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Psychiatric Times. Vol. 24 No. 3
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Broken Sleep May Be Natural Sleep

By Walter A. Brown, MD | March 1, 2007
Dr Brown is clinical professor of psychiatry at Brown Medical School, Providence, RI, and Tufts University School of Medicine, Boston, and a practicing psychiatrist.

Challenging current thought
Also working against the clinical application of these findings is the extent to which they fly in the face of current thinking. The general public seems to regard 7 to 8 hours of unbroken sleep as our birthright; anything less means that something is awry. Sleep specialists share this assumption. Sleep researcher J. Todd Arnedt, PhD, clinical assistant professor of psychiatry and neurology at the University of Michigan, acknowledges that the conventional approach to patients who cannot maintain sleep, and the one he uses, is to attempt to consolidate their sleep. He didn't know about the 2 bouts of sleep discovered by Ekirch and Wehr but, in light of that phenomenon, thinks that the conventional approach might not be the best one. He points out that how patients perceive their sleep determines to some extent how in fact they do sleep. He tries to get his patients with insomnia to "stop seeing their sleep as problematic." When they can do that, whatever sleep loss they encounter becomes more tolerable. If patients perceived interrupted sleep as normal, he points out, they might experience less distress when they awaken at night and fall back to sleep more easily.

Wehr agrees. He writes: "When modern humans find that their sleep is . . . interrupted by periods of wakefulness . . . they regard it as being disordered. . . . [A]n alternative explanation could be that a natural pattern of human sleep is breaking through into an artificial world in which it seems unfamiliar and unwelcome."

"Waking up after a couple of hours may not be insomnia," he says. "It may be normal sleep."4

Did the interval between bouts of sleep, common in earlier times, provide something of value or did our ancestors merely tolerate it? To be sure, this period offered our forebears an opportunity for uninterrupted sex, for quiet study, and for household chores.

Ekirch believes that the period of quiet wakefulness also offered a unique opportunity to contemplate dreams. People often awoke from a dreaming state and so were particularly likely to remember their dreams, and thus to gain access to an otherwise unavailable part of mental life. He believes that we may have lost something in our move to consolidated sleep.

Mary Carskadon, PhD, a sleep researcher at Brown University in Rhode Island, did not know of Ekirch's historical findings but did know of the segmented sleep pattern discovered by Wehr and of the fact that some animals take "2 sleeps." Considering these observations, she speculates that "maybe the brain can't keep you asleep for prolonged periods," and she wonders whether the archaic sleep pattern had some functional purpose. Like Ekirch, Carskadon believes that the change in sleep pattern "highlights something humanity might have lost in the hurly-burly times we live in today."

Much as we might envy the more relaxed sleep pattern of our forebears, we are unlikely to revert to it. As Carskadon points out, "It's hard to adapt to 2 bouts of sleep when you have to be at work at 8 am." She does feel, though, that it would benefit patients with interrupted sleep to tell them that such a sleep pattern may be natural.

The accountant troubled by broken sleep could well benefit from learning that the sleep pattern he finds so distressing may be more natural than the solid sleep he desires. And he should be told that in his nocturnal wakefulness he's far from alone. He's in the company not only of giraffes and chipmunks but also of his ancestors and many of his contemporaries. If the usual measures don't suffice to give him the solid sleep he wants, tell him to savor the period before he returns to sleep. It's a time to meditate, have sex, think about dreams. Or, as Wehr says, he can "just lie there and go back to sleep."

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by Christopher Carlson | November 05, 2011 1:13 PM EDT

What is also missing from this conversation is the effect created when seratonin levels fall with advancing age. While the melatonin/circadian connection is now popular, the seratonin/sleep-duration connection is less so. It becomes a chicken & egg question. Is the old guy cranky because he is sleep-deprived, or is he cranky because of reduced seratonin levels, also resulting in sleeplessness and symptomatic depression?

by Chevies Newman | July 12, 2011 7:29 AM EDT

Evolutionary trends are fascinating. Reframing nighttime arousal into a historic perspective may provide cognitive relief but we live differently. Not only artificial light but the need for nighttime arousal for a short period may have been helpful when large nocturnal animals were probing for breakfast.

Total sleep time was likely greater historically as well.

Lack of sleep consolidation runs closely in with mood and stress dysfunction and is grossly undertreeated.
Let's not run too hard on the normal variant hypothesis. There can be few problems worse than daytime hypoarousal and nighttime hyperarousal. It is almost always closely linked with distress.

In the above mentioned patient, resetting the pattern to hit wakefulness to alter the signal to noise ratio during the day may be helpful. A very low dose ssri and clonazepam for maintenance, Ambien for oset and 300 mg neuron tin would probably do the trick. 25-50 mg quetipene in addition can help.

The afternoon siesta is likely an adaptation to heat, and climate, early onset of activity with sunrise will get people to sleep early.

This will not change my practice but will alter my counseling. Good review, thank you.

by Anuradha kohli | July 01, 2011 11:19 AM EDT

Thanks for this article. I have had a segmented sleep pattern all my life and have never thought of it as a problem unless in times of trouble when I rather be asleep than be awake in the middle of the night worring!

by Patricia Hernandez | January 02, 2011 3:41 PM EST

Thanks for this article. I feel a whole lot better. I have been suffering from broken sleep for the last 2 and half months every since winter started and the skies became darker. Anxiety about the broken sleep (I kept getting up at 4 am) caused me to keep awake for the rest of the night. I took melatonin once and what's interesting is that I still woke up at 4am to use the restroom and then fell back asleep after 20 minutes. Sometimes I sleep straight through but only for 6 hrs. Yesterday I had the broken sleep again. I feel okay. The most I stay awake is 1 hr and back to sleep at 5am, sometimes half an hr. Wow I am glad I read this. Next time it happens I will use it to meditate spirtually and practice yoga breathing. :)





  • Ekirch AR. At Day's Close: Night in Times Past. New York: WW Norton; 2005.
  • Wehr TA. In short photoperiods, human sleep is biphasic. J Sleep Res.1992;1:103-107.

A version of this column was previously published in Applied Neurology.

References
1. Ekirch AR. At Day's Close: Night in Times Past. New York: WW Norton; 2005.
2. Wehr TA. In short photoperiods, human sleep is biphasic. J Sleep Res.1992;1:103-107.
3. Barbato G, Barker C, Bender C, et al. Extended sleep in humans in 14 hour nights (LD 10:14): relationship between REM density and spontaneous awakening. Electroencephalogr Clin Neurophysiol. 1994;90:291-297.
4. Wehr TA. Regulation of sleep and circadian rhythms. In: Turek FW, Zee PC, eds. Regulation of Sleep and Circadian Rhythms. New York: Marcel Dekker; 1999.
5. Dijk DJ, Daan S. Sleep EEG spectral analysis in a diurnal rodent: Eutamias sibiricus. J Comp Physiol [A]. 1989;165:205-215.
6. Tobler I, Schwierin B. Behavioural sleep in the giraffe (Giraffa camelopardalis) in a zoological garden. J Sleep Res. 1996;5:21-32.
7. Webb WB,Agnew HW Jr. Are we chronically sleep deprived? Bull Psychonomic Soc. 1975;6:47-48.


 
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