The California Cure Sweet Dreams: Fred Roberts
The California Cure
Future of Medicine
It is a family problem: My father didn’t sleep well, my brother doesn’t sleep well, my sister doesn’t sleep well, and I don’t sleep well. And this has been going on for 20 years.
Because of the intense nature of the financial stakes of running my own mergers and acquisitions company against Merrill Lynch and Goldman Sachs—with the all-or-nothing quality of those transactions—the stress and anxiety levels were very high. And so if I woke up in the middle of the night, I just attributed it to my work. It wasn’t until 10 years ago, when I retired, that I thought, Gee, my anxiety level is down, and I’m still experiencing this terrible sleeping pattern. So I had a traditional sleep study done where they wire you up.
As part of the test, you have to fill out this enormous questionnaire, and then you need a doctor to review the results. The doctor walked in and asked, “Um, why are you here?” He had not taken a moment to look at the data or a single piece of paper! He took a quick look at the file and said, “Test is negative, so I can’t explain what is wrong.” Then, apparently, he put a note in the file saying the test showed no sleeping problem.
A friend who is a doctor said there was this psychopharmacologist who is a real genius, and he could probably find some sort of remedy. I told him, “I want to sleep, but I don’t want to turn into Judy Garland, so let me think about this.” But eventually I did go to see the guy. He prescribed cutting-edge drugs that worked almost immediately, and I began sleeping and feeling wonderful. Invariably, after a few months, whatever drug he prescribed wore off, and he would change the prescription. When I was in New York last April, I had a terrible reaction to a new medicine and was really sick, so I finally convinced myself that this was no solution. I was becoming desperate.
It turns out that Dr. Sonia Ancoli-Israel, the sister of a friend, is one of the world’s leading authorities in sleep disorders. As soon as I saw Dr. Sonia (she lets me call her that) at her office at UC San Diego, she became the captain of the team. We requested all the records from 10 years ago. The most depressing part was when Dr. Sonia looked at the report, she said, “Who said you didn’t have a sleeping problem? If I had seen this study, I would have acted on it right then.” She conducted another study and found apnea-like symptoms, with some sort of muscle movement on top of that. She prescribed a BiPAP (bilevel positive airway pressure) machine, which alternates the pressure between inhaling and exhaling.
The normal reaction to this contraption is that people find it a miracle cure. My luck: It was not so easy. I am definitely sleeping better, but I still wake in the middle of the night—only now for short periods. It has been puzzling both to myself and Dr. Sonia.
The other piece of her solution is behavioral: Nothing in the bedroom except sleeping and, mercifully, sex. I have to go to bed and wake up at a certain time. Dr. Sonia’s team has also added a very, very small, very light prescription for the muscle movement. But it hasn’t made an appreciable difference, so we are moving to the next round of analysis.
I’m a photographer now. And while it wants to become a business, I won’t let it because I don’t want any of the strains of my old life to invade. And my entire body of work—about people in third-world countries who, I believe, have enormously rich lives but no economic wealth—is in many respects a repudiation of that old life. Given the acceptance of my work—in books and print, in gallery and museum shows—one would think I’d be sleeping like a baby.
Here’s what is so frustrating: On those occasions when I get a really good night’s sleep, whether through pills or being exhausted, I feel like a completely different human being. It’s an exquisite feeling I almost can’t describe. I want to feel that way. I have incredible faith in Dr. Sonia’s capabilities. Contrary to my first two experiences (initially, I had a person who was not focused on me and couldn’t have cared less; next, I stuck with the drug therapy because I believed in the doctor, but in the end, it didn’t work for me), with Dr. Sonia, I’ve found a more mechanical, nonchemical way to deal with my sleep problems.
My advice: If someone has a sleep disorder, they’d better deal with it, because it can be life threatening. There are people who can help. Whether they’re pharmacologists or sleep doctors doesn’t matter, as long as you can find a magic bullet.
The Science by Sonia Ancoli-Israel
Sleep disorders are often debilitating, resulting in daytime sleepiness, memory and concentration problems, depression and lethargy. Sleep apnea, a condition in which the airway collapses during the night, results in daytime sleepiness and puts people at risk for heart attacks, stroke and high blood pressure. Like Fred, if you snore loudly and are tired during the day, see your doctor to be evaluated. But with insomnia, what you believe really matters. Insomniacs often have unrealistic sleep expectations, don’t understand the cause of their problem and engage in catastrophic thinking about its effect. For Fred, like for most insomniacs, one of the most effective treatments available, Cognitive Behavioral Therapy for Insomnia (CBT-I), was very valuable. It has been shown to be as effective as sleep medications and, unlike meds, has lasting effects. Remember, insomnia is a real sleep disorder related to real problems. But also remember there is help out there. You can once again have a good night’s sleep.