The wide-awake club

24th October 1997 at 01:00

Modern life is tiring, and one of the biggest causes of exhaustion is stress. But what if you find it impossible to relax and get the aches - physical and mental - out of your system? Neil Sears talks to teachers who can't close their eyes at the end of a gruelling day, and discovers that at last the medical profession is taking sleep deprivation seriously.

It was only after he had fallen asleep at the wheel of his car and driven into the back of a truck that Michael Dobson finally sought medical help for the problem that was destroying his life. But his chronic tiredness had been a problem for years, and his quest for treatment was to prove too late to save his job at a flourishing school in Birmingham.

"When this Baker nonsense started, everyone was rushing round organising things, and we had to attend meetings every night," says Michael, recalling the beginning of the end of his career as a history teacher. "I'd sit there with my diary on my lap, the speaker would be droning on, and I would regularly fall asleep, snoring like a train. I'd then fall off my chair and hit my head on the floor. The first time it happened I came round to hear everyone laughing. "

Michael, 56, did not see the funny side, and within a few short years his daytime sleepiness became such a severe problem that he had given up work. "If you're falling asleep on a regular basis, as I did on the bus after I stopped driving, children think you're a drunk," he says. "I started to be treated like the dormouse at the Mad Hatter's tea party.

"I was seen as a bit of a half-wit, particularly when I managed to lose exam papers and coursework. One night I fell asleep at my desk and woke up at 7.30pm to find the school shut."

Feeling he was letting his colleagues down, he left work in 1993. But a year after he had first contacted his doctor, a treatment was found. Happily, he is now wide awake every morning.

The cause of Michael's exhaustion was apnoea, severe snoring which leads the sufferer to stop breathing, sometimes hundreds of times a night; regular breathing restarts only after the sufferer has woken. Michael's apnoea is now under control thanks to a mask and a machine which pumps air into his nose, keeping his airways open as he sleeps. It's just unfortunate that he took so long to find professional help, and that he found the remedy only after he had left teaching.

Yet he is just one of many thousands of teaching professionals who suffer from sleep-related problems. And although Michael says that his worsening condition was unrelated to the stresses of his job, others disagree.

"Sleeplessness is very common among our members," says Chris Keates, general secretary of the Birmingham branch of the National Association of Schoolmasters Union of Women Teachers. "We've already had seven cases in Birmingham since the beginning of September who haven't been able to go back to work because they haven't been sleeping and have poor concentration. Sleeplessness is often the first symptom of stress."

Teachers are not unique, of course: when the clocks go back on Sunday, the extra hour in bed will be a treat for millions of people who don't get enough rest. Experts estimate that at any time up to 30 per cent of the population is suffering from a lack of sleep, with a third of those considering their problem to be serious.

Modern life itself is partly to blame: cars whizzing through the streets at night, and televisions offering programmes 24 hours a day conspire to keep us awake. But the demands of the workplace are widely recognised as the biggest cause of sleeplessness. And the increasing stress suffered by teachers makes them particularly vulnerable.

The good news, however, is that the problem is finally being taken seriously by doctors. According to Dr Adrian Williams, director of the recently established sleep disorders centre at St Thomas' Hospital in central London, we are catching up with the US, where sleep has been treated as a separate medical discipline for decades.

"In this country most insomniacs are still seen by psychiatrists, but most of the time it is not a psychiatric problem," says Dr Williams, who gained his expertise in the sleep disorders centre at the University of California, Los Angeles. The solution, he says, is to encourage specialisation in sleep, with more sleep clinics and more training for doctors.

Dr Williams believes most sleep disorders can be tackled quickly. "There are only a handful of important reasons for being sleepy in the day. That's why I'm in the business - it's easy."

The thousands of people suffering from apnoea, often overweight, middle-aged men, can usually reduce their problem by slimming and cutting down on smoking, or by using appliances like Michael's. And many of us could improve our sleep patterns simply by buying a new bed; although we spend around a third of our lives in the land of nod, we tend to cling on to old, sagging mattresses that have survived far beyond their natural lifespan.

Dr Williams says insomnia can often be resolved through improved "sleep hygiene'" - sensible sleeping habits - but, for teachers frantic about coping with their responsibilities, the answer often does not seem so straightforward.

John Archer (not his real name), 47, until 1995 a head of department at an inner-city Birmingham comprehensive, found his worries about his job suddenly careered out of control in the early 1990s. "I was losing sleep for about four years before I stopped teaching," says John. "I had to deal with new initiatives both from government and school management, and with the pressure from the media and inspectors to perform miracles with under-achieving children. I'd just lie awake at night totally unable to go to sleep, and then fall asleep just before it was time to get up. But I didn't want to be seen as someone who couldn't cope."

John's problems, however, were getting worse and lasting through holidays: he got a stomach ulcer, which made it even harder for him to get to sleep, and his daytime sleepiness resulted in blurred vision in the afternoon. His doctor agreed the problems were stress-related.

John was becoming desperate. "Because of the tiredness, I'd deteriorated in terms of short-temperedness," he says. "It would have been easy for me to have sworn at or struck a child. Thank God I didn't do anything." John rejected sleeping pills, but continued to deteriorate, and was soon facing disciplinary action for neglecting paperwork.

First he went on long-term sick leave, and gradually began to get more sleep by exercising daily, and stopping thinking about teaching. Then he solved his problem - by taking early retirement. Now his sleep is disrupted only by the nightmares in which he finds himself in a classroom.

John jumped before he might have been pushed, but the tightening of early-retirement rules will make his example harder to follow. Brian Carter, Midlands secretary of the National Union of Teachers, says exhausted teachers can easily find their careers at risk. "We worked with a newly qualified teacher who just couldn't get to work on time," says Mr Carter. "He was worrying about the job, and wasn't sleeping until dawn broke. He'd then oversleep. The school would have to call him to get him to come in. They bought him an alarm clock, but it didn't help, and after just a few weeks he was facing disciplinary procedure."

It was then that Mr Carter suggested that this was a case of more than simple laziness. The young teacher was referred to a doctor, and advised to go for a walk before bedtime, and to reduce stress by being more organised. He resolved his problems, and kept his job.

Hilary Pulham, 52, formerly a support teacher of English as a Second Language, was not so lucky. Like John, she took early retirement. Yet while stress contributed to her sleep problem, it was caused primarily by a condition shared by around one in 2,000 people: narcolepsy.

"With narcolepsy your brain is working in four-hourly cycles, so it is switching off every four hours," says Hilary, honorary secretary of Britain's Narcolepsy Association, which has 700 members. "If you don't fall asleep you do silly things, like write down a lot of rubbish."

Hilary's narcolepsy developed when she was 15, yet she kept it under control until her job was changed. Instead of being based in one school, she suddenly had to drive between schools that were miles apart. She no longer had time for a daytime nap, and started falling asleep in meetings. Disciplinary procedures followed, and Hilary became increasingly stressed. Like John, she decided her health should come first, and took early retirement. She now copes with her illness by taking prescription amphetamines to stay awake, and by taking naps whenever necessary.

Dr Williams, at St Thomas' sleep disorders centre, says the rise of sleep awareness should help solve such problems far more quickly. Not only is his centre now concentrating on serious sleep problems, alongside similar clinics being established across Britain, but moves are being made to emulate the influential National Sleep Foundation of America.

The foundation promotes better care for sleep problems, and produces leaflets warning that sleeplessness is a major cause of road accidents. In mid-October officials from the foundation came to Europe to meet Dr Williams and other professionals and assist in the creation of a similar body here.

Michael Dobson, now fully rested, is delighted things are changing; he only wishes his problems had been diagnosed earlier. "I had a good job in a good school, and I was making a cock-up of it," he says. "But it didn't have to be like that; if I'd known a cure was round the corner, I would have gone back to the job."

A to Zzzzz of sleep

Sleep expert Dr Adrian Williams's rules for better sleep hygiene Sleep as much as necessary but no more. Spending too long in bed becomes counter-productive. u Get up at the same time every morning. It helps you to go to sleep at the same time every night.

Take daily exercise.

Ensure your bedroom is as quiet as possible.

Keep your bedroom cool, as excessive warmth disrupts sleep.

Don't go to bed hungry. A light snack may aid sleep.

Use sleeping pills as sparingly as possible. Most insomniacs obtain no benefit from long-term use.

Avoid caffeine in the evening.

Avoid alcohol - it may help you nod off, but it fragments sleep Avoid tobacco; heavy smokers suffer disrupted sleep.

If you can't go to sleep, don't get mad, get up. A few minutes' reading or making a milky drink could help to calm you down and send you off.

Useful contacts: The Narcolepsy Association (send a stamped addressed envelope), 1 Brook Street, Stoke-on-Trent ST3 1JN The British Snoring and Sleep Apnoea Association, Castle Court, 41 London Road, Reigate, RH2 9RJ

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