Frustration and Disillusionment
Over the years, my frustration has grown as I’ve talked to more and more medical providers and came face to face with the realities of medical practice, the pharmaceutical industry, and our mammoth healthcare system. As I listened to the stories of more and more insomniacs I became more and more disillusioned. Too many times I had patient’s ask me, “Why was I never told about sleep transformation?” Too many times I heard the lament, “I only wish I’d known how to do this years ago.”
The research that sleep transformation works is overwhelming but when I shared it with healthcare providers I was confronted with disbelief. They truly could not see how retraining the sleep system was possible without medication. Even if they believed in the sleep transformation program, many providers were honest about just being too busy to actively address insomnia, which they saw as a low priority. Some were even more honest and expressed their own feelings of frustration and ineffectiveness around insomnia. For other providers resistance to sleep transformation was more a matter of mistrust or beliefs about healthcare economics. Needless to say, I was surprised to encounter this long list of obstacles to something I originally saw as so simple.
Seeing some of these complexities I entered problem solving mode. In order to join with providers and help them to overcome these real obstacles I designed the SHARP™ program, Sleep for Health, Healing, and Relapse Prevention™. SHARP is a specialized program of Radical Sleep Transformation specifically designed to assist healthcare providers in offering sleep transformation to their patients while removing as many obstacles to patient access as possible. Then I hit another barrier. As I talked to medical directors about beginning to share the SHARP program I was shocked when confronted with statements like, “Well, we can’t support or endorse any program with private interests.”
You can prescribed more than a billion dollars a year in sleep medications to feed the profits of massive pharmaceutical companies but it’s a conflict for you to offer your patients a free training program?
What!? Now I was in disbelief.
Respect and Understanding
As I was able to get some perspective I began to ask why. Why were these incredibly smart and compassionate healers so uncomfortable with the non-medication option? Why was it so hard for them to believe the evidence, even when the obstacles of time and money and effectiveness were overcome? Why was a medical director threatened by integrating a formal program sleep transformation training alongside the traditional medication options?
For a while I was stumped. The men and women I was talking to were intelligent. Extremely so. They were critically thinking, compassionate individuals who have dedicated their life to serving and healing. Some of them were friends and colleagues whom I have tremendous respect for.
I went back to read those papers I wrote in grad school and I reread many of the research articles I had used to write those papers. The answers had been there all along.
In asking medical providers to focus more on insomnia and to offer non-medication treatments I was bumping up against a major gap in medical training. Most providers have received little to no training in sleep and sleep disorders.1–2 The best medical schools offer only few hours of training in sleep and sleep disorders while most schools include no formal training in these areas. I was also up against years of training that leads providers to give medications a preferred status to medications even when medications may not be the safest or most effective options.
I came to understand that this bias is about more than training; it is also driven by the powerful influence of pharmaceutical companies. Seth Godin, one of the most innovative thinkers in marketing, gives us some insight into the reason for this influence, “In 2003 pharmaceutical companies spent more on marketing and sales that they did on research and development. When it comes time to invest, it’s pretty clear that spreading the ideas behind the medicine is more important than inventing the medicine itself.”3 Providers diligently strive to remain objective in their medical decision making. However, in 2012 they were faced with the $27 Billion influence of pharmaceutical companies.4–5 This combination of training and influence has led providers to hold a dual standard for scientific evidence they require to support medication versus non-medication health solutions.
We have a lot of trust and respect for the knowledge, opinions and recommendations of our healthcare providers. Providers take the power and responsibility associated with our trust in them very seriously. In order to recommend a healthcare solution they have to believe in it and trust that it is the best thing for you, their patient. It is easy for them recommend medications because they know them; they are highly trained to evaluate and judge them. When it comes to non-medication options they have almost no training, which makes them difficult to recommend wisely and effectively.
Even when a provider is knowledgeable and confident about non-medication alternatives they still must navigate the challenge of limited time and competing priorities. This was hard for me to swallow at first. We’re talking about people’s health here, people’s lives. The more I learned the more I understood the tremendous pressures they are under and the dysfunctional realities of the system within which these providers are required to work. Providers would love to spend more time with you and you would probably be much happier if you didn’t feel that your provider was distracted and rushed when he or she was with you. Unfortunately, our healthcare system prioritizes a brief consultative model, so until we revolt, we will be rushed and frustrated. Now, what about priorities?
The average visit with a patient is only a few minutes long and most individuals don’t go into the visit to talk about sleep. Sleep typically only comes up as related to another problem. Let’s say you’re in the office because of pain in your feet related to diabetes and then you also mention you’re having trouble sleeping. Talk about priorities. If you have only a few minutes would you rather talk about diabetes, a problem that could kill you, rob you of your sight, or lead you to lose a foot? Or would you rather talk about your insomnia? The decision is pretty clear for most of us. Yes, sleep is important but most providers are appropriately prioritizing it in the face of more serious and urgent medical concerns.
“Our healthcare providers….are committed, passionate, and compassionate healers who have taken on the tremendous responsibility of making high stakes decisions based on intensely complex information within the demanding requirements of a broken system. They deserve our respect, our courtesy, and our gratitude.”
As if the demands of time and competing priorities weren’t enough, when providers do engage insomnia they often feel ineffective. The drugs they have available have significant risks that make providers uncomfortable prescribing them in many cases. On top their safety concerns, many providers say sleep medications just don’t work that well; that their patients often come back dissatisfied and still struggling to sleep. Despite this, providers typically feel they don’t have anything else to offer their patients. Talk about a recipe for frustration.
I used to get excited when I heard this. “Oooh. They’re unhappy with sleep medications. They want something better. I have just the thing!” I’d say to myself. My excitement was met with another obstacle. Mistrust. Providers are more and more required to act as the gatekeepers of healthcare. They must decide what is appropriate or necessary and what is not in order to act as good stewards of healthcare resources generally and their patient’s financial resources specifically. This is a daunting task when you think about all the pharmaceutical, medical equipment, diagnostic, laboratory, and specialty medical service companies vying for provider attention and recommendation. They are already short on time for patients. Where are they going to find time to learn everything the need to know about the priority treatments and procedures let alone the new non-medication solution for a frustrating but low priority health problem? Often it is easiest to defer it to outside judgment. “Is it covered by insurance?” providers would ask. They seemed to feel that if a service or product was covered by an insurance company then it was legitimate.
I have come away from these experiences with a profound respect for our healthcare providers and their service to us. They are committed, passionate, and compassionate healers who have taken on the tremendous responsibility of making high stakes decisions based on intensely complex information within the demanding requirements of a broken system. They deserve our respect, our courtesy, and our gratitude.
Unfortunately this new respect for healthcare providers has not lessened my frustration or disillusionment. Sleep is too important to be ignored or lost to higher priorities, even if they are legitimate. It is too important to be lost to convenience, disbelief, or mistrust. The burdens of undertreated insomnia in terms of finances and suffering are too great to go unchallenged.
We are in need of a Sleep Health Revolution™ and we must be the ones to start it.
Birth of the Sleep Health Revolution
This personal journey out of insomnia and into the complex and frustrating trenches of healthcare has shaped my belief in the necessity of a sleep health revolution. We cannot rely on drug companies whose essential goal is to sell more medication. We cannot rely on insurance companies whose primary focus is delivering the cheapest possible care. We cannot rely on our healthcare providers who are in a daily battle to provide the best care possible in the midst of a merciless system driving them away from time with patients and toward assembly line medicine.
What does a sleep health revolution look like? I’m glad you asked.
It begins by making the principals and teachings of radical sleep transformation AVAILABLE to EVERYONE for FREE. This is why I’ve chosen to make a digital “Sleep Health Revolution” edition of this book available for free. It is also why I created the SHARP program, which provides basic sleep transformation training at no cost. These resources can be accessed here at no cost:
I’ve made these resources available. Now it’s time for you to use them and share them with the three steps of the sleep health revolution (These are outlined in my post: Sleep Health Revolution: Radical Sleep Transformation for Everyone).
Personal Invitation to the Revolution
As I write this I realize how ridiculous these goals might seem. There are many whose sleep is important enough for them to take charge of their own sleep health and many who will be so excited about their success to be willing to share with friends and family and invite them to the sleep revolution. But who is going to care enough about their own sleep health, let alone the sleep health of other individuals and their community, to spread the idea that sleep is important and we can take charge of our sleep without pills? Who is willing to begin to talk to their doctors about how they wish they had told them about the principles of sleep transformation before giving them a pill? Who is willing to encourage their doctors to join the revolution and begin sharing sleep transformation with all of their patients? I’m hoping that you are.
I’m hoping you’re willing to join me and many others in the revolution. In fact, whether you or not you think of yourself as a revolutionary, you joined when you started reading this blog. Take the next step. Download the revolution edition of my book and watch the SHARP sleep transformation videos. The information in these resources can take you a long way toward personal sleep transformation, maybe all the way.
Learn more about how you can become a revolutionary in my post Sleep Health Revolution: Radical Sleep Transformation for Everyone.