What to do if you strug­gle to snooze

The Jewish Chronicle - - LIFE - JEN­NIFER LIP­MAN

IF I’D done this in­ter­view two years ago,” I tell Dr Hugh Sel­sick when we meet, “I’d have spent most of it cry­ing.” Not be­cause jovial Dr Sel­sick has that ef­fect, but be­cause he’s an in­som­nia spe­cial­ist, and it’s so rare to see a doc­tor who truly un­der­stands. I’ve had sleep prob­lems for 16 years, ex­pe­ri­enc­ing pe­ri­ods of barely sleep­ing, nightly panic at­tacks and mind­numb­ing wake­ful­ness, crash­ing out in meet­ings and sob­bing at 3am from sheer frus­tra­tion.

I’ve seen all man­ner of sleep ther­a­pists. What I haven’t had is a doc­tor who can speak from first­hand ex­pe­ri­ence, as Dr Sel­sick can.

Be­fore univer­sity he spent a year in Is­rael on the Ma­chon pro­gramme. Liv­ing on kib­butz, he strug­gled with sleep­less­ness, ex­hausted from the early starts but un­able to nap in the af­ter­noon. Re­turn­ing home to South Africa he de­vel­oped re­ally bad in­som­nia for sev­eral months. “It just re­solved one day and I don’t know why, but it was hor­ren­dous.”

He vol­un­teeredas a sub­ject in a sleep ex­per­i­ment. “While I was get­ting my head wired up, the pro­fes­sor hooked me.” Mov­ing to Lon­don, he trained as a psy­chi­a­trist and start­ing to see pa­tients at the Royal Lon­don Hos­pi­tal for In­te­grated Medicine nine years ago.

“The thing about in­som­nia is it’s a com­pletely in­vis­i­ble dis­or­der. I’ve met thou­sands of in­som­ni­acs and I couldn’t tell you had it,” he tells me. “Peo­ple feel hid­den.”

Dr Sel­sick says peo­ple have been strug­gling with sleep for a long time

— although shift work, noise and the 24/7 work­ing cul­ture may have made the prob­lem more wide­spread — yet it re­mains poorly un­der­stood. “Most doc­tors don’t know how to as­sess it, how to treat it, or even whether it is treat­able,” he says.

“It just wasn’t viewed as some­thing that could be stud­ied or was in­ter­est­ing to study.” In­som­nia was of­ten seen as a symp­tom of an­other dis­or­der, such as de­pres­sion, lead­ing doc­tors to as­sume if they treated the lat­ter, the for­mer would clear up.

“Some­times it will but of­ten it won’t,” says Dr Sel­sick. “That’s a prob­lem be­cause in­som­nia is a se­ri­ous dis­or­der in its own right, and it af­fects qual­ity of life.” It is a risk fac­tor for other psy­chi­atric dis­or­ders, “if you treat just the de­pres­sion the risk of that per­son hav­ing an­other de­pres­sive episode is much higher”.

He sees up to 70 pa­tients a week, ei­ther alone or in groups. The NHS funded clinic at­tracts pa­tients from as far afield as York, Corn­wall and the Chan­nel Is­lands. Some, he ac­knowl­edges, sleep more than they think — peo­ple are no­to­ri­ously bad at es­ti­mat­ing their kip — but he says, “If they are feel­ing un­well dur­ing the day there’s a prob­lem that needs to be treated.

“I’ve had more peo­ple cry­ing in this clinic than in my gen­eral psy­chi­a­try clin­ics. Part of it is that in­cred­i­ble re­lief,” he says. “Most peo­ple have ei­ther been fobbed off by their GPs or told have a glass of warm milk be­fore bed, or just to live with it.”

This rings true to me, hav­ing bro­ken down in many pro­fes­sional’s of­fices. “Some of the feed­back is that even if you don’t cure my in­som­nia the fact you re­alise this is a big thing in my life is enor­mous,” he says.

Pa­tients are tasked with a se­ries of ac­tions, in­clud­ing mak­ing sure you get up at the same time ev­ery day how­ever badly you’ve slept — “it’s hard but makes a sig­nif­i­cant dif­fer­ence” — avoid­ing nap­ping, and, fi­nally, sleep sched­ul­ing. This last so­lu­tion helps around 80% of pa­tients.

It in­volves re­strict­ing time in bed to match ac­tual sleep (only spend­ing five hours in bed if you gen­er­ally only sleep for five hours) and us­ing the bed­room only for sleep and sex, rather than spend­ing time in it awake. Af­ter 15 min­utes of at­tempt­ing sleep, peo­ple are en­cour­aged to leave the room and do some­thing re­lax­ing, such as lis­ten­ing to a pod­cast, un­til they are sleepy.

Dr Sel­sick sighs that the tech­nique is badly mis­un­der­stood. “Peo­ple will say I tried it for two or three nights and it was hor­ren­dous. What they don’t re­alise is that the point is not to make you feel sleepy on the night you do it.” In­stead, it’s about de­stroy­ing neg­a­tive as­so­ci­a­tions by con­di­tion­ing a dif­fer­ent mind­set.

For good sleep­ers, go­ing to bed makes them sleepy and makes them sleep

— a pat­tern re­in­forced over thou­sands of nights. In­som­ni­acs, how­ever, have been to bed thou­sands of times, un­suc­cess­fully. The act of do­ing so is as­so­ci­ated with anx­i­ety, frus­tra­tion and —ul­ti­mately —wake­ful­ness.

We talk about how I can be nod­ding off on the sofa yet wide awake mo­ments later in bed; Dr Sel­sick nods: “That’s this process kick­ing in. The point of the tech­nique is to break those path­ways.”

With sleep sched­ul­ing, “you may spend a lot less time in bed but it’s spent asleep. Over many weeks it shifts your as­so­ci­a­tion of the bed­room from a place where you’re awake to a place where you’re asleep, so the act of go­ing to bed makes you sleep.” It may take months, hewarns “but once it works, this path­way be­comes so strong”.

“I ask my pa­tients to do some re­ally tough things so I think it does help that I can at least ap­pre­ci­ate how much harder it is for them be­cause they’re start­ing from a place of ab­so­lute ex­haus­tion.”

If rewiring sleep pat­terns is the ul­ti­mate goal, in the short-term, unusu­ally, Dr Sel­sick doesn’t ad­vise against sleep­ing pills. With a healthy but very con­trolled habit, this is mu­sic to my ears. “Our phi­los­o­phy s that our prime job is to get peo­ple sleep­ing well. Mostly that in­volves do­ing Cog­ni­tive Be­hav­iour Ther­apy but some­times that in­volves med­i­ca­tion, and we would do them along­side each other.”

He com­pares sleep­ing drugs to in­sulin; with­out it a di­a­betic’s blood sugar will spi­ral “yet no one would ever say they’re ad­dicted to the in­sulin”. Like in­sulin, pills are a treat­ment not a cure, and just be­cause the con­di­tion re­turns when you stop the medicine doesn’t mean you’re ad­dicted. “The vast ma­jor­ity who take sleep­ing pills do not be­come ad­dicted,” he says. “There is a risk, but it’s nowhere near as com­mon as peo­ple think.”

In re­sponse to de­mand, Dr Sel­sick is launch­ing an on­line ver­sion of the treat­ment pro­gramme. His plan, longterm, is to fo­cus on the most com­plex cases, in­clud­ing dis­or­ders like night ter­rors or sleep paral­y­sis.

What­ever the spe­cific com­plaint, it’s clear his ex­per­tise is highly sought af­ter; even on se­cu­rity at Alyth Gar­dens syn­a­gogue, he gets asked about sleep is­sues. He has his share of sto­ries, in­clud­ing the man who told him he drank 16 cups of cof­fee a day, and couldn’t un­der­stand why he wasn’t sleep­ing. “I said do you think that might be in­ter­fer­ing with your sleep and he said no — af­ter 6pm I switch to lat­tes.”

Pas­sion­ate about Ju­daism and Is­rael, Dr Sel­sick looks back on his gap year as per­haps the most for­ma­tive of his life “in ev­ery way”. Thirty years on, he’s em­phatic that sleep is a ne­glected area of study.

“Most peo­ple don’t re­alise that help is avail­able,” he says. “It’s a se­ri­ous con­di­tion that has a huge im­pact on peo­ple’s lives, their jobs and the econ­omy. ”

Whether he would have fo­cused on sleep medicine were it not for his ex­pe­ri­ence, he’s un­sure. But per­haps it was pre-or­dained. “It oc­curred to me a few years ago that maybe it was prophetic that my bar­mitz­vah por­tion was Vayet­zeh— Ja­cob’s dream,” he chuck­les.

Of course, if his pa­tients are dream­ing, he must be do­ing some­thing right.


If sleep is elu­sive, there are so­lu­tions

Sleep doc­tor: Hugh Sel­sick­knows what it’s like

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