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Have you ever been so tired that no sooner did you lie down and close your eyes but you opened them again and found yourself in exactly the same position, only it's now 8 hours later and light outside? If not, you may not understand what I am about to discuss. You are too removed from your childhood, the land of deep and uninterrupted sleep. Nocturnal awakenings disrupt the sleep of roughly one-third of the general population. If you're still a spring chicken, beware: sleep quality diminishes as you age. 

Because as you get older you generally have a harder time falling asleep and more trouble staying asleep than in your youth. It is a misconception that sleep needs decline with age. No matter how old you are, you require about 8 hours of nightly shut-eye, but due to changes in sleep architecture the elderly report being less satisfied with sleep and more tired during the day. This may be due in part both to physical and psychiatric conditions and the medications used to treat them. For example an enlarged prostate can lead to frequent urination, which causes one to get out of bed more often, compromising sleep. And sleep apnea, or pauses in breathing while you sleep, can also result in frequent awakenings. My dear father has both conditions, coupled with a small bladder, which I must have inherited. Because no matter how little water I drink during the day, I need to pee at least three times overnight. My PSA, or a measure of prostate enlargement, is really low, so it must be all the fruit I consume. And indeed going every 2 or 3 hours is a measure of adequate hydration, so it makes sense that this urinary frequency should persist all 24 hours. Knowing this doesn't make it any less of a burden to have to get out of bed so many times.

If you have sleep apnea - and if you snore you probably do, though sleep apnea can occur in the absence of snoring; if you wake up gasping for breath then you definitely do - then I urge you to get yourself treated. Go in for a sleep study. Get yourself a breathing mask. Especially if you're overweight, since the risk of this condition increases as body mass goes up. Or at least sleep on your side, which makes it less likely that your airway will collapse or become obstructed. I'd be remiss in my duties as a doctor if I didn't tell you this as I do my own father, who I hope heeds my advice. Because untreated sleep apnea can lead to heart failure and even sudden death. You heard right: Death. And now we are on topic. 

Because as I learned as a young boy, "Life is but a dream." The corollary to which is "death is like deep sleep." Or, death is long sleep, and sleep is short death. Not the sleep that is filled with dreams, but deep sleep, the kind you enjoyed every night as a child, and which is likely vanishing into the ever more distant past. (Note: the best measure of a clear conscience is how soundly you sleep. If you find yourself tossing and turning, racked with guilt and anxiety over the prior events or those to come, either do something about it or stop thinking; preferably both.) If like a third of adults you have at least one symptom of insomnia, and cannot even remember the last time you enjoyed a full night of uninterrupted shut-eye, maybe you've had surgery and were given general anesthesia, as I did when I broke my leg and the orthopedists operated. When they had me count back from 10 I didn't make it to 5. Then I woke up 5 hours later as though I had only just closed my eyes. In the interim, it was as if time had stood still. 

Of course, the surgical scar and the radiographic images showing pins in my hip convinced me that though nothing seemed to happen while my eyes were closed, the surgeons had been diligently at work. I was alive during that time, as the doctors can attest. They commented on how low my heart rate fell, dipping below 40 beats per minute, and that in a less fit patient they would have called off the procedure, but knowing I've run marathons they were confident enough to proceed. But where was I when I was under? None of this happened to me. Surgeries, worries, pleasures. None of it mattered to my sleeping mind, which is like having no mind at all. All I knew was perfect peace. Not even that. There was nothing. And nothing was okay. If I hadn't woken up from the operation, and there are those that do not, like Joan Rivers, then that transcendence of time and space would have lasted an eternity. Or not. Because eternity implies time and where I was time didn't exist. Time is an aspect of the waking world, whose characteristic is change. When you're unconscious, you're not of this world. It's enough to make the thinking person dizzy. The mind has a hard time understanding the realm of no mind, to relate to the concept of no time and no space. But if as metaphysicians pose, this is the ultimate reality, it is worth investigating.

The waking mind cherishes its existence and cannot tolerate the thought of its cessation, which is why we instinctively avoid conversations about death. But when we go beyond mind, as in sleep or surgery, we are not afraid of death or of anything else, because fear itself is rooted in thought, which is the mind, and when we are in the realm of no mind, and consequently no thought, there is no fear or any other emotion. No pleasure either, but isn't deep sleep a pleasure beyond compare? I have had this conversation with some of my older relatives, who like most people love life and being closer to the life expectancy of 78 are presumably nearer the end of it than I. My mother, for instance, cherishes her existence. And the thought of death brings to mind the thought of all of life's pleasures coming to an abrupt end. No more strong coffee and savory eggs to go with it. The flowers outside her bedroom. The chirping of the birds to announce a new day. The boys she raised and adores. The home she created with my father, who she still loves deeply despite their rather tumultuous separation. She doesn't want to lose these things. I tell her that when she goes, the mind that loves life and disdains death won't be around to have an opinion on the subject.

Think of sleep. You cherish it, as freedom from worries and concerns, as being so refreshing. Do you love life in your sleep? Do you wish to wake up? Do you miss the coffee and the flowers and the friends? Not at all. These are all thoughts. Life is a state of mind. And without a mind to think these thoughts, there is nothing. Only peace. Only there is no consciousness, so it's as if you don't even exist. And that's scary to the mind. But as I found in post-op recovery, after 5 hours of non-existence, nothing is not so bad. Really, it's quite a rush. Because in death, without mind, there is nothing to be afraid of, because there is nothing to be afraid. There is nothing to fear once there is nothing that fears. The trick is to bring the peace of deep sleep into waking life. I haven't consistently done this, but I've had my successes. Until serenity is my steady state, to borrow a scientific term, it is just another theory to me. And being a theory it's merely a thought, which I've learned from the transition from waking to dream and to sleep, is not reality.

Dwell on this while you can because you won't be doing any thinking tonight. That is, unless like me you get up to pee. You can rest while you're alive. Just be sure to lie on your side.


  1. I wish I could get a night of sleep like you described. I have a toddler so it has been a while for me since I slept uninterrupted all night long! I have never had general anesthesia either, just local. Eventually I will get a peaceful night's rest, just waiting for that day!

  2. wishing you sweet dreams Cynthia...


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