Washington Post is at it again: More disdainful comments about sleep

The author’s article suffers from a specific and very serious flaw with respect to her disdainful comments about sleep.

The flaw shows up in two related ways. First, she only discusses sleep in the context of “quantity,” based on the so-called need for more hours of sleep. But that model itself is flawed, because what people really need is greater “quality” in their sleep, because “sleep quality drives sleep quantity.”

The second flaw derives from the first. By focusing on sleep quantity, she avoids the most important advances in the field of sleep medicine–advances that have already saved lives and dramatically increased quality of life.

For example, she reports on the connection that sleeping more hours might prevent car accidents, and as a sleep specialist I concur that it might. But, a much more powerful way to prevent accidents would be to find out why the individual is sleeping less than they supposedly should be sleeping.

The answer to this question, more than 70% of the time is that the person suffers from undiagnosed and untreated sleep apnea. The author may believe she is not dissuading someone from doing something about their sleep deprivation. But, the tone of the article dismisses a lack of sleep as another thing we needn’t worry about.

In fact, a lack of sleep is an excellent marker for people suffering marked sleep fragmentation caused by physical sleep disorders such as sleep apnea.

Thus, a very useful and cost-effective approach to healthcare in the case of sleep disturbance strongly supports a proactive stance to diagnose sleep disorders early to avoid not just accidents but also to reduce morbidity associated with strokes, depression, diabetes, heart disease and daytime fatigue and sleepiness.

To do so requires going well beyond the superficialities embedded within this author’s commentary.

Furthermore, as I propose on my site, “aggressive treatment of a sleep disorder is one of the cheapest health insurance policies you can buy!”

This author’s misleading commentary about sleep will steer people in the wrong direction and lead to greater health care costs and worse outcomes.

Maybe after a good night’s sleep, she’ll reconsider!

Pillow Talk at the Washington Post

Here’s a comment I wrote to Robin Wright in a Washington Post article on pillows:

Pillows can also improve sleep to some extent, and for some with mild sleep breathing problems, there are “neck extension” pillows that may actually reduce some of the breathing events.

However, the big problem with “pillow talk” as well as “mattress talk” is that the discussion always creates assumptions that large changes in your sleep will occur if you just find the right mattress or pillow. No doubt, there is some truth in this perspective but not nearly as much as the bedding manufacturers would like you to believe.

The real facts are that when a person suffers from a physical sleep disorder, pillows and mattresses should almost never be considered primary treatment options, yet many people and their physicians actually think about pillows and mattresses long before they even consider the notion of visiting with a sleep specialist, a medical doctor with specific training, expertise and board-certification in the field of sleep medicine.

I cannot count the number of people who I have met in my career in sleep medicine who had obvious sleep disorders by my assessment, yet they chose to go shopping at sleep centers (aka mattress stores) with the firm belief that a mattress was a viable treatment option.

Unfortunately, many in the media foster these misguided approaches to sleep medical care by writing articles about pillows or mattresses instead of writing articles about pillows, mattressess and sleep disorders.

Barry Krakow MD

Ultimate Auto-Pilot Flying at 21,000 Feet

Interesting video at CNN site on pilots who may have dozed off during a flight. Where’s the caffeine when you really need it?

Antidepressants, Emotional Numbing, and Sleep Disorders

Since the publication of my book, Sound Sleep, Sound Mind, I continue to monitor reports from sleep patients who come to clinic using antidepressant medication for a variety of reasons.

Some take these drugs to relieve a “sleep disturbance,” treat a “stressed out” life, manage clinical depression, or for no clearcut reason according to the patient.

When I ask these patients what exactly antidepressants achieve for them, the following are the most typical replies:

1. Decrease in irritability
2. Decrease in emotional outbursts
3. Decrease in anxiety or depression symptoms.

Few of these patients ever state the following:

1. Elimination of anxiety or depression
2. Elimination of a sleep disturbance
3. Markedly improved emotional coping.

Instead, the typical patient I see in a sleep clinic, while reporting some benefits from antidepressants, often wonders what they are treating beyond high stress levels, almost always states that the pills “numb” their emotions instead of fixing anything, and frequently wonder whether their depression is a direct result of loss of sleep or poor sleep quality.

What continues to confuse and bother me is that there tends to be this general consensus that a low threshold for prescribing antidepressants becomes the commonly accepted approach to poor coping, as if poor coping is code for depression and therefore antidepressants are a reasonable option.

My biggest complaint about this perspective from a sleep medicine vantage point is that poor coping could just as easily be due to fatigue and sleepiness from a sleep disorder, in which case antidepressant treatment is inappropriate whereas diagnosing and treating the sleep disorder is the appropriate treatment.

However, an even more fundamental complaint is the very acceptance of poor coping as a diagnosable condition requiring a pharmacological treatment. Poor coping in my clinical experience usually is a sign of weak emotional processing skills. If you give the patient a few sessions built around the premise that identifying underlying emotional reactions yields a lot of insight that leads to improved coping, then I think many prescription pads would be unused.

Human emotion is a natural part of our makeup, and almost anyone can learn to improve some of their coping skills by learning to recognize and work through some of their emotional reactions instead of just labeling them stress and seeking a new pill to wash away the feelings.

Daylight Savings Time vs Jet Lag

I just completed a brief interview on WTOP-AM in Washington D.C. on the impact of DST. As before, in my clinical experience, the more severe your complaints following the DST change, the more likely an underlying physical sleep disorder is part of the equation. The astute interviewer, Nathan Roberts, asked me if this problem was similar to jet lag. And, I feel once again that the more sleep difficulties you report following your travel experiences, it strongly suggests the presence of an underlying sleep problem.