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The Star Online: Lifestyle: Health

Sleep like a baby at any age

Posted: 18 May 2014 09:00 AM PDT

Learn the A to Zzz of getting a good night's slumber.

I HAVE a dream. A dream of a decent night's sleep. Not necessarily the hallowed, undisturbed eight hours – the impossible dream if you will – just six consecutive hours would do nicely; I'm not greedy. But for most of last year, even that eluded me.

For months I'd wake, heart pounding, in the dark pre-dawn hours for no discernible reason, soaked in sweat, unable to return to sleep. For months, that was, until I met the man of my dreams – Guy Meadows.

For much of my life, I would sleep like an anaesthetised patient on an operating table.

But about nine months ago, after a near-simultaneous one-two-three of major life events: getting married, buying our first home and a close family bereavement, somebody sneaked kryptonite into my pillowcase, and my superpower was gone.

Since then I had tried countless "solutions," from hot baths to a cold thermostat. I'd gone through three different types of eye mask and an entire menu of herbal teas. I had bought new pyjamas (soft) and a new mattress (hard). But however I approached it, the doorman at the entrance to the Land of Nod simply shook his head.

Cue Dr Guy Meadows, "The Sleep Doctor", who last month established the week-long Sleep School, on the Caribbean island of Grenada.

Now the first thing to note about Sleep School is that, ironically, it takes me a good eight hours to get there.

For the 90% of the population who do not suffer from insomnia, this might seem somewhat excessive. But to be candid, I would have flown to see the man in the moon if it meant I could start to sleep properly again.

The other 20 students, who had travelled from across the world for Sleep School's inaugural week at the start of December, obviously felt the same. Like me, they had exhausted all of their other options.

Battle lines

The battle lines were drawn: our showdown with the sandman was to take place just a stone's throw from the beach at LaSource, a holistic resort on the sleepy south-eastern coast of one of the Caribbean's sleepiest islands.

"People have become very good at sleeping very badly," says Meadows.

"Good sleepers don't have any rules. You ask them what they do to get to sleep and they'll say 'nothing'. You ask an insomniac what they do and they'll say 'everything'.

"Sleep is a natural physiological process. Our bodies know how to do it – we are just getting in the way."

Looking around the sun-drenched pavilion as my classmates introduce themselves and their own issues, I have to confess I'm a bit wary.

Where are the shiny, state-of-the-art machines, the comforting leads, wires and computers to analyse our sleeping patterns and return them to normal? There isn't a single pot of pills in sight. All we're given is a 50-page workbook, with blank spaces for our homework each night.

Next to the pavilion, a small, splashing water fountain gurgles and chuckles to itself – possibly at the idea of 21 adults flying across the world to learn a skill that newborn babies manage with ease.

My fellow sleep-schoolers range in age from early twenties to mid-sixties and come from all over the world: Britain, the United States, Germany, the Netherlands and Australia to name a few. But as we take turns describing our sleep issues, I'm struck by how similar we all are. Whenever somebody describes an experience, six or seven heads immediately nod in accord.

Clinical insomnia, Guy explains, is categorised as "three to four nights of poor sleep a week, lasting for more than a month". Looking round the room, I see straight away that we can all relate to that. The good news, he adds, is that we can all recover from it, too.

As if from thin air, Guy whips out a length of rope. Beckoning me to the centre of the class, he offers me one end of the rope, before gently pulling on the other, as if warming up for a bout of tug-of-war.

"What's your natural instinct when I pull?" he asks.

"To pull back," I reply, doing exactly that.

"Fine, but how much energy are you using in the process?" he asks me, as I place my feet shoulder-width apart, and feel my triceps straining. A lot. He's stronger than he looks.

"What if you simply let the rope go? How much energy would you be using then?" he asks. Obviously none. "So what do good sleepers do to get to sleep?"

"Nothing; insomniacs do everything."


This metaphor is at the heart of Guy's approach to insomnia. To win the battle once and for all, he says, we have to stop fighting.

His system – which he claims has an 87% success rate – is based on acceptance and commitment therapy (ACT).

This is a process of "welcoming" your problems, accepting them and then watching them lose their power and drift away. It's diffusion by defusion.

"The harder you try to fight insomnia, the more you fuel it," says Guy. "Instead you need to embrace it. Think of it as a patch of quicksand: the more you struggle with it, the deeper you sink."

I'm not particularly convinced. Doesn't dropping your end of the rope mean you've automatically lost the bout of tug-of-war? But, I reason, at least this approach is something I haven't tried before.

Guy, who has a PhD in sleep disorders, has devoted the past decade to this field, seeing more than 500 patients on a one-to-one basis every year. The majority come to him after trying a cornucopia of desperate remedies first. One of his clients had bought six new mattresses in the space of 12 months.

"The real solution," repeats Guy, "is to accept the situation. And the best way to unlock that is by practising Mindfulness."

Through a number of targeted exercises – including the analysis of a single raisin in painstaking detail – he introduces us to this concept. In a nutshell, it is about becoming acutely aware of your immediate surroundings via your five senses. In this way, you become an "observer", distancing yourself from troublesome thoughts. Or, as Guy puts it, "you move from the subjective into the objective, and from there, into sleep."

Sleep School consists of five two-hour classes over five consecutive days, and while it does seem somewhat flashy to fly to the Caribbean to experience it, there are a number of positives to tackling insomnia at a resort such as LaSource.

First, every package includes a free massage or treatment every day and guests are encouraged to join yoga or taichi classes first thing in the morning.

Second, you're in a group environment, which leads to a lowering of inhibitions and a ready-made support network. Third, you're completely shut off from any day-to-day concerns, and can fully focus on the study of sleep.

"This is the optimal learning environment – completely removed from the everyday stresses of life, with abundant relaxation all around you," says Guy.

It sounds corny, but he's right.

As the classes go on, a sense of camaraderie builds. This isn't just Insomniacs Anonymous – it's a full-blown fusion of summer school and pyjama party, and I'm genuinely enjoying it. But despite this, and our increasingly fascinating exploration of polysomnography (the technical term for sleep study), I'm still struggling with the most important part of my homework: a good night's sleep.


One of the final parts of our course involves a detailed look at something called the amygdala: two walnut-shaped and sized bumps at the back of your head that are key to your brain's emotional function.

"Your amygdala evolved to notice looming threats, such as lions or tigers, then flood your system with adrenaline and cortisol to help you fight them," explains Guy. "It's like a rev-counter. The problem comes when you're under lots of stress, and your amygdala keep getting pushed into the red. If this happens too often, your body adapts and thinks it needs to stay there permanently. And that means your system is flooded with adrenaline and cortisol when it doesn't need to be." Like, say, when you're asleep.

This all makes perfect sense. More than that, it's reassuring to know that I'm not a freak; my walnuts are just a little ... overactive. It's a revelation.

Then, on night four: a breakthrough. As usual, I wake up at about 4.30am, but before reaching for my iPod, accepting that I will not go back to sleep, I concentrate hard on being "present". On feeling the bed under my body, on the sound of the fan above me, on the ocean outside my balcony. And somehow, there's no jagged kryptonite under my head anymore. The next thing I know, it's 9am and I've missed my yoga class.

The final day of Sleep School is incredibly positive. Almost everyone feels they have made progress of some kind, even those who have struggled with insomnia for more than 40 years.

Guy waves us off outside the resort, and it's as if he's casting one final spell: I sleep for the entire plane journey, all the way to London. But it doesn't stop there. Soon after my return, I earn a "tenner": 10 hours of beautiful, undisturbed slumber. I wake from deep sleep amazingly refreshed and with the detailed schematics of a bicycle for cats in the front of my mind.

In the four weeks since Sleep School, I've admittedly had a handful of mediocre nights' sleep, but predominantly they've been good, sometimes excellent – and never bad. As far as I'm concerned, Sleep School was worth every penny. Plus, I tell myself, I can make the money back tenfold if I patent the Cat Cycle. Well, I can dream... — Guardian News & Media

Mental illness affects us all

Posted: 18 May 2014 09:00 AM PDT

Even the happiest country on Earth is not spared the spectre of mental disorders.

WHICH is the happiest nation on the planet? Fans of The Killing, an American crime drama television series, may be surprised to learn that it is Denmark. Nordic noir offers us a claustrophobic country shrouded in fog and lashed by icy rain, stalked by serial killers and riddled with corruption: a land from which noble souls such as Sarah Lund are compelled to flee, never to be seen again.

In stark contrast, the World Happiness Report 2013, written by leading academics, finds that levels of self-reported happiness are higher in Denmark than anywhere else, with fellow Scandinavian countries Norway and Sweden also in the top five. Britain is 22nd and the United States 17th. The lowest ranked nations – out of 156 – are Rwanda, Burundi, the Central African Republic, Benin, and last of all Togo.

Why are the Danish so happy? The World Happiness Report cites factors such as healthy life expectancy, GDP per capita, levels of social support, freedom to make life choices, perceptions of corruption, and the degree of generosity shown by citizens. Other experts have highlighted Denmark's high degree of income equality: this is a country, it seems, where people truly are "in it together".

Given that levels of happiness are so high in Denmark, it is reasonable to assume that Danes also enjoy good mental health. But a study published this month by the American Medical Association tells a very different story – one that demonstrates just how common mental health problems are, regardless of where people happen to live.

One of the many positive aspects of life in Denmark is its universal healthcare system. As part of that system, treatment for mental illness is recorded in the Danish Psychiatric Research Register: a resource that provides scientists with a treasure trove of data.

Since 1969, for every person living in Denmark the register has logged admissions to psychiatric hospitals, visits to outpatient psychiatric clinics, attendance at psychiatric emergency departments, and all diagnoses. As such, it provides a comprehensive and uniquely detailed picture of treatment for psychological problems in the country.

On the basis of the register's data, researchers estimated that 38% of Danish women and 32% of Danish men will receive treatment for a mental disorder at some point during their lifetime.

Remember: these statistics only include cases serious enough for professional help to be required. Of course, there are likely to be many more people with mental health conditions who for one reason or another don't seek treatment. This is why representative epidemiological surveys often produce even higher estimates for mental ill health than the Danish study.

But for all those who criticise such surveys for including problems that are mild or transient, this latest research constitutes a forceful riposte. Mental illness is not a figment of over-eager clinicians' imagination; the problem is real and widespread.

The Danish results contain fascinating details. Women are more likely than men to develop a mental health problem, and this pattern is certainly evident in Denmark.

We also see the classic dichotomy in the types of mental health problem experienced by men and women. When it comes to so-called "internalising" conditions, rates for Danish women are higher than for Danish men: for anxiety disorders, 19% of women will receive treatment compared with 13% of men; for depression the figures are 16% and 9% respectively.

Men, on the other hand, are more vulnerable to "externalising" disorders: in Denmark 8% of men will receive treatment for alcohol or drug problems, twice the figure for women.

Eating disorders such as anorexia nervosa and bulimia are much more prevalent among females (3%) than males (0.2%). Boys, however, show higher rates than girls of problems in early childhood such as autism (0.9%, 0.2%) and learning disabilities (1.8%, 1.2%).

The Danish study also gives us a very clear sense of when mental health problems tend to arise. For both sexes and for most conditions, it usually manifests during adolescence and early adulthood. The statistics show a substantial increase in cases from ages 10 to 20, a peak in the early 20s, and then a steady decrease with age.

Mood disorders such as depression, however, become more prevalent again after the age of 65, and another obvious exception to this pattern are organic problems such as dementia, for which rates rise dramatically from the age of about 70. (The lifetime risk of organic mental health problems in Denmark was 12% for women and 9% for men).

There is no reason to believe that the Danish statistics are anomalous. Well-run, scientifically credible epidemiological surveys suggest that each year 38% of those living in the EU experience mental illness, with anxiety disorders the most commonly experienced problem. That equates to 165 million people.

Yet fewer than a third of these individuals receive any form of treatment, with even fewer given the most effective forms of intervention. The scale of distress to which these figures attest is reason enough for action.

But policy-makers might also take on board the fact that psychological problems are estimated to cost the EU �800bil (RM5,584bil) annually.

Right now Britain is marking Mental Health Awareness Week. In the light of this timely reminder of how common mental illness is, the stigma still attached to these conditions is remarkable.

Pretty much everyone can expect either to experience a problem themselves or to know someone who has, and yet nine out of 10 people using mental health services in England report experiencing discrimination as a consequence, with much of that hostility coming from family and friends.

As a society, it is high time we faced up to the fact that mental illness is just as routine as physical illness (and assuredly no more shameful), and should be provided the high quality, timely care that these conditions require. – Guardian News & Media


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