Sunday, April 3, 2011

i couldn't help thinking, if people were rain

i was never idle long enough to do much thinking but I felt somehow that my instincts were right
hunter s. thompson

i made my flight from DC to Chicago by about 2.5 minutes. i ended up running through the airport and getting on just as they were boarding. A guy sitting a row in front of my offered to switch seats with a woman who had a back problem, so she could sit where there was more room. this put the man next to me. he was pretty quiet at first but eventually started talking to me about what i was doing in dc, why i was flying to chicago, how everything was going. we then spoke of other things- books, traveling, why i was hungover, and the time he spent in india. i was really surprised of how platonically intimate our conversation became. being on trains or airplanes with limited interruption and close physical proximity has some way of fostering intense connections between people that seem to make very little sense.

reading about south american cities has given me a strong urge to chronicle the thoughts that were racing through my head in the different places that i've traveled. i am going to start that as soon as i can and it's going to be a big project, i can tell. i have decided that writing is the only career that i will truly be happy in. for some reason right now I am feeling really inspired to write down everything that I am thinking; like i'm drowning in it. you don't need water to feel like you're drowning. my mind is reeling and all my memories are running together.

like i said in the previous post, here is the paper i got 2nd place for.

The Science of Sleep

Insomnia, Drug Culture and Depression

Carolyn Lang

Heather Knoelk looks down at the table, explaining her struggle for the past three years and the lengths she has gone to in order to alleviate it. She talks about the lack of concentration, the strange side effects of prescription drugs, how difficult it is for her to have a normal social life when she knows that she can not stay out as late as her friends for fear of disrupting her schedule. I am momentarily disarmed that a person who seems so effervescent and so often dissolves into an electrically white smile could feel consumed by anxiety, which she labels as the root of her problem. If she had not told me about her affliction, I would never have guessed. It reminds me of the saying that everyone is fighting a battle you know nothing about, and most people’s visible daily demeanors are only the part of the iceberg that is above water.

“I feel like people don’t really get it. It’s like- ‘If you’re tired, go to sleep.’ But I can’t, and at times, it’s almost painful,” she says, her expressive eyes flickering like candles being blown out.

Almost everyone has experienced a sleepless night. There are hundreds of factors that can occasionally disrupt a healthy sleep cycle. For some people, however, an inability to sleep is normal and nights of staring at the ceiling, worrying about things that will probably never happen and trouble getting through the next day are part of their lives all the time. There are as many ways of coping with insomnia as there are factors that can cause it, ranging from changes in behavior to use of an ever-expanding plethora of prescription drugs. It is undeniable that insomnia’s causes and effects have been a source of both fascination and frustration for decades, however the rapidly changing fields of modern medicine and psychology have changed the ways that people are dealing with it.

According to Dr. Charles Lawler, primary care physician at Mercy Hospital in Chicago, college students are especially susceptible to the conditions that perpetuate insomnia, from an erratic sleep schedule, to often intense amounts of stress, to the tendency to binge drink.

While there are a handful of neurological reasons for insomnia, including conditions like restless leg syndrome and destructive sleep apnea, most of the time the causes of insomnia are behavioral or psychological. More than half of the cases of insomnia Lawler sees (at least 15 per week) are rooted in anxiety, depression, or poor “sleep hygiene”- a person’s habits contributing to his ability to get a good night’s sleep including everything from caffeine intake and diet, to the noises surrounding him when he tries to sleep, to his routine minutes before he gets in bed.

* * *

Into the Evening

Many college students fail in establishing a regular, healthy evening routine and experience difficulty sleeping because of it. Once a person has set a precedent of an unproductive sleep schedule, he increases the chance that he will be up for hours and experience the racing thoughts characteristic of a sleepless night.

Greg Thompson*, a senior studying poetry, has developed an irregular sleep schedule that often leads him to stay up all night and sleep through class. Recently Thompson has become desperately exhausted and resorts to any means necessary to sleep.

It does not take much to see that Thompson is a deep thinker. He speaks about famously tormented writer Dave Foster Wallace with noticeable reverence and referenced dark science fiction classic Slaughterhouse-Five in casual conversation. He seems to draw connections between seemingly vapid occurrences and lights up when talking about his desire to write. At one point, I wonder if a map of the neurological activity in his brain would look like I imagine it- a riot of literature and poetry and THC.

Greg Thompson

October 13, 11:15 PM, 24 hours without sleep

My brain hurts. Things I've tried in the past: not sleeping, boozing myself to sleep, smoking myself to sleep, staring at my wall. Pretty much only the middle two see any success. I mean, none of those options are productive. But at least the two of them get me some shuteye.

Insomnia is not a black and white affliction that can be understood simply through a person’s description of an inability to sleep and treated with a chemical. While anxiety and depression are usually diagnosable, a person’s personality plays a large role in his ability to calm down in order to sleep.

“The way a person looks at life is a huge factor in things like depression and insomnia. Some people see so much amiss in the world and their life, and it bothers them. It doesn’t mean it’s bad; it’s not. But it may present more difficulties for them, and it will certainly keep them up,” Lawler said.

People with high levels of energies are often very creative and intelligent, but this eagerness of mind is often contrasted with a tendency toward depression, anxiety, and insomnia. In one of the most famous scenes of landmark 1960s novel The Bell Jar, Sylvia Plath describes a particularly creative period followed by a week of being unable to sleep that epitomizes the psychological effects that can result from fatigue: “I saw the days of the year stretching ahead like a series of bright, white boxes, and separating one box from another was sleep, like a black shade. Only for me, the long perspective of shades that set off one box from the next day had suddenly snapped up, and I could see day after day after day glaring ahead of me like a white, broad, infinitely desolate avenue.”

Lawler calls stress one of the most detrimental aspects to a person’s ability to get to sleep.

“It can really exacerbate the situation if you do something important or stressful before you go to sleep, like pay bills or try to plan something. Your mind won’t stop thinking about it. If you look at society, people’s schedules aren’t as random as you might think. People usually have dinner after work, and then watch TV for a few hours, and then go to bed. That allows your brain to quiet down before you sleep.”


11:30 PM

Oh, I guess I've tried meditation, too. It's great for a while. You know, during the part that I'm actually meditating. Real calming. But then I come back to the real world and I'm all like "FUCK I STILL HAVE SHIT TO DO BUT ALL I'VE BEEN DOING WAS SITTING AROUND IN FULL LOTUS STYLE!!! WHAT THE FUCK!!!" With that many exclamation points. Fucking six of them. What are they doing there? Do my thoughts really need to be that exciting? But they get that way whether I like them to or not. It's like my thoughts are all like... like "FUCK YOU" at me, because they know I think exclamation points generally make for weak writing.

Lawler explains that telling a person that he has insomnia can set off a mental chain of events that contribute to the person’s doubt that he will ever be able to sleep normally. The doubt is ultimately self-fulfilling. Many people resign to their inability to sleep and eventually learn to function on smaller and smaller amounts. Knoelk describes her inability to get more than six hours of sleep no matter what the circumstances as both frustrating and puzzling.

“The label of ‘insomnia’ I think can be detrimental. The diagnosis can contribute to a fixation on inability to sleep, or lead to depression later in life. If someone is depressed, you have to treat the underlying depression first, and not just tell him he has insomnia,” Lawler says. “It’s not simple cause and effect.”

The psychological effects of sleep deprivation set in far before the physical effects, and the first indications of a severe lack of sleep are paranoia and hallucination. The timing of these reactions varies widely depending on a person’s mental resistance. There are very few cases of insomnia that are so severe they push a person past these effects to mental unraveling, but ultimately, the effects of sleep deprivation become fatal before those of starvation or dehydration.

Dave Banaszak, a senior in Economics, has recently been struggling with extreme difficulty sleeping. As we sit in the darkening twilight, I notice the circles under his eyes look like bruised-colored half moons and wonder if they are always that pronounced. He seems controlled, if slightly drained, and talks about his difficulty sleeping as someone who has contemplated a problem so extensively he has lost the desire to reflect upon it. He calls his problem simply “racing thoughts,” and doesn’t elaborate much on what that means. His endearing demeanor becomes serious when he speaks about his desire to remain true to his religion and his constant failure to live a life embodying his ideals.

Banaszak suddenly seems very conflicted, and for the first time I wonder if this is a cause of significant inner turmoil not typically ascribed to a person of his age.

* * *

In the midnight hour


October 13, 12:00 AM

Hey look, it's midnight. What a strange place to be, only half an hour later. Midnight-thirty. I type. I feel as I've been hit by a truck. That actually happened once. Got hit by a truck. Driver's side: BAM. I fear my bones may break. So far I've only ever cracked a pinky. My muscles are so sore.

One a.m.

Now going on one and thirty. Rolling around on the floor. She's coming this weekend. Finally some good news. Absinthe and poetry.

Two a.m.

Now three a.m. I'm thinking about pickles. Ate pickled herring tonight. And if you want to get ethnographic about it: was I really thinking about pickles before or have I just filled the detail in by writing it so? Well, truthfully, I am now quite indeed thinking about pickles. I don't know how this has sprung on me.

In other entries, Thompson describes feelings of depression and an inability to get up in the morning. Thompson is currently taking anti-depressant Prozac to alleviate his depression and hopes that it will also help him deal with his trouble sleeping. He has also dabbled with prescription amphetamine Adderrall to improve his focus.

Lawler says that a prescription drug culture is becoming ubiquitous in the world of psychological medicine, but that he is hesitant to write prescriptions unless every other method of treatment has been exhausted.

“You remember how you used to see movies with patients laying on couches talking to psychiatrists about their problems? That used to happen, but it doesn’t happen anymore. Now almost all psychiatry is pharmacological. I always try to get to the root of a person’s insomnia by asking them what else is going on in their life. Some psychiatrists think it is Freudian, but I really believe there is almost always something that would be helped by something other than a drug. I think most people would benefit from behavioral or cognitive therapy more than anything else.”

The thought processes a person experiences in the middle of the night can be indicative of the issues bothering him that are only latently present in daily life, and what he can do to put them to rest.

Banaszak’s thoughts toward the middle of the night seem to indicate a feeling of guilt and confusion about the prospect of reconciling his human tendency toward error with his ideas of the way he should conduct himself.

Dave Banaszak

January 28, 12:59 AM

Thank God for hope. And literally in my case I can thank God for giving me hope. Without Him I don’t know how I would fall asleep at night. I don’t know how I would get through some days. I don’t know how I would tread year after year. I can only imagine what destructive item of life I would inevitably choose as my demise. Alcohol probably. That would be the death of me. Right now I’m walking a tight rope. I am dabbling a bit in my faith and a bit in the flesh. It can’t go on much longer. I hope. I guess if this dance continued it would be a living hell of sorts.

The strain and frustration of sleeplessness drives many people to use alcohol or smoke marijuana to slow the reeling of their mind. However, it has been proven that drinking excessively or smoking marijuana are not effective ways to fall asleep.

“I would like to dispel a rumor here: drinking alcohol does not help. I have heard many people that seem to think it does- maybe you will pass out more easily, but it will not help you stay asleep and you will not feel rested in the morning. If anything, it will further disrupt your schedule,” Lawler says.

* * *

Staring down the sunrise


October 15, 2:07 AM

I tried to write about David Lynch instead of Shakespeare today but I got docked points. Not specific enough. I think calling the ‘Rape of Lucrece’ the ‘Victorian Blue Velvet’ is pretty darn

specific. But I probably didn't actually say that, probably just babbled on about bears. I'd like to see a version of Hamlet where all the actors and actresses were bears. Or werebears.

It is hard not to wonder if this generation’s idea taking a pill to solve a problem and psychiatrists’ custom of prescription will result in a bunch of strung-out, if slightly more productive clones. Take a pill to fall asleep, to wake up, to focus, to be happy. It’s that easy, you can feel good all the time. You can gobble a prescription very closely resembling speed and stay up all night to study, and then take another pill to sleep as soon as you finish. Your body and mind are at your command in an instant swirl of candy-colored pills.

Knoelk, in stark opposition to the drug mentality of many young people, articulates her fear of developing a dependency on Ambien.

“I don’t want to have to take it every night. I have trouble getting to sleep and staying asleep; I used to wake up every half hour and I had no idea why. My doctor wanted to put me on two drugs: zolpidem (sedative-hypnotic) to fall asleep and trazodone (serotonin modulator) to stay asleep. I said no; I didn’t want to constantly feel like I had that level of drugs in my body.”


October 17, 3:22 AM

Popped an Adderall this morning because I needed to do some work and I was told it worked better than Prozac. That stuff just barely helps with the anxiety, let alone in attaining any semblance of concentration. Usually it's the anxiety that finally barrels me into getting things done, but Prozac just seems to flat line me out of interest. I'd never thought about ADD, but on the come down now my mental capacity seems to be disappearing, everything boring. It's not a depressive removal, like a crash or withdrawal, but a return to sifting the Internet for Twitter-sized articles because I can't be bothered with the longer papers of the subjects I'm actually interested in.

There is something truly revealing about a person’s thoughts when he is unable to sleep; when his deepest fears and insecurities seem to gain power over him as his ability to reason recedes and the night stretches painfully into the morning. There are fewer distractions to drown out the noise in one’s head, and those people particularly prone to over-thinking seem unable to repress their mind’s torment- as if they are getting into a fight within their own psyche.


April 24, 4:24 AM

Wouldn’t I rather be only in this world and not of this world? How much am I really committed to my faith? I'm committed but does it really show? Why do I have trouble sleeping? Why can't my mind be at ease? Is it mania?

* * *

The Morning After

Knoelk has experienced negative side effects of Ambien, from feeling as if the ground beneath her is moving to blacking out. These kinds of effects are not uncommon; Ambien is classified as a hypnotic drug and works by putting the mind in a dream-like state where a person’s thinking is drastically altered. If a person remains awake after taking Ambien, he may experience a ‘trip’ and his actions often become very strange.

In the past, psychiatrists prescribed benzodiazepine-derivative drugs like Valium that had sedative and relaxant effects instead of hypnotics. These drugs were so widely abused that they are hardly ever prescribed anymore.

Lawler says that the most fitting time to prescribe a sleeping pill is during adjustment-disorder insomnia. This type of insomnia usually results from a major, and often traumatic change in a person’s life, including death or divorce.

“If something like that is going on, you’re not going to sleep, and that’s normal. I still think about it before I prescribe a medication, though, because some people do have an inclination toward dependency, even when a drug is not addictive.”

Chronic insomnia with no clear cause or trigger, however, is not uncommon.

“The difficulties of insomnia shouldn’t be undermined; it can pose so many problems for people and sleep is such a big part of life. It’s almost mysterious- we spend about a third of our lives sleeping, and if people are having significant trouble with that, it will definitely be pervasive in many aspects of their life,” Lawler says.

* * *

All the Days Ahead

Lawler’s recommendations for people who are unable to sleep include exercising early in the morning, getting up at the same time every day, getting in bed only when you want to sleep, and developing a routine to reduce stress. He explains the meaning of medical jargon for the chemicals of the brain and body related to stress and sleeplessness: serotonin, melatonin, norepinephrine, and dopamine: that seem to be constantly used and misused in self-diagnosis by people with no medical knowledge. A healthy diet and lifestyle assist in regulating the levels of these chemicals in the body and make it more likely for a person to be able to sleep.

Lawler’s consistent emphasis is the same: a person with trouble sleeping is probably dealing with another problem that has manifested itself in insomnia. In order to control the insomnia, the person must first address the underlying cause of his affliction and then work to change his daily life.

“If someone comes in to me with heart problems and high blood pressure, I don’t just prescribe beta blockers. I tell him he needs to change his lifestyle and diet. Insomnia is no different from that methodology,” Lawler says.

Knoelk is in the process of slowly getting off Ambien, and describes the measures she has taken to help herself, including things as seemingly minor as making sure the color of the numbers on her alarm clock are red (perhaps counter intuitively, clocks with blue light tend to be very bright, and the shorter wavelength of blue light has been found to be the most alerting to the brain). Knoelk gets up at 9am regardless of when she goes to sleep, has eliminated caffeine from her diet, and does not get into bed until a few minutes before she wants to sleep. She no longer uses Ambien every night and is noticing small improvements. She is occasionally frustrated by the degree of regimen she has needed to develop to control her insomnia, but says that she has gotten to a level of normalcy she finds rewarding.

“Before I felt like I was at a standstill- I couldn’t sleep one night, and I would stress out about it so much that I wouldn’t be able to sleep the next night- it was like a vicious cycle. Now that I am taking steps in fixing it, I feel like I am more in control, even when it’s difficult.”

While Knoelk’s method of developing control in her daily life is not as easy as taking a pill, it seems that she is defying the current trend of an instant fix, withdrawal, and regret the next day. A person’s decisions about his mind and body are his own, but it is worth considering the pros and cons before resulting to prescription. Ultimately, though, whatever helps you sleep at night.

*name has been changed

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