4When in doubt, you can always turn to Mark Twain. He said that what gets us into trouble is not what we don't know. "It's what we know for sure that just ain't so." Twain also said "I was gratified to be able to answer promptly, and I did. I said I didn't know."
It would be great to be able to share the precise circumstances that gave rise to such wisdom, but better to take his advice and confess ignorance.The final words of Guy Leschziner's account of a lifetime as a neurologist at the pointy end of sleep medicine are "I just don't know". The path to that conclusion has involved richly detailed accounts of the neuroscience surrounding narcolepsy, cataplexy, insomnia, parasomnia and every type of sleep disorder and dream. He describes hundreds of hills and valleys in the geography of the land of nod.Such a grasp of medical science doesn't come from reading a few books and attending wellbeing seminars. He also has a wonderful rapport with the patients whose stories he shares as a prelude to a more cerebral consideration of their situation; often an ability to listen to the whole of someone's story turns up valuable clues. Yet time and again, he comes up against dilemmas about which he is happy to conclude that he doesn't know the answer.There are a lot of pundits in the field of sleep and many of them claim greater certainty on the basis of far less education and experience. Sleep is up there with diet as an area about which everyone is free to pontificate; perhaps the loss of any agreed moral structure for society as a whole means we have to moralise about things such as food and sleep.Just recently, I was walking through a shopping mall and was brought up short by a quote emblazoned on a window. I am always suspicious of stores that bait their hooks with bits of ersatz wisdom. I'd prefer something more transparent, such as "20 per cent off". I paused, however, because the quote claimed "the key to spiritual and career success". I was still wondering what 'spiritual success' might possibly mean when I realised the store actually sold pyjamas. Also pillowslips. These came packaged with a moral universe. They had all the answers.Leschziner is not so authoritarian, which is what makes this such an invigorating book. He appreciates that many of those who suffer from traumatic sleep are tired of the moralising of onlookers. Insomnia is often seen as the punishment for stressful living or some other form of self-harm. These beliefs don't help the sufferer.Leschziner details cases where seeking help for insomnia made it worse because the treatment drew attention to nothing but negatives. Some sufferers, exhausted by 11pm, would become terrified of going to bed because of the cold dread they felt. Leschziner is among those prepared to back right away from medication, especially tablets that rearrange the natural architecture of sleep.He details a counter-intuitive therapy in which he denies an insomniac time in bed. He got to this point by observing that the worse some people sleep, the more time they spend in bed not sleeping. This sets up a psychological reaction where bed becomes a hell-hole. His alternative therapy has been surprisingly helpful. But his wisdom is all in the detail. Don't try this at home without reading what he has to say. Leschziner doesn't have seven dot points for better sleep or anything else.Leschziner is interested in people. We meet, for example, Jackie, a gentle soul in her 70s, who has no recollection of taking a ride on her motorbike in the middle of the night. She has the same neurological oddities as Alex, in his 20s, who has been ordering pizza over the phone while still asleep since he was at boarding school. Don eats compulsively in his sleep.One of the most alarming cases, however, is that of Jamie who has the rare Kleine-Levin syndrome (KLS) in which times of intense sleepiness tend to run alongside outbreaks of manic and offensive behaviour. It is one of a number of conditions in which disturbed sleep can lead to bizarre sexual behaviour. Leschziner often spends years helping patients at the extreme end, in this case acting a bit like a detective, discovering connections between migraine and KLS. He learns a great deal even as definitive solutions elude him.This book is a terrific window on the mystery of being human. One of its best chapters concerns dreaming ("Inception"). It deals with many paradoxes, such as the fact that we seem to dream more when we are in the womb than at any other time. If dreaming is somehow about dealing with life's issues, why then do we dream most when we have the fewest life issues to dream about? But if dreaming is not about dealing with the waking world, how do you explain the nightmares associated with PTSD?Leschziner probes these issues with the fine skills of a surgeon. He bridges the false dichotomy between mind and brain. Although he is wrong to blame Descartes for claiming there is a sharp division between mind and body, he is right to create a much more humane integration of all aspects of the person. His breadth and human wisdom have led him to great understanding of both our sleeping and waking selves.Michael McGirr is the author of Books that Saved my Life and Snooze: The Lost Art of Sleep, both published by Text.Most Viewed in Entertainment