With words like ginormous, selfie, and fauxhawk being added to the English language recently, I want to start a similar campaign to remove three words from our vernacular. Well, not exactly three words, but a three-word phrase that I think would radically change the way we sleep and more importantly think about sleep forever.
So what three words can create a thought so insidious, an idea so dangerous, that it affects tens of millions of people every night?
"I can't sleep."
Like the worldwide eradication of smallpox, starting today, I want to begin a movement to eliminate the phrase "I can't sleep" from the face of the earth. I envision a world where the only place you can find a sample of the phrase is in a super secret laboratory hidden somewhere in Russia.
With everything going on in the world, why would anyone waste their time championing such a trivial cause? The reason is that this small statement is the lie that insomnia patients everywhere are rehearsing in their minds every night before they "try" to sleep.
"Dr. Winter, I can't sleep."
"Dr. Winter, if I don't take these pills I simply can't sleep."
"Dr. Winter, you have to help me. I can't sleep and haven't in months."
As insignificant as this sound, this phrase is the foundation of a tremendous amount of insomnia in this world, and make no mistake, insomnia costs money -- big money. The National Sleep Foundation estimates the indirect costs related to insomnia (work loss, property damage from accidents, and transportation to and from healthcare providers) to be between $28-35 billion.
How can one such innocent sounding sentence wreak such havoc? Everyone reading this blog needs to understand something about the brain that for all intents and purposes is universal: The brain is relentlessly driven to eat, drink, and sleep. When food, water, and sleep are taken away, the brain becomes even more motivated to satisfy these drives, sometime to extreme ends. Don't believe me? Type "Guy falls asleep while..." into a YouTube search. You will see what I mean.
So if all humans sleep, how is this myth that millions of us can't being propagated? As a doctor, I think physicians have to shoulder some of the responsibility. Let me give you an example that happened a week ago when I was lecturing a group of physicians who treat insomnia. At one point during my talk I asked those in attendance if they had any questions. A very senior physician raised his hand and earnestly asked, "Yes, but what if you have a patient that just can't sleep?"
By asking that question, it is clear that this physician has bought into the lie. It's no different than the doctor giving Michael Jackson propofol. He was told by his patient that sleep was impossible without a drug. The doctor may have become convinced of it, and we all know the outcome. How can this happen? Imagine a patient complaining to a doctor of a headache. Now imagine the patient telling the doctor that the reason he has the headache is that there is a small demon living inside his brain, and that the only treatment that will rid the foul creature is a dangerous chemotherapy drug. How far would that treatment go? Nowhere. The doctor would simply acknowledge that the patient has a headache, but help to educate the patient that his reasoning for why the headache is there is flawed. Why are we not doing this with patients who have insomnia?
We, as a society, need to start addressing sleep problems for what they are. When a patient tells me that the reason they are seeing me is that they cannot sleep, the session pauses immediately until we have this premise worked out. I kindly explain that it is not compatible with life to not sleep for any meaningful amount of time. In fact, not sleeping has a pretty nice way of making us really sleepy! I insist that we talk about the real problem. The patient does not sleep when they want to sleep or that the patient's sleep is unsatisfactory. Perhaps the patient wakes up a lot. Maybe he has significant trouble sleeping in his bed, but can easily fall asleep in the living room watching TV. Maybe his days and nights are reversed. Whatever it is, we don't move ahead until everyone in the room is talking in a language about sleep and insomnia that is based in reality.
This kind of restructuring must happen if we are to move in the right direction when it comes to sleep disorders. There is so much information available to the average individual concerning sleep and how important it is. Think of how terrifying this information would sound if you perceived a reality in which you did not sleep. Consider the pressure that person would be under to get a good night's sleep.
One of my favorite expressions is, "Sleep always wins." The treatment of insomnia has to begin with certain understandings and chief among them is that everyone in my office who comes to see me sleeps. They also eat something and drink some fluids every now and then as well. I rank these statements right up there with the sun comes up about every 24 hours and an apple thrown up into the air is eventually going to fall back to earth. If a patient cannot agree on these basic tenants, moving forward with insomnia therapy is often useless.
So here is my challenge to everyone who has taken the time to read these words: When you hear someone say, "I can't sleep," it is your responsibility to reject this statement and help the uninformed party to find his or her reality. Here is a script to help guide you: "It sounds like you are frustrated with your sleep, but I assure you that everyone sleeps. That's a scientific certainty. Do you mean you are having some difficulties achieving a sleep that is satisfying you?" Say anything that allows you to be supportive but clearly indicates that you are not going to be a party to the flawed premise.
Vincent Van Gogh wrote in 1882, "At night when I cannot sleep, which often happens, I always look at the wood engravings with renewed pleasure." Two years late, Vincent wrote about sleeping again, but his tone had a significant change -- "I cannot eat and I cannot sleep" -- but then qualifies this with an important phrase, "that is to say not enough..." One of the greatest painters of all time seemed to figure out that while his sleep was troubled, he was sleeping. Hopefully by changing the way we speak about insomnia, we can fill our starry nights with better quality sleep.
For more by Dr. Christopher Winter, click here.
For more on sleep, click here.