Insomniac Book

Gayle Greene has written a wonderfully witty and harrowing memoir of her life with insomnia. Insomniacs will find a lot to empathize with here, as she recounts each failed treatment and wacky solution prescribed by professionals and non-professionals (most of whom are 'normal sleepers') who just don't get it. Greene and I have different problems (her issue is idiopathic sleep maintenance, while I'm a late chronotype with a circadian rhythm sleep onset disorder) but our paths through treatment have been remarkably similar, as I suspect has been the case with many of us with sleep problems - despite the wide range of sleep disorders that have been identified. She really hits the nail on the head regarding several issues: 1) the medical community's steadfast cheerleading for CBTI (cognitive behavioral therapy for insomnia) despite the shoddy evidence that CBTI is effective for all types of insomnia; 2) the seemingly inexplicable foray of pulmonologists into the field of sleep medicine (spoiler alert: apnea is easy to diagnose and treat, and it's a big moneymaker); and 3) the complex architecture that makes up our sleep, which medical professionals are still only beginning to understand. She highlights relevant research, subjects herself to attending a bunch of boring and expensive medical conferences in the name of research (and is treated as a suspicious outsider at each one), and above all, gives people like us a voice, which we desperately need. People who suffer from sleep disorders are viewed as lazy, neurotic, sleep-obsessed pill junkies - Greene pointedly remarks that most people would seem neurotic and sleep-obsessed if they weren't getting enough sleep, and she recounts the benefits and pitfalls of hypnotics, from trazodone to benzos to z-drugs. Curiously, the one medication that has finally worked for me is not one she has listed as trying, but that just shows that there really is no "one size fits all" approach to sleep medicine.

Unfortunately, the population that desperately needs to read this book is the population of medical professionals who treat people with sleep disorders, and it's unlikely that any of them will go near it. The fact is, a humanities scholar writing about medicine has no place among the Physician's Desk Reference and the latest edition of the DSM, which is a complete shame. Psychiatrists and medical professionals, in my experience, put on blinders and focus only on the research that favors the cheap treatment (CBTI) or the fancy new drugs, and don't listen to their patients - only when we get lucky and find a professional who believes us do we have any chance of getting to a place where we can get a decent night's sleep.