Distorted Perception of Sleep

It is common for tension to occur in the doctor-patient
relationship occurs when the patient reports symptoms that are
distressing to the patient, but which do not seem serious to the doctor.



Each instance of this is different, so it is hard to make
generalizations.  However, in the case of sleep problems,
patients
have one thing working against them.  All too often, doctors
relent, or try simply to save time, by writing a prescription.



The problem is described nicely in the New York Times Magazine:

href="http://www.nytimes.com/2007/11/18/magazine/18sleep-t.html?pagewanted=2&_r=1&ref=magazine">The
Sleep-Industrial Complex

By JON MOOALLEM

November 18, 2007

Complaints may be about difficulty falling
asleep or
about waking up during the night. But it’s hard to know
exactly
what those complaints should be judged against. Nor has research
determined which objective measures -- total time slept,
percentage of time spent in the various stages of sleep, etc.
--
correlate to a person's subjective feeling of having slept
well
or poorly. Some people whose sleep looks normal in the lab complain
bitterly; some whose sleep looks terrible never do.



Even something as empirical-seeming as how long we sleep becomes
problematic. In studies, insomniacs almost invariably overestimate how
long it took them to fall asleep and underestimate how long they slept;
in one, more than a third of the participants consistently thought
they’d slept at least an hour less than their brain-wave
activity
indicated.

In other words, there is little correlation between subjective sleep
quality, and objective measures of sleep.  In the most extreme
cases, people come in saying that they have not slept at all in months,
something that generally is held to be impossible.  



It takes a certain skill to be able to listen intently while someone
tells you something that is impossible, yet still take them seriously
and treat them with respect.  It also takes a lot of time.
 



It is much easier to just write a prescription.



In saying that, I do not mean to dismiss the importance of prescription
sleep aids.  Sleep is important to health, both mental and
physical.  Sometimes the objective tests indicate there is
nothing seriously wrong with the person's sleep.  It those
cases, research indicates that counseling and education should fix the
problem.  But sometimes it doesn't.



The point is that it is important to obtain the objective data, but
also
to listen to the patient.  If those two sources of information
suggest two different courses of action, then one has to decide which
course of action to take.  Just remember, if the first course
of action you choose does not produce the desired result, then it may
be appropriate to go back are try the other course of action.