Can't Sleep? You're Not Alone

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Speaker 3 This is fresh air. I'm Terry Gross.
If you've ever had trouble sleeping, you know that the more you worry about not being able to fall asleep, the more likely you are to keep staying awake.

Speaker 3 So, what do you do? Pills, Therapy? Meditation? Or just learn to accept that you'll feel like a zombie the next day? My guest, Jennifer Sr., knows this feeling.

Speaker 3 She suddenly went from sleeping through the night to suffering from insomnia. That started about 25 years ago when she was 29.

Speaker 3 Senior is a staff writer at The Atlantic magazine, so she eventually decided to write an article about her own insomnia and the latest science surrounding sleep and insomnia.

Speaker 3 She interviewed some of the top sleep researchers. Her article in the new issue of The Atlantic is titled, Why Can't Americans Sleep? Insomnia Has Become a Public Health Emergency.

Speaker 3 It's on the Atlantic website. The Newsstand Edition will be available July 15th.
Her article in The Atlantic about grief, love, loss, and memory won a Pulitzer Prize.

Speaker 3 She also won two National Magazine Awards. She spent five years at the New York Times as a book critic and opinion columnist and 18 years at New York Magazine.

Speaker 3 She's also the author of the book All Joy and No Fun, The Paradox of Modern Parenthood. Jennifer Sr., welcome back to Fresh Air.

Speaker 5 Thank you so much for having me. It's wonderful to be here.

Speaker 3 It's wonderful to have you. As preparation for this interview, I had trouble sleeping last night.

Speaker 3 At about 5 a.m., I couldn't get back to sleep. Occasionally, I'd fall back asleep and wake up and look at the clock, and each time that happened, only five minutes had elapsed.

Speaker 3 So I slept for a full five minutes, woke up, tossed and turned, and then slept five minutes more, etc., etc. I wanted to get out of bed desperately.

Speaker 3 I was like feeling hopeless and uncomfortable, but I knew I'd regret it during the day.

Speaker 3 So I just thought I'd tell you a little bit of backstory. I don't have insomnia per se, but I have my nights when it's just like really hard to sleep.

Speaker 3 I've come to think of sleep as a talent, you know, that some people have and some people don't.

Speaker 5 You know what? I would call it a gift. I mean, a talent suggests that like people have worked at it, and some people have.

Speaker 5 I want to thank you for telling me that. It is interesting, post-publication, how many people have written me saying I'm a fellow traveler, and you wouldn't know.

Speaker 3 You're right. I like to tell people that the night before I stopped sleeping, I slept.
Not only that, I slept well. And you go on to say that you used to sleep through the night.

Speaker 3 Like you'd go to bed and you'd just like wake up seven or eight hours later. That's amazing to me.
I don't think I've ever slept through the whole night in my life.

Speaker 3 What was that first sleepless night like?

Speaker 5 Puzzling. I mean, it's a cliche among sleep clinicians that everyone idealizes their pre-insomnia selves, right? That they say, that everybody says, oh, my sleep was perfect.
I'm sorry.

Speaker 5 My sleep was really great. And it was so consistent.
that I didn't need an alarm clock when I lost one. I always slept from 1 until 9.

Speaker 5 And I had standing appointments at 10 o'clock that I'd never miss. I mean, it was so remarkably regular.

Speaker 5 So that when it first happened, I thought, like, have I been poisoned? I really had no idea. I mean, it just, I greeted it with bafflement.
and kind of curiosity more than anything else.

Speaker 5 It wasn't alarm. It was just like, huh, that's weird.

Speaker 5 I thought sort of nothing of it until it became regular and then really regular and then super intense. And then I wasn't waking up at five in the morning.
I was just staying up all night.

Speaker 5 So, you know, it

Speaker 5 got bad in a hurry. Did it lead to panic? Or as Ron Burgundy says in Anchorman, you know, that escalated quickly.
I mean, it just got bad.

Speaker 3 Did it lead to panic in bed?

Speaker 5 Yeah. Oh, God, a lot.
And

Speaker 5 I remember one time I did exactly the wrong thing. You're never supposed to do this for anybody who's suffering.
I left a lot of runway.

Speaker 5 I went to bed at like 8 o'clock, even though I was a 1 o'clock sleeper, because I was exhausted and because I wanted to sleep and I wanted to leave a lot of extra time.

Speaker 5 And I happened to fall asleep very quickly and then woke up thinking, oh, great, I slept through the night. And I had slept until 10.30.
So two hours.

Speaker 3 What did you think was wrong with you?

Speaker 5 I didn't know. I mean, this is the problem.

Speaker 5 I was not perseverating or stressing or lying awake thinking about anything. People would say to me, What are you thinking about? What are you obsessing about?

Speaker 5 And I would say, My mind is a whistling prairie. It's a whistling cockshell.
There is nothing in my head at all. I'm just lying there expecting to fall asleep.

Speaker 5 And so I couldn't determine what happened.

Speaker 3 Honestly, I really were thinking was like, I can't fall asleep. Oh, God, give me, like, I can't sleep.

Speaker 5 Oh, so eventually you do the countdown clock. Absolutely.
Okay, so that's like down the road. In the beginning, it was just all bewilderment and like this must be biologically driven.
What happened?

Speaker 5 Eventually, it was sheer blinding panic where I was, my mind was racing and I was going, what's going on? Something must be happening. Oh, my God.

Speaker 5 And I'd be staring at the clock and going, oh my God, now I only have five hours to sleep. Now I only have four hours to sleep.
Now I only have three. Now I only have two.
Now I only have one.

Speaker 5 Now I have 20 minutes. I mean, that was certainly happening.
And there would also be this kind of sound cloud of, I'm going to get fired. I'm not going to be able to do my job,

Speaker 5 I'll never be an appealing girlfriend, any of these things, right?

Speaker 5 Like the things that you think when you're at 29, you know, I'll be perceived as a basket case, or I'll not be able to exercise, you know, and I was quite active. I'd run, I'd do whatever.

Speaker 5 Oh, and eventually I would have these weird repetitive thoughts. At the time, I was covering like theater.
It was a really fun job.

Speaker 5 I was covering theater for New York magazine for no money, just writing all these kind of squibs about things that would open.

Speaker 5 And I would see all these kind of cool musicals like Hedwig and the Angry Inch and, you know, cool stuff. And snippets of songs would run through my head.
And I would just sit there and think,

Speaker 5 would the orchestra please pack up and go home? I can't deal with this.

Speaker 3 So among the things you tried early on were acupuncture, Tylenol PM, melatonin, running four miles, breathing exercises, listening to a meditation tape.

Speaker 3 What did you learn about those approaches and how effective they were for you? And what did you learn about yourself after trying them?

Speaker 5 I learned I'd never done acupuncture before and I learned that it was wonderful, just not particularly helpful for that. I did acupressure too, and same deal.

Speaker 5 I guess I learned also that there was this whole alternative medicine kind of shadow world that was starting to bloom back in the late 90s? Maybe it even had before.

Speaker 5 I learned that once you're in a certain state of panic, trying to meditate is very hard, right? Because it's something that most people fail at initially.

Speaker 5 I mean, there's no such thing as failing when you meditate. You always have to bring yourself back to paying attention to your body or to a mantra or whatever form of meditation you do.

Speaker 5 Your mind is prone to wander. That's what it does.
But if you're having trouble sleeping, that's a super alarming

Speaker 5 quality to be noticing in yourself. And it's wandering to catastrophic thoughts.
So

Speaker 5 I noticed that. I noticed that melatonin, particularly in the megawatt doses that Americans take,

Speaker 5 just makes you feel...

Speaker 5 Oh, so it's often sold in 3 milligram and 5 milligram doses. You can even find 10.

Speaker 5 The people who really look at this stuff will tell you, first of all, if you take it late at night, that's when your melatonin peaks anyway. What melatonin does is regulate your circadian rhythms.

Speaker 5 So it's not necessarily what your body responds to for sleep itself. So it tells you, it starts signaling when you're supposed to wind down and when sleep is coming and when it's supposed to happen.

Speaker 5 But taking these giant doses, which in some countries are regulated, you know, like they're widely available here for three milligrams and five milligrams.

Speaker 5 That kind of stuff is regulated in some countries in Europe. It's not necessarily the best solution for everyone.

Speaker 5 And it wasn't for me.

Speaker 3 If you're going to bed and it's already dark and you're on a regular schedule, it's not going to help your circadian rhythms.

Speaker 2 Is that the theory?

Speaker 5 Aaron Powell, yes. The theory is that your body is already producing quite a bit of it, so just hammering it with more remote won't necessarily tell it to go to bed.

Speaker 5 It's already being told to go to bed, and it might just make you feel off.

Speaker 5 If you really want to use it right, you can order like 300 microgram doses online and start taking them.

Speaker 5 You know, take one when the sun sets, take another maybe two hours later to start telling your body, hey, hey, hey, it's time. But that would be the way to do it for me.

Speaker 3 So you interviewed a lot of sleep researchers, and the first question you asked each of them was,

Speaker 3 What's the myth about sleep that you'd most like to debunk? So what was the most frequent answer?

Speaker 5 That you need eight hours.

Speaker 3 You know, when I read that, I cheered.

Speaker 4 Because

Speaker 3 for me, if I'm in bed, forget how much of the time I'm in bed I'm actually sleeping, but if I'm in bed for seven hours, I feel like victory is mine.

Speaker 3 Because more typically, it's like six and a half hours, and I feel so bad. I feel like you're harming yourself.
You really have to find a way to get more sleep, but it never seems to work.

Speaker 3 And so that was really great to read that. But everybody told you that, that you really don't need eight hours of sleep?

Speaker 5 It wasn't that they said you really don't need it. They said that this was this myth out there that was just a kind of tyranny, and I'll explain why.

Speaker 5 And uh I spoke to so many people that I was really struck by how many people did say it. So here are the things to bear in mind.

Speaker 5 Obviously, people vary, right? And there's even this vanishingly, but it's really interesting, small number of people who are called short sleepers, who need only four to six hours.

Speaker 5 Very few people are like that, but you can always sort of tell who they are. They hurtle through the world as if they'd been fired from a slingshot.
They're just kind of amazing. But

Speaker 5 it varies from person to person.

Speaker 5 It varies depending on your age. So a lot of clinicians would tell me about people in their late 60s or their 70s coming into their clinic and saying, I can't sleep eight hours.

Speaker 5 And the doctors would just look at them or therapists would look at them and say, well, at this age, you're not supposed to. It's a bummer, but it's true.

Speaker 3 And why is that?

Speaker 5 Aaron Powell, we don't function optimally as we get older in most ways. And there are cognitive decrements and ways that the brain

Speaker 5 changes, right? So I'm sure it's broadly a part of that. But the specifics in circadian signaling,

Speaker 5 there's some thought that

Speaker 5 we're designed to sleep biphasically in two episodes. And as we get older, that seems to happen.
We seem to wake up early.

Speaker 5 And if we had enough time, we could probably fall back asleep, but don't, because our jobs tell us we can't, or we just have to get on with our days. But

Speaker 5 it seems that we settle into that rhythm again.

Speaker 5 So that's some of it. But there is a really robust body of literature.
One of them was done by this famous guy named Kripke looking at like a million people.

Speaker 5 And 6.5 hours to 7.4 was associated with the best health outcomes. Now, there are design issues with all of these studies, right?

Speaker 5 It's impossible because they are almost by definition going to be observational. They're not going to be randomized.

Speaker 5 Also,

Speaker 5 you can only control for what you can control for. It's just what you can think of.
So you can control for age, for body weight, for do you smoke, for sex?

Speaker 5 Did you once have cancer? Things like this. But to quote Donald Rumsfeld, there are unknown unknowns, right? So

Speaker 5 there are things you just can't think of to control force. So there are people who believe Kripke's data and people who don't.
These kinds of studies have been replicated, though.

Speaker 3 Aaron Powell, so people who are night owls usually get scolded by the rest of their family, like, you're staying up too late. It's not healthy.

Speaker 3 Is it not healthy? Like, as long as you could get a sufficient amount of sleep and sleep later in the day, is it not healthy?

Speaker 5 You have just put your finger on what I think people are coming around to believing.

Speaker 5 I spoke to a Circadian rhythms expert who said exactly this: that the studies that sort of show, oh,

Speaker 5 night owls have worse health outcomes, it's likely because we night owls have to rise early for our jobs. And if we were given more time to sleep, we'd be fine.

Speaker 5 And then there was one other study that recently came along that said, actually,

Speaker 5 it's that night owls sort of are more likely to drink more or to smoke cigarettes. So if you're correct, if you don't like your Jamesons or if you don't smoke your Marlboro's, you're okay, right?

Speaker 5 So yeah, that's correct.

Speaker 3 So you say you want to reframe the discussion around drugs that are used as sleeping aids.

Speaker 3 And I'd like to talk with you about some of the drugs most frequently recommended for sleep and the advantages and disadvantages of them.

Speaker 3 But let's start with why do you think the discussion around drugs needs to be reframed?

Speaker 5 I'm so glad you asked me that. I really think it does.
I've, since writing about this, also discovered what a lot of people take, you know, and that a lot of people rely on stuff.

Speaker 5 And why do I think it should be reframed?

Speaker 5 Well,

Speaker 5 because

Speaker 5 I think that there is a real stigma associated with sleep drugs and taking drugs for sleep that is no longer associated with, say, taking antidepressants.

Speaker 5 I think we've come a remarkable distance as a culture in talking openly about depression and destigmatizing antidepressants. I don't think that's true at all for sleep.

Speaker 5 I think people still think of sleep meds as being, you're addicted to them.

Speaker 5 Think about, I'm hoping a number of people in the audience have, or a good percentage, have watched White Lotus.

Speaker 5 I mean, think about Parker Posey just narcotizing herself into La La Land every night, which is

Speaker 5 where she resided during the day too, frankly.

Speaker 5 That was not not a favorable depiction. There's some pretty ugly associations with sleep meds.

Speaker 3 You quote an editorial from 2024 in the American Journal of Psychiatry.

Speaker 3 And I want to read that, read the part that you quote: Weak science, alarming FDA black box warnings, and media reporting have fueled an anti-benzodiazepine movement.

Speaker 3 This has created an atmosphere of fear and stigma among patients, many of whom can benefit from such medications.

Speaker 3 No, I'm not sure if that editorial was referring to the use of benzos for insomnia, but is that something you found other doctors agreed with, that there was a stigma about taking medication for sleep?

Speaker 5 Interestingly, yes. And often, by the way, it is people who prescribe who talk about the stigma.
You know, I should be clear.

Speaker 5 Although I think clinicians would say this too, who don't, that there shouldn't be a stigma. You know,

Speaker 5 there was a fellow named Andrew Crystal who was on a sleep panel. He is a prescribing doctor.

Speaker 5 He said during a sleep panel that I attended last year at this big sleep conference that he was

Speaker 5 always just kind of saddened by how many accomplished people and well-educated people, it was really well-educated people, this was the difference, who he would say, like, look, let's just start you on something.

Speaker 5 There's no shame in this. And they would instantly look at him and think that they were about to tumble into the gutter.
That was like his

Speaker 5 phrase, you know, that they'd wind up in the gutter if they took this stuff. And that was my fear when I first developed insomnia.

Speaker 5 I refused, refused to take anything to help, thinking that I would become an addict. And the irony now is that I refused for so long that now I have developed a dependence.
I think the other thing,

Speaker 5 or if you want to talk about some of the misconceptions out there or some of the the misleading stuff that this editorial was referring to, there was a very well-publicized study that came out that said that benzos were

Speaker 5 associated or caused dementia.

Speaker 5 But two years later, another study came along in the exact same journal, the British Medical Journal, saying actually there's no association between benzodiazepines and dementia at all.

Speaker 5 So it's really hard to determine these things. More work needs to be done.
It's very hard to see. But people were really anxious for two years.
And

Speaker 5 people who had gone completely off the rails and were suddenly in a panic and could have benefited from, let's say, short-term use of benzos

Speaker 5 probably were very afraid of them on account of that, right? And you have to sort of weigh benefits and risks. And I think that's what I'd say about this.

Speaker 3 Aaron Powell, what medications come under the category of benzos, benzodiazepines?

Speaker 5 Ah, great question.

Speaker 5 Valium, Adavan,

Speaker 5 Rusterol,

Speaker 5 Clonopin,

Speaker 5 Xanax.

Speaker 5 I'm sure I'm missing some. Oh,

Speaker 5 actually, ambien is considered one for the purpose of these studies. I think its mechanism of action is slightly different.
But when they're doing this lump, they're talking about ambien as well.

Speaker 5 And also, for that matter, the quote-unquote Z drugs, Ambien has siblings as well.

Speaker 3 Trevor Burrus, Jr.: So, when you talk about people taking those drugs, you're talking about a lot of people.

Speaker 5 Oh, yeah.

Speaker 3 Are you just counting people who take them for insomnia or those people who take it for other things like just anxiety?

Speaker 5 So, here is the statistic that I think is the most relevant:

Speaker 5 18% of Americans take sleep medication

Speaker 5 every night or some nights. And that's a lot of people.

Speaker 5 And when I mentioned that to someone as I was fact-checking, it was a doctor who was one of the most prominent in the field, Suzanne Burdish from Brigham and Women's.

Speaker 5 She wrote me back and she said, that can't be right. That's too low.

Speaker 5 So

Speaker 5 it's a lot you know, so I don't know, were people lying in the survey? I don't really know. But a lot of people take stuff.

Speaker 5 And, you know, 30 to 35 percent of Americans suffer from some symptoms of insomnia, at least temporarily. And 12 percent suffer from insomnia as a really obdurate

Speaker 5 condition. And that's an at least, at least 12 percent.
And if you're a millennial, that number goes to 15. So there's a lot of people out there who are suffering.

Speaker 3 Yeah. Well, let me reintroduce you again.
My guest is Jennifer Sr., a staff writer at The Atlantic.

Speaker 3 Her latest article called Why Americans Can't Sleep is about her insomnia and the latest research into insomnia and ways of treating it. We'll talk more after a break.

Speaker 3 I'm Terry Gross, and this is fresh air.

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Speaker 3 So we've been talking about some medical treatments, you know, medicines that are prescribed for insomnia.

Speaker 3 Let's talk about psychological therapies that are tried for insomnia. And one of them is CBTI.
So, that stands for Cognitive Behavioral Therapy for Insomnia.

Speaker 3 So, would you describe what that therapy is? You've read about it. You've also tried it twice.

Speaker 5 Yes, I have. Okay, so it is a very effective therapy.

Speaker 5 It's just very hard to do. But But here is what it is in a nutshell.
You have to change your thinking about not sleeping. That's the cognitive part, right?

Speaker 5 And you have to change your behaviors around sleep. So you kind of set the same bedtimes and wake-up times.
And

Speaker 5 as you said, you try to regard the bed only as like a place to sleep and have sex. You don't want to associate it with a zone of total torment.

Speaker 5 You want to wind down at night, but the big behavioral shift that you want to do,

Speaker 5 this is like the tentpole of cognitive behavioral therapy, and it's super

Speaker 5 torturous. I mean, it's murder for some people, and it certainly was for me.
But it's effective if you can stick with it, is you want to do sleep restriction. So you basically,

Speaker 5 let's say from looking over your sleep diaries, you discover that you spend nine hours in bed, but you only sleep five hours of them.

Speaker 5 You compress those five hours into a teeny tiny window. You decide when you want to wake up every morning, let's say at seven, and you only go to bed at two.

Speaker 5 So you can only get those five hours in that window from two to seven. That's it.
You have to be out of bed besides that.

Speaker 5 And once you've done a majority of nights for that two to seven period, you can reward yourself with 15 extra minutes, going to bed 15 extra minutes earlier.

Speaker 5 It's really hard because most people can't just squish that sleep in. Sleep is not like some accordion you can contract into a case.
So it's hard and people drop out.

Speaker 5 But the idea is that you just eventually

Speaker 5 both capitulate to exhaustion and you kind of re-regulate and you reset and you accumulate the sleep debt and eventually start really falling asleep. There's sleep pressure is what they call it.

Speaker 3 Aaron Powell, yeah, I could see if it typically takes you a while to fall asleep and you're only allowing yourself five hours, you won't necessarily get the five hours sleep because it's going to maybe take you an hour to fall asleep even if you're tired.

Speaker 3 Is that the problem?

Speaker 5 That's the problem. There's also the soundtrack of terror in your head.
Oh no, now I've only got four hours. Now I've only got three.

Speaker 5 There's another paradoxical kind of soundtrack. I mean, this is the cognitive piece of

Speaker 5 which is that you have to change your thinking around sleep.

Speaker 5 What the most persuasive person about this, you know, on this subject told me was he's a guy named Wilfred Pidgin, and he was just delightful.

Speaker 5 What he said to me was, look,

Speaker 5 just because you've smoked for 20 years doesn't mean you shouldn't stop smoking, right? You're looking from this point forward, right?

Speaker 5 And what health benefits you're going to get from not smoking from this moment forward. Same with not sleeping.
Like, just forget it, right? Like, you're done. And now

Speaker 5 you've got to refocus and think, oh, this is going to be so good for my health.

Speaker 3 I'm going to paraphrase you here.

Speaker 3 You say that throughout the night, people with insomnia, the arousal centers of the brain keep chattering or clattering away, as does the prefrontal cortex, which is in charge of planning and decision making.

Speaker 3 So in regular sleepers, those regions of the brain go offline. They quiet down.

Speaker 3 So the parts of the brain that should be resting aren't resting if you have insomnia. Can you go into that in some more detail?

Speaker 5 So, particularly in depressed insomniacs, in depressed people, and insomnia is a really good recipe for depression,

Speaker 5 your brain, when you are in REM sleep,

Speaker 5 it's much more intense. And so, that part of your brain is more active, right? And that's the part with all the primal drives.
It's your fears and your anger.

Speaker 5 It's not necessarily the stuff that you're basking in, right? So that's one thing.

Speaker 5 And also, yeah, the part of you that's really supposed to go offline is your prefrontal cortex, which plans, it's the executive function part, its decision-making, all that stuff.

Speaker 5 And that really is supposed to go offline when you sleep, which is why your dreams can be so wild and sort of have no logic. It's because there's no director there, right?

Speaker 5 But in insomniacs or poor sleepers,

Speaker 5 it's half there. It's not entirely offline.
So when people say they haven't slept a wink, in some ways that's what they feel like, because they feel like their waking brain was still active.

Speaker 5 And in point of fact, to some degree, it was.

Speaker 3 And although parts of your brain go offline when you're sleeping, parts of the brain are doing really important stuff. What are the parts of the brain doing when you're sleeping?

Speaker 5 The most important thing, which I've only recently discovered, is rinsing out toxins, which is super fascinating. It's called the glynphatic system.
This is something they just found.

Speaker 5 And it's this waterway in your brain of these kind of microcanals

Speaker 5 that flush out all sorts of terrible stuff out, including amyloid proteins, which are associated with dementia. I mean, so imagine the importance in that way, too.

Speaker 5 And then there's just all of the healing that goes on during sleep. There's your heart is repairing.
Your muscles are repairing. Sleep is essential to regeneration and growth.

Speaker 5 Adolescents need it for this reason, and older people need it just to heal, you know, so there's that too.

Speaker 5 Oh, and also emotional regulation. Let's not forget that, right? You know, and we all know that.
You wake up and you haven't slept and you're irritable and awful.

Speaker 3 I want to ask you about antidepressants because that's something that you tried

Speaker 3 in the hopes that it would help you sleep, and it did. I don't know how long you stayed on the antidepressant you were taking, but are antidepressants often prescribed for insomnia?

Speaker 5 Yes.

Speaker 5 And sometimes they help, and sometimes they don't. If depression is at the root, then absolutely they can.

Speaker 5 Although it's important to note, and this is absolutely true for me, many antidepressants can have a paradoxical effect and make you extremely wakeful.

Speaker 5 So it's important for people who are seeking relief not to lose hope if they try one antidepressant and it does not work.

Speaker 5 They all have slightly different or very different depends mechanisms of action. Some of them are not well known, they're mysterious, but they have different effects on different people.

Speaker 3 Is it sometimes hard to tell whether the depression was caused by the insomnia or the insomnia was caused by the depression?

Speaker 5 Totally. Yes.
And I was told that I was just depressed and my insomnia was a symptom, and I didn't believe it because

Speaker 5 no, I wasn't, you know, but it made me depressed. I mean, it made me depressed fairly quickly, because you can't live for very long if you are extremely s sleep-deprived and not be really miserable.

Speaker 5 So I was responsive when I took the antidepressant, but the one that I took made me really vague.

Speaker 5 It blew out all the circuitry that was responsible for generating metaphors, which is what I do as a writer. So it made my writing really flat and unexciting.
So I had to go off that.

Speaker 5 And as soon as I went on one that left my metaphors intact, I needed a sleep medication too.

Speaker 5 So I don't know, it made me feel better, but it didn't sort of solve the sleep problem. The problem is, as doctors like to say, bi-directional.

Speaker 5 Depression can cause insomnia. Insomnia can cause depression.
It can be a loop. There's now some thinking that it's more often that insomnia causes depression than the other way around.

Speaker 5 It's just very hard to know, you know?

Speaker 3 Let me reintroduce you because I want to talk about long COVID after the break. If you're just joining us, my guest is Jennifer Sr.

Speaker 3 Her new article in The Atlantic is titled, Why Can't Americans Sleep? Insomnia Has Become a Public Health Emergency. We'll be right back.
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Speaker 3 So I want to move away from insomnia to talk about long COVID, which you have, although I suspect there's probably some interconnection there.

Speaker 3 But in 2022, and this was long after you developed insomnia, you got COVID and a very mild case. You were barely symptomatic.
You basically still went about your day.

Speaker 3 But after that, you got long COVID. And you wrote an article about it in The Atlantic.
And the article was titled,

Speaker 3 What Not to Ask Me About My Long COVID. And you're right, asking, are you doing any better? doesn't help You have to think of it as a chronic illness.

Speaker 3 But I do want to ask you, because I think with every year we know a little bit more about long COVID, although so much of it is still a mystery because COVID itself is so new.

Speaker 3 But have you improved over time? Has it changed for better or worse over time?

Speaker 3 And my follow-up will be like, have you learned more about it? Do you feel like you know more about what it is?

Speaker 5 Thank you for asking.

Speaker 5 I don't consider that a ridiculous question now, particularly because it's been my three-year anniversary was like June 28th.

Speaker 5 And the symptoms really started like on day six when I was positive the first time and just waxed until they were really debilitating and sort of unbearable.

Speaker 5 I'm worse. I'm a lot worse.
And I think some of it is just that

Speaker 5 I got reinfected and that makes you worse. I couldn't fight it once and I was already weakened and I think it was just another assault.
I got the Novavax, which long haulers love.

Speaker 5 It improves some of them.

Speaker 5 And I got

Speaker 5 that one year and it really improved me. It functioned as a medicine.
But I got it this year and it made me worse.

Speaker 5 So, you know, and I'm sure that every anti-vaxxer in the world is going to seize on this, but you know, the fact is that boosters and vaccinations reduce the risk of long COVID by about a third.

Speaker 5 So I think once you have it, it's really hard to know how things are going to go. So many people report feeling better after vaccines.

Speaker 5 And like I said, when I got vaccinated once, I felt so much better. So we know more about it and we don't.
We still don't really understand the underlying pathophysiology, actually.

Speaker 5 We still, everybody in my long COVID Zoom group talks about this. No one's really found anything that's worked for them in any significant way.

Speaker 5 I mean, it's really enraging. And now, of course, the budget's been slashed.

Speaker 5 It's down to

Speaker 5 very, you know, it was $11 billion, now it's $2 billion for research. And

Speaker 5 it's an administration that's very vaccine hostile and is very hostile to research generally. So that's very dispiriting.
And I have a couple of things that are well known.

Speaker 5 They happen post-virus to lots of people. They're They're happening to more people now because so many people got COVID.
So I have two autoimmune phenomena things.

Speaker 5 One is called POTS, and another is called MCAS.

Speaker 5 They are acronyms for, if you care,

Speaker 5 postural orthostatic tachycardia syndrome. It means that when I stand up, my heart races and my blood pressure plunges, and my autonomic nervous system, like my, it's just totally offline.

Speaker 5 People know some stuff about that.

Speaker 5 They can treat it. There's no cure.

Speaker 5 Mast cell activation syndrome is the other. It basically means that histamines are running rampant through your body.
They can treat it. They can't cure it.

Speaker 5 What I really have is perpetual dizziness. And it's awful.
I'm dizzy now. I'm dizzy sitting up.
I'm dizzy standing. The world bounces in my field of vision.

Speaker 5 It's like everything looks like the Blair Witch Project. It's really tough.
And people

Speaker 5 can't really figure it out. And that's upsetting.

Speaker 3 Trevor Burrus, Jr.: That sounds so life-changing. Has it changed your sense of identity, too?

Speaker 5 Totally. And it is life-changing.

Speaker 5 I'm taking an eighteen-month leave from the Atlantic.

Speaker 5 I might write a book about yeah, I th this story was the last thing I'm doing for a while. I might write a book about living in a broken body, but um I won't take an advance for it because

Speaker 5 that would be too stressful and I might not wanna to do it. Although, my

Speaker 5 natural inclination is to convert most experiences into writing. So, you know, whether it's mine or other people's experiences, I actually write about myself very little.

Speaker 5 This was like the first time I really did it. And I don't know how I feel about it, but it has totally changed my identity.

Speaker 5 And not, you want to know what? It's almost worse to not have my identity changed.

Speaker 5 It's almost worse to wake up every morning and think, oh, I can just stand up and get out of bed and brush my teeth and go about my day. I forget, actually,

Speaker 5 some of the time.

Speaker 5 A lot of the time. And I forget when I'm lying down.
And I still plan like a person sometimes who has all this energy and then sputter out and remember I'm not. It's...
It's very strange.

Speaker 5 And also, we're all trapped in limbo because this is still new.

Speaker 5 So some of us are, I mean, it's ridiculous at this point, but are sort of hanging on to the idea that people will get a better beat on it. But, you know, my body hasn't fixed itself in three years.

Speaker 5 Who am I kidding?

Speaker 3 Does the lung COVID and the insomnia have any interconnection?

Speaker 5 Yes, very possibly. There's a confound here.
Autoimmune diseases run in my family. My mother has one.

Speaker 5 She has also an immunodeficiency. The critical infantrymen in her immune system are not there, and she has

Speaker 5 already an autoimmune disease. My son has an autoimmune disease.
I was immunocompromised. I had a shortage of natural killer cells going into this

Speaker 5 epidemic, and the ones that I did have were inert.

Speaker 5 I was sickly starting from the time I was a kid. It could have been that I would have gotten long COVID no matter what.

Speaker 5 God knows I got every imaginable infectious disease before this pandemic, including spinal meningitis, like really impressive things.

Speaker 5 That said,

Speaker 5 people who have insomnia are natural killer cell deficient, and insomniacs were more likely to get long COVID.

Speaker 5 They found this out from a study of, I believe, nurses who had gotten less sleep versus those who had not.

Speaker 5 They were more likely to develop long COVID. So

Speaker 5 maybe that, you know, it's hard to know, right? It's really hard to know.

Speaker 3 Aaron Powell, so one more question about insomnia. Are you afraid to go to bed? Do you like dread going to bed at night?

Speaker 5 Oh, no. No.
And I haven't for a long time. No, no, no.

Speaker 5 I've learned enough of the cognitive kind of restructuring stuff to say to myself, particularly since I've changed jobs, I'm no longer being fed like a foie gras goose as a book critic, having to review so many books in such a short period of time, I now have a schedule where I can think, okay, a lost night of sleep is fine, you know, and if I don't sleep tonight, I'll sleep the next night, and it's okay, and I know how to meditate, so you know, I can do that.

Speaker 5 So, no, I'm no longer beset by those kinds of terrors. So, absolutely not.

Speaker 3 All right. Well, listen, I wish you well with your sleep and your health.

Speaker 3 And thank you so much for coming back to fresh air.

Speaker 5 Thank you so much for having me back on.

Speaker 3 Jennifer Sr.'s new article, Why Can't Americans Sleep, is on the Atlantic's website and will be on newsstands July 15th. She's a staff writer at The Atlantic.

Speaker 3 After we take a short break, TV critic David Biancoule will review the new HBO and Max documentary about the history of Ms. magazine called Dear Ms., A Revolution in Print.
This is Fresh Air.

Speaker 9 This message comes from Dignity Memorial and Memphis Funeral Home, one of their nationwide providers.

Speaker 7 Retired football coach Bill Muir shares how they curated a memory table for his wife Barbara that brought joy to family and friends at her celebration of life.

Speaker 10 They had a scrabble board there, and on the scrabble board, it spelled out the names of all of our grandchildren. There was a decal from her high school.

Speaker 10 You know, her sister, she walked around and said to me, Bill, how do they know so much about Barbara? Their meticulous care and the detail in which they put it together speaks volumes.

Speaker 10 I felt very special.

Speaker 9 Find a provider near you, like Memphis Funeral Home, at DignityMemorial.com.

Speaker 3 HBO has a new documentary, also streaming on Max, about the formation, contents, and legacy of one of the more influential and controversial magazines of the 20th century.

Speaker 3 The magazine was called Ms., and the documentary is called Dear Ms. A Revolution in Print.
Our TV critic David Biancoule has this review.

Speaker 11 Ms. magazine was launched more than 50 years ago with a test balloon sneak preview issue that had to break even if the magazine were to keep publishing.

Speaker 11 HBO's new documentary, Dear Ms., A Revolution in Print, takes an inventive approach in explaining what made this particular publication and its contents so unusual and meaningful.

Speaker 11 The documentary is divided into three parts, each telling a different aspect of the Ms. magazine story.
And each is told by a different director, each with her own specific perspective.

Speaker 11 One major theme of the documentary is that the women's movement, like many political movements, contained activists from all over the spectrum. Giving voice to three different voices in Dear Ms.

Speaker 11 is one way to reflect

Speaker 11 But another major theme of the documentary is how important and groundbreaking it was to identify and publicize concerns that women had in common.

Speaker 11 In the program's first part, director Salima Karoma examines the genesis of Ms. Magazine.

Speaker 11 Original staffer Letty Cotton Pogremen remembers the meetings that led to the articles in that first issue and even the magazine's name.

Speaker 12 We assigned, we got that manuscript, we edited, we put into production.

Speaker 12 It was a blur of glorious hyperactivity.

Speaker 12 And, you know, we were still batting around a title. We had a lot of mebes, maybe going to be so gender,

Speaker 12 Lilith,

Speaker 12 Bimbo.

Speaker 12 Sister was thrown out because it sounded like a nun's magazine.

Speaker 12 But Ms., it's a synthesis of Mrs.

Speaker 4 and Ms.

Speaker 12 Ms. was the all-purpose business nomenclature for women whose marital status you didn't know.
Ms. seemed to me perfect.

Speaker 11 A feminist magazine aimed at and run by women, from today's perspective, seems like an obvious, even brilliant idea. Back then, though, it was seen by many as a threat or a mistake or both.

Speaker 11 Take, for example, ABC News anchor and commentator Harry Reasoner.

Speaker 13 We put 300,000 copies out on the newsstands and hoped that they would sell over the course of eight weeks.

Speaker 12 See if people are interested. See if maybe people might use the subscription card.
Maybe, maybe it'll get a little news.

Speaker 14 The first edition of Ms., described as a new magazine for women, is at hand, and it's pretty sad. It is so clearly just another in the great but irrelevant tradition of American shock magazines.

Speaker 14 I was talking to a couple of other chauvinist pigs over the weekend, and one of them wanted to bet. I'll take five issues and under, he said.
You take the field, and I'll give you two to one.

Speaker 14 He got no takers.

Speaker 11 Reasoner was wrong, and later in the documentary, he's shown admitting as much. Magazine founder Gloria Steinem, on the other hand, gets to look back with no small sense of pride.

Speaker 5 I have to say, I think we were smarter than we thought we were.

Speaker 5 I feel good about this issue.

Speaker 5 A lot of these articles could still be relevant.

Speaker 11 The first part of Dear Ms.

Speaker 11 recounts the early feminist voices championed by the magazine, such as Shirley Chisholm, the first woman to run for president of the United States, and Alice Walker, published in Ms.

Speaker 11 before she wrote The Color Purple. Part 2, directed by Alice Gu, examines the magazine's reach and impact.
The first editor of Ms.

Speaker 11 magazine, Suzanne Braun Levine, explains how its 1977 cover story on sexual harassment gave name to an issue that soon became a central part of the national conversation.

Speaker 11 Three years later, it was the basis of the 1980 hit movie 9 to 5, starring Dolly Parton as a secretary rebelling against her chauvinistic boss.

Speaker 15 If something doesn't have a name, you can't build a response to it. You can't talk about it.
You can't rebel against it.

Speaker 16 Let's don't get excited. Get your scummy hands off of me.

Speaker 16 Look, I've been straight with you from the first day I got here, and I put up with all your pinching and staring and chasing me around the desk because I need this job, but this is the last straw.

Speaker 17 In the movie 9-5, women get even. In real life, many women can't afford to confront the boss.
But women are reporting sexual harassment more than ever before.

Speaker 15 The minute it had a name, things took off and changed.

Speaker 11 And in part three, director Cecilia Aldorando looks frankly at some of the issues that divided women in the movement and even women on the magazine's staff.

Speaker 11 One of them, Lindsay Van Gelder, recalls the sexual revolution that was brewing in 1972. Not only was Ms.

Speaker 11 Magazine released that year, but so were such attention-getting porn films as Deep Throat and Behind the Green Door.

Speaker 5 I was the last generation to grow up without porn.

Speaker 5 I was born in 1944. Porn really hit the mainstream in 1972.

Speaker 5 It was the golden age of pornography, they called it.

Speaker 3 Porn chic.

Speaker 5 You thought it was kind of liberating to go to these porn films.

Speaker 11 The magazine dealt with that issue and others in the decades since in ways that were anything but consistent or unifying. But the complexity is what makes this documentary so intriguing.

Speaker 11 And from the very first issue, what made Ms. Magazine so distinctive.

Speaker 3 David Biancouli is a professor of television studies at Rowan University. He reviewed the new HBO documentary called Dear Ms., a Revolution in Print.
It's also streaming on Max.

Speaker 3 Tomorrow on Fresh Air, our guest will be RB singer, songwriter, musician, and producer Rafael Sadiq. Before going solo, he led the group Tony Tony Tony and formed the group Lucy Pearl.

Speaker 3 He's produced recordings by D'Angelo, Whitney Houston, John Legend, Erica Badu, Alicia Keys, and Beyoncé. I hope you'll join us.

Speaker 3 To keep up with what's on the show and get highlights of our interviews, follow us on Instagram at NPR Fresh Air. Fresh Air's executive producer is Danny Miller.

Speaker 3 Our technical director and engineer is Audrey Bentham. Our managing producer is Sam Brigger.

Speaker 3 Our interviews and reviews are produced and edited by Phyllis Myers, Anne Ribaldonato, Lauren Krenzel, Teresa Madden, Monique Nazareth, Thea Chaloner, Susan Yucundi, and Anna Bauman.

Speaker 3 Our digital media producer is Molly C. V.
Nesper. Hope Wilson is our consulting visual producer.
Roberta Shorak directs the show. Our co-host is Tanya Mosley.
I'm Terry Gross.

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Speaker 18 I think that when the barn doors open and the hens run to the paddocks, you can truly see what a happy hen really is. I love pasteur-raised eggs because you can see the

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Speaker 7 To learn more about how Vital Farms farmers care for their hens, visit vitalfarms.com.

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