A good night’s sleep, something once considered prosaic, has become a good deal more difficult over the last several decades. So much so, that it is now possible to enroll in an immersive, five-day “Mastering Sleep” class under the watchful care a of board-certified expert in behavioral sleep medicine.[1] A recent (2024) Gallup poll reflected what we already seem to know: Americans are sleeping less and are more stressed, with women under the age of fifty reporting getting less sleep than they need and greater levels of stress.[2] Perhaps it should not be surprising to observe that three of the most popular memoirs on experiences of insomnia have been penned by women. Samantha Harvey, a writer, lays bare her fears in her year-long struggle with falling asleep. “Heart thrup-thrup-thrup, scalp tight. Now my small room is over-brimming. The louder thrupping of my heart. . . . Lying on one side, cradling my head. Sleepiness vanishes, like the picture when you turned off an old TV screen; it recedes into a dot.”[3]
In her memoir entitled Sleepless, the French psychoanalyst Marie Darrieussecq chronicles her battles with insomnia in an attempt to quiet the “Castrol oil drum going glong glong in my head.” “I’ve been running on barbiturates for almost thirty years. I savor soporifics, I booze on benzodiazepines, I stagnate on sedatives, I’m hypnotic with narcotics.”[4] Other sleep tactics proved equally ineffective—yoga, meditation, fasting, a weighted blanket, and a mat of synthetic flowers on which to lie down. In addition to the physiological distress, Darrieussecq says that insomnia is freighted with its own moral baggage: To sleep poorly “is poorly regarded” against the backdrop of the “sleep of the just” whose consciences are (supposedly) clear and clean.[5] Harvey too senses this. She reports hearing the word “greed” whispered somewhere in the darkness. “You are too greedy for sleep,” she writes, “Jesus slumps backwards, dead, mouth agape at the ceiling.”[6] The suggestion of employing “sleep hygiene” seems to chide the insomniac for dirty habits.[7] Another author, Marina Benjamin, speaks of insomnia’s isolating effects. “It is, bottom line, a condition of profound loneliness. And not even a dignified loneliness, because in insomnia you are cannibalized by your own gnawing thoughts.”[8]
With the development of sleep medicine, our late modern era has witnessed the advent of sleep disorders like narcolepsy, sleep apnea, restless leg syndrome, sleep work shift disorder (SWSD), non-24-hour sleep-wake disorder, parasomnia, insomnia, and REM behavior disorder (RBD), to name just a few.[9] Nearly one-third of Americans will suffer from one of at least seventy-five clinical sleep disorders at some point during our lives.[10] Sleep disturbances are more common among women, and more likely for everyone as we age. Nearly half of all people 65 and older will have some complaint of disturbed sleep.[11] But insomnia in some form is by far the largest culprit. Up to 40 percent of adults may suffer from insomnia—defined generally as “difficulty initiating or maintaining sleep”—at some point.[12] While the stories of the advent of sleep medicine are numerous and contested, a more clinical understanding of insomnia arrived in 1979 with the publication of the first Diagnostic Classification of Sleep and Arousal Disorders—which listed sixty-eight different sleep-related disorders—based on symptoms rather than signs, following the general approach of psychiatry.[13] The disorders were divided into four categories: disorders of initiating and maintaining sleep (insomnias); disorders of excessive somnolence; disorders of sleep-wake cycle; and dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias).[14] There are only a few conditions that can be adequately treated by medication or surgery. For most disorders—especially insomnias not caused by another condition—treatments ranging from cognitive-behavioral therapy to changes in personal habits or societal arrangements show varying degrees of efficacy.[15]
Psychophysiological, or primary, insomnia is the most common form of insomnia, which identifies stress and the accompanying physiological arousal as a primary cause, as opposed to secondary insomnia, which is a symptom of an existing medical, psychiatric, or environmental condition.[16] A core feature of psychophysiological insomnia [hereafter referred to as insomnia unless otherwise noted] is a heightened concern over the inability to fall asleep, which contributes to conditioning factors where one’s sleep environment often becomes negatively associated with sleeplessness. Insomnia can often occur in response to some stressful event in life. In such cases, this kind of insomnia is initially referred to as “adjustment sleep disorder,” which typically resolves after several days.[17] Nevertheless, treatment is recommended, which may include a temporary course of medication, redeveloping positive associations with one’s sleep environment, and good sleep hygiene in order to avoid chronic (psychophysiological) insomnia, where symptoms persist.[18]
Significant life events notwithstanding, the occurrence and experience of insomnia is certainly influenced by behaviors and habits and varies with age, gender, inherent predisposition, and the incidents of other diseases and related medications, among others.
North Americans have been getting less sleep over the last several decades. A 2018 study reported that nearly one third of Americans (32.9%) sleep less than six hours a night (up from 28.6% in 2004), with Hispanics and African Americans faring worse.[19] North Americans are world leaders in unused vacation time; ours is a 24/7 world with ubiquitous screen time and energy drinks. The health impacts of getting less sleep—regardless of the causes—are well-documented, and include cardiovascular disease, diabetes, and cancer.[20] Uncontrolled sleep apnea, for instance, has been linked to depression, anxiety, and irritability.[21] Sociologists, philosophers, and historians have pointed out that our issues concerning sleep have much to do with the invention of artificial light, which has disrupted our natural sleep rhythms.[22] But it is not entirely clear whether insomnia is a disease or a symptom, or both.
One main goal of this project is to offer a theological understanding of sleep and sleeplessness, framing these, and our practices surrounding them, in God’s divine economy. Part of this involves teasing out the differences between sleep hygiene as a component of the contemporary medical understanding of insomnia and the pursuit of sleep as a spiritual discipline, or thick practice. Indeed, a Christian perspective on sleep will acknowledge sleep as God’s good gift as part of our createdness. Sleep also gives us daily opportunities to place our trust in God’s goodness and protection while also reminding us of our own finitude and final sleep. Moreover, a Christian perspective will also attempt to articulate the deeper purposes (teloi) of sleep and sleeplessness with respect to the core Christian claims of the Incarnation of Jesus Christ and our own bodily resurrection secured by him. While these theological realities do not necessarily reject sleep hygienic practices, such theological realities do place sleep hygiene in its proper context.
Hygiene takes its name from the Hygiea, Greek goddess of health, daughter of Asclepius, the God of medicine.[23] The Oxford English Dictionary defines hygiene as “that department of knowledge or practice which relates to the maintaining of health.”[24] Hence, the idea of “sleep hygiene” seems clear enough: It speaks to the practices that promote sleeping well on a regular basis. While there have always been remedies for getting a good night’s rest—including the judicious placement of sheep’s lungs on the side of one’s head, dripping poppy juice into leech-bored holes behind the ears, or a warm glass of milk—the advent of sleep hygiene in the modern era appears to be something more than simply updated techniques for inducing somnolence.[25] These older practices of inducing sleep have given way to the five principles, four pillars, the three Cs, the three Ss, or the “10 3 2 1 0” rule of sleep.[26] A new term has been added to our cultural lexicon: “orthosomnia,” defined as an obsessive pursuit of a perfect night’s sleep.[27] But contemporary sleep hygiene differs from older methods in other, more significant ways, to be discussed shortly.
Though the phrase “sleep hygiene” began to appear in the late nineteenth century, Dr. Peter Hauri (1933–2013), professor of psychology and a clinical psychologist at Dartmouth, is credited with bringing the phrase to prominence with the publication of his 1977 monograph The Sleep Disorders.[28] There he offered scientifically informed “Rules to Better Sleep Hygiene,” such as establishing a regular wake time to “strengthen circadian cycling,” avoiding caffeine and alcohol in the evenings, attending to one’s sleeping environment, the occasional sleeping pill if necessary, and avoiding “trying harder and harder to fall asleep.”[29] Hauri himself disdained the phrase “sleep hygiene” and expressed concern over thoughtless distribution of his rules, suggesting that mental health professionals handing out little pamphlets would be “no more effective . . . than handing a neurotic patient a list of ten ‘rules for healthy emotional living.’”[30] Rather, his focus was on summarizing research evidence “accumulated to scientifically support a set of rules on how to get better sleep.”[31]
William Dement (1928–2020), the father of sleep medicine, was an ardent apologist.[32] In The Promise of Sleep: The Scientific Connection between Health, Happiness, and a Good Night’s Sleep, he encouraged his readers to take sleep seriously as the foundation for good health, offering prescriptions for a “sleep sick society,” and to consider these as “doctor’s orders.”[33] Dement acknowledges that the founding principle that led to the establishment of sleep disorders medicine was to treat patients’ sleep complaints by looking only at their sleep: “If patients complained about their sleep, it was their sleep that should be examined, not their wakefulness. This was the conceptual breakthrough that established sleep disorders medicine.”[34] Here we find the first distinguishing feature of contemporary sleep hygiene—namely, its location within the new discipline of sleep science or medicine—as one distinguishing feature of sleep hygiene from its older forms.
Historically, contemporary sleep hygiene is a particular development of the medicalization of sleep.[35] Sleep is increasingly dominated by biomedical discussions bent on bringing it under our explicit control. In his work Wild Nights: How Taming Sleep Created Our Restless World, Benjamin Reiss argues that “our sense that we can conquer sleep, tame it, make it conform, relies on the same environmentally devastating mindset . . . an attitude of dominion over nature (including our own bodies) through technology and consumerism.”[36] Sociologist Simon Williams views the medicalization of sleep as a multifaced process that “[defines] a problem in medical terms, using medical language to describe the problem, adopting a medical framework to understand a problem, or using medical intervention to ‘treat’ it.”[37] This does not necessarily ascribe imperialist motives to medicine itself.[38] Here Williams draws a helpful distinction between medicalization and healthicization. While the former advances biomedical causes and interventions related to sleep, the latter advances lifestyle explanations and behavioral interventions. Here he echoes the work of sociologist Peter Conrad (1945–2024), who asserted that if medicalization tends to turn moral concerns into medical issues, healthicization takes health concerns and turns them into moral ones.[39] If this is indeed the case, it is worth asking about the nature of these moral messages associated with the healthicization of sleep or “sleep hygiene.”
Certainly, scientific and medical developments surrounding sleep—the discovery of circadian rhythms, REM sleep, developments in brain science, the discovery and effective treatment of sleep apnea—have offered valuable insights into the nature of sleep and contributed to health and wellbeing. While the advent of the International Classification of Sleep Disorders has contributed to the medicalization of sleep, there are other spheres of influence like the media, our capitalist economy, and a growing emphasis on good sleep for the individual, citizen, or society in the name of health, productivity, and well-being.[40] This is not all bad news, says Williams, for there are indeed some serious sleep issues that have been successfully managed due to the development of sleep science. In a later work (2011), Williams revisited his understanding of the medicalization of sleep, where he identifies medicine’s increasing power to not only control but customize the human body when it comes to sleep, including a growing influence of the pharmaceutical industry on sleep.[41] The recent phenomenon known as shift work sleep disorder (SWSD) serves as an example, where a social-behavioral problem is given a biomedical diagnosis to be treated with the “wakefulness” drug Modafinil.[42] But these treatments also stand in tension with cognitive behavioral therapy for insomnia (CBT-I), which includes other practices like sleep restriction therapy, sleep position therapy, and stimulus control therapy.[43]
Williams also expresses concerns over how the biomedicalization of sleep may foster a more “neurochemical” notion of selfhood, especially as we have come to understand sleep as an active brain state.[44] Finally, he observes a continued focus on the promise of a good night’s sleep as the “passport” to health, happiness, and wellbeing. With the advent of these self-surveillance practices, responsibility shifts from the professional to the individual in the form of sleep hygiene. Sleep hygiene, then, is rooted in a thoroughly medicalized understanding of sleep and insomnia. Contemporary discussions of sleep hygiene routinely acknowledge that it is incorporated as the psychological component of a clinical approach to insomnia—whether chronic or temporary.[45] It is worth remembering that Hauri’s discussion of sleep hygiene occurred in his book entitled The Sleep Disorders. Though the medicalization of sleep warrants a theological critique, as it underwrites an anthropology where spiritual matters are considerably muted, if considered at all, I will focus on the medically informed practices of sleep hygiene, or what Williams calls the healthicization of sleep.
A second distinctive concerns the economic dimensions of sleep hygiene, which of course has a cultural component as well. For years, doctors have been worried about the health consequences of Americans’ disregard for and mismanagement of sleep. Descartes, Hume, and Lock were a few of the philosophers who disparaged sleep for its irrelevance in the pursuit of useful knowledge as part of a larger wresting of sleep from notions of necessity or nature. As Jonathan Crary quipped in his book 24/7: “Within the globalist neoliberal paradigm, sleeping is for losers.”[46] He asserts that a temporal alignment of the individual with worldwide functioning markets has rendered irrelevant the distinctions between work and non-work time. He sees sleep as the only remaining barrier, or “natural condition,” that capitalism has been unable to eliminate.[47]
Employers too have expressed concern over lost income from poor sleep. In the United States, the costs of insomnia are estimated to be as high as $100 billion, most of which reflect indirect costs due to lost productivity, accidents, or disproportionate usage of healthcare resources.[48] The connection between insomnia, hygiene, and the economy is prefigured in a 1919 Good Health magazine, which decried insomnia as “the most deadly enemy of business or the professional man.”[49] Benjamin Reiss has pointed out the larger social implications of this economic cycle, arguing that we are faced with two sleep crises: Sleep is a psychological crisis for those living in relative affluence, who try to wrestle their sleep into submission; but sleep is also an existential crisis for those expected to sleep according to the rules of others, yet who are often denied the time, space, and security to do so.[50] According to Reiss, it is the economization of sleep begun in the industrial revolution that links these two crises.
But the very health and economic problems that created this paradigm promise to be addressed by the burgeoning sleep aid industry. In 2007, Jon Mooallem penned an article in The New York Times entitled “The Sleep Industrial Complex” to name the confluence of science, medicine, and consumerism in addressing sleep hygiene.[51] The National Sleep Foundation (NSF) is a non-profit organization largely financed by the pharmaceutical industry, while the American Academy of Sleep Medicine and the Better Sleep Council are non-profits supported by the mattress industry. Better sleeping drugs and better beds are the way to an idealized, paralytic oblivion-like sleep on demand, notes Mooallem. “Does your restless mind keep you from sleeping?” asks one Lunesta commercial.[52] But mattress producers deride the pharmaceutical approach to sleep, labeling it as cheating, since it essentially “promotes sleep over all the rules you break.”[53] In other words, the use of sleeping pills in any form is bad hygiene. And yet, eighteen percent of adults in the United States use some type of medication to help them sleep.[54] Collectively, these industries are pushing the value of their products to help attain various life goals through better sleep: “Sleep better, lose weight.” “Sleep better and live longer.” “Sleep better and be more productive.”
There is a troubling cycle here when it comes to sleep hygiene: Better sleep makes us more economically productive, affording us the additional income to spend on products ensuring that we sleep more efficiently and effectively. Benjamin Reiss has discussed the larger social implications of this economic cycle. On the one hand, sleep is put in the service of profit; on the other, we now have a host of commercial products promising us the possibility of sleep on demand.[55] While biomedical attempts to control sleep intensify, competing economic interests pull sleep “this way and that” when it comes to sleep hygiene.[56]
Our society seems to have radically restricted its [sleep’s] meanings to the realm of medicine, hygiene, economics, and psychology: we need sleep—and we need to do it the right way—to be healthy, productive, and well-adjusted. . . . . Sleep now inspires unprecedented levels of medical concern, along with pervasive anxiety and countless attempts at micromanagement. Pills and sleep clinics are only part of this development, which also involves mattress companies, peddlers of self-help, big coffee chains, drowsy truckers, public health professionals, hyperstimulating electronic devices, napping consultants, high-speed travel and higher-speed communications, scientific researchers, military planners, risk management professionals, labor organizers, governmental regulators, space travel researchers, self-monitoring systems, smartphone sleep apps, sleep coaches, online sleep therapy programs, and even smart beds that analyze our patterns of movement, breath and perspiration.[57]
One might say that in our current cultural context sleep has come to be understood primarily as a limited resource that must be managed well. Certainly, the benefits of a good night’s sleep are well-documented. But Christians may want to challenge this rather narrow interpretation of sleep.
A third feature of sleep hygiene concerns its stance on the body vis-à-vis our desire. In the face of insomnia, the sleepless body is viewed as the enemy, or at least a rebellious partner of the human will. As Sarah Coakley has noted, while materialism may be the dominant metaphysic—especially in the field of neurology—some form of Cartesian dualism persists to the degree that we perceive some “I” or “self” in relation to the “body.”[58] Specifically, this “I” is often described as an immaterial mind or soul that is independent from one’s body and marks the true self. In a sense, the sleepless body represents one of the last formidable affronts to our powers of control, our demands and desires, and our ability to create the right pill, or even find the right sleep routine. Curiously, one of the earlier instances of the phrase “sleep hygiene” occurred in the1918 journal Medical Insurance, where the author criticized hygiene as the human disposition to “turn night into day, or to dispense with sleep as far as possible . . . . in the mad rush for time.”[59] The author may be alluding to the prophet Amos (5:8), exposing our pretentions to the divine.[60]
Here too there may be an interesting dynamic at work. On the one hand, we are encouraged to attend to our bodies by pursuing particular hygienic practices that will help us renew our minds and bodies, while on the other, we seem to be at war with our bodies, whether we battle against somnolence or sleeplessness. The irony of insomnia is well-attested in the hygienic literature: The harder one tries to fall asleep, the more elusive sleep becomes. The more we try to command the body, the more it seems to rebel. Insomnia can be a forceful reminder of our psychosomatic nature.[61] And yet, we find that pharmaceutical companies recognize that framing sleep as a matter of the will has great appeal. Reiss observes that the drug Belsomra treats insomnia neurologically—rather than simply inducing sleep—by deactivating orexins, a neurotransmitter (neuropeptide) that keeps people awake. As he shrewdly observes, it is not a lack of sleep that is the problem, but rather “being awake when you don’t want to be.”[62] In so doing, marketers have tapped into the desire for sleep on demand as a way of exercising one’s will over against one’s body.
Placing the moral over the metaphysical is one way of saying that sleep hygiene is a thin morality that is blind, uninterested in deeper causality beyond what can be empirically measured (science & medicine) or how it serves as a passport to good health, well-being, and happiness—however these might be defined. It is also possible to detect a utilitarian calculus at work here. It may even be appropriate to describe good sleep as a form of salvation. While following sleep hygienic practices may indeed help one get better sleep, which is surely a good thing, it leaves broader questions concerning one’s anxieties, habits, and dispositions largely unanswered.
In stating that sleep hygiene places the moral over the metaphysical, I mean to say that sleep hygiene does not consider what sleep is ultimately for—the teleological question—beyond those causes that can be described in a scientific worldview that investigates earthly causes alone. From this immanent perspective (i.e. a vantage point “from below” that methodologically and intentionally omits any divine or transcendent perspective), the purpose(s) of sleep are to be more alert, productive, and present with others. These are certainly valid purposes, but they are not necessarily theological reasons. Questions of purpose do indeed arise within sleep science, though no satisfactory theories have been put forward as to sleep’s purpose from an evolutionary perspective.[63] This should not be read as a methodological indictment of contemporary science; much good has been accomplished by a disciplined focus on material and efficient causality. But if there is no particular, discernable order in nature, it invites certain attitudes toward it that share much in common with nominalism (namely, the assertion that any discernable order in nature is merely a creative exercise of the mind). To adapt one of Oliver O’Donovan’s insightful comments on nominalism, sleep is not for anything, but rather something for which we have found a use.[64] Moreover, considering the purpose of sleep from a theological perspective will offer its own unique challenges.
Theology, being the highest form of knowledge, must surely have an answer to why humans spend on average twenty-five years of their lives sleeping.
- Karl Gustel Wärnberg, “On the Theology of Sleep”[65]
More could be said here, but in the space remaining I want to situate contemporary sleep hygiene in God’s divine economy, thereby taking it to a metaphysical plane.[66] After all, the first mention of sleep in Scripture is a God-induced sleep (Gen 2:21). This means considering sleep—its divine purpose(s), our own attitudes towards it, our inability to procure it on demand, and our practices surrounding it—in light of God’s divine economy as revealed in Jesus Christ and attested in Holy Scripture. In short, a Christian perspective on insomnia or sleeplessness will consider it not merely as a physiological and behavioral problem, but also as a spiritual problem. Perhaps one way of helping clarify what theology brings to conversations about sleep is to consider common existential attitudes about sleep—sleep as a friend or an adversary, as a limited commodity or restraint, as an escape or reward, or as means toward enhancing productivity. Certainly, there is something to be gained from investigating the thoughts, dispositions, habits, and attitudes underlying these various stances. But hopefully, a theology of sleep (and sleeplessness) would inform these investigations more deeply. To date, however, only one monograph addresses sleep from a theological (and liturgical) perspective.[67] Moreover, a theology of sleep would need to address a long-standing connection between sleep and sloth. We conclude here with a few theological comments that might frame a theology of sleep and sleeplessness.
First, it is important to affirm that sleep hygiene is not bad—much good can come from it. Nor is this a general criticism of using pharmaceuticals to address bouts of insomnia. But the dominant discourse of sleep hygiene is unacceptably thin. A theological perspective on sleep invites us to consider our own sleeplessness and sleep hygiene in relation to the God who rests, but never sleeps (Ps 121:2–4), and who gives sleep to his beloved (Ps 127:2). The psalmist invites us to think of sleep as God’s gift, though this concept would require some unpacking.
Second, if sleep hygiene has indeed become medicalized, Christians should be aware that while sleep medicine may indeed prove helpful, we have access to the One who is able to expose and heal the hurtful habits and moral afflictions that often result in disturbed sleep. While insomnia might require overnight observation in a sleep laboratory, we are always under the watchful care of the Father, who is intimately acquainted with all our ways, ever mindful of “the anxious thoughts that find us, surround us, and bind us.”[68]
Third, if sleep hygiene is rooted in the sleep industrial complex, we are again mindful that in light of God’s divine economy, Jesus Christ, as Lord over our economic lives, exposes how our work habits and patterns of consumption often fail to remedy what truly afflicts us. A theological perspective exposes the folly of associating sleep with weakness or reducing it to merely a means of economic productivity.
Fourth, if sleep hygiene treats the body as an adversary of the will, then the Incarnation of Christ reminds us that embodiment, finitude, and sleep are good and proper to creaturely existence. It reminds us that God has entered into our human condition, having experienced his own exhaustion and sleeplessness, having become a sympathetic advocate on our behalf (Heb 4:15), without ceasing to be God.[69] The Incarnation also reminds us that there may be good reasons for sleeplessness—as a form of lament, or as a time to listen to or wrestle with God (Ps 77:2–4). Moreover, the Incarnation attests to our psychosomatic nature, exposing the folly of thinking that Lunesta—or any other sleep drug—can bring the kind of peace that can only come from God to our anxious, restless minds, without denying the possibility of God’s mediating grace through pharmaceuticals and other sleep aids.
Finally, if sleep hygiene elevates the moral over the metaphysical, a theological perspective gives us the telos, or ultimate purpose, of sleep as God’s creatures called to a life of spiritual discipline and discipleship, a purpose that flows from God’s very being and the created order established by God. A theological perspective on sleep and insomnia remind us that the stakes of insomnia are considerably higher than the sleep industrial complex would have us believe.
This is not new. As a practical example, consider the teaching of John Chrysostom (d. 407), who, inspired by the monastics, urged his congregation to pray before bed. If, according to the rules of contemporary sleep hygiene, the bed should be reserved for sleep, sex, or sickness (the three S’s), a Christian perspective would add prayer and judgment. In her work entitled Christians at Home: John Chrysostom and Domestic Rituals in Fourth-Century Antioch, Blake Leyerle points out that the fourth-century bishop encouraged Christians to carefully review their actions throughout the day when preparing for bed:
As judges sit under curtains to deliberate, so too do you: instead of curtains seek out a quiet time and place. When you have gotten up from dinner and are about to lie down, then sit in judgment: this is the convenient time for you; and the place is your bed, and bedroom.[70]
In fact, he even urged family prayer in the middle of the night: “If you have children, wake them up also, and let your house become altogether a church during the night.”[71] Leyerle imagines Chrysostom’s parishioners protesting that unlike monks, they had businesses and households to manage. But Chrysostom was undeterred and appealed to the poet king David. If a busy king prayed “more scrupulously than the monks living in the mountains,” business could hardly be an excuse for them.[72] Anticipating this evening exercise, says Leyerle, was meant to serve as a kind of ethical spur. Moreover, it fits the larger pattern of judgment at the end of one’s life. This pattern is meant to reinforce right action and instill a distinct conception of time by creating a greater awareness of the final judgment.
If this all sounds a bit fanatical, or like a curious bit of moralizing from a bygone era, Kelly Kapic’s recent work, You’re Only Human, urges Christians to consider sleep as a spiritual discipline.[73] While his treatment is brief, he observes that sleep itself is an act of faith; it reminds us of our lack of control, our creatureliness. While these thoughts alone fall short of a fully formed spiritual practice, they lay the potential groundwork for the inclusion of other historical practices in the history of the faith, such as the Ignatian Daily Examen or compline in The Book of Common Prayer. These may expose our need for control, our fears and failures, our inflated sense of importance, and our ultimate commitments. Thus, it may very well be the case that articulating a discipline of sleep will involve retrieving the rich history of nighttime practices and prayer in the Christian faith, not uncritically but appropriately reshaped to fit (to some degree) our cultural context. Basic practices like prayer and judgment have the potential to reframe our habits and dispositions—including our own sleeping habits and our attitudes towards sleep—within God’s divine economy. In this regard, a theology of sleep may have little new to say at all. Nevertheless, a good place to start is this evening prayer from the Scottish theologian John Baillie (1886–1960):
O Thou who art from everlasting to everlasting, I would turn my thoughts to Thee as the hours of darkness and sleep begin. O Sun of my soul, I rejoice to know that all night I shall be under the unsleeping eye of One who dwells in eternal light.
To thy care, O Father, I would now commend my body and my soul. All day Thou hast watched over me and Thy companionship has filled my heart with peace. Let me not go through any part of this night unaccompanied by Thee.
Give me sound and refreshing sleep:
Give me safety from all perils:
Give me in my sleep freedom from restless dreams:
Give me control of my thoughts, if I should lie awake:
Give me wisdom to remember that the night was made for sleeping, and not for the harbouring of anxious thoughts or fretful or shameful thoughts.
Give me grace, if as I lie abed I think at all, to think upon Thee.[74]
[1] See for instance, “Mastering Sleep: With Dr. Michael Grandner,” CanyonRanch, https://www.canyonranch.com/events?location=tucson.
[2] Sarah Fioroni and Dan Foy, “Americans Sleeping Less, More Stressed,” Wellbeing, April 15, 2024, https://news.gallup.com/poll/642704/americans-sleeping-less-stressed.aspx.
[3] Samantha Harvey, The Shapeless Unease: A Year of Not Sleeping (Grove Press, 2020), 5.
[4] Marie Darrieussecq, Sleepless: A Memoir of Insomnia, trans. Penny Hueston (Semiotext(e), 2021), 197, 30, respectively.
[5] Darrieussecq, Sleepless, 14.
[6] Harvey, The Shapeless Unease, 5.
[7] Katy Waldman, “The Late-Night Revelations in a Memoir of Insomnia,” The New Yorker, June 4, 2020, https://www.newyorker.com/books/page-turner/the-late-night-revelations-in-a-memoir-of-insomnia.
[8] Marina Benjamin, Insomnia (Catapult, 2018), 34.
[9] In REM sleep behavior disorder people act out their dreams, which are typically most vivid when in REM sleep. Non-24-hour sleep-wake disorder is a specific kind of circadian rhythm disorder common especially in people who are blind. Parasomnias are sleep disorders involving abnormal movements, behaviors, emotions, perceptions, and dreams that can occur at any point in the sleep cycle.
[10] Steven W. Lockley and Russell G. Foster, Sleep: A Very Short Introduction (Oxford University Press, 2012), 71.
[11] Stuart F. Quan, “Sleep Disturbances and Their Relationship to Cardiovascular Disease,” American Journal of Lifestyle Medicine 3, no. 1 suppl. (2009): 55s–59s, https://doi.org/10.1177/1559827609331709.
[12] The Encyclopedia of Sleep and Sleep Disorders, “Insomnia,” ed. Michael. J. Thorpy and Jan Yager (Facts on File, 1991), 104; Lockley and Foster, Sleep, 72. There are different forms of insomnia, sleep-onset, sleep-maintenance, transient, and chronic being the most common.
[13] Associated Professional Sleep Societies (APSS) and the Association of Sleep Disorders Centers (ASCD), “Diagnostic Classification of Sleep and Arousal Disorders,” Sleep 2, no. 1 (1979): 1–154. The list of maladies was divided into four categories: (1) disorders of initiating and maintaining sleep (insomnias), (2) disorders of excessive somnolence, (3) disorders of sleep-wake cycle, and (4) dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias). For two narratives of the development of sleep medicine, see Kenton Kroker, The Sleep of Others and the Transformation of Sleep Research (University of Toronto Press, 2007); Kenneth Miller: Mapping the Darkness: The Visionary Scientists Who Unlocked the Mystery of Sleep (Hachette Books, 2023).
[14] The dozen or so insomnias included those with psychoses, alcoholism, personality disorders, and restless leg syndrome. Somnolence disorders comprised daytime sleepiness caused by narcolepsy and apnea, including rare conditions like sleep drunkenness and menstrual-associated syndrome. Sleep phase disorders were listed under the third category. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (American Psychiatric Association, 2013), https://doi.org/10.1176/appi.books.9780890425596.
[15] Miller, Mapping the Darkness, 219. See also Kroker, Sleep of Others, 387–90.
[16] More specifically, the International Classification of Sleep Disorders (2005) identifies psychophysiological insomnia, paradoxical insomnia, idiopathic insomnia, and some cases of inadequate sleep hygiene as forms of primary insomnia. Mario G. Terzano and Liborio Parrino, “Chapter 44—Neurological Perspectives in Insomnia and Hyperarousal Syndromes,” in Handbook of Clinical Neurology vol. 99, ed. Pasquale Montagna and Sudhansu Chokroverty (Elsevier, 2011), 706. The terms primary and secondary insomnia in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 1994) have been replaced in the DSM-V (2013) with a unitary diagnosis of insomnia disorder in order to advocate for insomnia detection and treatment in the presence of other comorbid mental disorders. Lee Seng Esmond Seow, Swapna Kamal Verma, Yee Ming Mok, Sunita Kumar, Sherilyn Chang, Pratika Satghare et al., “Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population,” Journal of Clinical Sleep Medicine 14, no. 2 (2018): 237–44, https://doi.org/10.5664/jcsm.6942.
[17] Adjustment sleep disorder is synonymous with transient psychophysiological insomnia and situational insomnia.
[18] Encyclopedia of Sleep and Sleep Disorders, “Adjustment Sleep Disorder,” 5.
[19] Meilan Solly, “Nearly One-Third of Americans Sleep Fewer Than Six Hours Per Night,” Smithsonian Magazine, December 26, 2018, https://www.smithsonianmag.com/smart-news/almost-one-third-americans-sleep-fewer-six-hours-night-180971116/.
[20] Quan, “Sleep Disturbances.”
[21] Sandee LaMotte, “Sleep Apnea, Lack of Deep Sleep Linked to Damage in Brain, Study Says,” CNN, May 10, 2023, https://www.cnn.com/2023/05/10/health/sleep-apnea-brain-damage-study-wellness/index.html.
[22] Much has been written on the influence of technology on human sleep patterns over the last century. A. Roger Ekirch has argued that diurnal sleep—two sleep cycles divided by a period of wakefulness lasting an hour or more—was common in the preindustrial era and has been largely replaced by “consolidated sleep,” which is likely more of a social construct than biologically driven. At Day’s Close: Night in Times Past (W. W. Norton, 2005).
[23] Hygiea is also mentioned in the Hippocratic Oath (ca/ 400 BCE).
[24] Oxford English Dictionary, “Hygiene,” July 14, 2023, https://doi.org/10.1093/OED/1192046729.
[25] Benjamin Reiss, Wild Nights: How Taming Sleep Created Our Restless World (Basic Books, 2017), 207. As the cultural historian Lee Scrivner observed, Victorians deployed all variety of electrical sleep gadgetry—belts, rods, brushes, and even a vibrating helmet to induce sleep—in an attempt to attain that elusive good night of sleep. Becoming Insomniac: How Sleeplessness Alarmed Modernity (Palgrave Macmillan, 2014), 28–29.
[26] The three Cs for infant sleep: Consistent, Calm, and Connection; the three Ss: reserving the bed for Sleep, Sex, or Sickness. The 10 3 2 1 0 rule: no caffeine ten hours before bedtime; no alcohol three hours before; no work two hours before, no screen time one hour before, and no hitting the snooze button.
[27] Rachel Wolfe, “The Hottest New Bedtime for 20-Somethings Is 9 p.m.,” The Wallstreet Journal, February 1, 2024, https://www.wsj.com/health/wellness/early-sleep-bedtime-6ecd1d67.
[28] Peter J. Hauri, Current Concepts: The Sleep Disorders (Upjohn, 1977), 26. Some attribute the term to Nathaniel Kleitman (1895–1999), Sleep and Wakefulness (University of Chicago Press, 1939). Kleitman entitled one chapter (ch. 30) “Hygiene of Sleep and Wakefulness.” See also Marie de Manacéïene, Sleep: Its Physiology, Pathology, Hygiene, and Psychology (London: Walter Scott, 1897). However, Paolo Mantegazza (1831–1910) used the term in the second edition of his Elementi D’Igiene in 1865. There are significant overlaps between Mantegazza and Hauri. See Gian L. Gigli and Mariarosaria Valenta, “Should the Definition of ‘Sleep Hygiene’ be Antedated of a Century? A Historical Note Based on an Old Book by Paolo Mantegazza, Rediscovered,” Neurological Science 34 (2013): 755–60, https://doi.org/10.1007/s10072-012-1140-8.
[29] Hauri, Current Concepts, 26. “Although the overprescription of hypnotics may be an important cause of chronic insomnia, the informed use of hypnotics is essential in the management of sleeplessness” (p. 29).
[30] Peter J. Hauri, “Sleep Hygiene, Relaxation Therapy, and Cognitive Interventions,” in Case Studies in Insomnia, ed. Peter J. Hauri (Springer, 1991), 66.
[31] Colin A. Espie, “The ‘Five Principles’ of Good Sleep Health,” Journal of Sleep Research 31, e13502 (2021): https://doi.org/10.1111/jsr.13502, citing Hauri, “Sleep Hygiene,” 65. Espie notes that one can see iteration of sleep hygiene across Hauri’s writings. It was never intended to be static or rigid.
[32] Dement’s foundational work was preceded by Nathaniel Kleitman (1895–1999), who set up the first sleep lab in 1925 and is credited with the discovery of REM sleep in 1958 with student Eugene Aserinsky (1921–1998). Dement was another of Kleitman’s students. He has done foundational work on elucidating the phases of the sleep cycle, identifying the physiological basis of dreams, and is credited for founding the world’s first sleep disorder center.
[33] William C. Dement and Christopher Vaughan, The Promise of Sleep: The Scientific Connection Between Health, Happiness, and a Good Night’s Sleep (Macmillan, 1999), 9–10.
[34] Miller, Mapping the Darkness, 182. William C. Dement, “History of Sleep Medicine,” Neurologic Clinics 23, no. 4 (2005): 945–65, https://doi.org/10.1016/j.ncl.2005.07.001; William C. Dement, “History of Sleep Medicine,” Sleep Medicine Clinics 3, no. 2 (2008): 147–65, https://doi.org/10.1016/j.jsmc.2008.01.003.
[35] For an understanding of how medicalization has shifted over time, see Wieteke van Dijk, Marjan J. Meinders, Marit A.C. Tanke, Gert P. Westert, and Patrick P.T. Jeurissen, “Medicalization Defined in Empirical Contexts—A Scoping Review,” International Journal of Health Policy and Management 9, no. 8 (2020): 327–44, https://doi.org/10.15171/ijhpm.2019.101.
[36] Reiss, Wild Nights, 15–16. “Taming sleep served an industrial society; and that society created unprecedented havoc for the natural world” (p. 16). Biomedical attempts to control sleep continue to intensify as economic interests push and pull sleep in different directions, leaving one with a growing sense “that the rules governing sleep in much of the West are coming undone.” Reiss, Wild Nights, 216.
[37] Simon J. Williams, Sleep and Society: Sociological Ventures into the (Un)known . . . (Routledge, 2005), 144; Peter Conrad, “Medicalization and Social Control,” Annual Review of Sociology 18 (1992): 211, https://www.jstor.org/stable/2083452. Moreover, it can also occur on different levels—interactional, conceptual, institutional.
[38] Williams, Sleep and Society, 144.
[39] Conrad, “Medicalization and Social Control,” 223. See also Peter Conrad, “Medicalization: Changing Contours, Characteristics, and Contexts,” in Medical Sociology on the Move: New Directions in Theory, ed. William C. Cockerham (Springer, 2013), 195–214, https://doi.org/10.1007/978-94-007-6193-3_10.
[40] Williams, Sleep and Society, 164. “Sleep . . . is now big business, with a burgeoning sleep industry ready and waiting to capitalize upon it. [In] the tension or contradiction between the ‘incessant’ demands of the so-called 24/7 era and our continuing need to sleep . . . capitalism cashes in both ways as a ‘disrupter’ and ‘guarantor’ of our sleep” (p. 165).
[41] Simon J. Williams, The Politics of Sleep: Governing (Un)consciousness in the Late Modern Age (Palgrave Macmillan, 2011).
[42] Williams, Politics of Sleep, 137.
[43] Stimulus control therapy was developed by the psychologist Richard Bootzin (1940–2014), who argued that insomnia often arose from Pavlovian conditioning. See Miller, Mapping the Darkness, 229. In 1993, sleep restriction therapy (SRT), sleep conditioning therapy (SCT), and sleep hygiene were incorporated into a more effective approach known as cognitive-behavioral therapy for insomnia (CBT-I) by the Canadian psychologist Charles Morin. This form of psychotherapy focuses on identifying and correcting harmful patterns of thought and feeling rather than analyzing the roots of those patterns.
[44] Williams, Politics of Sleep, 142; drawing on Nicholas Rose, The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-First Century (Princeton University Press, 2007), 222. Williams says our self-understanding may shift as we increasingly understand sleep as an active state of the brain—a fact uncovered by neuroscientists—and view sleep medications as working on ourselves while we sleep.
[45] See for example Sonia Ancoli-Israel, Ruth Pat-Horencyzk, and Jennifer Martin, “Sleep Disorders,” Comprehensive Clinical Psychology 7 (1998): 307–26, https://doi.org/10.1016/B0080-4270(73)00075-4. “Sleep hygiene is an educational approach for treatment of insomnia that was developed by Hauri and Linde (1990) . . . Sleep hygiene has been incorporated into most psychological interventions for insomnia. Clinically, these instructions provide a good start for treatment” (pp. 316–17).
[46] Jonathan Crary, 24/7: Late Capitalism and the Ends of Sleep (Verso, 2013), 14.
[47] Crary, 24/7, 74.
[48] Russell P. Rosenbert, Ruthe Benca, Paul Doghramji, and Thomas Roth, “A 2023 Update on Managing Insomnia in Primary Care: Insights from Expert Consensus Group,” Primary Care Companion for CNS Disorders 25, no. 1 (2023): 22nr03385, https://doi.org/10.4088/PCC.22nr03385.
[49] Stanley, “Short History,” quoting J. K. Case, Good Health Magazine 54 (1919), n.p.
[50] Reiss, Wild Nights, 7.
[51] Jon Mooallem, “The Sleep Industrial Complex,” The New York Times, November 18, 2007, https://www.nytimes.com/2007/11/18/health/18iht-18sleept.8377935.html.
[52] Lunesta is a sedative-hypnotic medication for treating insomnia.
[53] Mooallem, “The Sleep Industrial Complex,” quoting Pete Bils of Comfort Select: “The sleeping pill is an easy path. It promotes sleep over all the rules you break.”
[54] Cynthia Reuben, Nazik Elgaddal, and Lindsey I. Black, “Sleep Medication Use in Adults Aged 18 and Over: United States, 2020,” NCHS Data Brief 462 (January 2023), https://www.cdc.gov/nchs/data/databriefs/db462.pdf. This includes those who report taking sleep medication most nights (6%), every night (2%) or some nights (10%).
[55] Reiss, Wild Nights, 8.
[56] Reiss, Wild Nights, 216.
[57] Reiss, Wild Nights, 19, 23.
[58] Sarah Coakley, The New Asceticism: Sexuality, Gender, and the Quest for God (Bloomsbury, 2015), 1 fn. 1, 20.
[59] Ferdinand E. Daniel, “Editorial,” Medical Insurance: Devoted to the Insurance Examiner and Clinical Diagnostician 34–35 (1918): 167.
[60] “He who made the Pleiades and Orion, and turns deep darkness into the morning, and darkens the day into night, who calls for the waters of the sea, and pours them out upon the surface of the earth, the Lord is his name” (Amos 5:8, RSV).
[61] Indeed, the term psychophysiological insomnia acknowledges this reality.
[62] Reiss, Wild Nights, 208.
[63] Lockley and Foster, Sleep, 40.
[64] Oliver O’Donovan, Resurrection and the Moral Order: An Outline for Evangelical Ethics, 2nd ed. (Eerdmans, 1994).
[65] Karl Gustel Wärnberg, “On the Theology of Sleep,” First Things, November 2016, https://www.firstthings.com/blogs/firstthoughts/2016/09/on-the-theology-of-sleep.
[66] See D. Stephen Long, Nancy Ruth Fox, and Tripp York, Calculated Futures: Theology, Ethics, and Economics (Baylor University Press, 2007).
[67] Andrew Bishop, Theosomnia: A Christian Theology of Sleep (Jessica Kingsley, 2018).
[68] Fernando Ortega and Juan F. Ortega, Jesus King of Angels (Warner Chappell Music, 1998).
[69] Ephrem (d. 373) captured the mystery of the Incarnation in an early hymn: “Who then, my Lord, compares to you? The Watcher slept, the Great was small, the Pure baptized, the Life who died, the King abased to honor all: praised by your glory.” Ephrem of Edessa, “Jesus Christ our Lord,” trans. J. Howard Rhys, in The Hymnal 1982: According to the Use of The Episcopal Church (Church Publishing, 1985), no. 443.
[70] John Chrysostom, Homilies in Matthew 42.3, quoted in Blake Leyerle, Christians at Home: John Chrysostom and Domestic Rituals in Fourth-Century Antioch (Penn State University Press, 2024), 31. This was a traditional philosophical exercise. See Pierre Hadot, Philosophy as a Way of Life: Spiritual Exercises from Socrates to Foucault, ed. Arnold I. Davidson, trans. Michael Chase (Blackwell, 1995), 134–35.
[71] Chrysostom, Hom. Acts 26.4, in Leyerle, Christians at Home, 13.
[72] Chrysostom, Hom. Ps. 145.1, 6, in Leyerle, Christians at Home, 14.
[73] Kelly M. Kapic, You’re Only Human: How Your Limits Reflect God’s Design and Why That’s Good News (Brazos Press, 2022), 214 ff. Kapic too acknowledges the importance of sleep hygiene but is “more interested in examining why sleep matters theologically than in giving advice for increased ability to sleep.”
[74] John Baillie, A Diary of Private Prayer (Oxford University Press, 1949), 11.
Todd T. W. Daly, “Searching for Sleep: Sleep Hygiene as a Biomedical and Theological Problem,” Dignitas 32, no. 1–2 (2025): 16–23, www.cbhd.org/dignitas-articles/searching-for-sleep-sleep-hygiene-as-a-biomedical-and-theological-problem.