Monday, May 14, 2012

Gayle Greene on Insomniac

Gayle, you are an insomniac, so did you find yourself with a mound of research for your own purposes and decide to write this book, or how did you decide to do it?

It was a middle of the night inspiration. My partner was trying to get to sleep and I was yammering away, with the 3 AM spurt of energy I usually get, and I said, out of nowhere, “I think my next book should be about insomnia.” Long pause, I thought I’d lost him— then much to my surprise, he said, “that’s a very good idea.”

Turn your obsessions into books, I tell my students; I mean, how else are you going to stay with the material long enough to make it into a book, unless you’re obsessed with it? I think of Laura Hillebrand, ill and impoverished, hanging in there writing the book she had to write. Her friends probably thought she was crazy—“you’re writing about a racehorse?” –but what a great book Seabiscuit turned out to be. Well, insomnia is the problem I’ve been obsessed with, that I’ve lived around, that’s bent my life into its weird shape, vampire hours and all; and I had so much frustration built up around this issue, from hearing useless advice from doctors and well-meaning friends and family, telling me I should just relax, drink some warm milk, take a hot bath. You have to live in the body of a person who can’t sleep night after night to know what chronic insomnia is , how it wears you down, and no doctor I ever talked to had a clue.

You describe a less-than-helpful response of the medical establishment to insomnia. What do you think causes doctors to act like it’s not a serious problem?

Medical training is a hazing in sleep deprivation, and many doctors pride themselves on how little sleep they need. You have to be a good sleeper to get through medical school and residency, you need to be able to drop off easily and wake quickly, and it helps if you don't need much sleep; someone like me would never make it through. There’s enormous variability in how much sleep we need and how we react to sleep loss, and the differences are genetic; they’re not a matter of character or will power. So the medical profession is to some extent self-selective when it comes to sleep, which is why doctors don’t have a lot of tolerance for sleep problems: buck up, get a grip, a little sleep loss never hurt anybody, it must be something you’re doing wrong, you have bad sleep habits, or (my least favorite) you probably don’t need as much sleep as you think. When a condition is not well understood, there’s a tendency to blame the patient—we’ve seen this with migraines, ulcers, and other problems once said to be psychological, now known to have a physiological basis. Narcolepsy used to blamed on the laziness or craziness of the sufferer, and sufferers of REM Behavior Disorder, who act out their dreams, were said to have a screw loose; but in the past several years there have been breakthroughs with both of these sleep disorders, so that they’re now understood to be a glitch in the brain, not the mind gone awry. We’re far from any breakthrough like that with insomnia, and it’s always easier to say, "it’s something you’re doing wrong" than to say, "we don’t know and we can’t help." Doctors don’t really know much about sleep: they get 1-2 hours instruction about sleep in their entire medical education and training. And even sleep researchers can’t tell us how we sleep, or why.
I’ve heard people say Heath Ledger and Michael Jackson would still be alive if they had not had insomnia. Is that your impression? Who else has struggled with this disorder?
Insomnia is practically an occupational hazard for actors. Lady Gaga and George Clooney are recently in the news with this problem; a few years ago, it was Eminem and Drew Barrymore. My question is not why some actors have it, but why they all don’t have it, considering the stress they’re under. Imagine having an early morning shoot, needing to look bright-eyed and beautiful before a camera, the world watching at close range, as you appear, hollowed out and haggard from lack of sleep. You’d need nerves of steel, you’d need a “heat-hits-the-pillow-and-I’m-out” kind of sleep system, which not everybody has. Elvis had serious insomnia and got hooked into an upper-downer cycle, as did Judy Garland, uppers to control her weight, sleeping pills to sleep. She died of an overdose; so did Marilyn Monroe and Anna Nicole Smith. The prescription drugs found in Heath Ledger’s apartment, Lunesta, Ambien, Restoril, Ativan, Xanax, Valium, were all for sleep; he was desperate for sleep, as was Michael Jackson. Insomniacs shudder at these stories; most of us have had moments when we’ll do anything for sleep.
In a poignant moment for me, I read that you were ignored at scientific meetings you had visited trying to learn what scientists were studying to help cure insomnia. Do you think this treatment was because you were out of the field, because you are a woman, or both?

Those meetings were so awful I had to laugh—in fact, that’s the only way I could write about them, in comic vein. I think it was ageism more than sexism, actually—if I’d been 30 rather than late fifties-early sixties, I’d have had no trouble getting those guys to give me the time of day. A few were friendly and interested and forthcoming, but with most, eyes would click up and down, doing that measuring thing people do, ticking off sex, age, style, position, figuring out whether you’re important enough to warrant time. One man turned on his heel and walked away, mid sentence; two refused to speak to me without honoraria; one hung up on me. I think it was partly that I was not a scientist, but also, there’s also a deep dislike of insomniacs —“the only thing I like to see walk through my office door less than a kid with ADD is an insomniac,” I heard a doctor say. “It’ a swamp,” a researcher said, “a can of worms.” So I had pretty much everything going against me, I had outsider stamped all over me, with my peasant skirts and unruly hair, and I probably did look a little alarming, doing these conferences on 3-4 hours sleep, and I probably came on strong, as the questions pent up for years came rushing out. But the bottom line is, they’re used to being the observers, the ones who are doing the studies, not the ones being studied, especially not by the likes of me. And I did feel like I was studying them as an alien tribe. (Did I tell you, Insomniac was shortlisted for the Gregory Bateson Prize, Society for Cultural Anthropology?)
How did you get the science background to write the book?

The chutzpah, you mean. I grew up in a family where bodies were interesting and a subject of conversation. My father was a doctor, and my mother was tremendously knowledgeable about bodies and health. The book I wrote before Insomniac was a biography of a woman scientist, Dr. Alice Stewart (The Woman Who Knew Too Much: Alice Stewart and the Secrets of Radiation), and though her area was radiation epidemiology, she was a physician, and working with her taught me how to read a scientific study, and made me bolder about writing about science on my own. She discovered in the 1950s that if you x-ray pregnant women, you double the risk of a childhood cancer, a discovery that revolutionized medical practice and made her a guru of the anti-nuclear movement. Before that, I co-authored a book on cancer and the environment with a physician, Dr. Vicki Ratner, and learned an enormous amount from her; that book never got pushed through to publication, because I ended up writing about Stewart instead. But I’m a great believer that you can get a background in anything if you’re motivated enough, you just plunge in and start to read, and amateurs’ insights may be valuable, because they’re closer to basic questions— questions like, how come the emperor has no clothes? 

One of your Amazon reviewers comments that your book is not a how-to guide for insomniacs trying to get to sleep. Were you ever tempted to write such a book?
There are no one size fits all solutions with insomnia, because it’s so complicated—it’s not one thing (as narcolepsy is), it’ s many things; there are no markers for it, not even a clear way of diagnosing it; we all come to it by different routes, and therefore what works for me may not work for you. There are obvious “do nots”: avoid caffeine and alcohol, avoid evening naps, don’t engage in work or social activities that hype you up in the evening, don’t eat big meals late at night. Most insomniacs already know such things, and yet there’s an entire cottage industry of books that announces them like they were new news.

Here’s an Amazon review I’m proud of:

"This isn't a 'self-help' but a self-helping book. Here's just about everything you can try, with details about what happened to the author when she tried them. She is wonderfully careful to stress that everyone experiences insomnia differently, and the best she can do is share her own and a few other's experiences. And her indignation that medical science has simply given up on insomnia as just too hard."

I like the idea that the book is self-helping: that’s what I hoped to do, help people find a way of their own, learn how to trouble-shoot their condition and work out ways for themselves; and I’ve had dozens of emails from readers telling me that the book has worked this way for them. Talking to insomniacs was a big part of this, because we’re the experts, we’re the only ones who know what works, not some man in a white coat who may have a degree but who’s probably given sleep all of ten-minutes thought, or who has a CPAP machine he wants to sell you. So it is in a way a self-help book, though not in a usual package.

You present evidence that drug development, rather than understanding, is the goal of most scientists who study insomnia. Has there been any more basic research since the book was published, that you know about? Do you see any promising findings on the horizon?

Actually, I found a split in the world of sleep medicine, between the mind people and the brain people: neuroscience is trying to understand the neurophysiology of sleep, to figure out how the sleep system works, while most insomnia research tells us insomnia is about conditioning, bad habits and attitudes that we can retrain by going to bed and getting up at the same time every day, cleaning up our sleep habits, restricting our sleep. Drug research is done mainly by drug companies, and they’ve certainly tried to find a better pill, but it’s difficult, when so little is known about sleep. The hope is in the basic research that will figure out how sleep works; then maybe someone can figure out why it doesn’t work for some people and develop treatments that target the problem, rather than just bludgeoning the central nervous system, as current medications do. Since my book came out, there have been new discoveries about genetic factors in long and short sleep and how people react to sleep deprivation—this is all very exciting, and exactly what I predicted; but research has a long way to go before it will understand sleep well enough to develop effective treatments .

When people hear you have insomnia, what is their response? How do you cope with it?

They assume you’re crazy, screwed up, stressed out, that you have a guilty conscience, or something like that. For a long while, I kind of accepted this—I know I don’t live a stress-free life. But then I opened m eyes and started looking around at the people I know—and hey, wait a minute, she’s got a lot more anxiety than I have, and he’s a lot more stressed out, and she’s tangled up in knots of rage about her life and work—and they sleep like a stones. Sure enough, when I started researching sleep, I learned that the sleep system is a physiological system, like the digestive system or respiratory system; some people have weaker or stronger systems, just as some people have strong stomachs or musculoskeletal systems; and the differences are coming to be understood as genetic. People tend to assume that their good sleep is on account of something they’re doing right and therefore my insomnia is on account of something I’m doing wrong, but the good sleep is no more something a person can take credit for than being tall or blond. It’s a gift, like extraordinary beauty, talent, or intelligence. 
You’ve connected with insomniacs all over the world through talks, radio broadcasts, and blogs. What insights did you get from talking with all these sleepless people?

The main thing I learned talking to other insomniacs is how much misery this problem causes. I knew this from my own experience, but I hadn’t seen anything yet. I’m in a profession where I can pretty much set my own hours, and I have access to medications— I’ve got it easy. But for people who have to function in a 9 to 5 world, who have to get kids off to school, it can wreak such havoc that the person can’t hold a job, has to go on disability. So it knocked some of the self-pity right out of me. “Nobody ever died of insomnia,” I’ve heard doctors say, but it’s not true: insomnia is a risk for depression, alcoholism, suicide. “People die of insomnia, all the time,” says a character in Stephen King’s Insomnia, “although the medical examiner usually ends up writing suicide on the ‘cause-of-death’ line, rather than insomnia.” Then too there’s the death by a thousand cuts it inflicts: Insomniacs have two to three times the rate of doctor consultations as people without sleep complaints, twice the number of hospitalizations, and more than twice the rate of auto accidents. So we may not drop dead of insomnia the next day, but chronic sleep loss may be cutting years off our lives. It’s simply outrageous that it’s not taken more seriously.

Do you have any advice on agents, publishing, e-publishing today?
The last article I wrote, “Science with a Skew: The Nuclear Power Industry After Chernobyl and Fukushima,” was turned down by alternative print media, and so I gave it to the Asia-Pacific Journal,

—and it went viral, more than 39,000 references, last I Googled it, and was translated into Japanese. That was a lesson to me—skip the print and go straight for the web. Of course you have to be willing to write for nothing, but I’m used to that.

Do you use social media? What are the up and down sides to them for authors today?

Sort of. I wish I were less of a technoklutz. I joined Facebook because I was told I’d need to promote my book—I ended up doing nothing by way of promotion, but I’ve had fun connecting with former students and long-lost friends—and with anti-nuclear activists. So it hasn’t done a thing for Insomniac, but it was helpful when I was writing about Fukushima, it put me in touch with stuff published all over the world. If you’re writing about something that isn’t honestly presented in mainstream media—and that’s a lot of things—the Web is where it’s at.

Any other thoughts about writing Insomniac you’d like to share with the readers? 
Turn your obsessions into books—I think that was a good instinct. It was a 6–year slog, writing Insomniac, and a steep learning curve, but I’m glad I did it. Do I sleep any better? Not really. But I know a lot more about sleep, I have a better understanding of where my problem came from, in terms of nature and nurture, and I know there are many people far worse off than I am. It’s a great mystery, sleep, and it still fascinates me, which is pretty amazing, after such a total immersion in the subject.

Do you have a blog, and/or do you want to refer the readers to your Amazon book page?  (though I haven’t done much with it in awhile)


Anonymous said...

I love the idea of writing about what plagues you, learning more about it as you go. Very good idea!
Liz P

Anonymous said...

Hi Laura,
Glad to see you fixed those wierd mis-spelled names of drugs in this interview. I was wondering about that.

Marcus R