musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Sleep, that knits the ravelled sleeve


At first, in a long hospital residency, and finally, a lengthy and enjoyable career as an on-call obstetrician/gynaecologist in a busy hospital practice, I found it difficult to fall asleep for those seemingly brief periods between gynaecological emergencies requiring surgery, and managing an often busy obstetrical ward. Somewhere along that continuum, I learned self-hypnosis and meditation and, although there was often not enough time to practice it fully, over the years, I must have learned a few tricks.

When I even think of sleep, my mind often wanders, and things similar to what happens in that borderline state before I actually accept the gift of somnolence seem to assume undue importance. Just before falling asleep last night for example, I remembered the poem Journey of the Magi, by T. S. Eliot. Despite reading it many years ago in university, small parts of it have stuck with me all this time. It deals with the Wise Men journeying to the birth of Jesus and the fact that those Magi could not possibly have understood the profundities of the unfolding mystery that they were to witness; the fact that they continued to pursue the long journey despite its difficulties and without knowing what they were supposed to find was all the more mysterious and wonderful to me as I dozed off. Parts of the poem with partially remembered words slowly swirled in my head, and I was surprised that any of  the Magi were ever able to find sleep:

‘A cold coming we had of it, just the worst time of the year for a journey, and such a long journey… There were times we regretted the summer palaces on slopes, the terraces, and the silken girls bringing sherbet… the night-fires going out, and the lack of shelters, and the cities hostile and the towns unfriendly and the villages dirty and charging high prices: a hard time we had of it. At the end we preferred to travel all night, sleeping in snatches, with the voices singing in our ears, saying that this was all folly…’ And so on… I think it’s the last few lines that I remember best, however:

‘We returned to our places, these Kingdoms, but no longer at ease here, in the old dispensation, with an alien people clutching their gods. I should be glad of another death.’

I suppose what I’m getting at are the busy day’s problems, the worries, and questions that still plague us even after we go to bed; with all of these stamping around in our heads, why do we wonder why we simply can’t drift off to sleep?

The picture I chose for the frontispiece of this essay is the painting Night and Sleep by Evelyn Morgan (1878) which depicts Nyx, the Greek goddess of night, flying over a darkening sky with her son Hypnos, the good-natured god of sleep who occupied a liminal area between sleeping and waking.

The important thing to realize about sleep when we so value alertness is that ‘The brain doesn’t sleep. Neither does the body. We do.[i]… We presume waking to be the centre of the universe of consciousness, and we relegate sleeping and dreaming to secondary, subservient positions… As wakists, we presume that who we are is limited to our waking-world identity. Essential parts of who we are, however, are obscured by the glare of waking life. And these become more visible at night – in the deep waters of sleep and dreams… We presume awareness of deep sleep is impossible because we have no waking reference points to conceptualise, name or recall it.’

It’s no wonder we sometimes have difficulty falling asleep: ‘The Dalai Lama teaches that the psychospiritual experience of falling asleep is identical to that of dying. Our familiar, waking self dies in sleep.’ We, who are often content with our usually hyper-aroused lives, do not easily relinquish consciousness and drift into sleep -especially if we think of his words (unaided by medications, alcohol, or drugs). Sleep is not a will-power thing; it requires a certain amount of humility and acquiescence. ‘Like an airplane in gradual descent from flight above the weather, coming down from hyperarousal involves negotiating a layer of turbulence… Our challenge is to avoid reflexively re-ascending to escape this experience. Humility is about trusting that the safety of sleep resides just beyond the turbulence.’ Interestingly ‘The word bed is, in fact, derived from garden bed. We replant the body in bed, temporarily returning it to its origins for nourishment.

‘As the body settles into bed, our challenge is to let go of our ordinary mind, our waking sense of self. This part of us, the part of us we usually call I, is simply incapable of sleeping. It can walk us to the shoreline of the sea of sleep, but it can’t swim… the part of us we call I can do only waking. Because wakism holds that this I is all that there is to us, it reinforces our addiction to waking and our reluctance to fall asleep.’ From the perspective of our waking self, ‘falling asleep is an accident. We can only slip, slide or trip into it.’ Letting go of the waking self is an act of humility.

When I was very young, I remember my mother standing at the door to my bedroom while a party of adults was going on outside on the midsummer lawn; she’d obviously seen me staring at it from the window: “Go to sleep,” she’d say with an exasperated smile. Thinking of that now, I realize how a command like that was doomed to fail: invoking sleep is about a gentler, more compassionate conversation. It’s an invitation, as if from Hypnos himself, to ‘Come to sleep’. In a way, invoking, not commanding sleep helps us fall in love with the act; it is a gift and not something we have to ask for, but something we have to be willing to stop working for and accept with thanks…

I‘m not sure how I discovered this so many years ago on those rare occasions on call when there was a lull in the night’s demands for me. And then, when in the middle of the night, I had to be available on a moment’s notice to exit the darkness of the ‘call room’ at a run and plunge into a room full of activity and occasional dire emergency and be my usual waking self.

Perhaps I felt the presence of Hypnos in the once dark corner of the call room, and he was smiling as he readied his next gift for when I returned: a gift of Love -or at least one of Hope…

[i] https://aeon.co/essays/the-cure-for-insomnia-is-to-fall-in-love-with-sleep-again

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