Patterns, tennis and football; parasomnia, a night at the sleep clinic, and benzo madness
THIS much-delayed post (the Annoying Son’s exams, all that football and Wimbledon) finds patterns in unlikely places, not least the beauty of tennis scores. But really it is about health. Or illness. Why write about illness, a private matter surely? Not pretty and possibly excruciating with emotion. ‘I had no desire to tell anyone about my malady,’ writes Tim Parks in Teach Us to Sit Still, a memoir of the novelist’s crippling gut ailment and its eventual fix. ‘These were precisely the pains and humiliations one learns early on not to mention.’ Parks set off on a winding trudge through mainstream medicine; a journey heaped with frustration that eventually led him onwards to meditation and a miraculous remedy – about which the author, a lifelong sceptic, still shakes his head.
‘My plan, like anyone else’s, was to confide in the doctors and pretend it wasn’t happening.’ But Parks’ plan didn’t hold. Instead, he wrote about his experience, because, simply put, ‘This is reality.’
Reality and a true story – one of unexpected connections and patterns. We like true stories.
me and my shadow
Apophenia describes an disposition where people perceive connections that do not actually exist. Under the sway of apophenia, meaningful patterns linking random events are not only searched for, but also revealed: from the lay-out of a scattering of stones in the dirt at your feet, leading perhaps to a random series of numbers, which links later to the way the cards come out the dealer’s hand at the casino.
Apophenia might be characterised as delusional thinking. The possibility exists that the beginning stages of schizophrenia lie within its bounds.
Or, thinking differently, perhaps apophenia is less delusion, more like a hunch, or an interpretive style that connects the deeper patterns that may play out in our lives. But this apophenia only engages after the performance – tracing the patterns we’re often too close, or too busy, to see in the moment. When finally we discern such patterns, we often call it an epiphany.
The term apophenia was created by the German psychiatrist Klaus Conrad, who was clear that an apophany does not reveal hidden interconnections, but merely the solipsism of the self-absorbed (and possibly paranoid) soul.
But patterns are seductive. At the Patternity consultancy there are patterns everywhere: the inevitable stripes and squares, nets and grids; but also mosaics, webs, octagons, leaf patterns and woodgrain; ziggurats, barcodes, brick walls, and hair in a twist.
pattern on pattern
There are shoe laces, honeycombs, fields, valleys and Rothkos, and probably car parks – like this high rise on a back street in central London.
Patternity really ought to have a brutalist car park; a vanishing mode of period vehicle storage. I pointed to this one in town recently with the Annoying Son, admiring its concrete panels in the shape of elongated diamonds. Look, try to remember this building. You can tell your grandchildren: ‘They used to park cars in the sky in the twentieth century. Not ten feet underground, but high in the air. How crazy is that?’
For a while in the 1970s car parks were civic monuments. But now they’re being taken down and turned into hotels. This one will soon be gone and for a while a huge hole in the ground will take it’s place. People will walk past the hole and, having already forgotten, will wonder what was that building before they tore it down? And so the urban past recedes into collective amnesia.
Greta Garbo under a pattern beach umbrella (1932)
‘Yes there are stripes,’ says Patternity co-founder Grace Winteringham, before asserting that there’s a lot more to it than this. The mission statement at Patterinity is ‘to use pattern as a tool to help people better understand life’ That patterns are ‘our primary way of learning about the world we live in.’
I cannot decide whether such sweeping claims for patterns is useful thinking any longer, or just empty Zen – like observing that air is everywhere and we breathe it all the time.*
Perhaps it depends what you understand by ‘meaning’ and ‘meaningful’. Lately there appear to be patterns in my health that I hadn’t spotted. It’s like driving through a town but only taking in the layout as you depart. Climbing away up the hill, looking back over your shoulder, things finally take shape. Where you hadn’t realised there were connections, belatedly you observe. And then, finally, you do the meaning.
But before we start looking for patterns of illness, some words about patterns in tennis scores.
three tennis thumbs from the 1970s
In the first round of the 2016 French open Andy Murray beat Radek Štěpánek in five sets, coming from two sets down to win 3:6, 3:6, 6:0, 6:3, 7:5. Murray had the weight on his racket in a match played over two days against a player hundreds beneath him in the rankings. To retrieve a two set deficit is nevertheless a great result. But the scoreline doesn’t look right. The sequence of games won and lost is ugly.
Murray will worry little about contributing to an ugly score line. Just getting through, winning is the thing. Many successful sports people do fuss over the details. Murray eats the same dinner each night through Wimbledon. McEnroe neurotically avoided stepping on the chalk tramlines at change over. Nadal and Connors bounced the ball just the right number of repetitions preparing to serve. If Connors was distracted mid bounce, the ritual would need to start all over again. Lendl was pernickety unwrapping a new racket. Sampras fiddled with his towels. Borg, his headband.
The repeated tic supports focus. No deviation, no ambivalence, no either/or. Not too many thoughts, wrote Richard Ford in The Sportswriter, just one big thought: win.
You’d assume the repeat rituals and fastidious tendencies would extend to strong feelings about what makes a good looking tennis result. And yet, apart from the love and loathing of the tennis bagel (0:6; or worse, 0:6, 0:6. Or, shame, shame, shame, 0:6, 0:6, 0:6) pretty scorelines are never spoken of.
Do players have favourites? I know I do, I think about them some nights as I go to sleep.
There’s an aesthetics to tennis results. Or there should be. 6:4, 3:6, 6:3, 3:6, 8:6 is a very good score line – an absorbing, appealing pattern indicating gain and counter gain. A tight narrative of something closely fought, featuring some degrees of symmetry, but not so much that it looks like a maths puzzle or art work.
6:4, 3:6, 6:3, 3:6, 8:6 was the result of Bjorn Borg v Vitas Gerulaitis in the Wimbledon semi final of 1977. The match is considered a classic of the early modern era. It lasted hours – with lots of net play and dramatic rallies – going late into the evening, well past sunset, with the Wimbledon scoreboard bleary in the dusk on our 1970s TV set.
In the Wimbledon final of 1977, Borg defeated Jimmy Connors, also over five sets – 3:6, 6:2, 6:1, 5:7, 6:4. This is a problematic result. It’s ragged and lopsided. The descending 3, 2, 1 of minority games in the first three sets is troubling. In fact, set three, 6:1, is a real low point (And I’m sure Connors would agree). How can a good final with a good looking scoreline include a 6:1 slap in the middle? Fortunately, the last two sets redeem the overall result. A gritty 5:7 fightback from Connors in the fourth – taking them into a fifth set that suggests an even struggle through ten games between the tiring but determined players – with thrust and counter thrust – before Borg finally managed to pull clear, to take the match and retain his title.**
One requirement of beautiful tennis results is no large discrepancies. Connors v Riessen in Round Two of 1977, 6:4, 8:9, 6:1, 8:6 is hard to accept given the freakish one sided third set. And Nastase v Borg 6:0, 8:6, 6:3 is just perverse. Querrey beats Djokovic at Wimbledon 2016 by 7:6 6:1 3:6 7:6, is a washing line score – the tight opening and concluding sets as the poles propping up the sagging middle of the contest.
somehow, somewhere, he lost his game
A match should probably have a minimum of four sets. This is a fine-looking four setter from Round One of the 2013 French Open, as Youzhny beats Andújar 4:6, 6:4, 6:2, 6:3. The eventual winner dropping the first set is often surprisingly pleasing; while the 4, 2, 3 pattern of minority games has rhythm, or syncopation. Or is it harmony?
This next one, however, is an ugly four setter, 6:2, 4:6, 7:5, 6:1, as Federer beats Roddick at the 2006 US Open. The choppy 6:2, 4:6, 7:5, is a rising tide of ugliness. So ugly that the 6:1 actually comes as a relief. In contrast, in 1989, at the Australian Open, Edberg beats Smith 6:4, 3:6, 6:4, 6:3, with a scoreline that gives off a quiet hum of satisfaction with its 4s, 3s and 6s hitched in a chain.***
As a child who read very few books during an era of terrible youth TV and no computers, sport was a major spectacle. Sport had me fixated. Out of this fertile fixation grew many strands. (Imagine a tennis ball sprouting tentacles at the Patternity gallery.) One such tentacle was scoreline appreciation: poring over results, loving or loathing their appearance – a fringe and largely useless number philia.
the goalie clings to the ball as if it were life
Football results as a pre-teen – just looking at them, week after week, developing preferences and personal favourites. In time I came to recognise the scorelines that gave pleasure and the ones that made me feel uncomfortable. I found 2:2, 3:2, 0:2 and 5:1 very pleasing. But 1:3 was repellent. And I felt, and still do, surprisingly itchy presented with 4:2.
If my team won – then great. If they succeeded with a fine looking result – this felt better. But an ugly scoreline ever so tainted the joy of victory, as I recoiled slightly. If only the win could’ve looked smarter.
There was a rare 5:3. It happened one weekend when I was about nine years old. I’d never previously encountered such an exotic scoreline.
Well, except the one historical 5:3 I was aware of. A distant, near legendary match from the 1966 World Cup, when Portugal came from three nil behind at Goodison Park to eliminate North Korea, the tournament’s giant killers. This was very far back and so extraordinary it might actually have never existed, like a unicorn or dragons.
5:3. I think it was against Ipswich, or Stoke. I stared at the printed result, trying to make sense of the numbers as an event, but also as a sensation – to evaluate my feelings concerning such a wild outcome. Was it exciting, promising, decadent, almost illicit – or a execrable, cartoonish distortion of what proper football results should look like, bringing the whole game itself into disrepute? Was 5:3 actually mocking something I loved?
It was always likely I would turn away from 5:3. The only thing that kept me from flatly rejecting the wayward scoreline was the possibility that it was a good match, actually exciting to watch. I knew that it was important not to lose perspective. It’s the game that matters, not pretty score lines. I told myself this. But with how much conviction?
In November 2004, Arsenal beat Tottenham 5:4. Or to be precise, 4:5. As part of an ongoing rivalry, the Chelsea boss José Mourinho mocked the scoreline, citing the number of goals conceded by Arsenal as further proof that their coach Arsene Wenger was allowing the once well-stitched-together Arsenal backline to unravel; and that this unravelling would bring the title to Mourinho and Chelsea (and he was right). Mourinho called the result a hockey score, and therefore a crime against football.
There were summer nights as a child when I was told to go to bed, but could hear the older children still playing outside in the late evening light. I couldn’t sleep – I wanted to be still outdoors, kicking the ball. I would lie in the bed unmoving, holding my hands together in a loose knot, and think of perfect football scores, using them as practical magic, hypnotic spells to bring on the bye-byes. (Later, as a teen, there would also be perfect five sets at the tennis.) If still sleep didn’t come, ‘in those dismal hours of the night,’ as Nabokov writes, ‘when the insomniac longs for a third side after already trying the two he has’, I would recite the winners of all the European Cup going back to 1956. I still do this sometimes. But lately something else has come along to mess with my nights.
|it’s a trip|
I have this sleep thing. It started a few years ago. Some nights I throw myself out of bed in the middle of a dream. This mainly happens between 3am to 4am and it hurts. It’s a problem.
It seems to me that all my life I’ve had vivid dreams. Sometimes the dreams resemble films at the cinema; a handful of them have even concluded with a roll of credits. One night several weeks ago, I dreamed I was on the threshold of a large tunnel in space. The tunnel was shaped like a cone and hovered in front of me, very 2001: A Space Odyssey.
The interior of the cone was brightly lit, with walls of flickering psychedelic lamps stretched deep inside. The colours flooded my brain. I was nervous. A hidden commander, that might have been the voice of the writer Will Self, started issuing threats from inside the cone using a vocoder sound effect. **** I recognised the portent of the angry voice, it meant that I was about to be physically attacked.
I needed to protect myself. I reached down for a small wooden sports bat – like a rounders club – and lifted it up in a hurry, ready to fight for my life. There was a crash.
I woke up standing next to the bed. The wooden leg of the bedside table was gripped tight in my fist. All the contents of the table – the lamp, iPad, water glass – lay scattered across the carpet.
At first I stood there baffled. It’s usually the way – needing several seconds to figure out the abrupt change of situation, that I am no longer asleep, or in bed, but into the aftermath of another crazy dream. Quick on the heels of confusion, comes astonishment, disappointment, then regret: what is up with the internal me that he needs a bat to keep him safe in his dreams?
the usual suspects
In a previous post I described waking up to a crime scene – a coffee cup thrown onto the floor with dregs splattered across the carpet. A spilled water glass rolled towards the cupboard. Then there was the time of an abrupt awakening after I catapulted out of the bed and smack into the wall. As I lay there, sore and confuddled, my long legs, collapsed in a heap like Bambi, didn’t appear to know how to move.
A serial dream catalyst is football. I stopped playing a long time ago, but for unfathomable reasons the game lingers on in my sub-conscious as a tormented field of endeavour and dispute. I kick the wardrobe some nights stretching beyond the end of the bed to make a sliding tackle. Several times I’ve jumped up attempting a diving header. Silba recently reported a nocturnal hectoring of fellow defenders at a corner: ‘Who’s marking the guy at the back? Keeper, Hello!’
what is the keeper playing at?
One night I shouted Fuck, Tosspot, Cunt. Tourette’s in the dark. The Annoying Son recorded a nocturnal vocal performances stuffed with expletives. He asked the next morning did I want to listen? But I couldn’t. Instead I got a referral to a sleep specialist.
She told me I had a parasomia, but she couldn’t say which one, or what to do about it. First I would need to spend the night at their sleep clinic and have my dream waves analysed.
Dr Sleep put me on the waiting list. But the list was long. What should I do in the meantime? She gave me some melatonin and told me to keep a sleep diary.
In the beginning the melatonin quelled the outbursts and there was nothing to write about. But then the melatonin stopped being so effective and the outbursts resumed as the diary started filling up.
Night of Sep 16: 2.38, wake sitting up at end of the bed, scratching my face hard. Very disoriented. Go back to sleep. An hour later, same thing happens again.
Night of Sep 17: twice found myself climbing out the wrong side of the bed getting away from something in my dream. Happened at 2am. Then again around 4am.
Sep 28: wake up and the bedside lamp has been knocked over and is lying on the floor.
Sep 30: woke from a bad dream that I can’t remember, tangled up in the duvet, felt like we’d been wrestling something bad.
Oct 1: woke around 5.10am sitting at the side of the bed, legs like in yoga, confused.
Oct 8: 3.20am Awake at the bottom of the bed, just sprung from a tense dream. Scared. Keep telling myself the dream is over, but other parts of my brain take a long while to agree.
Oct 9: Shouted out loudly in my sleep. Don’t know what.
Oct 24: 2.50am woke up at the foot of the bed, trying to climb into the wardrobe without using the door. A material impossibility in real life is just a test of your perseverance in dreamland.
Nov 9: Shouted out No! at 4am
Nov 17: middle of the night, woke sitting up in centre of the bed. Feel stuck. I can recognise that it’s the wrong place or position for sleeping. But can’t lie back down. Seem unable to disconnect from the spell of the dream to wake up properly. I just continue to sit there – so confused. Something’s taking much longer to engage than normal – consciousness?
Nov 22: 4am, woke from angry, violent dream, apparently trying to throttle the life out of the lamp.
Dec 17: wake at 2.30, angry and defensive.
Early Jan: two nights running in bed with Silba, in the early days of the new relationship, she said I called out, became agitated and started ‘chuntering’.
Feb, March, April: Silba’s developing a night-time technique. Sleeping with one eye open, she shushes me at the first stirring and clamps her legs on top of mine. It’s called a lock down in cage fighting
By May, the melatonin had become useless as my sleep turned dangerous and chaotic. One night in the middle of the month, dreaming that my dad was about the be shot, I jumped into the path of a bullet to save him. (Yes, I was surprised at the self sacrifice. Didn’t realise I had it in me.) I dived out of the bed and straight into the bedroom door, which was half open. My left shoulder took the hit. It still hurts. More pressing however is the confusion. I’m lost. For moments that stretch out in time, it feels like I’ve temporarily misplaced myself. ‘I never was lost in the woods in my whole life,’ said the American frontiersman Daniel Boone, ‘though once I was confused for three days.’
I’m not sure who I am. Or, it’s more like this: I’m not sure how I fit together. I focus on the legs. I know these are my legs half knotted up in a section of duvet. (I’m not that discombobulated.) But I don’t know how to work these legs. It’s not paralysis, but confusion that temporarily makes the thought of movement incomprehensible.
I will gather myself together shortly. I know this will happen. It’s just going to take some figuring out. All my life so far, using my legs hasn’t required any figuring out. But now it does.*****
I call all my thoughts and legs into line to focus on climbing into bed. And with a push, and then a rush, I make it – the simple motor skills return. The Smiths song Reel Around the Fountain plays in my head: ‘I dreamt about you last night, and I fell out of bed twice.’ I lie back on the mattress and breathe out. I’m back to me again.******
One night some years ago the American comedian Mike Birbiglia dived out through a hotel window. The room was on the second floor. Birbiglia has Rem Behaviour Disorder (RBD). He was having a bad dream which he acted out.
Birbiglia smashed through the window into the grounds of the hotel. He woke on making impact with the spongey grass of the manicured lawn, with a clutch of guests looking down at him in astonishment.
Birbiglia had blood all over his face. He didn’t make a joke about what had happened, just got into his car and drove to the nearest hospital – small bits of glass sticking out of his forehead. The doctor who patched-up Birbiglia’s face said he was lucky to be alive. (Seriously?)
It was the last act of many years of similar, escalating events to which the comedian had always responded with procrastination and denial. Birbiglia finally did something about his sleep disorder and went to see a specialist. ( He also turned it into a stand-up routine and feature film.)
In the morning, I email the sleep clinic for an update on an appointment for a sleep over. I pester them. (This is something I’m quite good at – the art of pestering without annoying.) I say I hurt my shoulder and I’m anxious what kind of damage I’ll do next time I fling myself out of bed.*******
The following morning, a kind woman emails back offering a cancellation for the following week. She says bring pyjamas and DVDs.
I mention the clinic in an email to a friend. He says, you’ve always got something going on. Is it true? Do I like to keep busy with my health – my secret lover?
|St George the Martyr, London|
The clinic is a specialist unit attached to a large hospital in the centre of town. It’s in the square with the church where Ted Hughes and Sylvia Plath were married. I have a suitcase, with laptop, iPad, phone, headphones, chargers, and several DVDs. When I arrive at the hospital building, the lift’s not working and the clinic’s on the seventh floor.
I tell myself this is a good exercise opportunity and start to climb. (It’s three flights of stairs for each floor. I’m not sure why I’m writing this.) I finally get to the clinic and a nurse with a septum ring laughs and points to the other lift. The one that’s still working. She takes me to my room.
She says it’s only me doing the sleep test. The other guys are being tested for epilepsy. There’s a plastic cupboard with drawers resembling a child’s play kitchen. I look through the small window beyond the far side of the bed to a classic summertime London sky – grey and full of construction cranes, some pigeons twitching on a rooftop in the middle distance.
The nurse shows me the adjoining bathroom. She says never leave the door open because it blocks the cameras. I look at the four cameras housed in corner mounts hanging from the ceiling. There’s live footage of me from various angles displayed on a monitor on a shelf by the door. I ask the obvious question about privacy and she says the camera averts its gaze whenever I disrobe. How does it know to? She says there’s a control button in the nurses’ station, we turn it off if we see you’re not dressed.
I sit there on my bed and look at the cameras and then out the window. The pigeons are moving again. I put my glasses on for a better view. It’s not pigeons, but builders in shiny hats crossing a nearby roof in single file.
Some basic sleep facts. There are two separate parts to sleep. There’s rapid eye movement (rem), where the dreaming happens. And then there’s the rest of the night, the non-rem sleep; some of which is light, and some deep. Through the night we cycle through these sleep stages. The cycles last about 90 minutes. But more of the rem sleep occurs closer to morning and waking up time.
There are two types of sleep disorder. There’s rem disorder and non-rem sleep disorder. These disorders are also called parasomias and there’s a lot of them. Here are some of the non-rem parasomias.
Sleep talking (or somniloquy). Sleep laughing. Sleepwalking – which may take in not just walking – but cleaning, cooking, even driving, and with no subsequent memory of the activities. There is sleep eating; sleep-sex (or sexsomnia); and sleep drunkenness – a dense confusion after suddenly waking in the night. Then there are the auditory sleep starts – sudden jolts or hallucinations of a loud noise, or explosion, possibly accompanied by a flash of light. These various auditory sleep starts share the alarming collective title of ‘exploding head syndrome’. Then there’s teeth grinding (or bruxism); and restless legs, and similar related tics featuring limbs flailing and misbehaving.
None of these is my paraomia. Not even close. I conclude I must fit into a different category as lunch and another nurse arrives.
This nurse starts putting electrodes on my head. And then my chin and chest. She fixes the electrode pads to my skin using glue. She also attaches the electrodes onto my neck, legs, arms, shoulders and my little right finger.
I think of my lunch going cold as the woman patiently constructs a complex pattern of wires and pads. She asks lots of questions about my sleep. So I tell her the whole story. (Well, she asked.)
We start with the early years. When I was a child I sometimes couldn’t get to sleep at night – hence the tennis scores. And then some mornings I couldn’t wake up. Struggling to regain consciousness, I would hear my mum waking my sisters in the next room, but couldn’t open my eyes. I was stuck, paralysed, trapped under my eyelids. I’d lie there willing my mother to come to my room and shake me. I used to panic. My heart would race. From a six-year-old’s perspective I worried that my breath would run out.
I never told my parents about these events. It’s puzzling. Instead, I taught myself a fix. It took a while. I knew I had to stop the panic. The key was to slow my breathing down. To gather all my energy and then launch a big, concerted push. I had only one push to make it – this is what I told myself. So, needed to get it right.
I’d hear my mum or my sisters talking in the next room, but would block them out and try to picture myself under water, looking up towards the light of the sun beyond the waves as I began to climb up from the deep to the surface – kicking my legs, gaining speed, closer to the surface, closer, closer, breath running low, almost run out. But then at last – forcing my head through the swell, up above the waves – I was awake again. Breathless, but fully back to life.
The nurse says there’s a technical word for this kind of experience, but she can’t remember. We discuss vivid dreams. Sharing some stand out examples as we move forward from child to adult. I decide not to mention the sleep sex and skip to the teeth grinding. Last time I sold my house, the dentist had to make me a mouth guard – like for a boxer. It cost more than a £100 and was not nice. I tried wearing it in the night, but it felt like I was suffocating in my mouth. I guess boxers don’t sleep with their shield in.
The nurse says her boyfriend thrashes around a lot in bed in his sleep.
What about you?
I snore a bit, she says. I guess.
She presses on the last of the pads to the base of my skull. Each pad has a wire which connects to a dark moulded oblong transmitter inserted inside a bum-pack loosely hung round my hips. This is my personal flight recorder, I say – my black box for the night.
She doesn’t reply.
How do I go to the toilet with all these wires?
She tells me not to fall asleep before bedtime or tonight’s test won’t work properly. I glance over at the mini selection of DVDs. There’s a Kursosawa I still haven’t watched, a silent Murnau, and Magnolia. Face it, watching a film, in bed, having been told to stay awake – you’re going to fall asleep.
I decide to stick to the laptop instead, through the afternoon and into the evening.
REM parasomnias occur during the later stages of sleep and include nocturnal groaning, breath-holding, wheezing and squeaking when exhaling.
Then there’s the extra-frightening sleep paralysis. This dramatic condition occurs during the later stages of sleep, the hypnagogic period, where the muscle atonia – the immobilising mechanism that protects us from our dreams – spills over into wakefulness, as the subject regains consciousness but is unable to move, or speak.
Sleep paralysis can last from thirty seconds to several minutes and is often accompanied by a feeling of unease and the sensation of being pressed down upon. Additional symptoms can include a tingling or buzzing, or even hallucinations of being in danger – a kind of waking nightmare. Sleep paralysis is explored in The Nightmare (2015), Rodney Ascher’s immersive carnivalesque documentary catalogue of the freakery the condition brings forth. The film is as frightening as made-up horror.
The Nightmare, Henry Fuseli (1781)
In Japanese folklore, sleep paralysis is known as ‘kanashibari’ – meaning ‘to tie with an iron rope’ There are depictions of the Japanese Buddist deity Fudo Myo-o wielding a chain to tame the sleeping nemesis. The Hmong people speak of a ‘pressure demon’ that visits at night. The myth of the incubus, famously depicted in Fuseli’s painting The Nightmare, perhaps derives from the uncanny distress of sleep paralysis. Film-maker Wes Craven’s Freddy Krueger was first inspired by a sleep paralysis story the director read in the newspaper.
Sleep is mysterious – where do we go, what happens, what visions and revelations? And how do we get back?
The last of the parasomias is Rem Sleep Behaviour Disorder (RBD) For this rare but intense condition the usual sleep-time muscle atonia is largely absent, leaving subjects to act out their dreams. This acting out can lead to the sleeper suffering or causing injury. RBD occurs while the patient is fully asleep.
‘The patient’s dreams are often violent and intense, involving classic fight-or-flight scenarios. Behaviours include limb and body jerking, punching, kicking, talking, shouting, swearing, leaping from bed, running into walls or furniture, and striking the bed partner.’
I read this and reflect upon the recent disruptions listed in my sleep diary, the litany of fight or flight emergencies.
Less than half of one per cent of the population are affected by violent RBD. Men are affected more than women. The onset of the condition typically occurs from 50, although it will likely have been building for decades.
RBD is the best studied of the rem sleep disorders. The distrubances may repeat cyclically in a single night of sleep, recurring approximately every 90 minutes. The frequency of dream enactment ranges from a few times a week to nightly. On waking up, ‘individuals find themselves in a state of fear… able to recall and describe vivid dreams, usually of a threatening nature… in which they are pursued or in danger, with attempts to escape or fight back.’
This is me – the textbook description of RBD is like a mirror, reflecting my night-time self back. It’s everything that’s been happening.
‘REM-sleep related behaviours can lead to serious injury to patients… or their bed partners… Reported injuries include lacerations, bone fractures, falls, and even subdural hematomas.’ I look up subdural hematoma: ‘serious head injury’ between the skull and the brain, possibly involving blood.
I think about the hard wall in my bedroom at home. Visualise the mass of the wardrobe. There’s the sharp edges of the side table and the bedroom door, which I leave open at night, with the metal latch sticking out the side.
The doctor at my first consultation told me many patients first arrive to the clinic wearing bandages or with bruises on their foreheads. ‘They wake up with a head wound and decide to get an appointment.’
It’s not hard to imagine ignoring a condition like RBD – hoping it will just go away – until it starts to bite. It’s easy to imagine, because it’s what I’ve been doing for years. I just shrugged and put it down to an unexpected twist to getting older: So, this is 40, slower joints, declining memory, hectic sleep.
Mike Birbiglia had severe RBD and for years he did nothing about it. At each violent incident he’d worry about it through the next day. And then, ‘I’d have dinner’. He’d wake in the morning lying in a heap of books, having charged into the shelves in his sleep. Or start the day surrounded by glass debris from attacking the coffee table overnight. He’d say, this can’t go on. That he must do something. Later he’d tell friends and they would agree. He’d tell his dad, and his dad, a GP, would say you need to speak to someone about this, go see a specialist. And Birbiglia would concur. ‘And then I’d have dinner.’ He even had the phone number for the specialist. But he didn’t dial the number. He had dinner instead. And then he jumped out the window.
If you avoid arrows and evade swords, you will die
‘Ensuring environmental safety is essential when treating patients with RBD. Patients and their bed partners require education about ways of minimising injuries. Objects that may be used to cause injury must be removed from the room.’
I gaze through the clinic window and envisage the bedroom back home stripped for RBD. The bed will have to go – just sleep on the mattress – the rest of the furniture along with it. But removing the furniture won’t fix the hard walls. Does anyone manufacture protector buffers for sleep disorder. (Is there such a thing as a sleep shop? There should be.) The idea of a buffer provokes images of toddler soft play areas, those gummy plastic foam pads in primary blue and red. Could I really embrace a life sleeping in a chamber of squeaky pads?
Maybe it doesn’t need to be plastic or primary. This could equally be an interiors question with its own tasteful solution. It is possible John Lewis do padded fabrics, something extra quilted, in cream and beige stripes. A gracefully patterned padded cell for the wacky sleeper.
Another nurse arrives. She reels off questions from a clipboard. Can you tell me your name? What is your religion? Do you feel dizzy? Do you understand where you are?
In a hospital room on the seventh floor, I reply.
Central London will do, she says, then pops a thermometer in my mouth. Just say central London next time. She connects a pulse reader with serrated teeth to my index finger.
I’m interested in my stats – the vital signs of the quick of life. I wait quietly for the right moment to ask how I’m performing. One year at the summer fete of the Annoying Son’s primary school, I had my blood pressure taken at the ambulance tent. The read-out was good for my age said the assistant. I walked out delighted – the father of a small child must take his triumphs where he finds them.********
The nurse removes the thermometer. I ask about my pulse – any good? But she doesn’t reply. She plugs me in for an ECG and tells me to keep still. The ECG reader beeps like Kraftwerk. I glance over at the paper reading of my heart. The zig zags form an interesting shape – I should send it to Patternity.
Next along is blood pressure – my favourite. The cuff goes on and auto-inflates. I both dislike and love the weird sensation of the brief constriction followed by slow release. I ask for my reading. The nurse chews her lip and says it’s quite low. I tell her that’s a good thing. She doesn’t reply.*********
She departs and I resume with the sleep reading.
My wild dreams and the definition for RBD are as close as twins. Normally, when people are asleep, and they dream they’re being chased by lions, when according to the dream logic the only way to stay safe is to jump off the edge of that cliff – they don’t actually jump with their body. That’s because they’re temporarily paralysed in their bed and safe for vivid dreamwork. Maybe they shift to another dream. Or surface with a start. But they don’t wake up thrown out of bed, sprawled across the floor.
Because of a dopamine deficiency, or a lesion in the head, people with RBD fail to set up the temporary road block between the brain and their limbs to keep them paralysed during rem sleep. Rem disorder sleepers cannot be relied upon to keep their body still. They do jump off the cliff.
So, I get it, I understood this now. But why so many fearful, angry, violent dreams. What’s with all the fight or flight?
they took the green pill
In Apichatpong Weerasethakul’s film Cemetery of Splendour, a hushed hospital ward is filled with soldiers in the grip of a mysterious sleeping sickness. The men sleep all day and night while attended to by a team of nurses who whisper and ponder at the enigma of the soldiers who never wake. As the story unwinds, it is revealed that the sleep hospital is built on the site of a ancient palace where warlike kings were buried thousands of years ago. In this alternate, subterranean realm, the kings are still at war, drawing on the energies of the sleeping soldiers to keep the battle going.
The soldiers in Cemetery of Splendour will never recover from their sleeping sickness. They lie there in the role of human battery packs, in uncanny compositions redolent of The Matrix (reminiscent also of the Annoying Son and his friends with their various devices down the years. Or any given commuter rail platform or underground carriage – so many eyes glued to the screens, the handhelds living off human energy, sucking the life out of us all).
The surface of Cemetery of Splendour is tropical, calm and unhurried. (As is normal with sleep.) A humid lull hangs heavy, hinting at the sediments of disquiet beneath. (Also, just like when we sleep.) It is a theme of Apichatpong’s work: that only so much reality can be discerned through the surface detail, that there are eerie secrets obscured by the visible.
In sleep, the film-maker has his perfect thematic metaphor. (Or is it an allegory for the political situation in Thailand?) The peacefulness of the sleeping soldiers, though sad, is also entrancing. It leads you on. Sleep is good, kind, and restoring. Sleep is (well, mostly) your friend. As I watch Cemetery of Splendour, absorbed by its languid mood (while in the seat next door, Silba fidgets impatiently in frustration at Apichatpong’s singular pace), I think that surely it is time to put to rest the criticism intended in the notion the sleep of reason.
Sleep is anything but anti-reason. Regardless of the bad dreams, I welcome sleep. Sleep gets you through. How else do you survive a messy mid-life break-up with a crooked stick? (Well, there was also confidants, books, music, wine. But always best of all there was sleep.) Sleep keeps you sane. Without shut-eye you’re screwed. ‘Networks in the brain that generate normal sleep and the networks that generate normal mental health overlap,’ observes Russell Foster, Professor of Circadian Neuroscience, Oxford.
In a BBC radio discussion on circadian rhythms and developing theories of sleep, Steve Jones, Professor of Genetics at Oxford University, asserts the importance of quality slumber: ‘Every mental health disorder is associated with sleep disorder.’
The parasomnia hasn’t brought me to dread bedtime and sleep. ‘The only thing I want is to lie still like stones or wool,’ writes Pablo Neruda. ‘The only thing I want is to see no more stores, no gardens, no more goods, no spectacles, no elevators.’ Most nights, all I want to see is no more day as I hit the pillow.**********
But all this violence. What happened to the sweet dreams? I want them back – to puzzle out, then root out the jeopardy presently hogging the dream space.
was it all just an unflagged dream?
In discussing the David Lynch film Mullholland Drive – both its surreal, oneiric tone, but also the story location, of Los Angeles as the city of dreams – the culture critic Michael Wood observes how even the dreams we have when we sleep are not made of dreams. Not ‘dreams’ as in the things we aspire to, not those kinds of hopes. In fact our dreamwork is scraped together fragments – ‘mixed wreckage from the waking day’ – randomly re-spooled in our unconscious during slumber.
I read this reasoned assertion by Wood and nod in agreement. I’ve always thought sleep and dreams are the psychological complexities of being alive being duly processed and tidied at the end of the busy day. That all those Freudian interpretations of wishes and urges, though seductive as all great storytelling, are not the final word on what happens when we close our eyes.
‘Sleep used to be this dark place’ says Professor Steve Jones. As far as hard science was concerned, ‘Nothing was happening. Just sleep to rest your body.’
And then neuroscience began to unearth unexpected data concerning the night. ‘We know now that sleep is as full of activity and exciting events as the waking world,’ Jones continues. ‘Much of this takes place in episodes of rem sleep… Suddenly your eyes dart around and you are completely paralysed for a few minutes [or not in some cases]… You may have violent dreams… This all seems rather odd… But this is the brain re-organising itself… To deal with the damages and experiences it’s had on the previous day, readying itself for tomorrow.’
Once more, I listen to these sensible words and concur. It’s not just a metaphor any longer – it’s also become science: sleep processes the day (and perhaps some leftovers from previous days, weeks, months and years).
And yet. What if Jones and Wood are right, but also wrong? There surely must be more going on during the night yet to be properly understood. At the BBC, once again, Jones declares that in terms of breaking new ground, sleep is the most exciting thing currently going on in biology, neurology and genetics. ‘Just like the way genetic science seemed 20 years ago,’ he says. ‘[Sleep] It’s at the centre. It seems to overlap with everything.’
Sleep is the new frontier. It’s only a couple of decades since it was found that our day-night clock – the self regulator, our when-we-want-to-sleep and when-we-want-to-wake-up circadian patterns – were controlled by a single oscillator located in the hypothalamus in the brain. But more recently still, just the last few years, a radical revision has taken place, with geneticists locating similar regulating circadian timepieces in each and every one of our cells. That’s a lot of clocks.
The ever changing kaleidoscopic views of sleep science opens the field for further speculation concerning the full story of slumber.
All those dreams of pipes, build ups, drips, trickles, leaks, sprays, fountains, geysers, torrentials and floods. Dreams of waterfalls and white water and crashing waves. To then, at last, wake up bursting for the toilet.
So much story energy for something so prosaic. These many years of dreams as metaphors using roundabout tales and intricate imagery simply to wake me up to go pee. Why so long-winded, layered and oblique? Why not just rig up a PA system in our sleep, a klaxxon, or hooter – Wake up, man, you have to urinate!
|a piss is just a piss|
But perhaps the wild dreaming has nothing to do with how I’m feeling or the shape of my psyche.
Back at the sleep clinic, yet another new nurse comes into the room. She has eyes like black olives. I wonder if she also gets bad sleep, and which kind? The nurse does my pulse, my BP and asks my religion. Do you know where you are? In the sleep clinic in central London, I reply. It is now early evening, I add, to underscore just how clear-headed and plugged into the moment I’m feeling.
As she finishes up and leaves, the consultant arrives. But it’s not the same one from several months ago. This consultant is a young bloke dressed in a country check shirt, suggesting alternative careers as a rural solicitor or science teacher at a private school.
He briefly explains about the sleep test. The why and how. Stuff I know already. It’s a perfunctory courtesy call. Until he switches to a line of pointed queries.
What is my sense of smell like?
Has it noticeably declined in recent times?
How strong would I rate it from one to ten?
I say that I smell alright. Which isn’t quite the way to put it. I add how I like perfume.
Do you feel drowsy in the day?
(I tell him about the place at work I’ve discovered that nobody knows. The room has purple cushions and a lock. I go there some afternoons and close my eyes for ten minutes. The consultant listens politely, but I know he’s not interested in my cubbyhole. This isn’t confession.)
Do you ever fall over?
The consultant doesn’t comment. He leans in and holds onto my wrists for another strength test. He does it harder than the nurses, more manly.
I continue. Telling him I read that the cause of RBD is lesions and malfunctions in the brain stem.
|prescription pills make patterns|
Benzos breed dependency. I once had a partner who periodically got hooked on benzos and then had to unhook herself back. She once summoned me to the bathroom as witness to a ceremonial flushing of two fistfuls of pills – pink hexagonals in a downward swirly pattern, headed for the Thames and the communal water system.
The GP says it’s something else. That this morning he received a fax from the sleep clinic, a copy of my ECG which shows there’s an issue with my heart.
|landscape as spiral|
And so, in the interest of cultural transmission through the generations, I once said the same to the Annoying Son: What’s the best cure for toothache?
Shoot yourself you in the leg. Or better still, get someone to do it for you.
|mountains and birds in a pattern (photo by Abbas Kiarostami RIP)|