WillSpirit!

One manifestation of my brain’s atypicality can be seen by tracking my sleep patterns. Over about a six day cycle, I regularly drift from spending about nine hours asleep to getting only three hours a night. It averages out to six hours per twenty-four, which is not bad, but it’s hard to maintain a sense of predictability and regularity with this pattern. Also, sometimes around 8:30 pm I feel worn out to the point that I can’t stop myself from going to bed early, but then I wake up after midnight, like I have now, and remain awake for four or five hours. After that I’ll go back to bed and (hopefully) sleep for another hour or two. Over the years I’ve tried many things to smooth out this roller-coaster, but to no avail. I don’t want to take sleeping medications 50% of the time, which is what I would need to avoid the three-hours-of-sleep nights. And if I try to stay awake when I’m tempted to tuck in early, I find my mood sinks so low that nothing gets done except sitting and brooding. Or watching TV and dozing off. Reading and writing just don’t happen when I feel that way.

I try to take advantage of the nights I don’t sleep. I write or study or meditate. If I’m at our Yosemite place, I may sit in the hot tub and marvel at the stars (so many stars up there in those primordially dark skies). Now that I take fewer psychiatric medications, I see that I need even less sleep. As humans age, some data suggests they tend to sleep fewer hours (there is better evidence that the proportion of time in REM sleep decreases). Since I started out not requiring much more than six hours, it’s beginning to look like I’ll end up needing only five.

What is sleep doing for us, anyway? In what I’ve read, and it’s not extensive, the answer is clear: no one knows.

One popular idea is that it helps consolidate memories. Experiments with sleep deprivation after certain types of learning tasks back this up. In particular Rapid Eye Movement (REM) sleep seems connected with acquiring new skills. When people sleep after learning complex tasks, brain imaging sometimes shows that the same regions are active during REM sleep as were active when the task was being practiced. This seems to suggest that REM is replaying the learned activity, presumably in order to fix it in the mind.

On the other hand, although facility at learning tasks (technically called ‘procedural memory’) associates with sleep, the ease of learning information (‘declarative memory’) does not. And even if REM helps some forms of memory formation, that does not explain the need for all the other stages of sleep (and there are several).

Although I like to understand the brain, I am happy that there remain so many mysteries. My suspicion is that this will be the case for a long time, possibly forever. The organ has such unimaginable complexity that figuring out what it does is truly daunting. Despite all that we’ve learned, we really don’t understand more than some superficial information like which areas demand more blood during which activities, or the types of neurotransmitters that mediate different brain functions. The fine details of how computation (a.k.a. thought) occurs remain quite obscure. Some basic facts have been established. For instance that information processing is modular. This means that incoming visual data get broken down into components such as depth, color, movement, and orientation in space. Each of these are handled by separate (though often adjacent) clumps of nerve tissue, and later recombined. But computational studies remain coarse in the level of activity they investigate: typically the combined signals of hundreds of simultaneously active cells.

In fairness to the brain science community, I am oversimplifying. Enormous amounts of research have been done. So much has been learned that I really have only vague estimates about how much is known. But I have a pretty good idea about what is not understood: i.e., most of what the brain does.

It is easy to get impressed with the volume of factual information about the brain that scientists have collected in the past one hundred years. But it is even easier (and more important) to get a sense of awe from the realization that despite all the millions of pages written about the brain, we really don’t know something as basic as why sleep evolved.

Psychiatrists, and those who consult with them, would do well to keep this in mind as they try to address complex personal issues (like excessive worrying, chronic sadness, or uneven sleep) by adding one or a few chemicals to the blood stream. These solutes reach every cell in the brain, and affect many, many more neurons than the ones ‘targeted’. And even in the cells the medications are meant to affect, the actions are varied and all too often transient. The brain is quite adept at restoring its native state (see my post on receptor downregulation).

Sometimes it is better to accept an atypical pattern, like wacky sleep cycles, than to wrestle the brain into normative behavior with drugs. Besides, there can be advantages. Like writing a post in the middle of the night, so tomorrow I can concentrate on the other work of blogging: reading what others write. Or maybe I’ll have time for more fun with Mandy and the dogs. Or a longer workout. If I gave in now and took a sleeping pill, I would spend a nice restful night in bed. But I would wake up tomorrow after too many hours asleep, and still feel groggy. And if I kept taking the pill night after night, pretty soon my sleep would be dependent on the drug. If I stopped it, I would face several nights of near-total insomnia before I got back to what my brain wants: a six day rotation between nine hours and three hours of sleep.

I don’t know what this says about my brain’s health. It would be easy to call the three-hour nights ‘hypomanic’. In fact, I used to live in fear of them, thinking that hypomania meant possible manic loss-of-control and/or inevitable subsequent depression. Now I find that is not true. Provided I always allow myself to sleep when I can, and make sure that even if I can’t sleep I get some time in bed resting and calming my thoughts, I do pretty well. I don’t find myself making horrible decisions, or getting pounded by despairing feelings of worthlessness and futility. Admittedly, in my life I have seldom had true manic episodes (maybe only one time, but it lasted 2 years and destroyed my life). So I don’t worry too much about completely ‘losing it’, and (for instance) gambling away my life savings. But I know some who do have more trouble with severe mania, who find they can manage it with less or no medication, provided they are diligent and committed to keeping things healthy. It helps to have a devoted and observant spouse.

Society exerts pressure on people to conform. That becomes obvious in grade school, and it never changes. The main body of humanity tugs hard on the fringes, trying to pull them into the huddled center. Deviance, or even disagreement, tend to be poorly tolerated. So those of us with brains that function ‘differently’ from the ones comfortably in the center of the bell curve have to contend with criticism, rejection, and pressure to take drugs. All are either indirect or direct efforts to get us to conform.

There are mental states that pose hazards. Particularly to the individual who suffers them (i.e., suicide), and more rarely to others (e.g., the family left bankrupt by a manic run to a casino, or the spouse broken-hearted by a string of impulsive and dangerous sexual liaisons). The tiny threat of physical violence against strangers (the ‘psycho’ murdering students with an assault weapon), gets a great deal of attention. But if we define wanton violence as pathological (which I’m not saying is a bad idea), then many heads of state should be diagnosed as ill. If we go a step further, and say all those with a propensity for needlessly harming others require pharmacologic therapy, then we really should have force fed George W. Bush with Seroquel.

I’m not saying that no one should get psychiatric medications. That is not my position. But it is all-too-clear they are overused, that they cause physical and mental anguish, and that they are not particularly effective (unless you count drugging someone into a slurred stupor a success). The pharmaceutical companies have had free reign to promote their product, and we need to rise up and apply counter-promotion to balance the scales.

In a larger sense, it is vital that we stand against the shove of society, and reclaim our right to be different. The tension between those who demand absolute obedience to the dominant culture’s standards, and those who advocate diversity and creativity, is never ending. The first step is to recognize that this is the problem we face. We need to demand to be allowed to be different, and then accept help when we want it. Otherwise we get the current situation, where we are told we are sick, and have to refuse drugs at every turn.

I’ll be up for a while longer. I’ll edit this post, write a letter or two, and explore some of my fellow travelers’s blogs. I’ll appreciate this night of little sleep as a time for making up the lost ground that resulted from weeks of rocky moods while withdrawing from Cymbalta. I’ll be glad I’m different. I’ll claim my privilege to consider myself ‘better’ than the boring norm.