Taking out the trash has a whole new meaning after reading a "most-emailed" New York Times article, "Goodnight. Sleep Clean." According to some sleep researchers, my daily "thinking" leads to an accumulation of "junk," and the cleaning staff for removing this waste only comes out while I am sleeping. What an intriguing metaphor. While I know that the article is referring to cerebrotoxins and not specific thoughts, is it such a leap to imagine that the cleaning process eliminates thoughts and memories? Given popular culture's fascination with "junk" (think Storage Wars, Pawn Stars, Hoarders), there may be a whole new genre of reality TV shows in the wings if someone can figure out how to share the excess that's cleared as we sleep ("Discarded Thoughts of the Rich and Famous," "Thought Hoarders," "Brain Storage Wars").
But I digress. The real kicker in the Times article comes from juxtaposing two sentences -- one from paragraph 16 and one from paragraph 28. "Modern society is increasingly ill equipped to provide our brains with the requisite cleaning time," and "Now that we have a better understanding of why sleep is so important, a new generation of drug makers can work to create the best possible environment for the trash pickup to occur in the first place -- to make certain that our brain's sleeping metabolism is as efficient as it can possibly be."
In other words, we have a new medical problem so let's invent a drug that can cure the problem. Given that sleep deprivation affects nearly all adults there would be a huge market for this drug, so it would not be surprising if efforts are underway to develop the equivalent of a brain Roomba.
The rush to medicalize social conditions is one of my pet peeves as a public health professional. Why did this column, which started with the recognition that sleep deprivation was a recent social phenomenon, end with a clarion call to the pharmaceutical industry to solve the problem? Wouldn't it be better to call for social and policy change that addresses root causes of sleep deprivation or recommendations for lifestyle approaches to reducing stress and increasing restfulness? I was not alone in my reaction. A quick read of the hundreds of comments posted found a large percentage of them asking the same questions.
Instead, we have one more example of what a 2009 BBC program called "The Medicalisation of Normality." Life does not have to be a medical condition. Bette Midler jokes, "Thirty years ago my audiences were on drugs, now they're on medications." Even if the demographics of her audiences didn't change over the years, her observation is apt. Data from the CDC on trends in prescription drug use from 1988-1994 and 2005-2008 show that rates have nearly doubled in all age groups, genders, and racial/ethnic groups.
Yes, there are medications that save lives through treatment and prevention, but let's not blindly accept a cultural norm that the best solutions to conditions of living come from medications. Lifestyle and social change is possible, but it takes time. Could it be that we need more patience and fewer patients?