People need sleep and many are having difficulty getting it, especially with advancing age. Hardly a day goes by that I do not see a patient asking for a sleep medication. People think that all that is needed is to take a pill every night at bedtime and, like magic, they will get 8 hours of refreshing sleep every night for the rest of their lives. Life, and medicines, do not always work that way. When I tell patients the truth, that evidence is that long term sleep medications are more harmful than beneficial in patients over the age of 60, I am met with responses that combine disbelief and anger. Some patients have left my practice.
Sleep deprived patients are among the most desperate patients I see. By the time they come to see me they often have not slept well for months and are struggling to function. When they take a sleeping pill and it works it is an incredible relief to them. After a few weeks of treatment the thought of stopping the medication brings a sense of panic.
There are alternatives to long term sedative use but they require time and effort and we live in a world where things that require time and effort are undesirable. Cognitive Behavioral Therapy, a specific form of psychotherapy, has been shown to be more effective than medication in restoring normal sleep. It takes several weeks and is not inexpensive so many patients are resistant. Sleep deprivation therapy, an approach where patients limit time in bed to hours actually slept (sometimes starting at as little as four hours a night) can also be effective but is equally undesirable. When given the choice between changing behavior or taking a pill, Americans choose the latter.
What makes matters more difficult is that many patients are unwilling to change habits and behaviors that make sleep more difficult. When I bring up caffeine use, alcohol use, watching television in bed, use of iphones and tablets and other behaviors I am always met with a list of reasons why the patient cannot or will not follow my advice. They just want a pill. As my commitment to practice quality medicine is stronger than my desire to please, the visits become lengthy and difficult.
As frustrating as these interactions can be for both me and my patients I have learned that they are to be expected. I live in a world of people who have been conditioned to expect an easy fix to every problem, a world where effort is something to be avoided and not expended.
I cannot change the world, but I can do my part to change the lives of the patients under my care. When it comes to improving their sleep, it means encouraging them to take the difficult but better road.
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