When Strauss’s Clytemnestra enters the stage singing, “Ich habe keine gute Nächte mehr,” she speaks for many singers. Even without the homicidal nightmares of the former Mrs. Agamemnon, there are many reasons why a good, restful night’s sleep eludes many of us.
The study of sleep used to be a kind of stepchild of medicine, since it could not be specifically assigned to any of the traditional specialties. Today it is claimed by many, including anesthesiology, neurology, pulmonary medicine, psychiatry, and otolaryngology. This is because sleep is a complex phenomenon that can be disturbed by numerous disorders that are treated within many specialties.
Normal sleep involves a partial shutting-down of the brain’s activities. While consciousness is gone, however, the brain continues to work. Normal sleep is cyclical, with episodes of dreaming usually associated with rapid eye movement (REM) sleep. Even in the absence of Freudian or Jungian attributions, dreaming is considered an important activity that helps to rework and resolve the previous day’s conflicts. Restful sleep requires alternating periods of deeper and more shallow sleep. The cyclical nature of brain activity seen during sleeping continues during wakefulness, although it’s partly suppressed by the conscious brain. Nevertheless, even during waking hours there are periods of somnolence alternating with alertness.
All humans require an adequate amount of sleep. This amount may vary from as little as four hours to nine or 10 hours. Habitually sleeping less than the needed time leads to sleep deprivation. Although we speak of eight hours of sleep as “normal,” remember that “normal” is nothing more than a statistical convention–nobody is completely “normal” in every sense. If you require nine hours a night, eight hours won’t do–certainly not in the long run.
In experimental physiology, chronic sleep deprivation is a well-known stressor. It slows the reflexes, dulls the brain, and weakens the immune system. For those singers who work several jobs, including evening concerts or gigs, there is potential danger in “running on empty” for weeks and months at a time. As sleep deprivation accumulates, you will find a gradual personality change, and an increased propensity for making mistakes and developing illnesses. Don’t let your work ethic prevent you from taking afternoon naps when possible.
If lack of sleep is due to insomnia, try to work out whether worries are keeping you awake. One strategy is to imagine the worst possible situation (you lost your job, your lease is up). What would you do? If you can find an acceptable answer to the worst scenario (you may need to write it down), then, by definition, any other outcome is better and can be dealt with. Strategies such as this may work for situational anxiety. If you are generally anxious or depressed (feelings of stress are not linked to a specific situation but constantly reattach themselves to new situations as they arise), you may need professional psychological help.
Should you take sleeping pills? If there is a specific need, they may be helpful. Such needs could be jet lag after overseas travel or anxiety before a big engagement. Try over-the-counter pills, such as melatonin or Tylenol-PM, first, since they are less expensive and not addictive. Alcohol at bedtime can induce sleep, but this is of poor quality and often interrupted by wakefulness in the middle of the night. [Ed: See Dr. Jahn’s column on alcohol and the voice in the June 1999 issue of CS]
If you repeatedly stop breathing during sleep, you may have what is known as sleep apnea. With this disorder, there is decreased flow of oxygen to the brain, resulting in a rise in blood pressure, and sleep is disturbed. Patients with sleep apnea sleep long, awaken groggy and tired, and remain sleepy throughout the day.
Rarely, sleep apnea is caused by a failure of brain regulation. Much more commonly, it is due to obstruction of the airway. Obstructive sleep apnea may occur when the nasal passage, palate, and/or pharyngeal walls block the airway. Snoring, caused by turbulent airflow, often accompanies such obstruction. Evaluation by a sleep laboratory is a good place to start if you suspect you may have sleep apnea. Treatment for obstructive sleep apnea may include weight loss, cessation of alcohol or other medications, or sleeping with a machine that assists respiration. The obstruction can sometimes be relieved by simple measures, such as using a night-time bite guard to pull the jaw forward or placing a breathe-strip across the top of the nose.
Surgical treatment for obstruction includes straightening the nasal septum, reducing the turbinates, or removing the tonsils or adenoids. For singers, other surgical measures, such as shortening the palate or repositioning the tongue, are potentially voice-altering. Unless the sleep apnea is a serious health hazard and no other measures will work, such surgery to the vocal tract should be avoided and, if necessary, performed only by a surgeon who is familiar with the specifics of vocal technique.
