LAUSANNE — There are books and newspaper articles, technologies promising relief, even theater productions devoted to the topic. Indeed, it seems like everyone is talking about insomnia these days.
In Switzerland, insomnia already affects about a third of the population, according to a study carried out between 2009 and 2012 by the Center for Investigation and Research in Sleep at Lausanne University Hospital. And it's only getting worse, say doctors José Haba-Rubio and Raphaël Heinzer, authors a book entitled Je rêve de dormir ("I Dream of Sleeping"). "We are clearly facing a public health problem," Heinzer insists.
But where did it come from? How did this scourge become so strong? Haba-Rubio says it "appeared with the evolution of society" — especially after electric lighting was invented. And is has been accelerated, Heinzer adds, by "the pressures of a productivist world and the perpetual interconnection made possible by new technologies, which have ended up disrupting our sleep-wake rhythms."
With our current way of life, our wake system is hyper-stimulated.
U.S. researchers have conducted studies among three tribes living away from any technology. "None of them had a word for insomnia," Haba-Rubio says. "For them, insomnia doesn't exist. Sleep is still a natural phenomenon."
That may be the case. But there's still the question of why the insomnia problems keep getting worse. Thomas Edison's light bulb isn't exactly a recent invention, after all. Nor, at this point, is the internet, for that matter. Haba-Rubio says the answer lies in our overly stressful and hectic lifestyles.
"There should be a balance in our sleep-wake system," he says. "But with our current way of life, our wake system is hyper-stimulated. We have so much to do, professionally but also in our free time, that the sleep system can't compensate for this state of hyperarousal."
Can't sleep — Photo: Alyssa L. Miller
Complicating matters are our attitudes about sleep, Heinzer argues. "We have great expectations regarding sleep, and that's a real problem," he says, noting as evidence the popularity of electronic and connected gadgets that promise to analyze and improve sleep. "But the more we try to control our sleep so as to perform better the next day, the more it eludes us," he says. "These excessive expectations create a kind of focalization, which can actually end up producing insomnia."
The problem with pills
But what exactly is insomnia? Specialists distinguish secondary insomnia (which is related to another pathology, such as depression or respiratory illness) from primary insomnia. By nature, though, sleep disorders can easily become chronic, meaning that in the case of the secondary variety, the insomnia can continue even after the contributing pathology has been treated.
"Secondary insomnia then becomes a pathology in itself," Haba-Rubio explains. "It's as if the brain has learned to sleep badly."
When dealing with primary insomnia, doctors talk in most cases about "psychophysiological" insomnia. And for good reason: If the insomnia is triggered by a psychological factor, stress or a difficult event, "this episode will induce a real change of the brain system," says Haba-Rubio. "Sometimes it only takes a few bad nights for insomnia to set in. This bad memory remains, and ultimately it's the fear of not being able to sleep that prevents you from sleeping."
In terms of treatments, somnologists advocate the benefits of cognitive-behavioral therapy, which consists of techniques to relearn how to sleep, by temporarily restricting the amount of time spent in bed, for instance. The goal is for patients to change their bedtime behavior and get back to enjoying the experience.
You will always need to increase the dosage.
Breaking the association between bad nights and poor performance is also a way to block the anxiety insomnia can generate. "It is essential that insomniacs be able to regain confidence in their ability to sleep," Heinzer explains. "It's the only way to break this vicious circle."
The doctors don't recommend sleeping pills. "We haven't found the right medicine, the perfect sleeping pill that produces physiological sleep," Haba-Rubio says. "These are only drugs that slow down wakefulness and slow down brain activity, with all the potential side effects and addiction risks this entails."
The other pitfall of sleep medication is that users build up a tolerance. "For the drugs to keep on having the same effect, you will always need to increase the dosage," he adds. Despite the risks, an estimated one in five Swiss people take sleeping pills at least once a month.
Even for those who don't get hooked on pills, insomnia can have some some serious personal and economic repercussions and ought, therefore, to be treated as a real public health issue, Haba-Rubio and Heinzer argue. A good starting point would be to launch a public information campaign on "sleeping well," the way the state already does for healthy eating.
"We know that the less we sleep, the more we encounter other health problems," says Haba-Rubio.
The military has seized control in one of Africa's largest countries, which until recently had made significant progress towards transitioning to democracy after years of strongman rule. But the people, and international community, may not be willing to turn back.
This week the head of Sudan's Sovereign Council, General Abdel Fattah El Burhan, declared the dissolution of the transitional council, which has been in place since the overthrow of former president Omar el-Bashir in 2019. He also disbanded all the structures that had been set up as part of the transitional roadmap, and decreed a state of emergency.
In essence, he staged a palace coup against the transitional authority he chaired.
The general's actions, which included the arrest of Prime Minister Abdalla Hamdok, are a culmination of a long period of tension between the civilian and military wings of the council.
A popular uprising may be inevitable
The tensions were punctuated by an alleged attempted coup only weeks earlier. The days leading to the palace coup were marked by street protests for and against the military. Does this mark the end of the transition as envisaged by the protest movement?
Their ability to confront counter revolutionary forces cannot be underestimated.
The popular uprising against Bashir's government was led by the Sudan Professional Association. It ushered in the political transitional union of civilians and the military establishment. The interim arrangement was to lead to a return to civilian rule.
But this cohabitation was tenuous from the start, given the oversized role of the military in the transition. Moreover, the military appeared to be reluctant to see the civilian leadership as an equal partner in shepherding through the transition.
Nevertheless, until recently there had been progress towards creating the institutional architecture for the transition. Despite the challenges and notable tension between the signatories to the accord, it was never evident that the dysfunction was so great as to herald the collapse of the transitional authority.
For now, the transition might be disrupted and in fact temporarily upended. But the lesson from Sudan is never to count the masses out of the equation. Their ability to mobilize and confront counter revolutionary forces cannot be underestimated.
The transitional pact itself had been anchored by eight arduously negotiated protocols. These included regional autonomy, integration of the national army, revenue sharing and repatriation of internal refugees. There was also an agreement to share out positions in national political institutions, such as the legislative and executive branch.
Progress towards these goals was at different stages of implementation. More substantive progress was expected to follow after the end of the transition. This was due in 2022 when the chair of the sovereignty council handed over to a civilian leader. This military intervention is clearly self-serving and an opportunistic power grab.
A promised to civilian rule in July 2023 through national elections.
In November, the rotational chairmanship of the transitional council was to be passed from the military to the civilian wing of the council. That meant the military would cede strong leverage to the civilians. Instead, with the coup afoot, Burhan has announced both a dissolution of the council as well as the dismissal of provincial governors. He has unilaterally promised return to civilian rule in July 2023 through national elections.
Prior to this, the military had been systematically challenging the pre-eminence of the civilian authority. It undermined them and publicly berated them for governmental failures and weaknesses. For the last few months there has been a deliberate attempt to sharply criticize the civilian council as riddled with divisions, incompetent and undermining state stability.
File photo shows Sudan's Prime Minister Abdalla Hamdok in August 2020
Generals in suits
Since the revolution against Bashir's government, the military have fancied themselves as generals in suits. They have continued to wield enough power to almost run a parallel government in tension with the prime minister. This was evident when the military continued to have the say on security and foreign affairs.
For their part, civilian officials concentrated on rejuvenating the economy and mobilizing international support for the transitional council.
This didn't stop the military from accusing the civilian leadership of failing to resuscitate the country's ailing economy. True, the economy has continued to struggle from high inflation, low industrial output and dwindling foreign direct investment. As in all economies, conditions have been exacerbated by the effects of COVID-19.
Sudan's weakened economy is, however, not sufficient reason for the military intervention. Clearly this is merely an excuse.
Demands of the revolution
The success or failure of this coup will rest on a number of factors.
First is the ability of the military to use force. This includes potential violent confrontation with the counter-coup forces. This will dictate the capacity of the military to change the terms of the transition.
Second is whether the military can harness popular public support in the same way that the Guinean or Egyptian militaries did. This appears to be a tall order, given that popular support appears to be far less forthcoming.
The international community's appetite for military coups is wearing thin.
Third, the ability of the Sudanese masses to mobilize against military authorities cannot be overlooked. Massive nationwide street protests and defiance campaigns underpinned by underground organizational capabilities brought down governments in 1964, 1985 and 2019. They could once again present a stern test to the military.
Finally, the international community's appetite for military coups is wearing thin. The ability of the military to overcome pressure from regional and international actors to return to the status quo could be decisive, given the international support needed to prop up the crippled economy.
The Sudanese population may have been growing frustrated with its civilian authority's ability to deliver on the demands of the revolution. But it is also true that another coup to reinstate military rule is not something the protesters believe would address the challenges they were facing.
Sudan has needed and will require compromise and principled political goodwill to realise a difficult transition. This will entail setbacks but undoubtedly military intervention in whatever guise is monumentally counterproductive to the aspirations of the protest movement.
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