lying awake thinking about what a basket case you'll be tomorrow because you're not asleep, well, that thought alone will keep you awake.
C.B.T. asks you to look at the situation differently, and replace the negative thought with a positive one.
"I'll fall asleep eventually."
"I can handle this if it only happens a few nights a week."
"I usually function pretty well even when I don't sleep."
So the problem is not that we are constructing our cognitive reality to begin with; it simply needs restructuring. This is another cultural meme: that we need to impose structure. As if Nature is not already elegantly structured. And it can all be done through thinking, i.e. changing our way of thinking. So happy talk is replaced with happy thought. It's a lot cheaper and more convenient to talk yourself into a good mood, than to pay a therapist to do it. Many of these well-intentioned folks are providing and recommending online, or prerecorded therapy, for the same practical reasons.
In my freshman semester in college, I lived in a new dorm, in which you and your roommate shared a 9x12 space, sleeping side-by-side on two bunks that pulled out from a banquette, forming a couch during the day. My roommate, an engineering major, had difficulty sleeping, especially when facing an exam the next day. I am very sensitive to sound when sleeping, and will wake up at the slightest noise. I would hear him sit up, look at his clock in the dark, curse, and slam his head back down on the pillow. This would go on for hours. Meanwhile, he was small and thin, and had to have the heat on full blast, and be fully covered up with blankets. I have the opposite body type, and would be lying on top of my bedding, sweating. After a semester, thankfully, I was allowed to move into the old dorm, with large rooms meant for architecture and design students. In those days we used drawing boards. I think I began to sleep a lot better. Until the end of the semester, when we would stage all-night charrettes, to get the work finished for final critiques.
Zen recognizes that we are in a state of wakefulness-sleeplessness at all times. According to this model, we are sleep-walking through a spectrum of relative alertness that is not simply either awake or asleep, but both awake and asleep simultaneously. While Zen meditation (zazen) may also be considered a technique, we do not have a specific goal in mind, to improve our lives by practicing it. If any improvement occurs, it is a function of embracing what is, that is, natural, rather than attempting to control outcomes. If we end up being able to sleep when tired, or as another quote has it, to sleep when we sleep, fine. But if we set a goal of being able to sleep better, we distort the potential effect of zazen. Zen may be therapeutic in a global sense, but it is not a targeted therapy.
Naturally it occurred to me, when the articles on insomnia assert that there is no dependable cure, to ask, how about meditation? Or not sleeping, as a natural alternative? It recalls a bit by the comedian Shelly Berman, skeptically examining a claim that flying is the "safest way to travel," as compared to driving. He said, with his usual nonchalance, "I don't know how much consideration they've given to walking..." I don't know how much consideration they've given to meditation, or to what kind.
But this is not to make light of the seriousness of insomnia, or the consequences to which it can lead. From yet another NYT article by Pagan Kennedy, titled The Insomnia Machine:
In 1914, The Lancet reported on a clergyman who was found dead in a pool; he had left behind this suicide note: "Another sleepless night, no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night."
Note that this was a clergyman, one whose faith did not sustain him through the horrors of the night. And in those days, of course, the pharmacy to which he would have had access was severely limited, compared to the onslaught of pills on offer for what ails you today. Ms. Kennedy sympathizes:
I came across that passage with a shock of recognition. Many people think that the worst part of insomnia is the daytime grogginess. But like that pastor, I suffered most in the dark hours after midnight, when my desire for sleep, my raging thirst for it, would drive me into temporary insanity. On the worst nights, my mind would turn into a mad dog that snapped and gnawed itself.
It would seem that in both cases, there is something afoot, other than a simple lack of sleep. In fact, one could be forgiven for proposing that attempting to sleep, under these conditions, amounts to an evasive maneuver, an attempt to avoid confronting the basic problem. If we define our issue as a lack of sleep, we can more easily imagine that it is not something that we are responsible for, and therefore rationalize looking to others to provide the solution. She goes on to set a comforting cultural context:
Though one in 10 American adults suffer from chronic insomnia, we have yet to answer the most fundamental questions about the affliction. Scientists are still arguing about the mechanisms of sleep and the reasons it fails in seemingly healthy people. There are few — if any — reliable treatments for insomnia. At the same time, medical journals warn that bad sleep can fester into diseases like cancer and diabetes. Deep in the night, those warnings scuttle around my mind like rats.
Suddenly we enter into an even deeper level of discomfort: the threat of irreversible disease, from medical journals, no less, another talisman meant to lend credibility. If we are not fundamentally responsible for our sleeping or waking states, how much more are we not responsible for the festering, physiological calamities that may result from a simple lack of sleep. We must turn to medication; or, just one typo away, meditation.
But when you look into the meditations on offer, they are of the same ilk as talk-therapy approaches, with you as listener, packaged as "More Sleep Inducing Podcasts":
For instance, in 2013, Drew Ackerman created a podcast to lead listeners into slumberland. Now, three times a week, he climbs into a makeshift studio in the back of a closet and spins whimsical stories about matters of no importance. "Fasten your sleep-belts," he might murmur in a codeine drawl before jumping into a tale about the glug-glug-glug sound of a water cooler.
"People need to be validated," Mr. Ackerman said. "If I'm thirsty, I drink; if I'm hungry, I can eat. But when I want to sleep, that's not under my control. And that's why this is such a painful mystery."
Most of us have the luxury of eating and drinking when hungry and thirsty, which is not the case in many parts of the world, including the USA. Open another can. But the idea that sleep is not under our control is worth challenging. What if the control we exert is not to control? In a desperate attempt to control her inability to sleep when she felt she had to sleep, Ms. Kennedy resorted to her own devices:
But instead of a meltdown, I had a wild idea: What if there was another, easier, way to drive the miserable thoughts from my mind? I began to fantasize about a machine that would do the thinking for me. I pictured it like another brain that would fit on top of my head. The next day, I cobbled together my first insomnia machine.
The insomnia machine, from the catchy title of the piece, consisted of a knit sock, earplugs and a digital playback device that allowed her to listen to lulling soundtracks to cut off the predations of her monkey mind. In other words, a kind of patch, over the abyss. This while sleeping with her boyfriend, who may have found that he had some difficulty himself, as a result of his girlfriend's machine.
The subtitle of Ms. Kennedy's article, "When medicine fails, where can the sleepless turn?" is also revealing. In another irony endemic in our culture, what are basically nostrums are peddled as medicine. Which makes them acceptable, if disingenuous, or even fraudulent. If I am uncomfortable — physically, mentally, or emotionally — I take something for it, and get to call it medicine. It may not cure what ails me, but it allows me to put up with it, or to ignore it, at least for now.
Matsuoka Roshi would often say that most people go through life with something missing. They don't know what it is, exactly, but they know for sure that it is missing. They come to Zen, he would say, to find it. The sleepless have something missing in their lives. They define it as sleep. In order to get more and better sleep, they turn to chemical, physical, and psychological techniques to induce it.
If the meditation applied here were zazen, instead of some ersatz meditation comprised of listening to audio books, or music, or whatever other distractions one may cobble together, it may be that sufferers of insomnia could find what is truly missing in their lives, and insomnia would become a thing of the past, a kind of modern-day malady directly connected to the pace, and memes, of modern life. Even 1914 is not that long ago, though it seems like ancient history today.
The difference with other so-called meditations is that Zen does not encourage us to avoid suffering, or to consider it abnormal. If we cannot sleep, we cannot sleep. If we are awake, we are awake. But even then, we are still asleep, in the most important sense of the word. Perhaps we are not really awake, when we think we are awake. By the same token, perhaps we are not really asleep, when we think we are. To paraphrase a famous Zen master's response to a similar complaint, Why don't you go to a place neither asleep, nor awake?
If we sit in zazen, we engage in falling asleep, while staying awake. If you have difficulty sleeping, we recommend keeping your meditation cushion near your bed. When you have trouble drifting off, just pull the cushion onto the bed, face the headboard, and draw the blankets around your shoulders. In short order, if you are practicing the real zazen, simply paying attention to the posture, the breath — and, yes, your runaway thoughts — you will soon find yourself regarding your condition with more patience, and sympathy. Wakefulness is as natural a condition as is sleeping like a baby.
Personal patience begins with accepting the cardinal principals of suffering (S. dukkha) — namely impermanence, imperfection, and insubstantiality. We recognize that this existence is already brief, and whatever suffering is present will soon pass. There is no need to go drowning ourselves, dramatically. Just wait awhile and you will die soon enough. Meanwhile, we observe that nothing in this existence is perfect, including our precious selves. And if we examine this self very closely, we come to the same conclusion as Buddha — there is no there, there. What is there to suffer insomnia?
When I shaved my head recently, but retained my beard, my wife brought me a cartoon of the well-known R. Crumb comic character, Mr. Natural. She suggested that if I let my beard grow, I would soon look just like him. Which is probably appropriate. In Zen meditation, we look to find the natural posture, the natural breath, and the natural mind. A logical extension would be to embrace our sleep pattern as natural, no matter what form it takes. Insisting on a preconceived idea of what is natural or normal, or at least culturally correct, may be the root of the problem.
Followers of Zen and practitioners of zazen do not claim to offer a silver bullet, or a panacea for all life's problems, quite the opposite. But we do not suggest that we simply grin and bear it, either. Instead, we take action. The way we take determinative action, is called zazen. It is a commonplace in Zen that when we take up zazen consistently, we need less sleep. Ancient monks used to sit up all night, rather than lying down to sleep. Try it some time. You might like it.
As Matsuoka Roshi often said, indicating the zazen posture: This is the most you can do! I join him in urging you: Don't give up!