“I enjoy convalescence. It is the part that makes the illness worth while.” ~ George Bernard Shaw
In January I set aside seven days for self-imposed bed rest. For seven days in a row I rested in bed for 12 hours a day. Most of that time was taken up by sleep (and the most amazingly vivid dreams I have had in a long time). The hours I was awake, I engaged in light reading (no screens allowed) or just letting my imagination wander. I was not sick or even particularly run down, but winter is long, cold and dark and I am tired. The ephemeral frenzy of spring, summer’s endless days and the steady thrum of the harvest season leave little time for lazy, Sunday lie-ins. From thaw-out to freeze-up I hit the ground running every day and during the growing seasons I average about six and a half hours of sleep a night, leaving me with a sleep debt to make up for. So I went to bed.
Historically, bed rest as a therapeutic treatment was an extended period of remaining supine, to recover from illness or exertion, or to gain general health benefits. It was something that you did even if you were generally well but wanted to increase vitality and vigour. Bed rest has an interesting and mixed history with Hippocrates recommending it to his patients as early as the 4th century. At its peak of practice in the 18- to early 1900’s, it was frequently prescribed for soldiers who suffered nerve damage after amputation in the American Civil War and the Great War. It was a popular treatment for patients with tuberculosis, and for those diagnosed with nervous exhaustion or ‘hysteria’, particularly in women (where the treatment was found to be unbearably oppressive and infantilizing for many, including Virginia Woolf and Charlotte Perkins Gilman, who wrote about a harrowing rest cure in the classic novella The Yellow Wallpaper.)
In its extreme form promoted by the American physician Dr. Silas Weir Mitchell (who treated both Woolf and Gilman), the ‘rest cure’ required complete recumbency 24 hours a day for weeks or even months on end, not even raising one’s head to eat or drink, or lifting one’s arms. Sewing, reading and writing were forbidden. Bed resters had nurses attending to all their physical needs.
Around this time, convalescent homes were also quite common. These facilities provided care for those who were no longer sick, but not yet fully recovered, with all the amenities needed to gradually return to health, usually by spending plenty of time outdoors in fresh, wholesome air, bathing in seawater or sunshine and resting in bed. This was similar to the traditional European spa therapy which follows a pattern of an early bed time, extended sleep, and an afternoon nap or rest. Convalescence comes from the Latin word ‘convolescere’ which means ‘to grow fully strong’ and it was once considered a distinctly separate and essential stage of aftercare and recovery from illness. A form of bed rest is still prescribed today for complications during pregnancy, such as being at risk for pre-term labour, although there is some debate as to how beneficial this practice is.
While I can’t get on board with Dr. Mitchell’s bizarre techniques, I have been curious to explore the possible benefits of bed rest for sleep recovery after attending a class onSimple Cures for Chronic Conditions with Paul Bergner at the Green Nation’s Conference in 2014. There he talked about bed rest as just one part of the classical idea of a health regimen that also includes, “diet, exercise, rest, water, air, bodywork, and emotions.” In his own practice, Bergner has had success with, “prescriptions of 9.5-12 hours of bed rest a night, most often for three to seven days, but some times as long as three weeks.”
“Be as religious and disciplined about your sleep as you are about your work. We tend to wear our ability to get by on little sleep as some sort of badge of honor that validates our work ethic. But what it really is is a profound failure of self-respect and of priorities. What could possibly be more important than your health and your sanity, from which all else springs?” ~ Maria Popova
Each night, an average adult requires 8-9 hours of sleep for optimal health, but most of us, especially women, incur a sleep debt, and get less than that, somewhere between 5.9 – 6.7 hours a night during the week. This sets us up for the effects of sleep debt: fatigue, irritability, insulin resistance, elevated cortisol levels, declines in cognitive ability, suppressed immune function, endocrine and hormone disruption, and increased risk of stroke and heart attacks. Sleep debt accumulates over time, making it more difficult to pay off with the odd nap or Sunday sleep-in. Sleep recovery is possible, but it can take time and requires some discipline.
That’s where bed rest can play a beneficial role. An extended period of quiet, restful time in bed is often needed to help us get the hours of actual sleep we require to recover from sleep debt. Paul Bergner has observed that it can take 11-12 hours of bed rest to log enough hours actually asleep.
In pre-industrial, oil lamp and candlelit times, people stayed in bed for up to 14 hours a night, mostly during the winter months, falling asleep shortly after dusk, sleeping for about 4 – 5 hours, waking for an hour or two, and then sleeping for another few hours. Instead of stressful tossing and turning, all sorts of pleasant and relaxed activities happened during these wakeful hours in the middle of the night, including reading, writing, praying, contemplative thinking, spending time with family members, snacking, having sex (the time between first and second sleep supposedly being quite fertile) and occasionally even visiting neighbours. Now that’s a winter sleep strategy I can get on board with!
As I learn more about plants and the natural world, become more aware of the seasons and all their subtle, nuanced shifts and cycles, and connect more intimately with the ecosystems I inhabit, I am increasingly drawn to feed, move and rest my body using nature’s rhythms as a model. I am also a bit more suspicious of modern expectations around our waking, resting and sleeping hours, especially when those expectations push us toward being 24 hour consumers of goods, entertainment, artificial lighting and such.
“People can accept you sick or well. What’s lacking is patience for the convalescent.” ~Alain de Botton
However, in a culture founded on a Protestant work ethic, that values extreme productivity, progress and the accumulation of wealth and goods, concepts like second sleeps, convalescence and bed rest are dismissed as impractical or impossible in the face of daily demands and responsibilities. We especially see this in pharmaceutical advertising. “Pop a pill and get back to work!” is the stoic battle cry that precedes many a congested, sneezy, drippy, achy, run-down worker’s contagious day at the office. Moms are encouraged to ‘power through’ their sick days with medication to keep going. Masking symptoms so we can ignore them and get on with life is the expected approach to all that ails us. Personally, I have a hard time finding much of value or common sense in that approach, and I fear the consequences when we diminish our capacity for deeply restorative rest.
There is a term in German botany and zoology called Winterruhe (pronounced like: vin-ter ruh-ah), which means ‘winter quiet’ or ‘winter rest’. It is a state of reduced activity in plants and certain warm-blooded animals. It’s different from the true hibernation that occurs in some mammals, in that metabolism and core temperature do not drop as much and there are periods of eating and movement during this time. Call it ‘hibernation light’ if you will. I love the idea of Winterruhe and its reduced activity, and I am drawn to the possibility of incorporating something like it into my life. It feels like the perfect balance to summer’s long, joyful, but ultimately exhausting days of hard, physical labour and I definitely want to structure more Winterrhue into my seasonal routine. I think a week of bed rest in January will be an annual event, perhaps with shorter periods of bed rest spread out over the year. And knowing how important sleep is to my health and vitality, I’m going to be more disciplined about getting enough of it.
Now, midway between the gradually lengthening days of Winter Solstice and Spring Equinox, I am grateful for the darkness that has afforded me the time to convalesce, to grow strong, to rest and pay off my sleep debt. I’m looking forward to the sun’s increasing warmth, the stirring of the soil as life returns to the land, and all the activity that comes with that awakening. Soon my days will be long, full and busy again. But, until then, there’s still time for a few more naps and extended sleeps!
Allen C, Glasziou P, Del Mar C. “Bed rest: a potentially harmful treatment needs more careful evaluation”. The Lancet 1999. www.pubmed.gov
Alexander, K. “Your Ancestors Didn’t Sleep Like You”. Slumberwise May 2013 http://slumberwise.com/science/your-ancestors-didnt-sleep-like-you
Bergner, Paul. “Sleep debt: pathophysiology and natural therapeutics”. Medical Herbalism A Journal for the Clinical Practitioner 2003. http://medherb.com/bi/Issue-133-Spring-2003.pdf.pdf
Breus, Michael J. Ph.D. “Can You Ever Really Catch-up on Sleep?” Psychology Today November 2013 https://www.psychologytoday.com/blog/sleep-newzzz/201311/can-you-ever-really-catch-sleep
The Family Health Guide. “Repaying Your Sleep Debt”. Harvard Health Publications: Harvard Health Medical School 2007. http://www.health.harvard.edu/staying-healthy/repaying-your-sleep-debt
Stiles, Anne. “The Rest Cure, 1873-1925.” BRANCH: Britain, Representation and Nineteenth-Century History. Ed. Dino Franco Felluga. Extension of Romanticism and Victorianism on the Net. http://www.branchcollective.org/?ps_articles=anne-stiles-the-rest-cure-1873-1925
Thomas, Carolyn. “Convalescence: The Forgotten Phase of Illness Recovery”. Heart Sisters June 2014 http://myheartsisters.org/2014/06/08/convalescence/
“Winterruhe.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. Date accessed (01/02/ 2016). https://de.wikipedia.org/wiki/Winterruhe
Personal notes from Green Nations Conference 2014, “Simple Cures for Chronic Conditions” presented by Paul Bergner