Physicians need to wake up to the importance of a good night’s sleep

Studies in the past have shown that when someone complains about not being able to sleep to a doctor, more often than not, a sleeping pill is prescribed. The reason is that young doctors are taught in training that pharmaceuticals like Zolpidem (Ambien) stimulates GABA receptors in the brain, promoting sleep. There’s essentially no mention that cognitive behavioral therapy for insomnia works just as well for insomnia in the short term, but is superior to drugs in the long term.

You’d think that medical students would get at least some education about a part of patient’s lives that they spend 1/3 of their lives doing, which is sleep. Well, not really.

I remember getting only about 2-3 hours of lectures on sleep during medical school. I’m told by a medical school professor that due to stiff competition between various subjects such as molecular biology, anatomy, pathology and pharmacology for student’s time in classes, sleep gets squeezed out in the end.

This problem was brought to light by a study in a major sleep journal (Sleep Medicine) which showed that the quality and quantity of sleep education varied tremendously between various international countries. For example, the average number of hours on time spent on sleep education was 2.5 hours. In 1990, a survey reported that medical students received about 2 hours of sleep education, and not much has changed recently. In fact, 27% of respondents reported no training in sleep at all. Pediatric sleep topics grabbed a mere 17 minutes on average.

Even now, despite knowing that untreated obstructive sleep apnea can significantly increase your risk of heart attacks and stroke, doctors are still prescribing blood thinning medications and high blood pressure medications, while ignoring the patient’s severe snoring problem. We also know that poor quality and quantity of sleep is strongly linked to increased rates of cancer, sudden death, and motor vehicle accidents.

I think it’s time that physicians finally wake up to the importance of a good night’s sleep. Sadly, most mainstream physicians and surgeons that I know still don’t take sleep very seriously.

How can you as the patient better educate your doctor about the importance of a good night’s sleep?

Steven Y. Park is an otolaryngologist at Montefiore Medical Center, Bronx, New York.  He is author of Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many Of Us Are Sick And Tired.

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  • Anonymous

    Thanks for this important reminder, Dr. Park.

    Not only are med students learning to treat sleep problems with prescription drugs, but after they graduate, they continue to be ‘educated’ by their friendly neighbourhood Big Pharma drug reps. As the Wall Street Journal told us last year, drug companies spend $12 billion a year just on “detailing” – sending sales reps to visit doctors and other prescribers in order to boost drug sales.  Big Pharma also spends $4.8 billion for Direct-To-Consumer (“Ask your doctor”) advertising, and an additional $400 million on annual advertising in professional journals. 

    THAT’S why prescriptions for sleep drugs like Ambien, Lunesta and others topped $19 billion last year.

    I’m curious about what you’d specifically recommend to our under-trained physicians on how to stop  – and reverse – the disturbing reality of docs who don’t, as you say, take sleep very seriously.  Where should they start if they want to set aside the prescription pad?

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    I need a visit from the cognitive-behavioral rep.

  • Anonymous

    As an internist in the NoVA (DC area), I have to say this is untrue.  When people come to more for unexplained insomnia, I try to work with them for any alternative other than sleeping pills.  I order sleep studies when indicated.  I discuss RLS symptoms.  I ask about anxiety and depression.  I spend A LOT of time discussing behavioral/lifestyle changes the patients can make to help with sleep.  Almost 90% of the time, the patient (usually a busy professional +/- night school +/- children) insists that they’ve “tried all that” and want their sleeping pill.  I have patients who come to me from other doctors upset that I will not refill their Ambien/Lunesta/Klonopin, even though the other doctor gave them 30 tabs with 11 refills!  When I tell them I will only write for ten tabs, and they need to come in and see me when they need a refill, they invariably find another doctor (which is fine with me). 

    • http://www.facebook.com/DoctorStevenPark Steven Park

      12345jp, 

      There are always exceptions to the rule, and you are one of them. I do know a number of PCPs that do ask the right questions about sleep, and try other proven conservative options for sleep complaints. The point of my article is that in general, sleep complaints are not adequately addressed. You have to admit, it’s very time consuming.

      Almost every day I see patients on multiple medications for diabetes, hypertension, high cholesterol, and anxiety, but no one is addressing the severe snoring and apnea symptoms. It’s no surprise that an estimated 90% of people with sleep apnea are not diagnosed in this country.

      I’m told that insurance companies rank obstructive sleep apnea in the same league as cancer in terns of mortality. This goes along with a figure I’ve seen stating that people with sleep apnea die 20 years earlier.

      Patients can fill out simple obstructive sleep apnea specific screening questionnaires such as the Epworth Sleepiness Scale and the STOP-BANG questionnaire.

      http://doctorstevenpark.com 

  • Anonymous

    Great post! I am one of those people who needs more than 8 hours of sleep to be rested. Sleep and nutrition education are sorely lacking in medical school. While I had a year of nutrition as a nursing student (the basics and then as it applied to pathophysiology like Diabetes), my husband had none at his medical school. Then when the wackos comes forth with the latest diet craze like gluten free, the physician has nothing to hang his hat on. We are what we eat and if we don’t get enough sleep we are walking zombies. 

  • http://www.facebook.com/people/Jackie-Swenson/100000046998781 Jackie Swenson

    Two family doctors/internists had misdiagnosed/ignored my complaint of severe headaches and allergy-like symptoms 21 years ago.  They noticed on my report that I did not sleep well, frequently experiencing night-mares and the lack of sleep had affected my skin causing acnes…

    They thought I had been over-working and over-stressed…  I had to press for referrals to eventually see a neurologist who then solved the puzzle after ordering an MRI. 

    Now I wondered if those doctors had just been projecting their own ‘stress’ on their patients? 

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