Dreamland: Adventures in the Strange Science of Sleep (6 page)

The effects of poor sleep build and quickly manifest in working mothers’ lives. Some have difficulties functioning at their jobs, an important concern given that most professionals see their greatest salary increases during their late twenties and early thirties—a time when many working women head home to a young child. The side effects of a crying child in the middle of the night aren’t limited to sleepy mothers fighting the urge to nod off at their desks. As one study found, the quality of a child’s sleep often predicts maternal mood, stress levels, and fatigue. It’s a very simple equation: the more sleep a child gets, the healthier the mother will be.

If Ferber’s method was as simple in practice as in theory, then its promise of painless sleep would do a lot to improve the lives of working adults. But it’s not simple. The excruciating first nights of the Ferber approach can require listening to a child’s searing screams go on for well past what seems safe or healthy. That leads many parents to William Sears, a professor of pediatrics at the University of California, Irvine, School of Medicine, whose approach to sleep is almost the exact opposite of Ferber’s. The father of eight children, Sears has become one of the leading voices of what is known as attachment parenting. He believes that through sharing a bed with an infant, parents not only develop a stronger bond with their child but also respond to their needs better. Many parents who subscribe to Sears’s approach do so out of the worry that allowing a baby to cry for too long sets in motion a range of long-term health effects. One article in
Mothering
magazine gives a general idea of how far this line of thought goes. “But there is no doubt that repeated lack of responsiveness to a baby’s cries—even for only five minutes at a time—is potentially damaging to the baby’s mental health,” it warned. “Babies who are left to cry it out alone may fail to develop a basic sense of trust or an understanding of themselves as a causal agent, possibly leading to feelings of powerlessness, low self-esteem, and chronic anxiety later in life.” James J. McKenna, a professor of anthropology at Notre Dame, has argued that mothers who share a bed with their child are more likely to breast-feed. These babies, when they do inevitably wake up, may also fall asleep faster when their parents are right next to them. With better-quality sleep, the brain would then have more energy to devote to cognitive or physical development.

In many ways, co-sleeping prods parents into reverting to an approach to sleep that was widely practiced in the United States a few generations ago, and remains common in African-American and Asian-American households today. Until the start of the twentieth century, most American babies were placed in a cradle in the same room as their parents or a live-in nurse. Once old enough, young children graduated to sharing a bed with siblings of the same sex. But, as Peter Stearns noted in a paper published in the
Journal of Social History
, children’s sleep habits changed more dramatically between 1900 and 1925 than at perhaps any other time in history. Noisy new inventions like radios and vacuum cleaners entered the home for the first time and gave parents a reason to segregate their children into a quiet place at night while adult life went on. Women’s magazines, meanwhile, ran articles written by experts who argued that traditional sleeping habits were dangerous and unhygienic. And if those concerns weren’t bad enough, a shared bed began to cause a sort of class anxiety. Middle-class parents, in particular, began to worry that their children’s sleeping arrangements said something about the financial condition of the family. Many parents believed that a move out of the city and into the suburbs meant that they had to provide their offspring, even infants, with their own rooms. One sleep expert I spoke with said that some middle-class parents remain adamantly opposed to bed sharing because they see it as a step down the economic ladder, especially if their infant doesn’t have his or her own room. “Parents now tell me, ‘Oh my God, it’s going to be a huge problem that my children are going to have to sleep in the same room,’ ” she told me. “It’s not the question of ‘How do I deal with it?’ Now it’s ‘Should I move?’ ”

In recent years, sleep scientists have begun to join pediatricians and anthropologists in the contested field of children’s sleep. What they found may surprise you. Jodi Mindell is the associate director of the Sleep Disorders Center at the Children’s Hospital of Philadelphia, the first pediatric hospital in the United States and among the best in the world. There, as part of a team that cares for conditions ranging in complexity from narcolepsy to extreme fussiness, she treats about fifty patients a week. Mindell realized one day that she didn’t know the answer to a basic question: how do babies around the world sleep? She could do little more than guess whether parents who put their baby down to sleep in San Francisco did so at the same time or in the same way as their friends in Tokyo.

Along with Avi Sadeh of Tel Aviv University and others, Mindell polled nearly thirty thousand parents of infants and toddlers in Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, the United Kingdom, the United States, and Vietnam. It was one of the first, and most extensive, surveys of global infant sleep patterns. All of the subjects in the study lived in conditions that roughly corresponded to a middle-class lifestyle in the United States. Each household featured electric lights, televisions, refrigerators, running water, and other comforts. Mindell gave the families a list of basic questions that any parent would be able to answer easily: What times does your child go to sleep? Does your child sleep alone or in a bed with you? And, does your child have a sleep problem?

To say that the answers were unexpected is an understatement. Families on different continents didn’t even seem engaged in the same activity. In New Zealand, for instance, the average bedtime for a child under the age of three was 7:30. In Hong Kong, it was 10:30. But bedtimes were not the only difference. Nearly everything that made up the children’s sleeping habits depended on their location, a triumph of culture over biology. In Australia, 15 percent of parents said they regularly shared a bed with their child. Almost six thousand miles away in Vietnam, nearly 95 percent of families did so. In Japan, children slept for an average of eleven and a half hours each night. The average infant in New Zealand slept thirteen hours. And, perhaps most surprising, 75 percent of parents in China, a country in which most families are co-sleepers, reported that their children had a sleep problem.

Any hope that a global survey of children’s sleep habits could provide an answer to the sleeping-training versus co-sleeping debate vanished. There were simply more variations than researchers thought possible. “I thought that there would maybe be a ten- or fifteen-minute difference in bedtimes and that would be about it,” Mindell told me. “Instead we got this eye-opening understanding that sleep is dramatically different in babies throughout the world.” She was left with more questions than answers. “We don’t know why there are those differences in sleep and what the impacts of them are,” Mindell continued. “Maybe someone could argue that Korean babies are getting less sleep and that’s because they are going to bed too late. But maybe there’s a true biological difference and Korean babies simply need less sleep. That’s a very different question and there are a lot of theories out there. It’s a whole career to figure it out.”

Cultural approaches to sleep work for the most part until toddlers get their first taste of globalization. To illustrate this point, Mindell tells the story of a mother who grew up in England, went to college in the United States, and eventually moved to Hong Kong for work. All of these destinations more or less followed the same Western approach to children’s sleep, segregating an infant into his or her own room from an early age. Once in Hong Kong, Mindell’s patient hired a nanny to care for her three children while she was at work. The nanny was from a rural area in China and approached each of her charges like she would a child in her own home. That meant that the children didn’t go into the expensive crib in the nursery or into their own beds when it was time for sleep, but instead were held in her arms or placed on the mattress next to her. This co-sleeping approach functioned reasonably well during the week. But when Mindell’s patient had solo charge of her children over the weekend, the crib regained its starring role. It was a nightmare. The mother couldn’t get her children to stop crying no matter what she tried. She asked her nanny to have the children sleep in their cribs or beds, but the nanny refused. After all, she argued, the kids liked it better her way.

At first glance, the point of the story appeared to be that co-sleeping worked better for this family. But Mindell says that wasn’t the issue. The children were stuck between East and West, sleeping next to someone one day and sleeping alone the next. It wasn’t sleep training versus co-sleeping that was the problem, she says, but consistency. “Children are more likely to be relaxed throughout the bedtime rituals if they have a good idea of what’s coming next,” Mindell told me. In the case of her patient in Hong Kong, either approach to sleep could have been effective if it was followed regularly.

When it comes to children’s sleep, routine is a better predictor of quality than whatever choice the parent makes regarding co-sleeping. Consistently following the same nightly script makes bedtime less of a battlefield. In one three-week study, Mindell investigated the effects of a nightly routine on four hundred mothers and their children, who ranged from newborns to toddlers. During the first week of the study, all of the mothers were told to follow their usual approach to sleep. After that, half of the mothers were given instructions on how to follow a specific plan. Each mother was advised to pick a consistent time that she would place her child in his or her crib or in the family bed each night. Thirty minutes before this bedtime, she was to give her child a bath, followed by a light massage or application of lotion. Then, she was to do a calming activity like cuddling, rocking, or singing a lullaby. Within thirty minutes after the bath, the child was to be in the spot where he or she usually slept, with the lights out. Each mother followed the instructions for two weeks and then reported any changes. By every measure, routines led to calmer nights. Children fell asleep faster, woke up fewer times during the night, and slept longer. When they did get up the next morning, they seemed to be in better moods. Parents improved their sleep quality as well, with the mothers feeling better able to handle their daily challenges.

Mindell’s work suggests that the advocates of co-sleeping and those of the cry-it-out method are both a little right and a little wrong. If consistency is the most important predictor of sleep quality, then it doesn’t necessarily matter if a child like Abigail sleeps in her family’s bed when she is two years old. There are signs that other professionals are softening their dogma when it comes to children’s sleep. Ferber, the guru of sleep training, revised his views on co-sleeping in a 2006 update to his best-selling book. He now advises parents that sharing a bed with their children can be a safe and effective option, as long as the parents follow basic guidelines to prevent accidentally harming their infants.

Eventually, almost all children decide to sleep in their own bed when they are given the option. Without prompting, Abigail has begun referring to the bed in her room as her “big-girl bed.” Her parents think that it won’t be long before she moves out of their bed. But calming their child’s ambivalence toward sleep is only part of their job. Soon, Abigail’s brain will be developed enough to experience a truly strange aspect of sleep. Abigail, you see, is about to have her first dreams.

5

What Dreams May Come

A
lice had lasagna with her dead father last night and is upset that he didn’t like the food. She says this while sitting on a metal folding chair in a cramped room in the middle of Manhattan. Outside, the streets are filled with tourists trying to find their way to the Christmas tree in Rockefeller Plaza. Inside, four of us are arranged in a semicircle facing a plastic fern in a bright-blue pot. We have come to this second-floor counseling center on a Sunday afternoon to spend two hours discussing our dreams. Alice is the first up to bat. She lets out a volley of coughs and proceeds to tell us that her father, who died two decades ago, popped up in her dreams several times last week, walking around and criticizing her cooking.

“How did that make you feel?” the woman to the right of me, who is leading the group, asks her.

“Awful. I had planned everything just so,” Alice replies.

“What do you think the message of that dream was?” the group leader asks.

“I think that I wanted to tell myself that I wasn’t meeting the expectations of my life,” Alice responds.

The group nods encouragingly while Alice goes into detail about her dream. I spend the time getting more and more nervous, rehearsing in my head what I am going to say, like an actor reviewing his lines minutes before showtime. I have come armed with two of the few recent dreams that I can remember. The first features a plot that would make for an anticlimactic heist movie. In it, I robbed a bank with three of my friends from high school and then sat eating pretzels in a Florida airport while we waited for our getaway flight. I decided to go with this dream because it was more exciting than the other one, in which I bought a green-and-white cocker spaniel puppy and named him Sprite.

Reciting the dream to a small group of strangers doesn’t scare me. It is the fact that these nice people seem convinced that dreams have hidden meanings, and I’m not so sure. The idea that in the middle of the night the brain sends coded messages to itself that reveal deep secrets seems like a plot device out of a bad soap opera. I am of the mind that dreams are more or less random. Though there is no telling whether my view is ultimately the correct one, studies seem to support it. By injecting a solution into a subject’s bloodstream that made blood flow visible, for example, researchers found that the brain’s long-term and emotional memory centers are most active during REM sleep, the phase of the sleep cycle when most dreaming occurs. That could be one reason why dreams have little narrative cohesion but are laden with moments from the past.

However, the members of the dream group gathered here today would beg to differ. They have come to discuss their dreams because they are convinced there is something inherently important, and even life changing, about their experiences in dreamland. To them, looking at a dream only in terms of the mechanics of the brain misses the point, kind of like basing an evaluation of the
Mona Lisa
on the pH level of the paint used alone. Alice isn’t concerned with what part of her brain was responsible for allowing her to interact with her father again. She cares about the emotions she experienced in her dream, feelings that were so strong she remembered them for several days afterward. By definition, that makes them meaningful for her.

The question of whether the contents of dreams tell us anything deep about ourselves presents a dilemma for those who study how the brain works. On the one hand, dreaming is a fascinating biological phenomenon universal to every person and most mammals, as far as we can tell (scientists once tried to ask a gorilla who knew sign language whether she dreamed at night, but the gorilla’s attempt to rip the researcher’s pants off put a quick end to that). Each night, nearly everyone becomes paralyzed every ninety minutes or so during REM sleep. The brain starts working overtime, and the sexual system perks up. During this dreaming stage, a man’s penis will become erect while a woman will experience increased vaginal blood flow. The brain will then create images and stories that the body responds to as if the events in dreamland were actually happening, as anyone who has woken up sweating and out of breath from a particularly scary dream well knows. These dreams happen regardless of a person’s physical state. Those who have lost their sight after they were toddlers continue to dream with images, for instance, while those who were blind from birth dream with sounds. And yet any trance that feels so real during a dream disappears almost immediately upon waking, leading some to believe that they don’t dream at all and others, like me, to remember only fleeting pieces that make dreams seem all the more puzzling (a green-and-white puppy?). The fact that all mammals experience dreams in roughly the same way suggests there is something vitally important about this stage of sleep.

Yet here is where the paradox comes in. For professional researchers, announcing that you are investigating dreams goes over about as well as proclaiming that you are intent on finding the lost continent of Atlantis or uncovering a UFO conspiracy hidden by the Federal Reserve. “If you’re going to get tenure or make a spectacular career in science, dreams are probably not the thing you want to study,” Patrick McNamara told me with knowing understatement. McNamara is the head of the Boston University School of Medicine’s Evolutionary Neurobehavior Laboratory, where he studies how the brain reacts in different situations. As part of his work, he has conducted research into dreams, nightmares, and what goes on in the brain during meditations and religious experiences. Even with a professorship and an impressive name for his lab, McNamara detects sideways glances from other neurologists. “Studying dreams is still considered a little New-Agey and not entirely respectable,” he said.

No matter its reputation now, the investigation of dreams is one of the foundations of sleep science. Dreams were what drew many early researchers to the field in the first place, driven by the chance to discover the mechanisms and meanings of a nightly experience that has intrigued us since humans scratched out the first written language. Most cultures, and nearly all major religions, have regarded dreams as omens at one time or another. Ancient Greeks thought that dreams were visions given to them by the gods. Early Muslims considered dream interpretation a religious discipline sanctioned by the Koran. And the Bible is a veritable dream fest. In Genesis, God speaks to Jacob in a dream and describes his plans for the Israelites. Later, Jacob’s son Joseph interprets Pharaoh’s dreams after all of the magicians in Egypt have failed to do so, a feat for which he would later receive a Broadway musical. In the New Testament, a different Joseph gets a visit from an angel in a dream that tells him that his virgin wife is pregnant with God’s son and that he shouldn’t freak out.

By the start of the modern era, science had become convinced that dreams were essentially nonsense. Yet the suggestion that they revealed something hidden in an individual’s mind changed that. In 1900, Sigmund Freud was a forty-three-year-old son of a wool merchant who had a small medical practice in Vienna. That year, he published a book that became the linchpin of dream theory for half a century. In
The Interpretation of Dreams
, he argued that, far from being random events, dreams were full of hidden meanings that were projections of the dreamer’s secret hopes and wishes. In effect, Freud identified the subconscious, a realm of thought beyond the mind’s control that colors our desires and intentions. Every night when a person went to sleep, Freud said, the mind cloaked these thoughts in symbols that could be uncovered and interpreted with the help of a therapist. Without dreams, our unconscious concerns would be so overwhelming that few of us could function. Dreams were what allowed us to think the unthinkable. These “letters to ourselves,” as he called them, were an important safety valve for the mind. Take them away, and psychic pressure would then build and lead to neurosis.

To prove his point, he gave examples of his own dreams. In what would eventually become the most discussed dream in psychology, Freud described seeing one of his female patients among a number of guests in a large hall. He takes her aside and faults her for not accepting his prescribed treatment for her illness. She replies that the pain is spreading to her throat and starting to choke her. He sees that she is puffy and begins to worry, wondering if he missed something in his examination. Freud then takes her to the window and asks her to open her mouth. She is reluctant to do so, and Freud finds himself getting annoyed. Soon, his friends Dr. M and Otto arrive and help him examine the patient. Together, they discover that she has a rash on her left shoulder. Dr. M surmises that the woman’s pains are due to an infection, but a bout of dysentery will rid her body of the toxin. Freud and Dr. M come to the conclusion that the cause of the trouble was most likely Otto, who had recently given her an injection of a heavy drug through a syringe that had not been properly cleaned.

On reflection, Freud found this dream much more than a simple, albeit strange, story. “If the method of dream-interpretation . . . is followed, it will be found that dreams do really possess a meaning, and are by no means the expression of disintegrated cerebral activity, as the writers on the subject would have us believe,” he wrote. By looking at each aspect of his dream as a stand-in for an emotion or anxiety, Freud found that the dream allayed his concerns that he was responsible for the health of a particularly difficult patient. First, the woman puts up a fight throughout the dream, making it clear that he thinks that any caregiver would have difficulty quickly discovering her problem. This is confirmed when it takes three doctors examining her simultaneously to find the rash on her left shoulder. And with the help of Dr. M, Freud finds that it was Otto who foolishly gave the woman an injection and caused her illness. Taken together, the content of the dream suggests to Freud that he could walk away from his patient, blameless for what happens to her. “The whole plea—for this dream is nothing else—recalls vividly the defense offered by a man who was accused by his neighbor of having returned a kettle in a damaged condition,” he writes. “In the first place, he had returned the kettle undamaged; in the second place it already had holes in it when he borrowed it; and in the third place, he had never borrowed it at all. A complicated defense, but so much for the better; if only one of those three lines of defense is recognized as valid, the man must be acquitted.”

Wish fulfillment like this could come in many forms in a dream. Freud saw them as a release of anxiety—a condition that he linked with sex, though he described the connection in less-than-direct terms. “Anxiety is a libidinal impulse which has its origin in the unconscious and is inhibited by the preconscious,” he wrote. “When, therefore, the sensation of inhibition is linked with anxiety in a dream, it must be a question of an act of volition which was at one time capable of generating libido—that is, it must be a question of a sexual impulse.” Perhaps unfairly, Freud’s theories soon became reduced to the view that everything in a dream had a sexual meaning that reflected and uncovered long-repressed urges from childhood. One review of Freudian literature found that by the middle of the twentieth century, analysts had identified 102 stand-ins for the penis in dreams and ninety-five symbols for the vagina. Even opposites—flying and falling—were called symbols for sex. Freudians pointed out fifty-five images for the act of sex itself, twenty-five icons of masturbation, thirteen figures of breasts, and twelve symbols for castration.

Freud saw a patient’s resistance to this theory of dream interpretation as proof that it was valid. He explained that even he was initially put off by the seemingly absurd notion of his dreams. “When I recollected the dream in the course of the morning, I laughed outright and said, ‘The dream is nonsense,’” Freud wrote. “But I could not get it out of my mind, and I was pursued by it all day, until at least, in the evening, I reproached myself with these words: ‘If in the course of a dream-interpretation one of your patients could find nothing better to say than “That is nonsense,” you would reprove him, and you would suspect that behind the dream there was hidden some disagreeable affair, the exposure of which he wanted to spare himself. Apply the same thing to your own case; your opinion that the dream is nonsense probably signified merely an inner resistance to its interpretation.’ ”

The fact that Freud didn’t interpret the dream about his patient along psychosexual lines spurred a subschool of analysts devoted to unlocking additional meanings from that dream alone. In 1991, for instance, a paper in the
International Journal of Psychoanalysis
postulated that the dream actually reflected the fact that “Freud may have been haunted by the repressed memory of an incident of erotic aggression enacted by himself against his sister Anna when he was 5 years old and she 3 years old.”