Sleep waves and recovery from drug and alcohol dependence: Towards a rhythm analysis of sleep in residential treatment

The paper reports on a study of the sleep of men and women living in drug and alcohol residential treatment services. Prompted by a biomedical literature that indicates that good sleep can play a critical role in recovery and a separate sociological literature that indicates that in residential treatment sleep, subjectively at least, can improve, the aim of this article is to deploy Lefebvre’s rhythmanalysis to make sense of empirical data on sleep in these settings.

Lefebvre’s rhythmanalysis, at once a conceptual and a methodological approach, is apposite to sleep because it seeks to examine the temporal, material and relational aspects of embodied social life. The central concept – rhythm – takes many interconnected forms. Embodied rhythms are, for instance, related to spatial rhythms, temporal rhythms, natural rhythms, and cosmic rhythms.

This focus on temporalities and rhythms finds resonance in biomedical literature on sleep in general, and sleep and drug use in particular, indicating potential for interdisciplinary research on this topic. The lexical affinities of sociobiological clocks and rhythms, although rooted in divergent epistemological traditions, offer opportunities for dialogue across the human sciences.

Rhythmanalysis may therefore be a way to respond to calls within the sociology of health and illness for interdisciplinary exchange between social and natural scientists. We foreground our empirical data with a brief review of how sleep is described in temporal and rhythmic terms within the natural and social science disciplines.

A language of rhythms: the circadian and entrainment

Sleep scientists work on the premise that sleep combines two interrelated processes: sleep pressure (a homeostatic process) which increases as individuals remain awake and decreases as they sleep, and circadian rhythm (the ‘internal biological clock’) which is unaffected by sleep deprivation. They assert that the homeostatic and circadian processes are interlinked: homeostatic processes primarily determine ‘slow-wave sleep’, whilst the circadian rhythm regulates Rapid Eye Movement (REM) sleep.

In ‘healthy’ sleep, the endogenous circadian clock is aligned with, or in the language of sleep science ‘entrained’ by, diurnal cues, known as ‘zeitgebers’, such that ‘normal’ sleep is in tune with the day/night cycle . Light is considered the dominant stimulus for this ‘entraining’ of circadian rhythms to local temporal environments .

Sleep science, then, frames sleep as a series of chronobiologically endogenous processes and circadian rhythms which are nevertheless influenced by external social factors and social ‘clocks’. Research on sleep and addiction currently prioritises a focus on endogenous (internal) processes; exploring alterations in circadian systems with exposure to substances of abuse. For example, studies of alcoholdependent adults at two weeks into withdrawal show phase differences in melatonin profiles relative to ‘healthy’ controls.

Additionally, male heroin-dependent individuals show disruption in cortisol rhythms three days post cessation, but not by day ten, suggesting that the first few weeks of abstinence may be a key time for chronobiologically informed treatments. However, the same individuals also show longer-term disruption to the rhythms of the ‘clock’ genes (identified as PER1 and PER2).

These genes are also implicated in reward processing, with clinical scientists suggesting that their continued disruption may contribute to persistent craving and withdrawal (Hasler et al., 2012; 2014). Despite this focus on endogenous processes, the model of sleep underpinning this research remains one which talks of both internal and external rhythms.

Rhythms, waves, everyday life and sleep

Lefebvre’s Rhythmanalysis is primarily an approach that seeks to capture the interplay of multiple rhythms e biological, experiential, spatial, temporal and social. A rhythmanalysis involves an ‘analytic operation’ to identify ‘the plurality of rhythmic interactions’ which Lefebvre refers to as ‘polyrhythms’.

It is crucial here to appreciate how he conceives rhythm; specifically, it involves repetition, but unlike the mechanical repetitious thud of machines, embodied and social repetition or rhythms never replicate their repetition, instead they invariably generate ‘something new and unforeseen’. Lefebvre most effectively communicates this idea of rhythm through the use of a maritime metaphor.

‘To grasp rhythm and polyrhythmias in a sensible, preconceptual but vivid way, it is enough to look carefully at the surface of the sea. Waves come in succession: they take shape in the vicinity of the beach, the cliff, the banks. The waves have a rhythm, which depends on the season, the water and the winds, but also on the sea that carries them, that brings them.

But look closely at each wave. It changes ceaselessly.’ The wave indicates incessant repetition yet with constant change as the interconnections of a multitude of things, objects, atmospheres, and processes create each wave as a unique configuration. Each sea has its rhythm, yet if we ‘look closely at each wave’ we might begin to grasp how bundles of movements, spaces, and objects alter’ (p79).

Study design and method

The empirical data presented in this article were generated through a study of 28 men and women who were in receipt of support for their recovery from addiction to alcohol and/or other drugs in England. At the time of the study, they were living in one of two residential rehabilitation services. Centre one provided support for men and women and offered supervised detoxification, which lasted four to six weeks, followed by a main treatment programme comprising group therapy, one-to-one counselling, creative workshops, complementary therapies, and participation in household duties.

Days and nights were highly structured, with regular times for waking, meals, classes, bed, and sleep. Each day began with a collective meeting and, when residents left, if successfully completing their treatment, there was a formal gathering to acknowledge their achievements. Centre Two provided support only for women and involved a less structured programme.

The routine and rhthyms of residential rehabilition

In his classic text Hidden Rhythms, Zerubavel (1981) argues that the temporal profile of each day comprises several components such as: structures, sequences, durations, and routines. The temporal profile of the days and nights were very evident in the two residential rehabilitation centres, and our participants were very aware of them.

Harry, for example, articulates the elements of the daily temporalities in Centre One as follows. ‘I’d wake up at six, and then I’d go downstairs. This is when I smoked, and had a cigarette. Then I’d go, half six, go to bed, have my antidepressant, and then go have a coffee or tea, and at quarter to eight, quarter past eight, breakfast.

At the moment, I’m just doing the big wash up after breakfast… and that only takes 20 minutes. And then there’s like half an hour with nothing to do, and then at quarter to ten we usually have group psychotherapy, that’s an hour to quarter past. Then it’s usually a lull, there’s nothing until one o’clock, lunch.

Experiential rhythms

The rationale for the routines of residential treatment is to give shape to the residents’ sleep routines. But individual experiences of sleep e sleep waves – rely on a bundle of embodied rhythms and polyrhythmias (Lefebvre, 2004). Their sleep waves are in part shaped by the rhythms of the institution but also in concert with the aggregation and interaction of their individual experiential rhythms.

For some, this interaction can become ‘metonymical’, that is where sleep/wake routines and the routines of rehabilitation become almost synonymous. Orla, for example, suggests that structure played an important role in her embodied biography, but it is only now that she can share the institutional logic and appreciate the importance of routine for her sleep.

Alignment and ‘ritualised routines’ in liminal spaces

The above discussion highlights how the sleep/wake routines of residential rehabilitation are desired and seen as ‘natural’ by residents and institution alike. The routines and structures also take on a further purpose. We cannot directly will sleep but we can, as Crossley (2004) suggests, ‘call on sleep’ by way of ritual, or ‘body techniques whose principle purposes concern the manipulation of our individual psychological and our social states, our subjective and intersubjective being’ (Crossley, 2004:46; Williams and Crossley, 2008).

Such rituals may include the imitation of sleep; laying down in bed, ‘on my left side, with my knees drawn up’ (Merleau-Ponty, 1962: 163). Residential rehabilitation seeks to ‘call on sleep’ through the imposition of routine and structure seen as ‘natural’ by both individual and institution. In highlighting the importance of routine in their earlier lives, Orla, Jeff and Tina suggest that they had once acquired the embodied know-how or ‘acquired the particular ritual in question as a body technique and . . . [were] thus disposed to respond to the initiation of the ritual as a call to order’ (Crossley, 2004: 46).

This helped to synchronise their sleep waves. For these residents, the ritual call to order had always been closely linked to routine; framing the experience of sleep and in turn shaping the belief (Crossley, 2004:44). Sleep becomes structure. Routine is presumed to be rooted in biology and becomes both the way sleep should be and a way to achieve sleep. Calling on sleep through ‘ritualised’ routine, however, is complex.

 

Author: Robert Meadows, Sarah Nettleton, Joanne Neale

 

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