In this article, Diletta and Simona situate the rise of everyday sleep-tracking practices within the sleep crisis discourse and explore these practices’ reshaping of 21st-century subjectivity.
On Wednesday 19th April 2023, the Understanding and Reimagining Sleep and Its Disorders project hosted its final online workshop in its programme of public engagement events for people experiencing difficulties with sleep associated with ageing, parenting, and/or the menopause.
The workshop was hosted by Project Lead, cultural theorist Dr Diletta De Cristofaro, and Dr Greg Elder, a sleep researcher at Northumbria University. Greg Elder’s research interests are focused on sleep disturbances in neurodegenerative dementia, as well as in healthy ageing more generally, and the workshop was an opportunity for participants to discuss sleep in relation to events and experiences associated with getting older.
Diletta De Cristofaro began the workshop by sharing an excerpt from Paul Auster’s Man in the Dark, a 2008 dystopian novel about an ageing journalist who is reflecting on a second civil war unfolding in present-day USA. The journalist describes his insomnia:
I am alone in the dark, turning the world around in my head as I struggle through another bout of insomnia. […] That’s what I do when sleep refuses to come. I lie in bed and tell myself stories. They might not add up to much, but as long as I’m inside them, they prevent me from thinking about the things I would prefer to forget. Concentration can be a problem, however, and more often than not my mind eventually drifts away from the story I’m trying to tell to the things I don’t want to think about. There’s nothing to be done.
Paul Auster, Man in the Dark (2008)
Diletta initially invited workshop participants to share their impressions of the passage itself. I was struck by how the excerpt instead instituted a space for participants to offer their own experiences in turn – of sleeping or, at least, of lying in bed trying to sleep.
Many participants used this time to reflect on the tools they had developed to cope with sleep difficulties. Some of these will be familiar to readers: Epsom salts, lavender, camomile tea, writing problems down, thinking of nice things. Others disclosed a movingly complex relationship to sleep management itself, how sleep difficulties commingled with other illnesses, or with other challenging life events. A picture began to emerge about how many of us operate with ambivalent sets of understandings about the role that sleep plays in relation to falling ill, healing, major life transitions, and ageing.
Next, Greg Elder delivered a short talk on sleep and ageing. The principal aim of his talk was to emphasise both the complexity of sleep and underscore the persistent uncertainty at the heart of sleep science research: we still do not know why sleep occurs. What we do know is that sleep is entangled with our physical and mental health, that everyone needs to sleep, and that humans will spend about one-third of our lives asleep.
Greg guided us through various tools available to scientists for measuring sleep. There are subjective methods, requiring sleepers to self-report, such as the use of questionnaires, sleep diaries, or self-reported sleep duration and quality measures.
There are also objective methods such as actigraphy, small devices with accelerometers to measure bodily movement, or more comprehensive forms of polysomnography, which will usually require a sleep patient to come to a sleep lab for overnight monitoring. Participants were pointed towards the wide potential range of recommended sleep duration. The National Sleep Foundation recommends that an older adult (65+) should have 7-8 hours sleep a night but that anything from 5 to 9 hours ‘may be appropriate’.
A picture from the companion creative workshop on Sleep and Ageing, led by artist Chiara Dellerba. The workshop focused on sounds.
At this point, a participant asked whether anyone else had heard of the theory that before the rise of industrial labour, patterns of sleep in human beings were divided into two phases of sleep rather than just one (the theory was first proposed, to my knowledge, by historian Roger Ekirch). Greg replied that what such theories demonstrated was the shifting role of sleep over time, both historical time as well as time over an individual’s lifespan. A conversation then followed which explored the ways that sleep and “being horizontal” figured in personal understandings of life, energy, and even health at the cellular level.
This cued up the second half of Greg’s talk, which considered the extent to which recent scientific research is discovering how life events have big effects on individual sleep. He talked us through a 2018 study which indicated that retirement is associated with a decrease in sleep difficulties. As a question prompt for final discussions, participants were asked: has your sleep experience changed in response to any particular events?
In thought-provoking testimony, participants described their own encounters between sleep and health in ageing. For some, sleep could be described in almost spiritual terms, as a liminality, a place where science and magic meet. For others, sleep disclosed the complex relationship we have with listening and responding to our own body – how entangled sleep is with comorbidities and life tragedies in both cause and effect. Greg responded to these conversations by stating how they emphasised for him the need for scientists to investigate more closely the secondary effects of sleep difficulties.
A core goal of all our workshops is to facilitate knowledge-sharing around sleep. The conversations that closed this final workshop testified to the importance of such facilitation work. There was a consensus – drawn from both experience and scientific knowledge – that awareness about sleep needs to be more firmly embedded into clinical practice, both in general practice and specialism. Lived experiences of sleep and ageing should not only inform health policy but co-produce and drive the health research which will improve sleep quality and understanding for all.
Understanding and Reimagining Sleep and Its Disorders is a public engagement project led by Dr Diletta Cristofaro and funded by the Wellcome Trust (Research Enrichment – Public Engagement grant). Hosted by Northumbria University and run in partnership with The Sleep Charity, the project consists in a workshop series, an online art exhibition, and resources.
As part of the public program connected to Dreamscape, an immersive sound installation by artist Eva Frapiccini, Dr Diletta De Cristofaro will be giving a talk about dreams in contemporary culture.
The first phase of the Reimagining Sleep project – a creative workshop series – is now completed. Find out more about the workshops by watching the video below and stay tuned for the project’s second phase, an art exhibition of works co-produced by workshop participants and artist Chiara Dellerba!
Video by North News
Understanding and Reimagining Sleep and Its Disorders is a public engagement project led by Dr Diletta Cristofaro and funded by the Wellcome Trust (Research Enrichment – Public Engagement grant). Hosted by Northumbria University and run in partnership with The Sleep Charity, the project consists in a workshop series, an online art exhibition, and resources.
On Friday 3rd March 2023, the Understanding and Reimagining Sleep and Its Disorders project held an online workshop for people experiencing difficulties with sleep associated with the menopause. The workshop was hosted by Project Lead, cultural theorist Dr Diletta De Cristofaro, and Professor in Psychology Jason Ellis, Director of the Northumbria Centre for Sleep Research.
Issues with sleep are amongst the most commonly recorded symptoms of menopausal transition, reported in up to 45% of perimenopausal and 60% of post-menopausal stages. There are all sorts of reasons for this. Perhaps most well-known are the shifts in hormonal activity associated with the menopause, such as decreases in oestrogen and progesterone levels, but there are also significant shifts in serotonin and dopamine levels at play in the dynamics of bodily change. The upshot of this can be devastating: a range of sleep-affecting symptoms such as hot flushes at night, mood disorders and anxiety, sleep disordered breathing, and therefore sharp increases in the likelihood of insomnia.
The tone of the workshop was informal. Participants were invited to engage in whichever ways they felt comfortable – asking questions in the chat or voicing them through microphones. Cameras could be turned off or on. Technical difficulties meant we were a little late in starting, slightly thrown by an ill-timed software update, but everyone attending nevertheless stayed until the end. Diletta De Cristofaro greeted us with a warm-up exercise where we voted for which animal we most associated with when waking in the morning. (Yawning monkey won, whilst restful bear received no votes.) Then, she invited participants to engage with a passage from Marina Benjamin’s Insomnia, a memoir about the author’s sleep difficulties:
When I think of insomnia’s wayward rhythms what I picture is this: gaudy insomnia with its wide lapels and toothy grin is the last groover on the dance floor, still going at it after everyone else has collapsed in a heap or gone home. […] Bleary-eyed, your body leaden, you hanker for nothing more than to sleep, and yet you must endure this thing—this coked-up arriviste!—who on top of everything else (the clowning, the nagging insistence, the manic glare) has no freaking beats.
Neither do I, as it happens. In menopause I have grown accustomed to having no rhythms to speak of, neither hormonal nor lunar, and certainly not circadian.
Marina Benjamin, Insomnia (2018)
Though not everyone related with this description as representative of their own experience, participants were interested by how Benjamin both personifies insomnia as a rebellious figure and draws the disruptions of menopausal and circadian rhythm together. It was suggested that her description of ‘wayward rhythms’ could stand in for a broader sense of incapacity, of not being able to function, experienced by many during the menopause.
After this, Jason Ellis presented his talk ‘Managing Sleep During Menopause’, outlining a range of treatment and management options. He discussed three pharmacological possibilities: hormone replacement therapy, the use of SSRIs (more typically used as antidepressants), and hypnotic drugs used to directly induce sleep. He also talked us through the evidence bases connected with the consumption of phytoestrogen in food, as well as with yoga, acupuncture, and cognitive behavioural therapy for insomnia (CBT-I).
Next, Jason talked us through a range of self-management strategies for disordered sleeping (which, since the 1970s, has been commonly described in sleep science as ‘Sleep Hygiene’). These included when to avoid spicy foods, how to reduce nocturia, recommending warm baths and stretching exercises about two hours before bed, offering tips for ‘sweat management’, endorsing natural fibre bedding and pyjamas, and keeping the bedroom cooler than normal.
The conversations that surrounded and followed this presentation were thoughtful and probing. We discussed dreams and lucid dreaming, delta waves and pink noise, and whether the “problem” of screens in bed was an overhyped factor of sleep deficit.
A repeated assertion amongst participants was that, sometimes, the sleep difficulties manifesting during menopause actively subvert the possibility for self-management. The experience of waking up very suddenly, without apparent cause, was one key example. Waking up suddenly bears a relation to cortisol (a steroid hormone active when the body wakes up but which can surge at the “wrong time”) as well as to the feeling of being engulfed with anxious thoughts at 3am. Such anxious thoughts are hard to manage because they feel so separate from wakefulness. Jason suggested using distraction techniques – such as counting down from 1000 by 7 – to deal with this, though he noted an alternate theory that advocates for overloading the brain emotionally (for example, through journaling).
The purpose of this workshop was not to be “therapeutic” nor to dictate ways of improving sleep. Instead, it was to acknowledge such ambivalences. We wanted to lay the groundwork for a further workshop held later in March, led by artist Chiara Dellerba, where participants were given space to build from these conversations and engage creatively with sleep practices and living with the menopause and the menopausal transition.
A picture of the creative workshop. Design and pictures in this post all by Chiara Dellerba.
Chiara led participants through a sensory reflection on the properties of plants – in particular, ashwagandha, valerian, and passion flower – to ease menopausal symptoms. The results of this creative workshop, co-produced by participants with Chiara, will be exhibited later this year. Stay tuned for updates!
Understanding and Reimagining Sleep and Its Disorders is a public engagement project led by Dr Diletta Cristofaro and funded by the Wellcome Trust (Research Enrichment – Public Engagement grant). Hosted by Northumbria University and run in partnership with The Sleep Charity, the project consists in a workshop series, an online art exhibition, and resources.
What can cultural production tell us about sleep and work?
In this invited blog post for the Society of Occupational Medicine, Dr Diletta De Cristofaro introduces the project’s research and public engagement work, with a focus on the relationship between sleep and work.
For World Sleep Day, Diletta De Cristofaro will be moderating the online roundtable “Hot Takes: Sleep Equity and Climate Change” organised by The Sociability of Sleep research-creation project (Université de Montréal/McGill University). The roundtable will feature scholars Jayson Porter, Kelton Minor, Arun Kumar, Benjamin Reiss, Devon Bate and Sarah Barnes.
This review of Alice Vernon’s Night Terrors: Troubles Sleep and the Stories We Tell About It (2022) by Diletta De Cristofaro is now out in the Spring 2023 issue of New Humanist magazine. The review explores how, in our obsession with getting more sleep, we are overlooking the strange mysteries of night terrors and other parasomnias.
On 27th January, Dr Diletta De Cristofaro will be taking part in the On Dreams roundtable at Istituto Svizzero in Rome
She’ll be joining artist Hunter Longe, neuroscience researcher Leila Salvesen, and moderator Eva Bossow. The event is linked to the exhibition L’arcobaleno riposa sulla strada and part of the Art-Science series, dedicated to the encounter between scientific research and artistic practices.
The three-part transdisciplinary event On Dreams at the Swiss Cultural Institute in Rome traces the multiple meanings of dreams and dreaming, and presents different approaches to the topic.
In these workshops, members of the public who have difficulties with their sleep and connections to the Newcastle area, will meet with researchers, psychologists, and artists to talk about the impact of sleep disorders in our lives. Together, we’ll discuss ways to increase awareness and improve the wellbeing of people who live with sleep disorders and we’ll produce creative responses about sleep which will be published as part of an online exhibition on this website.
Click the buttons below to find out more and register for the workshops!
