Mens Sana In Corpore Sano

Not poppy nor mandragora,

Nor all the drowsy syrups of the world,

Shall ever medicine thee to that sweet sleep . . .

--Othello

The man who now carries to bed with him the world's heaviest burden of responsibilities, Lyndon Baines Johnson, needs no drowsy syrups to help him get to sleep--and he often gets only five hours a night. Adman David Ogilvy takes a nightly dose of "a little yellow sleeping pill" which, his doctor assures him, is not habit-forming, and he falls asleep easily on his right side. Actress Julie Harris finds that a long run in an exacting role makes it progressively harder to sleep, sometimes reads aloud to herself for half an hour or more, then falls fast asleep with the lights on. World's Heavyweight Champion Sonny Liston sleeps as single mindedly as he fights, but in a different posture: usually on his back, says his wife. "I leave him there unless he starts snoring. Then I make him turn over on his side."

No Wolf or Owl. Though it has always been as natural and universal as eating and drinking, in recent years sleeping has become one of the most talked-of and sought-after boons of life. For many people it seems to be one of the most elusive. From breakfast to bedtime, modern man echoes a recurrent complaint: "It's so much harder to get to sleep, and to stay asleep, than it was in the old days." There is indeed much more to stay awake for. Electricity makes it possible to read through half the night without straining the eyes and without getting up to trim a wick. The same electricity brings in round-the-clock radio programs, while TV competes to make the late show later.

When he finally does go to bed and tries to sleep, the city dweller has to contend with the incessant noises. Sub urbanites are not much better off, and the remotest home on the range may lie under the path of roaring jet airliners --the same swift giants that carry a man halfway around the world in half a day, and throw his built-in waking-and-sleeping clock out of kilter.

No such noises shattered the sleep of the pioneers a century or more ago. But the tire screech of a hard-braked auto mobile is probably no more disturbing than the howl of a timber wolf rallying the pack. And no American today need lie awake worrying whether the soft fluting of a small owl is really the signal that a band of Indians is closing in for a scalping spree.

If the enemies of sleep have changed more in kind than in quantity, it still seems fairly certain that modern man sleeps less than his ancestors did. Some reasons are clear: generations ago, men did a great deal more physical work; they got plain tired, or downright bone-weary. And before Mr. Edison's electric bulb turned night into a gaudy imitation of day, it was hard on the eyes to read, write or sew after dark.

What Is Normal? Whatever the problems, sleep and slumber, dreams and dreaming have fascinated man ever since he evolved the wits to think about them. But not until the 20th century did truly scientific medical research get rolling. The results are summarized in a scholarly monograph, Sleep and Wakefulness, by Dr. Nathaniel Kleitman (University of Chicago Press; $12.50). Dr. Kleitman lists no fewer than 4,337 learned publications on sleep, but he winds up with the sobering conclusion that, even today, nobody can define the condition. The basic question remains unanswered: Is wakefulness the more natural and fundamental state, in which sleep is only a restorative interlude, or is sleep the truly normal condition?

From his eminence as the grand old sandman of science, Dr. Kleitman dismisses the popular theory that man has a "sleep center" in his brain that must be activated to lull him out of his nor mal wakefulness and into sleep. "The principal, if not the only mechanism involved," he says, "is a center or system whose activity induces and maintains wakefulness and whose inactivity leads to sleep."

Muscle Fatigue. What does it take to make the wakefulness center fall asleep? Aristotle noted that a heavy meal leads to somnolence, went on to speculate that sleep is caused by vapors rising from the stomach. Physicians have attributed falling asleep to temperature changes in different parts of the body. Neurologists have found complex explanations in various nerve bundles. Pavlov, who became famous by getting a dog to drool at the sound of a dinner bell, invented a theory of cortical inhibition.

Nonsense, says Dr. Kleitman: man goes to sleep when his muscles are so tired that they have to relax, though this is complicated by the tensing effects of emotions on muscles. The mere act of lying down leads to eventual relaxation of all but two muscle groups--the sphincters that remain contracted to keep the sleeper from soiling his bed. Muscular relaxation leads, by some mechanism that no one yet understands, to relaxation of the wakefulness center.

In the process, the temperature of the body drops about one degree. No man can lull himself to sleep, however, simply by cooling down his bedroom. His own internal thermostat will fight back. Not only will the discomfort of being chilled tend to keep him awake; it will make him shiver, and shivering speeds up the body's metabolism, which also heightens wakefulness.

Stored Energy. During sleep, the heart slows down from an average of 75 to 60 beats a minute. Breathing slows down, from an average 16 to 12 respirations a minute. Blood pressure falls. Sweating increases. The liver stores up glycogen ("animal starch") that will be needed during the day for conversion into blood sugar that is in turn converted into energy. The kidneys go on working, endlessly filtering metabolic poisons out of the blood, but because the sleeper has no water intake, his first morning urine is more concentrated and darker than during the day.

Sleep has no direct physiological effect on the brain. Because the brain has muscles, it does not get tired. What passes for "brain fatigue" is actually a combination of muscle fatigue and emotional factors, such as anxiety, boredom, or the hypnotic effects of a monotonously repeated task. The muscular and emotional components of sleepiness and wakefulness are almost impossible to sort out. Even the seemingly simple closing of the eyelids has a complex explanation: the eye muscles get tired (so that, in extreme fatigue, focusing becomes impossible), and the cornea must be kept bathed in fluid and protected from dust. Just lying down, with eyes open but with muscles relaxed, has some refreshing and restorative effect. Lying down with eyes closed, to shut out distracting movements, is a bit better. Getting so relaxed as to be half asleep, half awake, beginning to have dreamlike fantasies, is better yet. The last best help to man is sleep itself.

Warm Milk. By whatever mechanism, sleep is the great refresher, or as Shakespeare had it, "Sore labour's bath/Balm of hurt minds." The important thing is to fall asleep at the time of one's choosing. Responsible physicians doubt that there are any universal passports for a quick trip to Nirvana.

The one inviolable rule is: relax-which, of course, is easier said than done. Even the most tightly wound-up businessman can usually do so after 36 holes of golf because his tired muscles do his relaxing for him. But on his workaday routine he may use no more muscle power than it takes to walk to his car. At day's end his muscles are tense, not tired.

The before-dinner drink is a good relaxant, because alcohol depresses nerve cells in the brain, and these help the muscles to relax in their turn. A heavy dinner too late at night, topped by too much liquor, may soon induce a stuporous sleep, but this is likely to be interrupted by hydrostatic pressure in the bladder. At the other extreme, going to bed hungry results in stomach contractions, which keep most people awake. There is much to be said, both physiologically and even psychoanalytically, for Grandma's prescription of a glass of hot milk at bedtime. And for those who feel they have outgrown plain milk, there are soothing substitutes: Ovaltine, Sanka, cocoa or hot buttered rum.

Many men insist that they must have an alcoholic nightcap, but more and more have learned to pass up brandy after dinner, explaining: "It keeps me awake." If, in its place, they take vodka (a mixture of almost pure alcohol and water), they are on the right track. Scotch whisky and gin in moderate amounts are also unlikely to interfere with sleep. The trouble with brandy, bourbon and rye is that, compared with vodka, most brands contain 20 to 30 times as much of the ingredients known to liquor chemists as "congeners." Some of these are the aromatics that give the liquors their characteristic odor, taste and color. Others are chemically different kinds of alcohol, including fusel oil. Even in minute amounts, these congeners keep some people awake.

Caffeine, whether in coffee, tea or APC tablets (aspirin, phenacetin, caffeine), taken for a cold, definitely has a stimulating and sleep-postponing effect on a majority of people. But there is a substantial minority on whom, laboratory tests show, it has no effect at all. There are even a few people whom it puts to sleep.

Relax & Enjoy It. Short of the outright sleeping pills, which doctors call hypnotics, there are many drugs that help to bring on sleep, but these also affect different people in different ways. Ironically, some of the best-known pep pills put some people to sleep. Many of the antihistamines, intended to relieve allergies, are also prescribed as soporifics. Virtually all the tranquilizers tend to make falling asleep easier, but their mechanisms vary.

Though sleeplessness, usually dignified by its Latin (and medical) name, insomnia, is now an even commoner complaint than the common cold, few doctors recognize it as a disorder. Lack of sleep, they say, is self-curing, and no one ever died of it. The complaint, "I tossed and turned all night and didn't sleep a wink," is a myth. (Dr. Kleitman has heard it from a man who had just been observed sleeping soundly for seven hours.) The most that these hard-headed doctors will concede is that anxiety about not getting to sleep is itself upsetting, and they will prescribe just a few hypnotics to break a vicious cycle. But most doctors prescribe sleeping pills as freely as aspirin.

Shakespeare's poppy is still around in the form of morphine and its derivatives, plus synthetic substitutes. Mandragora is gone. But the drowsy syrups, and more recently tablets and capsules, have multiplied enormously. By far the most abundantly used and misused are the barbiturates. They come under a hundred names. New, synthetic hypnotics are claimed by their makers to be safer and in some cases surer.

Many doctors doubt these extravagant claims, but the sleep-pill business is booming. The number of prescriptions written for barbiturates is meaningless--too many prescriptions are renewed, in defiance of doctors' orders and federal and state laws, and many prescriptions are forged. Americans spend an estimated $60 million a year, legally or not, on prescription-type sleeping pills. Another $17 million goes for over-the-counter items which, by federal law, must contain none of the potent opiates or barbiturates. After the harried insomniac has spent a few hours in drug-induced sleep, he is likely to wake up heavy-lidded, furry-tongued, with the feeling known as barbiturate hangover. Then he may turn to pep-up pills as an antidote.

Insomniacs who shy away from pills have created a new industry. They can spend up to $480 for a hospital-type bed that cranks up at head and knees, down at the buttocks and feet. For $69.95 they get a gadget, the size of a table radio, that makes white noise--"a scientific blend of all sounds"--to drown out intruding racket. Other machines swish like the restless sea, or, in midwinter, hum like summer's air conditioner. There is a whole catalogue of ear plugs, His and Her reading lights, even a togetherness cigarette holder so that two can smoke in bed.

Not like a Log. There is no single best position for falling asleep, though the Encyclopaedia Britannica says all humankind adopts an approximately horizontal position. This is in contrast with birds, which sleep standing on one leg, with beak tucked under wing. Most people sleep on their sides, spending more time on one than the other, and tend to bend the hips and draw up the knees a little, the better to relax. Sleeping supine is likely to cause snoring, which may wake the sleeper himself, besides disturbing others.

Though many people claim that once they fall asleep they don't move, Dr. Kleitman is emphatic: "No normal person sleeps 'like a log.' " Anyone gets uncomfortable from staying in one position while asleep, just as he would while awake. To check this, his University of Chicago researchers rigged up Rube Goldberg devices to bedsprings and got electrical recordings of sleepers' tossing and turning. The average: 20 to 60 major movements during a night's sleep.

Most people will settle gladly for a few hours a night. But how many are really necessary? For centuries there have been six, seven-and eight-hour schools. Healthy men with strong digestions, Robert Burton held, need less sleep than those with weak stomachs; sanguine and choleric men need less than the phlegmatic, and the melancholic need most of all. Thomas Edison claimed that a man needed only four or five hours of sleep a night--but he also took daytime naps. Among volunteers in scientific studies, the natural sleeping time has ranged from about six to more than nine hours, with an average of 71.

No Instant Dream. However long they sleep, many men and women have difficulty staying asleep for the desired number of hours. Mothers get the habit of sleeping "with one ear open," afraid they may miss a high-pitched cry from a child's bedroom. Men in their 40s and over are more likely to be waked by bladder pressure.

Though it has not yet been proved, it seems likely that most predawn awakenings result from dreaming. The tensions of the day that a man carries to bed with him may be damped by a nightcap or pill, only to be reactivated by dreams after the first couple of hours, when sleep is deepest. It is in the study and explanation of dreaming that sleep scientists have recently made their most dramatic progress. The stuff that has been written about dreams would fill a library, and most of it makes as much sense as "such stuff as dreams are made on." Dr. Kleitman's Chicago team determined to collect accurate data. Such brilliant students as Dr. William Dement (now at Stanford University) and Dr. Edward Wolpert (now at Chicago's Michael Reese Hospital) stuck a tiny electrode on each side of a volunteer's eye and carried the leads to a brain-wave machine (electroencephalograph) in the next room.

The waves on the EEG showed when the sleeper's eyes were moving. Slow eye movements, taking three to four seconds, occurred when the sleeper was moving the position of his body. But rapid, almost flickering eye movements, now abbreviated in the trade jargon to REMs, occurred in varying stretches of five minutes to an hour, several times during a night's sleep. By waking and questioning their subjects after a REM period, the researchers found that they nearly always recalled having just finished a dream. By checking their EEG tracings with what their subjects told them, the Chicago researchers learned that:

>Most people dream four to five times a night.

>Dreams may last a few minutes to an hour, but average 20 minutes. >Events in a dream happen about as fast as corresponding events in reality. > Occasionally a sleeper has a series of related dreams, like soap-opera installments, and sometimes a common thread runs through two or more dreams like a leitmotiv. >Outside events, such as the noise of opening and closing doors, are rarely incorporated in the dreamer's libretto.

Guardian of What? Though such facts have been established, the basic question remains: Why does anybody dream at all? Kant and Schopenhauer equated dreams with insanity. Freud called dreaming "the guardian of sleep"; he concluded that the sleeper dreams of problems (often heavily disguised) that boil up in his unconscious because they are too painful or threatening for the conscious mind to face. The dream, he said, preserves sleep by offering a palliative for the problem.

Dr. Dement devised an ingenious experiment to find out what happens if a person is allowed to sleep his normal number of hours, but is not allowed to dream. His volunteers were awakened whenever their REMs indicated the beginning of a dream. Then they were allowed to fall asleep again. And so on, night after night. By the third night, most volunteers began to get edgy and act strange. In the final part of the experiment, when they were allowed to sleep as long as they wanted, they dreamed twice as much as usual.

Dr. Dement concluded that dreaming may be even more than the guardian of sleep: it may be the guardian of sanity itself, as sleep is the guardian of general health.

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