Sleep is disrespected: It is a bad habit. It wastes time. It prevents flexible schedules. Robots don’t need to sleep. I’ll catch up on the weekend–I only need four hours. Sleep is for sissies. Let’s pull an all-nighter.
Over the past ten years, I began to hear more and more of these attitudes in my psychiatric practice. I saw more people in my waiting room who had to be awakened to come into the office. I heard more about falling asleep at the wheel. A number of patients coming to be evaluated for adult ADHD (attention-deficit disorder) actually had a sleep disorder. I remember one young man calling to say that Adderall hadn’t helped at all, that it took an auto accident before his unsuspected sleep apnea was diagnosed.
More importantly, sleep and fatigue complaints became the most common complaint I heard, and were clearly a part of the depression, the anxiety, the PTSD, the relationship conflicts. I began to discover that with very complex patients with multiple problems, addressing the insomnia and lack of sleep was an excellent beginning tactic for treatment. Sometimes when it was not clear where to start, investigating sleep and helping improve sleep was a good entry point and made sense to my patients.
I began to reformulate Freud’s reputed statement that mental health and happiness was “to love and to work”. It seems we spend one-third of our lives working or learning; one-third of the time we are in relationships–friends, family, love and sex, and don’t forget enemies and competition; and one-third of the time we are asleep. I feel we must advocate for this last third and not allow it to be trivialized. Missing out on the sleep third of your life is dangerous. You can’t feel good. You must change your life. Mental health and happiness is “to love and to work and to sleep”.