Counting Sheep: The Science and Pleasures of Sleep and Dreams

To put icing on the cake, sleep-deprived doctors have an alarming tendency to fall asleep when driving their cars. An American study of paediatricians found that half of them admitted to having fallen asleep while driving, almost always after a night on duty. The on-call doctors notched up substantially more traffic accidents and traffic citations than their faculty colleagues. Their propensity to fall asleep at the wheel was unsurprising, considering they got less than three hours of sleep during on-call nights. So, after unintentionally jeopardising their patients’ lives while on duty in the hospital, sleep-deprived doctors put themselves and other road users at risk while driving home.

The madness of politicians

I have noted as something quite rare the sight of great persons who remain so utterly unmoved when engaged in high enterprises and in affairs of some moment that they do not even cut short their sleep.

Michel de Montaigne, ‘On Sleep’, Essays (1580)

Long hours and inadequate sleep are standard features of political life. Those highly motivated, hardy individuals who survive the fierce competition and reach the top must have an above-average capacity for coping with little sleep. Having got to the top, they then set a bad example to the rest of us by projecting an image of tireless and unceasing industry. To accuse a politician of looking tired is frankly insulting. But they are only human, and inside that aura of sleeplessness there often lurks a tired person who secretly wants to spend more time asleep in their own bed.

Mythology and image-making abound when politics meets sleep. During Margaret Thatcher’s tenure as prime minister an absurd myth was fostered that it is both feasible and admirable for people routinely to sleep for only four hours a night and work hard for the remaining twenty. Hogwash. With the possible exception of a tiny minority of extraordinary individuals, humans simply do not thrive or perform well for long on four hours’ sleep a night.

Negotiators sometimes deliberately exploit the debilitating effects of acute sleep deprivation to achieve their aims. People who have hardly slept for two or three days will agree to almost anything at four o’clock in the morning. Dragging out negotiations over several days may be irksome, but it can work if you make sure your side gets more sleep than the opposition. But more often than not, tiredness just gets in the way of rational politics. In 1997, after a sleep-deprived marathon of negotiation, representatives of 160 nations agreed the Kyoto Protocol, aimed at reducing global emissions of greenhouse gases. Three years later, fatigue helped to set back the environmental cause. In November 2000 an international summit convened in The Hague to thrash out unresolved problems left hanging by the Kyoto treaty. The negotiations ground on for 12 long days, leaving the delegates exhausted. In the early hours of the morning on the final day the British deputy prime minister, John Prescott, proposed a deal that he thought would break the logjam. But the deal collapsed, reportedly because the French delegate refused to make a difficult decision. A furious Prescott laid the blame squarely on the French environment minister. He told journalists: ‘She got cold feet, felt she could not explain it, said she was exhausted and tired and could not understand the detail and then refused to accept it. That is how the deal fell.’ The summit ended without reaching agreement.

The burden of work on the politicians and officials who run our nations has grown inexorably over the years. The number of decisions they must take has mushroomed, as the world has become an ever more complex, law-bound and media-scrutinised place. The insatiable demands of the 24-hour news media add greatly to the load. Political leaders are frequently overloaded, with insufficient time to think and formulate policy, let alone get enough sleep.

Academic observers of the British government scene calculated that between the 1960s and the 1990s the average working day for government ministers grew from 14 hours to 18 hours. The eminent political historian Peter Hennessy described the job of a British cabinet minister as ‘a conveyor belt to exhaustion and underachievement all round’, while a former senior adviser to the prime minister wrote that ‘Ministers are governed by diaries which seem designed to break them in physique or spirit in the shortest possible time.’

The diaries of the late Alan Clark, who served as a government minister in the 1980s and early 1990s, give illuminating glimpses into the sheer grind of ministerial life. Clark observed colleagues who were ‘boss-eyed’ with fatigue after working past midnight. One diary entry from 1984 describes how the civil servants would always find more work for him to do, no matter how little sleep he had had:

Today has been vilely full. Went early to Leicester after a late, late vote and impossible to drowse in the train as officials were watching me beadily in case (their excuse) anything in the brief ‘needed explaining’. I dropped off, as good as, several times during monologues at the various offices.

To add to the hazards of politics, Clark’s life was occasionally jeopardised by an exhausted government driver who had a tendency to nod off while conveying the minister along motorways at antisocial hours. Alan Clark’s experiences were by no means unusual. Geoffrey Howe, who was Foreign Secretary in the 1980s and who, like Alan Clark, worked under the notoriously unsleeping eye of Margaret Thatcher, described his gruelling work regime like this:

During six years at the Foreign Office I took home, to work through overnight while others slept, no less than 24 tonnes of paper … Six o’clock was my normal time for getting up. My average bedtime was about four hours earlier.

The long-hours culture affects not only the elected politicians but also the officials who serve them (and, some would claim, run the country). Sir John Coles, who was head of the British Diplomatic Service from 1994 to 1997, described the problem like this:

Long working hours, pressure and flurry were part of Foreign Office culture. We liked to feel busy and under pressure … But it became necessary to question some of this culture. These things did not necessarily lead to good policy. Tired, pressurised officials were liable to make mistakes.

The demands now are, if anything, even greater. In December 2000 Tony Blair was asked, during an Internet chat forum with members of the public, what he remembered dreaming about on the night after his first general election victory in 1997, and what was the last dream he remembered. The prime minister’s answer was revealing about the punishing lifestyle that goes with his job:

I don’t remember getting much sleep at all that night … After a couple of hours’ sleep, we were up early to prepare for going to Buckingham Palace. As for dreams, I’ve not had much chance for sleep over the past few days, let alone dreams.

Jet lag caused by frequent international travelling adds to the problem. In the immediate aftermath of the terrorist attacks in the USA on September 11, 2001, Tony Blair engaged in a gruelling programme of shuttle diplomacy that saw him travel more than 40,000 miles on 31 international flights in the space of a few weeks. And the fact that he then looked tired made the front pages of the newspapers.

British Members of Parliament work some of the strangest, if not the longest, hours of any legislature in the world. In October 2000 The Times published the results of one of the most detailed surveys ever carried out into MPs’ lifestyles. The survey revealed a nightmarish world of long hours and chronic sleep deprivation. Most MPs said they worked between 71 and 80 hours a week, with one in six working up to 90 hours a week. One government minister logged a working week of 91 hours in Westminster followed by 20 hours at the weekend, leaving an average of eight hours a day for everything else including travelling, family life and a little sleep.

The response from one MP was illustrative. The constituency he represented, and where his family still lived, was a long way from London. He would leave home at five a.m. on a Monday morning and return in the small hours of the following Friday morning. His weekend at home would be spent on constituency business, and then there were the occasional foreign trips with a parliamentary committee. He and his partner planned to go out together on Saturday nights but he was usually so tired by then he would fall asleep. Once, while driving home from London, he had almost fallen asleep at the wheel and crashed. There has been some modernisation of parliamentary schedules, in response to pressure from MPs, but the long-hours culture remains deeply embedded.

Some politicians cope with the long hours with the assistance of drugs of various kinds. In the USA, coke is a favourite – particularly the diet cola variety. During the US presidential election campaign in 2000, candidate Al Gore engaged in an electioneering programme of awesome intensity, involving 19-hour days and an itinerary that criss-crossed the continent. ‘Our campaign consists of a lot of long days and a lot of short nights,’ said Gore’s spokesman. ‘While some candidates may look for their feather pillows, Al Gore is looking for every single undecided voter he can find.’ To help him remain awake and vaguely sentient, Gore reportedly drank copious amounts of Diet Coke. One of his aides was explicit about the reason: ‘These are high-caffeine days. He needs his fuel to get through them.’ Sadly for Gore, the caffeine was not enough.

George W. Bush, who beat Al Gore by the slimmest of slim margins, became notorious during the election campaign for his verbal fluffs and tortured syntax. Whole books have been dedicated to Bush’s gaffes, malapropisms and garbled sentences. One American psychologist even suggested that Bush’s difficulties with the spoken word resulted from a lack of sleep in someone who apparently needed a lot of it.

Perhaps the defeated Al Gore could draw a minuscule crumb of comfort from an informal survey, which was conducted several months after the presidential election and reported to the International Conference for the Study of Dreams in July 2001. This survey found that conservative Republican supporters were nearly three times more likely to experience nightmares than their less conservative Democrat opponents. Half of the dreams recalled by Republicans were nightmares, compared with fewer than one in five of Democrats’ dreams. Moreover, the conservatives’ dreams were generally more frightening and more aggressive in content.

When the next big crisis erupts on the world stage, remember this. The politicians and officials who will be handling that crisis will be getting little sleep, perhaps for days at a time, and they will consequently become even more sleep-deprived than they already were. Their reactions, judgment, rationality, mood, memory, creativity and social skills will deteriorate, and they will become more prone to taking inappropriate risks. You might conclude that the world would be a safer and saner place if our leaders and their officials spent more time in bed (asleep).

Truly, madly, sleepily

I have an exposition of sleep come upon me.

William Shakespeare, A Midsummer Night’s Dream (1595–6)

The human errors caused by tiredness sometimes have truly catastrophic consequences, and there have been plenty of man-made disasters to prove it.

Tiredness lay behind the environmental disaster that occurred when the supertanker Exxon Valdez ran aground in Prince William Sound, Alaska, spilling 11 million gallons of crude oil into the pristine waters and polluting thousands of miles of shoreline. The official investigation by the US National Transportation Safety Board concluded that sleep deprivation was a direct cause. The accident took place just after midnight on 24 March 1989, when the Exxon Valdez was under the control of the third officer. He had slept for only six hours during the preceding 48 hours and was therefore substantially sleep-deprived. It appears that he fell asleep on duty. Media reporting at the time suggested that alcohol was to blame for the accident, but the real culprit was fatigue. In addition to the appalling environmental damage, one man’s tiredness cost his employer more than five billion dollars in punitive damages.

Tiredness contributed to the US Space Shuttle Challenger disaster. On a freezing cold morning in January 1986 the Challenger ascended for ten miles and then exploded, killing the crew of seven astronauts. It later emerged that crucial rubber O-ring seals had failed catastrophically at the low temperatures prevailing that morning. The US Presidential Commission that investigated the disaster concluded that there had been serious flaws in the decision-making processes leading up to the launch. The danger had been foreseeable, but tiredness had contributed to the bad decision to launch despite the icy conditions. Key managers had slept for less than two hours the night before and had been on duty since the early hours of the morning. They were at a dangerously low ebb when the fateful decision to launch was taken. The official report noted that ‘fatigue is not what caused the accident, but it didn’t help the decision-making process’. It also commented that ‘working excessive hours, while admirable, raises serious questions when it jeopardises job performance, particularly when critical management decisions are at stake’. Bear in mind that when official investigations search for the causes of disasters they instinctively focus on tangible, physical causes like rubber O-rings and air temperatures; intangible human factors like fatigue are seldom in the forefronts of investigators’ minds.

Lack of sleep has contributed to, if not caused, a string of disasters and near disasters in nuclear power plants. Many of them occurred in the early hours of the morning – a common feature of sleep-related accidents – and stemmed from failures by human operators to make sensible decisions when faced with the relevant information. Research has confirmed that nuclear power-plant operators who work night shifts experience real problems with sleepiness, distractibility and poor alertness. Even if they are not particularly sleep-deprived, they are unlikely to perform well in the early hours of the morning. And that is when the accidents happen.

The worst nuclear incident so far in the USA took place in March 1979, when the reactor at the Three Mile Island power station near Harrisburg in Pennsylvania came close to meltdown. The near-disaster at Three Mile Island arose in the early hours of the morning, after operators failed to recognise what their instruments were plainly telling them – namely, that an automatic valve had closed, cutting off the water supply to the coolant system. The reactor shut itself down automatically, as it was designed to do when a malfunction like that occurred. But a series of errors by the human operators led to a dangerous loss of coolant from the reactor core and almost turned an incident into a catastrophe. Radioactive gases were released from the partially exposed reactor core, but the containment vessel fortunately prevented them from escaping into the environment. Although no one died as a direct result of the Three Mile Island accident, it had a massive impact on the American nuclear industry. The damaged reactor took ten years to decontaminate and remained unusable. Fatigue is believed to have contributed to the operators’ repeated failures to handle the incident correctly.

The worst nuclear accident thus far in history occurred at the Chernobyl nuclear power station in April 1986. It too was sleep-related, and started in the early hours of the morning when the operators were at their lowest ebb. The disaster happened when the engineers operating one of the station’s four nuclear reactors made a series of irrational judgments. They attempted an ill-conceived experiment that involved shutting down the reactor’s regulatory and emergency safety systems and withdrawing most of the control rods from the core, while allowing the reactor to continue running. The operators exhibited the alarming propensity to take inappropriate risks that is characteristic of tired people. As a later report put it, they behaved ‘like intelligent idiots’.

The reckless behaviour of Chernobyl’s operators caused a chain reaction. At 1:23 a.m. on the morning of 26 April a series of explosions blew the reactor apart. There was a partial meltdown of the reactor’s graphite core and it caught fire. Large amounts of radioactive material were released into the environment – several times the amount created by the atom bombs dropped on Japan in World War Two. Some of it was carried by winds and contaminated several western European countries, including France and the UK. Thirty-two people at the Chernobyl plant died at the time of the accident and several more died soon after from severe radiation exposure. The long-term damage to the health of populations living in affected areas remains a matter of controversy, but it is undoubtedly huge. Several thousand people have died, or will die, as a result.

Over and over again, man-made disasters like Chernobyl and Exxon Valdez have occurred at night or in the early hours of the morning, when people’s reactions and judgment are at their weakest. We saw earlier that drivers are much more likely to have a serious crash late at night than in the middle of the morning. Almost everyone who works night shifts displays signs of sleepiness and impaired performance, and it is not difficult to see why. Working at night forces people to perform at a time when their biological clocks are telling them to sleep, and to sleep when their biological clocks are telling them they should be awake. They perform worse when they are at work, and they are less able to sleep when they go home, as a result of which they become tired and accident-prone. Add chronic sleep deprivation to the brew and you have a potentially lethal concoction. And we all have to live with the consequences.

The price of eternal vigilance is liberty

Care is heavy, therefore sleep you.

Thomas Dekker, Patient Grissil (1603)

If society were to recognise the true importance of sleep, then attitudes towards tiredness on the roads and in the workplace might become more enlightened. In a more sleep-conscious world it would no longer be socially acceptable, let alone admirable, for people to drive or turn up for work suffering from severe fatigue, any more than it is now acceptable to be drunk in the workplace or behind the wheel of a car. Napping during working hours would be tolerated and even encouraged, rather than stigmatised as a sign of sloth, drunkenness or illness. Meanwhile, society continues to turn a blind eye to people driving cars, flying aeroplanes, practising medicine, operating safety-critical machinery and running nations when they are mentally and physically impaired by lack of sleep.

In the next chapter we shall see that sleep-deprived people are bad at making decisions and communicating those decisions to others. Their judgment is impaired, they are easily distracted, they respond poorly to unexpected information, they lack flexibility, they persist with inappropriate solutions to problems and they are prone to taking foolish risks. These are not the characteristics any of us would wish to see in the people who make life-and-death decisions in the corridors of power, hospitals, flight decks or nuclear power stations.

3 Dead Tired

You lack the season of all natures, sleep.

William Shakespeare, Macbeth (1606)

Does it really matter that many people in industrialised countries no longer get enough sleep of sufficient quality at the right times? We have seen one reason: the fact that sleepiness causes accidents. But far more than that, inadequate sleep matters because of what it does to our minds and our bodies each and every day.

Sleep is eloquent in its absence. We know that if we miss a night’s sleep we will feel bad the next day. But the unpleasant sensations of acute fatigue evaporate after a good night’s sleep and we soon forget. Far less obvious are the insidious, cumulative consequences of seldom getting quite enough sleep, night after night, week after week. Chronic sleep deprivation creeps up on us. It has pervasive effects on our mood, social skills and mental abilities – especially judgment, creative thinking and problem solving. It can also impair our physical health and make us more vulnerable to disease, as we shall see in the next chapter. However, the first and most obvious symptom of insufficient sleep is sleepiness, and that is where we shall start.

Sleepiness

Life is one long process of getting tired.

Samuel Butler, Notebooks (1912)

The longer you go without sleep, the sleepier you feel. Objective measurements prove that there is indeed a close relationship between sleep deprivation and sleepiness. That relationship is ‘dose-dependent’, which means that the longer you have been deprived of sleep, the faster you will fall asleep when given the opportunity. Really tired people can fall asleep almost anywhere, as William Shakespeare observed:

Weariness

Can snore upon the flint, when resty sloth

Finds the down pillow hard.

If you are able to lie on a hard floor and go to sleep immediately during the middle of the day, you are probably sleep-deprived. (An obvious point, but no less true for that.)

Sleep will eventually force itself upon you if you go long enough without it. When scientists carry out sleep-deprivation experiments with human volunteers they often have to work quite hard to keep their subjects awake. Someone who has been deprived of sleep for two or three days requires stimulation, activity and variety to stop them falling asleep, no matter how well motivated they are to stay awake. Ian Oswald, a British scientist who conducted sleep-deprivation experiments in the 1960s, recalled walking the streets of Edinburgh flanked by exhausted volunteers whom he was working hard to keep awake. Even then, he would often see their eyelids closing as they walked along in a twilight state somewhere between waking and sleep.

Sleepiness and its flip side wakefulness determine how alive you feel and how well you perform every day of your life. But until the late 1970s there was no standard tool for measuring sleepiness. Then Mary Carskadon of Brown University in the USA invented a simple technique called the multiple sleep latency test (MSLT). It measures sleepiness like this. The subject is invited to go into a dark, quiet room in a sleep laboratory, to relax and fall asleep. Sensors detect the physiological signs of sleep (of which more later). As soon as the subject falls asleep, he or she is woken up. The key measurement is the time taken to fall asleep. The purpose of the MSLT is to measure daytime sleepiness, so the tests are generally carried out between ten in the morning and eight in the evening. The procedure is usually repeated four or five times during the course of a day.

The length of time between lying down and falling asleep is called the sleep latency. A daytime sleep latency of 15–25 minutes is generally interpreted as a reassuring sign of normality. Someone who is sleep-deprived will fall asleep faster. A sleep latency of less than ten minutes raises questions; there is a good chance that the person concerned will be experiencing intrusive daytime sleepiness, especially during the normal afternoon dip in wakefulness or when bored. A daytime sleep latency of less than five minutes usually signifies excessive tiredness, implying that the individual is substantially sleep-deprived or suffering from a sleep disorder.

Not everyone who falls asleep quickly in the MSLT is sleep-deprived, however. There are a few healthy people who can fall asleep in a trice, given the opportunity and the will. These individuals have the ability to go out like a light even after they have had unlimited amounts of sleep and without displaying any other signs of sleep deprivation. They just seem to be unusually good at relaxing and going to sleep during the day, regardless of their need for sleep. An unusually short sleep latency should therefore be viewed as strong evidence of sleep deprivation, but not conclusive proof.