Getting Enough Sleep Isn't Enough

Dr. Mark Burhenne, DDS, The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease, & Unhappiness

Snoring isn’t cute. Despite adorable viral videos of snoring babies, puppies, and grannies, snoring is a serious health issue. By now, with the prevalence of CPAP machines and mandibular advancement devices, we’re probably all somewhat familiar with sleep apnea. But Mark Burhenne insists this is only one form of “sleep-disordered breathing,” a category of breathing illnesses that can have cascading effects on your health, happiness, and quality of life.

Burhenne is one of a developing class of dentistry, specializing in sleep disorders. Many warning signs of sleep-disordered breathing, he writes, manifest in the mouth. This may include crowded teeth and recessed jaw, damage from chronic teeth grinding, and others. However, the signs he identifies still need quantified by MD sleep specialists before treatment can begin, or be compensated by insurance. That, he says, is where things become tricky.

The 8-Hour Sleep Paradox, Burhenne writes, is assuming counting the hours you spend asleep and assuming, as Mother probably taught you, that eight hours equals a good night. But simply being unconscious isn’t the same as getting a good night’s sleep. Citing multiple sources, Burhenne suggests that anywhere from half to four-fifths of Americans aren’t getting enough deep, restorative sleep, and lack of air is the most common reason.

Worse, we have a tendency to minimize or dismiss real problems. I say “we,” meaning the general population, but Burhenne writes, that includes medical professionals too. Patients diagnosed with “mild” sleep apnea often get sent home with best wishes and little more, but even mild apnea means a person’s airways close. And that means the person comes partway awake to breathe, and therefore isn’t getting necessary Stage-4 and REM sleep.

This book’s first few chapters explain the warning signs in themselves. These include now-familiar signs of sleep problems, like obesity and chronic fatigue. It also includes, but isn’t limited to, signs of poor sleep, like needing caffeine and frequent naps (guilty); or waking up with dry mouth or headaches, signs you’ve spent the night gasping for air. But if you’re browsing this book, you already know you need to change.

Mark Burhenne, DDS

But Burhenne avoids the most common shortcoming of self-help books, encouraging readers to diagnose themselves. Rather, after just two chapters on recognizing signs of sleep-disordered breathing, the largest portion of the book focuses on working with a sleep specialist to get an actual diagnosis that leads to treatment. This is difficult, Burhenne admits, because sleep studies are expensive, and insurance companies incentivize doctors to avoid costly tests.

Getting an appointment with a sleep specialist usually requires a recommendation from your GP. And if you aren’t middle-aged and overweight, Burhenne writes, many GPs won’t make that recommendation. So he provides tools to increase your doctor’s cooperation in the fifteen minutes you usually have, including the Epworth Sleepiness Scale and the STOP-BANG questionnaire. He also includes important questions to ask, and important information to provide.

After going through all that, patients have no guarantee their insurance will actually cover the procedures. Burhenne copiously expounds how to navigate the paperwork necessary to get treatments covered. This includes how to convince your insurance provider that you need some treatment other than CPAP, which is the most commonly used anti-apnea technology, but doesn’t work for everybody. Getting the right treatment takes effort, apparently, but it’s worth it.

Burhenne does provide life hacks that patients can apply individually. To give just two examples, this includes mouth taping, which is exactly what the name implies. If you have only a mildly obstructed airway, closing your mouth overnight with surgical tape can ensure you breathe through your nose for maximum efficiency. It also includes certain non-steroidal nasal sprays to keep airways open, again, for nose breathing, like your body prefers.

Nevertheless, Burhenne doesn’t mainly emphasize these internet-friendly hacks. He primarily keeps focus on medical science, including the most recent discoveries (as of when this book was written), and the information you need to get best results from your physician. A certain distrust for the medical establishment lingers beneath Burhenne’s prose. Though admittedly, this makes sense, considering the ideas he describes are still controversial in certain circles.

Medical pundits tell patients to watch our weight, manage our stress, and get our eight hours nightly. But we can’t do these if we’re tired from lack of deep, restorative sleep. It’s surprising to read this advice from a dentist, and I admit, I needed some convincing, but Burhenne certainly provides that. If, like me, you need not just more but better sleep, start here.

Who Am I When I Am You?

Makoto Shinkai, your name.

Mitsuha Miyamizu attends high-school in Japan’s rural uplands. After school, she’s an acolyte in her grandmother’s Shinto shrine, but she dreams of sleek, modern Tokyo lifestyles. Taki Tachibana attends high school in Tokyo, has a part-time restaurant job, and, though a talented artist, has no leisure time to practice. One day, they spontaneously wake up in one another’s bodies. This begins an adventure veering from madcap to remarkably poignant.

Japanese film critics have hailed Makoto Shinkai as the true successor to legendary anime director Hayao Miyazaki. Audience reactions to his latest movie, your name., certainly validate this claim. It’s broken Japanese box-office records, and created momentum that carries wholesale to American markets. According to his afterword, this novel isn’t an adaptation; rather, he created book and movie together, and they represent two halves of the same whole.

After overcoming denial, Mitsuha and Taki begin delving into living one another’s lives. Taki’s adolescent male anger helps turn Mitsuha assertive, bold, and popular. Mitsuha unlocks Taki’s buried feminine side, helping him snag a date with a pretty older co-worker. Without meaning to, the mismatched pair gradually coaxes one another to become the persons they’re meant to be. Despite their inability to communicate directly, they sense a growing spark.

If I hadn’t read high-browed reviews for Shinkai’s anime, I would’ve expected this premise to yield low comedy. Japanese gender-bending entertainments, like Rumiko Takahashi’s Ranma ½, generally use gender flips as opportunities for mild bawdry. And in fairness, Shinkai does have Taki occasionally feel up his newly-acquired female form. But these interludes stay brief; Shinkai is more interested in themes of identity, social role, and how others shape us.

Taki has no particular spiritual inclinations, until Mitsuha’s reverent grandmother begins teaching him how Shinto philosophy ties reality together. He shows developing interest in transcendent topics, and begins slowing his lifestyle to commune with the universe. Meanwhile, Mitsuha, accustomed to relaxing into society’s tides and simply going along, learns to assert herself, beginning to consider her own dreams worthwhile. They both grow.

Then, suddenly as they began, the body-flips stop.

Makoto Shinkai

The book’s second half veers into more esoteric territory. Desperate to reconnect with Mitsuha, Taki begins researching everything he remembers about her, but facts slip away like half-remembered dreams. He uncovers secrets he never expected, most of them quite dark. Chief among those is Mitsuha’s connection to a disaster so abrupt and unexpected, it almost brought Japan to a screeching halt several years ago, and which could happen again.

Here’s where I, the reviewer, risk becoming excessively pointy-headed. I cannot say what Shinkai intended in creating this story, but his narrative reflects themes found in several important critics. Mircea Eliade’s theory of the Eternal Return; Joseph Campbell’s myth of the circular journey; Umberto Eco’s hypothesis that priesthoods of story keep reality alive after exact facts fade from memory. Shinkai’s themes suddenly become profuse with deeper possibility.

Audiences unaccustomed to anime conventions may find Shinkai’s sudden thematic shifts confusing. Japanese pop storytelling doesn’t demand narrative through-lines like Western literature does; English-speaking audiences may feel like this story’s two halves belong in completely different books. Even I, a sometime anime connoisseur, find the transition jarring. Reading along, I felt Shinkai hadn’t finished the first half’s themes before the second half went a completely different direction.

On consideration, this raises a second critique: readers expecting something deep and literary, like Haruki Murakami or Kenzaburō Ōe, may consider this book under-written. Shinkai introduces momentous themes, but doesn’t investigate them. Remember, this is the companion volume to an animated feature film, not a novel in its own right. You must read this book within its own genre, even when it ventures into deeper territory.

So, readers must understand this novel within these stipulations. Considered that way, I find it remarkably sophisticated, a pop entertainment that exceeds its genre stereotypes. Shinkai introduces his characters, not by describing them, but by dropping them into deep water and showing us how they survive. And if he doesn’t resolve every theme he raises, he at least does them justice, keeping us thinking after we close the book.

Dedicated audiences and veteran anime fans can finish this compact book, under 175 pages, in one caffeine-fueled Saturday. But, like with many other similarly brief novels, you’ll wish it was longer. The final page is as unexpected as it is poignant. Like waking from an intense dream, one of Shinkai’s themes, you’ll remember a strikingly realized world that’s now gone, and you’ll wish you could go back.

More Human Than You

1001 Books To Read Before Your Kindle Battery Dies, Part 83
David Livingstone Smith, Less Than Human: Why We Demean, Enslave, and Exterminate Others

Nazis characterized Jews as rats, while Rwandan propagandists called Tutsis cockroaches. But while turning humans into household vermin justified killing them, colonists characterized Africans and Native Americans as cattle, which justified enslaving them. Both were instruments of control. To take away power from other people, we must first take away their human essence. But how do we do that, and why, and how do we live with ourselves afterward?

Philosopher David Livingstone Smith, in seeking sources to answer these questions, found that little has been written about dehumanization. The term gets discussed widely, especially in contexts of racism, sexism, and wartime propaganda. But little scholarly research has really addressed the social and psychological processes that let us perceive humans as “lower” life forms. That seems an oversight in today’s brutally sectarian times, which Smith decided to rectify.

We must begin any consideration of dehumanization with the question: what makes us human? This seems an obvious question, one easily answerable by science, but this is an illusion. Excessively specific definitions of humanity risk excluding groups, from racial categories to the disabled. Broader definitions risk including chimpanzees. Were australopithecines and Neanderthals human? Contemplate the question, and humanity becomes a philosophical rather than a scientific category.

It helps to understand the concept of essentialism here. Smith provides lucid explanations, which he clarifies throughout this volume, but the concept looms so large, it deserves some definition. Humans are different: skin color, height, language, disability. Yet across these superficial divides, we generally agree, some fundamental essence preserves our core humanity. The argument then becomes, what essence truly defines humanity? And does everyone classed “human” actually have human essence?

Humans, it appears, are master creators of categories and groups. While chimpanzees comprehend “Us” and “Them,” and sometimes brutally slaughter Them, only humans create narrow, intricate in-groups. Only humans create shifting alliances between such groups. Only humans institute rituals designed to reinforce such groups… and only humans show conscience enough to recognize when our group-creating inclinations harm the insiders we intended to help.

David Livingstone Smith

This capacity for unbounded cruelty, coupled with this unique ability to reflect on our own thinking— what Smith calls second-order thought— puts humans in the unique position of being both nature’s most destructive species, and its most creative. The two tendencies often travel together. The tendency to redefine humans into livestock, vermin, or monsters which need defeated, has often produced humanity’s most creative thinking, to our eternal discredit.

Understanding our capability for dehumanization requires delving into humanity’s most shameful history. Smith unpacks various genocides, like Rwanda, the Holocaust, the Turkish slaughter of Armenians, and Darfur. He also looks into European colonial history, where peoples once regarded as equals and allies, like Africans and Native Americans, became subhuman enemies almost overnight. The patterns Smith uncovers are chilling and informative. But as you’d expect, it makes for difficult reading.

This dovetails into humanity’s tendency to create races. Social scientists and philosophers have written on how races, far from being consistent or biologically mandated, are created and constantly reinvented by human societies. I was particularly struck, in Smith’s analysis, by how early children divide humans into groups, and how little those groups resemble the racial categories adults encourage others to fear. Racism both does and doesn’t need to be taught.

As the argument progresses, solutions become murkier. You cannot insist on transcendent human essentialism to people who believe designated groups lack human essence. And even when stereotypes of designated groups prove unreliable, bigotry remains remarkably intractable, immune to evidence. Smith doesn’t insult readers’ intelligence with false hopes or pat solutions. He makes readers live with our indictments, because nobody is immune from the capacity to push others outside humanity.

This isn’t a scientific text. Smith doesn’t rely on recently fashionable sciences like brain imaging and behavioral economics, currently voguish in mass-market nonfiction. Not only are such sciences less reliable than often peddled, but science lacks the vocabulary to describe the complex, amorphous interactions involved in this process. Humanity, and dehumanization, aren’t scientific facts to be analyzed, like amoebae. They’re philosophical concepts, changed by the fact of being examined.

Smith doesn’t pretend he has the last word. In his final chapter, Smith lays out questions that still need examined moving forward. This book represents an intermediate step in comprehending the ways human beings steal other humans’ essence. But as an intermediate, if considered with the sobriety the topic demands, this book offers us an opportunity to move forward. We could reclaim our humanity by restoring it to others.

Time For a New Economic Yardstick

Lorenzo Fioramonti, The World After GDP: Economics, Politics and International Relations in the Post-Growth Era

The Gross Domestic Product has proven a mediocre economic measurement at best. It totals the cash value of all economic transactions, but doesn’t measure costs and benefits commensurately; car wrecks and traffic congestion have cash value, but lovingly restoring Grandma’s classic Fairlane doesn’t, unless we sell it. I grew disgusted with GDP fifteen years ago, when national leaders presented shopping as the solution to the 9/11 attacks.

South African economist Lorenzo Fioramonti begins this dissertation with a brief history of Palau, an island nation once touted as miraculous for its powerful economy. After independence, it parlayed massive mineral reserves into Earth’s largest per-capita GDP. But that wealth wasn’t distributed equally, and GDP didn’t include non-priced factors, like environmental decay. When the minerals were tapped, the miracle proved illusory. Palau is now poor, physically blighted, and without hope.

Fioramonti sees a parable of modernity here. Economic measurements aren’t value-neutral; what economists count inevitably becomes what leaders and entrepreneurs pursue. Price elasticity causes an inverse relationship between market price and social value, meaning things we struggle to measure in dollars, like the environment or human communities, get forgotten… until catastrophe strikes. But it doesn’t have to be this way. Fioramonti progresses from grim history to optimistic forecasting.

GDP arose during World War II, for specifically wartime purposes: to quantify America’s ability to manufacture military supplies. Quoting several other economists, Fioramonti compares GDP to the Manhattan Project, a wartime planning tool that somehow persisted into peacetime and remains impervious to changing conditions. (It even triumphed in the Soviet Union, eventually, because the preferred Leninist measurement failed to account for the service industry.)

But even GDP’s chief inventor turned against his creation. Contemporary critics deride GDP for its inability to incorporate environmental costs: dirty air and flammable rivers have no price, and therefore no economic weight. But GDP pioneer Simon Kuznets realized his invention didn’t encompass human costs. Worn-out workers, sundered families, and communities severed from their roots have consequences, but no price, so they don’t get figured into the GDP.

Lorenzo Fioramonti

And this only includes what happens visibly. Early in this book, Fioramonti uses a familiar, but still impactful analogy. He writes that “food cooked at a restaurant and purchased by consumers is registered as part of a nation’s economy, but the same food cooked at home and shared with family and guests is not.” We could continue: grocery shopping counts, gardening doesn’t; replacing old socks counts, darning them doesn’t.

This leads directly into Fioramonti’s most important precept for creating an alternate economic measure: “one important step in shifting attention is to make the invisible visible. This is what ‘post-GDP’ scholars and activists are trying to achieve.” This proves more ideal that systematic. Though Fioramonti lists several alternate economic yardsticks devised since around 1975, none encapsulates every possible contingency. We need complementary measures, Fioramonti writes, not one-size-fits-all.

Among other topics, Fioramonti spends considerable time on what officials euphemistically call the “informal economy.” This sometimes means off-the-books accounting, like the Mafia, but it also includes everything productive we do that doesn’t generate money. Volunteer work, time spent with family, and home-cooked dinners all create value, but in ways that lack price, and therefore the GDP cannot track them. Does mom’s home cooking have no economic value?

“The GDP-induced categorization of work,” Fioramonti writes, “also hides the fact that only a fraction of people’s time is spent on formal jobs.” But other systems of measurement can include these pastimes. If the economic devaluation of environmental destruction doesn’t convince you the GDP measures the economy badly, then maybe you’ll be convinced when other measurements place value on your hobbies, community, or family. The GDP considers these wasted time.

I repeat, because Fioramonti does, that economic yardsticks are never value-neutral, despite what ardent capitalists claim. The GDP rewards whatever costs money, hides whatever “externalities” get buried off the books, and encourages reckless, interest-bearing debt. Fioramonti does a remarkable job detailing this history. Committed followers of events, like me, may have some prior familiarity with Fioramonti’s descriptions of what already exists, though he collates diverse sources in new, enlightening ways.

Then, when we’re convinced the status quo cannot continue, Fioramonti provides us the alternative. These aren’t just alternate accounting systems. They’re innovative value measurements, means of rewarding productive behaviors beyond slapping price tags on everything. Our world is changing, bringing the marketplace with it. If we don’t change our economic paradigms appropriately, history will surely leave us holding the bag for costs we’re not yet prepared to pay.

The Economics of Addiction

My father has emphysema. Who wouldn’t, after fifty-six years of smoking? Though he hasn’t been formally diagnosed, his pained breathing and persistent fatigue have finally forced him to use the word “emphysema” for the first time, at age 72. He once told me he began smoking at age fourteen, though he never mentioned why; after several false starts, he finally kicked the habit about eighteen months ago.

When my family relocated from California to Nebraska in 1992, so my parents could retire near where they grew up, I immediately noticed how many people smoked. My first job, behind the convenience store counter, involved accessing the tobacco rack for customers, a position for which I now suspect I was technically underage. While it wouldn’t be accurate to say most purchases included packs of smokes, enough did to worry me.

At that time, still under the sway of neoliberal political thinking, I would’ve never attributed economic reasoning to personal habits. I just wondered why smoking seemed so pervasive in Nebraska culture compared to California. Though I knew smokers Out West, they remained primarily obscure, pursuing their habits less blatantly. My workplace never completely stopped at smoke-break time, as it did in Nebraska, where smokers herded, lemming-like, toward the doors.

But thinking about my father’s struggling health, I realized I did see something similar in California. Though people smoking weed and consuming other drugs needed to maintain more cover than smokers do, the same basic behavior obtained. People embraced work, school, and other mandatory responsibilities as clear-headed as circumstances allowed, then when duty ended, they raced headlong to whatever substance made them feel human again. Legal or otherwise.

Addiction specialist Gabor Maté writes that understanding substance addicts in terms of recreational users is mistaken. Some people smoke weed, inject heroin, snort cocaine, and consume other drugs because their substances make them feel good. Addicts don’t want to feel good, however; they want to feel normal. They want whatever suffering infects their sober lives to vanish under the comforting glow of their favored substance, even for an hour.

Cocaine and heroin are painkillers. Before they became illegal, snake-oil salesmen included these drugs in their patent medicines because, no matter whatever else their concoctions included, Peruvian marching powder made the pain go away. So when considering what turns people into coke or smack addicts, or what hooks people on other painkillers like alcohol or Vicodin, we must look not at the drugs, but at whatever pain needs killed.

Nicotine and cannabis, however, aren’t painkillers. Like Valium, another widely abused substance, they’re anti-anxiety drugs. When jitters paralyze you, having a smoke, a toke, or a tab of V really drains the tension. So if painkillers require us to find the user’s unexamined pain, logic dictates, anti-anxiety drugs require us to find the unexamined anxiety. Why would a 14-year-old from bucolic western Nebraska have anxieties that need smoked out?

Rural life is frequently precarious. The principal economic driver, farming, is constantly subject to weather, market fluctuations, and other forces individuals cannot control. Dips in commodity prices take money from farmers, but also from businesses dependent on farmers, like equipment dealers, small-town banks, and entire rural downtowns. Despite tough-talking individualist myths, rural and small-town people, the western Nebraska population, live constantly at the verge of a sheer cliff.

Compare big-city life. Even after the collapse of 2008, the financial services sector remains America’s largest industry, in dollar terms. People wager massive fortunes on a 24-hour cycle. As we learned during the last economic contraction, financial services operates like a casino, plying big winners with rewards to keep them at the table. In Vegas, the rewards include comped drinks. One icon of bankers’ lifestyles is the three-martini lunch.

So while small-town people live constantly with the anxiety of hoping they’ll make next month’s payments, big-city moguls swallow the risks of gambling away Grandmother’s retirement savings. People raised in rural life, like my dad, or in California’s suburban uncertainty, smoke the anxiety away. While Bernie Madoff-type gamblers kill the pain of knowing they’re rewarded while they’re winning, but could lose everything at any moment.

Cocaine and heroin have little presence in western Nebraska, where I live, but at my construction job, I’m among the few men who don’t use tobacco. This isn’t coincidental. People’s favored drugs reflect their circumstances, and their circumstances have dollar measurements. Though hard drugs remain the province of urbanism, where difficulty and pain define daily life, rural workers will always prefer to smoke their fears away.