No Rest for the Wicked

No Rest for the Wicked

By VINEET GILL | | 26 September, 2015
Photo Courtesy: Cities of Sleep
Why do we sleep? The question has beguiled the scientific community for decades, and remains as fascinating and confounding as ever. Seeking to resolve this conundrum, Vineet Gill visits a sleep laboratory in the capital and heads over to experts who’ve devoted whole lifetimes to the subject, while pondering obsessively over his own out-of-sync circadian rhythm.
Sleep is the anathema of our age. It virtually interrupts everything we, as a society, seem to stand for — progress, activity, dynamism — grounding to a halt, for certain stretches of time each day, the restlessly spinning wheels of life. Sleep is an embarrassment, an act of capitulation, a failure to keep awake and to keep up with daily living; it is an accident, where we fall from a state of total wakefulness to, ideally, total blackout; it is a weakness, a fix, a disreputable craving. And most important of all, sleep is a mystery. 
We must begin with the whys and wherefores, the first attempt of the curious mind at grasping the philosophy of nature (or indeed the nature of philosophy). Why do we sleep? The answer to this question, after decades of sleep studies and with university departments around the world teeming with sleep experts, is yet to arrive. I am reminded of the story once related by the psychologist and writer Andrew Solomon about a Stanford University professor who had upwards of 50 years of experience in sleep studies. When asked why we sleep, the venerable sage responded so: “Because we get sleepy.” 
To be fair, the question itself is slightly reductive. It’s like asking, in a Socratic vein, why there is something rather than nothing, or why we are here rather than there, wherever “there” happens to be. Such questions are best answered using that snap Americanism, “because” — sometimes pronounced “becuzz” — which both begins and ends a sentence, a fittingly open-ended response to such expansive and meaningless queries. Why are we here? “Becuzz!” Why do we sleep? “Becuzz!” 
But, then, some of us can’t sleep. And this — why can’t I sleep? — is a legitimate question to pose and important enough to keep you up at nights (if you aren’t already up). The bed becomes a hostile setting for insomniacs. Having struggled to fall asleep for one, two and three days, the last thing a sleep-deprived person wants to look at is his own bed. Another thing you don’t wish to look at after a sleepless night is the morning. Daylight, as the edges of a window curtain soak it in (Larkin’s image), becomes a reminder of the night’s struggle and another premonition of the coming breakdown. 
Mornings, however, continue to interest me even after having spent a restless and wakeful night. I am not a clinical case of insomnia, far from it. But I have had my troubles with sleep. Mostly, I end up sleeping too little, or too much. My travels, both in and out of consciousness, are characterised by physical struggle: I force myself to sleep (often by staying still for long stretches of time on my bed and pretending, to myself, that I am asleep), and then, drag myself awake full of resentment for life. But I am also full of admiration for those who rise with the sun: the early birds, or in sleep terminology, the “larks”.  
These, the larks, are the ones who are naturally predisposed to waking up early. Reading bits and pieces on the subject, I recently dug out a respectable term for my proclivity to being a late riser. Our “chronotype” refers to the body’s internal rhythm, its natural sleep-wake cycle. This is what determines whether we’re larks or, on the other hand, owls. I am categorically an owl. Never mind the term being so evidently insulting to whomever it is applied, and that an owl is considered inferior, even on an ornithological scale, to a lark. 
To understand one’s chronotype, though, surely comes as a relief. There’s now a medically certified justification for my erratic schedule. This is something about my sleep pattern that I now, I say with timid but smug authority, know. Still, there is a lot that I don’t know in this regard. And to address my curiosity, my ignorance, I recently booked an appointment with a sleep specialist at a Delhi hospital, with the express objective of figuring out whether it was normal to live one’s life in contravention of the fascistic code “early-to-bed-early-to-rise”, which has become central to how we live, work or even play (what’s with Test matches beginning at 10 a.m.?) now. Was it, in other words, normal to be considered abnormal by “normal” people?
Dr Vivek Nangia, the director and head of the Department of Pulmonology at Fortis hospital, is the very image of normalcy. He looks like a man who has slept well the previous night, and the night previous to that. I waited for him at the hospital lobby, being terrorised by signs telling me to “take stairs in case of emergency” and one of them imploring silence in the hall by literally going, “Shhhhhh”. I was comforted by the sight of Dr Nangia, who wore his stethoscope, old-school style, around his neck. We were heading to the sleep lab, which was headed by him, and where he regularly carried out thorough night-long sleep analyses of his patients. 
We entered what seemed like a basic hospital ward, the tag on the door read F220. Nothing like the high-tech setting of my imaginings, nothing that reminded me of Stanley Kubrick. This sleep lab had only a bed on the side, a couple of computers, a mounted television set, and — that bane of the sleepless — a view from the window. The kind of room I would never sleep in. I asked Dr Nangia if he gets patients for analysis who are unable to sleep through the night. “Yes, when it happens, we usually try to repeat the study the following night,” he said in his measured and correct way. I wanted to ask him, reminded of myself, if he ever gets patients unable to sleep all through the second night too, but I preferred not sounding foolish. 
There was a small, portable looking kit — a multitude of wires and electrodes. And I saw a computer programme, Alice Sleepware, on the screen of a laptop, which showed rows of electronic sine-wave graphs, travelling jaggedly up and down, like a mathematical image of some hopelessly cacophonic song. Dr Nangia then explained to me how these electrodes are hooked up at various points on the patient’s body, to observe parameters like brain waves — EEG, EMG, EOG — snoring levels, oxygen saturation in the body, chest wall and abdominal movement, and so on. 
 
People who suffer from sleeplessness now have the option of undergoing a sleep analysis. “If someone is snoring very loudly,” Dr Nangia told me, by way of listing the symptoms that should make you go for a sleep analysis. “If someone is tossing and turning on the bed all the time, has restless sleep, has episodes of breathing difficulty or choking while asleep, doesn’t wake up fresh in the morning, feels excessively sleepy during the day, then they should consider going for a sleep analysis.” I was secretly placing mental ticks alongside my personal checklist. Wakes up tired — check. Restless sleep — check. For practical concerns, I asked him how much would the analysis cost: around Rs 8,500, excluding the price of the ward. This simple enough medical exercise, I was told, is crucial to determining whether a person suffers from obstructive sleep apnea — the commonest and most neglected of sleep disorders, which is connected to serious breathing difficulties.   
I don’t think I snore, although the people who have slept in my vicinity have sometimes taken to expressing some violently opposing views on this. But all this talk about breathing difficulties, choking episodes, the fact that I may be having one of these symptoms, caused serious concern. I wanted to address this issue urgently, the same way I have addressed most medical urgencies in my life: by fleeing the hospital and not thinking about it. The view from the window, which was next to a huge and shimmering branch of the peepal tree, showed nothing but the leisurely, somnolent swing of the leaves outside. 
“Basically, in India, the concept is, if you’re snoring at night that means you’re actually getting a good sleep. This is contrary to what doctors believe. For us, loud snoring does not mean you’re sleeping well.”
Dr Nangia had again touched upon the very sensitive subject of snoring. “Basically, in India, the concept is, if you’re snoring at night that means you’re actually getting a good sleep. This is contrary to what we believe. For us, loud snoring does not mean you’re sleeping well. Very loud snoring, along with episodes of breathing difficulties and choking, is a characteristic symptom of obstructive sleep apnea, which is related to a wide range of very 
serious diseases.” 
As I prepared to leave, Dr Nangia said, “But you don’t look like you have sleep apnea. Your face structure doesn’t look like it. Usually, you can look at a face and tell whether someone has it.” This was, needless to say, a proud moment for me, the first such inside a hospital. And taking the doctor at his word, I decided with relief to opt out of getting my own sleep analysis done. Ever.  
This typically irresponsible and daft attitude, the voice inside my head went, is just the thing that gets people killed. Ashish Jaiswal, a 37-year-old businessman from Allahabad and one of Dr Nangia’s patients, learnt not to ignore his long-running sleep disorder the hard way.  “I was driving in Allahabad, I remember, on a bridge,” Jaiswal told me. “When I just fell asleep at the wheel. The car went right off the road and into a ditch. Thankfully, I was left unhurt, but I decided then to take this thing very seriously.”
He was recently diagnosed with obstructive sleep apnea, and some of the results were alarming. “Normally, he said, “the oxygen level inside a human body during sleep is 98%, and mine came out as 41%. The doctor told me that my breathing was being obstructed 75 times in one hour.” Of late, however, he had seen a marked improvement in the quality of his sleep, following proper treatment. He now sleeps with a “triangular mask” covering his nose: “It helps open the blockage and supplies oxygen whenever my breathing is interrupted. The doctor said I have to wear it for a long time.” 
There was no medical help available for people like Jaiswal barely half a century ago. Sleep was considered a homogenous state, much like being awake, while dreams were seen as its language, to be decoded and interpreted by those who study the mind. However, in its modern form, both our understanding of sleep and its study have evolved. We now know that we fall asleep in stages — four to be precise, with one of them being REM (rapid eye movement) sleep, which is the stage when we dream. And the subject has attracted experts from a variety of disciplines. One such man of science, neuroscience to be specific, is the JNU professor BN Mallick. His research on REM sleep is a seminal work in neurobiology and sleep studies, and Mallick has given over 30 years of his life researching the subject from a little laboratory on the JNU campus. “It’s sad that no one knows about the work we have done in this lab,” he told me. “I am not saying it out of my own interest. This is for the sake of general interest. Because we are using tax payers’ money to do this work, you see?”
Professor Mallick’s main job at this lab is, as his website (which carries his 30-plus page CV) states: “exploring, unravelling and understanding (i) the basic neuronal mechanism(s) regulating Rapid Eye Movement (REM) Sleep and (ii) function(s) of REM sleep.” The number of parentheses in that sentence isn’t the only astonishing thing here: the work at the lab is actually cutting edge. What happens inside the brain when it undergoes a phase of REM sleep is crucial to our understanding of the subject, and to establish links between sleep loss and various other ailments. It is important for our general well-being. 
When I visited Professor Mallick’s room at JNU, he was happy to deliver a sort of elaborate university-level lecture for me: “...when EEG becomes decentralised,” he was saying nine minutes into the lecture. “...ah, I think I have to show you some slides because I think you’re not following.” I tamely nodded assent, and he was generous and forgiving enough to resume his talk. He showed me slides, videos, photographs. “That’s me with Aserinsky,” he said pointing at his computer screen, which showed a much-younger Professor Mallick with Eugene Aserinsky, the man who discovered REM sleep, on his left. 
The professor had two sets of spectacles on the table, using one of them to look at me and shifting to the other when he had to look at his computer. He even took out a laser pointer and beamed a little red dot on one of the charts on the wall. I followed some of it, while pretending to follow most of it. When he showed me his academic books on sleep, I posed the inevitable question: you’re not planning to write any popular science books on sleep? At this he referred me back to the pile of books on the table. The slimmest volume was called Sleep-Wakefulness with a tag on the cover saying, in no uncertain terms, “popular science”. 
The chapter headings went like, “Why does one sleep?”; “How much sleep is necessary and adequate?” Just the thing I needed to crack the ice and to, as it were, clear the academic air. “So, Professor Mallick,” I asked him, “Why does one sleep?” half expecting him to respond with a “Why don’t you read the book?” But generous and forgiving as always, the good professor replied, “See, when we talk about why we need to sleep... if we talk about sleep as a function, according to me, it does the housekeeping function for the brain. But if you want a single window answer, the function of sleep is maintaining brain’s excitability status,” he said. If that balance — that excitability status — is disturbed, anomalies like loss of memory or concentration may ensue.  
It was over an hour since I had walked in when I said goodbye to the professor and went outside to walk around the JNU campus. Some figure sitting on a wooden bench under an awning was asleep. He had his back straight against the bench, but his head was down — a siesta, I thought, the highest form of sleep. But walking past, I saw that he was as wide awake as I am on some days, in the small hours of the morning, when I am trying hard to get at least to a state of easeful repose. But this was different. The guy wasn’t asleep at all. He was fiddling with his phone, dreaming dreams that technology weaves for us, leaving hardly any room for anything more. 
 

Cities of Sleep

Cities of Sleep

Documentary | 77 minutes
Directed by Shaunak Sen 
 
Where do the lakhs of homeless people who comprise the urban poor  in the city of Delhi, a community that is affected most by its violent ravages caused by the weather and other socio-cultural factors, secure one night of sleep?
 
Photo: Salim KhanIn a vicious cycle, sleep becomes a luxury instead of a necessity for many people who are forced to be sleep deprived not because of personal reasons but due to factors beyond their control. Cities of Sleep, a poignant documentary directed by debutant Shaunak Sen due for release later this year, explores the existence of sleeper communities for the homeless in Delhi. The film goes beyond the day-to-day struggles of finding a safe sleeping spot in the city to more philosophical questions: what it means to not have a place to sleep every night, even a temporary one. It is an insight into what the film has termed the “sleep mafia” that looms over pavement dwellers and temporary shelter people. Securing a safe spot to sleep can be a question of life and death for a lot of people in the city. The film opens on a deserted street, with the radio at 12.30 a.m., evoking the peculiar loneliness that is privy only to nights. 
The film has two main protagonists, Shakeel and Ranjeet. Shakeel is a representation of the pavement dweller, who has survived over seven years on the road. His tale is that of rebellion; he is a renegade who has improvised places to sleep in such as subways, park benches, parking lots, abandoned cars and, recently, areas controlled by the sleep mafia. As the film goes on, it shadows his increasingly urgent attempts to find a place to sleep when winter rains are due. 
On the other end of the spectrum is Ranjeet, the person who runs the “sleep-cinema” community in Loha Pul in Delhi. The area is a double-storey iron bridge on the banks of the river Yamuna. The desolate land under the bridge has decrepit cinemas serving as a secure night shelter for over 400 homeless to come and sleep through the day for a nominal price. The flooding of the Yamuna poses a threat to people who sleep there every monsoon. As the film progresses, the socio-cultural factors that determine one night’s safe sleep for an individual in the city come to the fore. 
The sleep mafia’s role is fascinating and gruesome at the same time, and very characteristic of Delhi noir. The film is edited with finesse to follow the parallel worlds of all the different parties operating as part of this vicious circle. Meena Bazaar, in Old Delhi, is one of the stages of this drama, where as soon as night falls, a former tea seller moonlights as a cot provider to the hundreds of homeless people clamouring for his attention. These are people who are not fortunate enough to get a place in the various government shelters. He plays God, as he decides who gets to sleep and who doesn’t as he supplies them with cots, at rates that he commands according to his own wish. 
In the film, Sen draws up a powerful argument about how oppression can work within the city through something as basic as a place to sleep, and how that affects the life of a chunk of the city’s population, just out of sight and marginalised enough from the eyes of the privileged to not receive any respite. As one of the characters in the film tells you, talking about why people sleep on dividers, “If you have to escape dengue and malaria, sleep on the divider; the strong gush of wind from the passing cars will make sure there aren’t any mosquitoes hovering around.”
— Payel Majumdar

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