Why Most Doctors Know Almost Nothing About 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?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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5 thoughts on “Why Most Doctors Know Almost Nothing About Sleep

  1. I can think of few things more important than a good night’s rest. I can immediately tell the difference when I haven’t slept well.

    My father had sleeping problems throughout his life and almost got fired once for nodding off during a business meeting, despite going to bed early the night before. He had these types of problems often (as well as loud snoring). It wasn’t until he was well into his 40’s that he finally went and did a sleep study. Turns out we was coming out of REM 30x/minute. Now he sleeps with a CPAP, doesn’t snore much and is a much happier and more energetic person. I only wish he had known sooner!

  2. I find it strange that if you are having trouble breathing while conscious, you go to the emergency room. if this happens while you are sleeping, you and your doctor act like it didn’t happen. can you imagine if your doc saw you for shortness of breath and made you wait 3 weeks to get a chest xray? why does it take weeks and sometimes months to get a sleep study and then get a CPAP machine? it is very ironic that what happens while unconscious, stays unconscious and unrecognized by all, even when all the signs are there. I don’t know how to re-educate physicians systematically other than to start with the source and change medical school education.

  3. Great and interesting post. Yes I did notice that most doctors and physicians dont take it that seriously and this raises alot of concerns. I actually have a friend who has trouble sleepng at night and I think he may have sleeping disorder but his doctor wouldnt take him too seriously

  4. I am a dentist in Sydney, Australia.

    I have been treating patients for their snoring and obstructive sleep apnea for more than fifteen years. My standard questions at EVERY check-up include questions about snoring, sleep, waking refreshed and daytime sleepiness.

    Why don’t doctors spend a few minutes at every appointment asking the same questions? – the Drug Companies have nothing to gain from it, so the doctors are not educated in this area.

    NO – I don’t want a new drug to be invented so that the doctors will start taking notice – our patients are already being prescribed far too many toxic drugs by drug pushers called doctors.

    In fact, many of the drugs being pushed for sleep actually reduce the quality of sleep, and leave people thinking they have slept well, because they didn’t wake up for eight hours. But in fact, they end up walking around in a haze like zombies because they have had such poor quality sleep.

    Dr Deb is so right about the different attitudes to sleep breathing problems and breathing difficulty during waking hours. It is sleep disturbed breathing that actually kills people insidiously with cardiovascular disasters and more…

    But I got into this area of health because I noticed that those kids with obstructed airways had their faces developing badly, and always ended up needing orthodontic treatment. They were also doing poorly at school, and lacking energy. Often diagnosed with ADHD.

    Sort out their airway problems, and their minds improve, their grades improve, their focus improves and their sporting ability improves.

    For adults, sorting out the obstruction can change their lives – improve their work and their energy at play, help them lose weight, improve their sex lives, reduce risk of cardiovascular incidents and increase the length and quality of life – a lot…

    The thing is – CPAP is not the only way… and for many it is not the best way either…

    In fact, for mild to moderate sleep apnea, and for simple snoring, an oral appliance has been proven to be more effective.

    Now this needs some defining. If someone wears CPAP for eight hours every night, that will be the most effective.

    But the studies show that less than 70% of patients wear their CPAP as much as 60% of the night for only 60% of nights. 40% of nights, it is not worn – and when it is, it is only worn for part of the night, totalling no more that 36% of sleeping hours. This makes it only 36% effective at very best – and that is for only 70% of patients – the other 30% rarely wear the CPAP at all.

    This means that for the total number of patients who have a CPAP machine, they are only about 25% effective…

    Oral appliances are actually worn by more than 90% of patients for more than 90% of sleeping hours – that is what makes them effective – 81% effective…

    But a dentist who understands dentofacial orthopaedics and orthodontics, as well as understanding airway can do even better than just treating the problem with an appliance (called a mandibular advancement splint or MAS).

    With a comprehensive approach to treatment, involving various medical specialties and “alternative” health professionals, a dentist with the right knowledge can actually alter the entire shape of the airway and total body posture, and “cure” the patient. That’s right – they may get to the point where they never snore or have apneas again – without the need for a MAS or CPAP…

    Dr Park, I would love to hear from you privately – your webmaster will have my email address. It would be great to learn from each other…

    Trevor

  5. I teach at a medical school as a pharmacologist and in the behavioral sciences department. I have the only lecture on sleep in our curriculum that I know of and it is only 50 min. My lecture briefly touches on the pharmaceutical side of sleep disorders while heavily discussing behavioral therapies, however I know that I am probably in the minority as far as medical educators.