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The Vast Conspiracy to Create Insomniacs

Insomnia is exactly what the movers and shakers of our society want for us.

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In his book White Nights: The Story of a Prisoner in Russia, about being a POW in a Siberian labor camp during World War II, former Israeli prime minister Menachem Begin wrote that prisoners "subjected to extreme tortures had not cracked, but lost the will to resist with sleep deprivation. In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep, to sleep just a little, not to get up, to lie, to rest, to forget. . . . Anyone who has experienced this desire knows that not even hunger or thirst are comparable with it. I came across prisoners who signed what they were ordered to sign, only to get what the interrogator promised them. . . . uninterrupted sleep!"

Can you die from lack of sleep? Again, nobody really knows because sleeplessness is so confounded with so many other chronic and life-shortening maladies that it's hard to pin lethality on sleep deprivation alone. Experimental animals deprived of sleep for long die. Hard-to-contemplate experiments with rats and puppies (yes, puppies) have demonstrated that total sleep deprivation killed the former within 17 to 20 days (their hair began to fall out, they developed skin lesions, swollen paws, and hyperaccelerated metabolism) and the latter within 3 to 6 days.

Nonetheless, unforced insomnia that ends only in death, though very rare, does happen. Consider a disease called fatal familial insomnia (FFI). As described in The Family That Couldn't Sleep by D. T. Max, fatal familial insomnia is a genetic disease, first identified in the 1980s, in which prions—the same kind of mysterious, viruslike rogue protein responsible for mad cow disease and Creutzfeldt-Jakob Disease in humans—caused a rare, always lethal, condition characterized by relentless insomnia. Upon autopsy, the brain seems mostly normal, except that the prions have essentially scoured out the thalamus—a nodule still not well understood, which helps control the body's autonomic nervous system and natural sleep–wake cycles. The affected person experiences increasingly dire symptoms: worsening insomnia, profuse sweating, stiff neck, pinprick-sized pupils, sudden menopause in women, impotence in men, listlessness, tremors, uncontrollable crying, thrashing limbs, elevated blood pressure and pulse, loss of balance, dizziness, and emaciation, ultimately culminating in a state of chronic, agitated, hallucinatory stupor, alternating with ever-shorter periods of lucidity. No narcotic or anesthetic agent has any effect, and the end—generally around 15 months or so after symptoms first appear—is usually awful. Max describes one dying man "howling in the night, his arms and legs wrapped around themselves."

Almost nobody gets fatal familial insomnia, and yet, don't these symptoms strike a terrifying chord in the heart of anyone who's ever spent more than a few nights staring hollow-eyed into the darkness? The exhausted longing for sleep combined with the paradoxical inability to force yourself to "fall" asleep is maddening in that the harder you try, the greater your physiological stress, and the more awake you feel. The sense of existing in a surreal state, all nerves quivering as if expecting at any second that ominous knock on the door by the KGB or the Gestapo (or Homeland Security?), breeds anxiety and dread, an enveloping foreboding that something nearby is wrong and strange and dangerous.

With our poor night vision and relative helplessness before predators that growl and stalk the darkness, we have always felt, from our deepest hominid past, most vulnerable to harm after sunset: the "hour of the wolf" has more than metaphorical meaning. Night and death, sleep and death, have a long history of association. In The Iliad, Hades, the "Kingdom of the Dark," is also the kingdom of death, and it's during the night that the dead visit the living in the form of dreams. To be up and about in this land of the dead seems to be breaking a taboo, to be entering a forbidden borderland between waking and sleeping, living and dying, and risking unpleasant and unsought encounters with ghosts and specters, goblins and ghouls. And encounter them we often do, even if they originate in our own minds, haunting presences from our own lives. As an anonymous Japanese poet once put it, "the night offers toads and black dogs and corpses of the drowned."Robert Burton, whose 1621 book Anatomy of Melancholy, was probably the first full-length treatment of depression, encyclopedic in its scope, described the reciprocal interconnection among insomnia, depression, and the kind of anxious, hypochondriacal fantasy that feeds on itself in the middle of the night. "Waking overmuch, is both a symptom, and an ordinary cause [of melancholy]. It causeth dryness of the brain, frenzy, dotage, and makes the body dry, lean, hard, and ugly to behold . . . . The temperature of the brain is corrupted by it, the humours adust [burn or scorch], the eyes made to sink into the head, choler increased, and the whole body inflamed. . . . Waking, by reason of their continual cares, fears, sorrows, dry brains, is a symptom that much crucifies melancholy men, and must therefore be speedily helped, and sleep by all means procured, which sometimes is a sufficient remedy of itself without any other physic." During bouts of insomnia, we all know only too well, don't we, what that hot, dry, corrupted, shriveled brain feels like, mummifying inside our heads?

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