Insomnia is a very common problem, and sometimes a very frustrating and persistent one. But what if our expectations of an uninterrupted 7 or 8 hours of sleep is unrealistic? What if a night of sleep for 4 hours, wakefulness for an hour or two, and then more sleep for 3 hours is how most of humanity slept before artificial lighting?
In a provocative article last year in Applied Neurology, Dr. Walter Brown reviews historical descriptions of pre-industrial sleep and suggests that sleeping in two nightly shifts separated by an hour or two of quiet wakefulness is completely normal. I encourage you to read it. He proposes that the advent of inexpensive artificial light allowed us to stay awake long after sundown and has led us to be so chronically sleep deprived that we usually sleep for 7 uninterrupted hours nightly. This uninterrupted sleep pattern has now become the new norm. When our natural pattern of sleeping in two shifts reasserts itself, we find it abnormal and distressing. We are sure something is wrong, and a whole industry has sprung up to reinforce our anxiety and help us sleep the way we think we should.
Our expectations about our bodies go a long way toward shaping what symptoms we find distressing and what we ignore. Many patients are quite alarmed about entirely normal symptoms and refuse to be reassured. But patients alone are not to be blamed. Many forces have pushed modern medicine to pathologize normal symptoms. After all, pharmaceutical companies sell prescriptions, not reassurance. Doctors feel motivated to make diagnoses, not exclude them.
Physicians need to find a way to reassure patients when their symptoms are normal. We need to learn to say “there’s nothing wrong” in a way that is not dismissive but credible and comforting. And we need to become comfortable ourselves with the idea that sometimes there is no diagnosis.
(Thanks to Linda T. for pointing me to the article.)
I began writing my weekly medical news posts almost two years ago. This is my one-hundredth post. The feedback and encouragement from all of you has been very rewarding. I hope to continue to inform and teach as long as you all keep reading. Thanks.