Why Blame Our Patients for Their Own Bad Sleep?

One of the most surprising things about sleep is how little we know about it. It’s almost as though we in medicine and science have purposefully ignored it. Doctors in particular, after having to stay up all night to care for patients, know that they can’t really function without the normal amount of sleep, yet there is still heated debate about what sleep is for.  We don’t even ask our lab rats how they’ve slept because, of course they can’t tell us. But we do have hundreds of patients who can tell us how they sleep and how they feel. Why haven’t we started to ask them until recently? Over time doctors have been trained to discourage their patients from taking sleep medicines, I believe for very good reasons. But that leaves the patient only two choices; the fear and stigma of addiction or the horrible feelings of being tired, grumpy and discouraged every day.

So, one of the blocks to learning about sleep is that we doctors and scientists are humans too. We have shared human assumptions like “it’s natural to sleep”, so why even think about it?The main reason to think about it is that most of the world now has sleep issues. We were wrong to assume that we would just continue on sleeping normally. Now it is more “normal” to wake tired or to have trouble sleeping. The Center for Disease Control is now recognizing this as a major health need that is not being met. www.cdc.gov/features/dssleep/ . And, it is a global issue. It began in developed countries but is now showing up in undeveloped countries as well.

Unfortunately, sleep apnea was first described in obese individuals. So the general trend has been to blame the patient. We are taught that obesity is a disorder of “self-control”. That being fat is an undesirable personality trait and if one “tries harder” weight loss is easy. Although it is true that self-control helps us to lose a few pounds this is not the whole story for people who are truly obese. Both appetite, and how much fat we store are controlled by our intestinal bacteria, not by the person eating the doughnut. Hunger, like sleep is actually involuntary. But, since we doctors know little about how hunger is controlled we blame the patient.  Many of my patients have struggled for years to lose weight. They tell me that they eat less than other family members and still don’t lose. We don’t want to believe them because then we have to open our minds to other possibilities. Could sleeping badly tell the body that it needs to store fat? Could a low vitamin D level or some other hormone we don’t really understand yet be ruining this poor person’s life? Could their poop bacteria be wrong making them eat too much? (Who would ever even think of that?)

The “fat neck” explanation of sleep apnea has reigned for 20 years. This has had two very bad results:  we have attached “shame”, to something that is actually a brain cell malfunction AND we completely missed apnea in normal weight individuals. My headache patients didn’t look anything like what I had been trained to look for so the idea that they might have sleep apnea wouldn’t have occurred to me. It is now quite clear that apnea is not because the neck is fat. That allows us to at least wonder: “Could there be another cause and therefore a different treatment?” Once we become brainwashed by the idea of CPAP masks we stop wondering if insomnia shares anything with apnea. They are both about sleep, could they be related? See the Vitamin D or Sleep pages to see how all sleep disorders are related. Learn how to use RightSleep to fix your sleep.