17 responses to “The most important question never asked about sleep”

  1. useful and non medication and directs care back to patient; What they can do for themselves

  2. Sounds like an excersize only highly motivated patients would pursue and ultimately do they feel any better i.e. less fatigued as a result ?

  3. sounds like a grreat and simple question to help direct rational treatment.

  4. I think its a great question to ask, though often forget to ask it. Sure it takes some patient motivation but by the time patients speak to us about this they may be fairly desperate as this has a huge impact on their life, and therefore motivated to try something. When we see the havoc that sedatives/hypnotics and other meds used for sleep wreak on people’s lives (though addiction or simple side effects), anything that decreases our use of such medications can only be welcomed.

  5. What if a pt does not take naps during the day? Does it apply also to young working people? Would it be appropriate in this case to advice against going to bed at night if they do not feel sleepy?

  6. Confirms practice

  7. Good starting point. I was told also that the one important thing for insomniacs is to get them to wake up at exactly the same time every day!

  8. Fascinating. Makes sense. I do not remember ever asking about TIB or estimating Sleep efficiency. Thank you.
    On a related topic I have an increasing cohort of thankful people with improved cognitive function[STM] having persuaded them to discontinue using zopiclone on a regular basis.

  9. This made me think about modifying my approach to insomnia but I do think patient acceptance and compliance of this strategy would be middling to poor. Patients are often quite desperate due to chronic poor sleep leading to impaired performance at work/ irritability affeting interpersonal relationships etc. Perhaps combining this approach with the short term use of a hypnotic would improve patient compliance and reassure them that you appreciate the impact of this problem in their life.

  10. Helpful tip. I see so many people with iatrogenic insomnia due to chronic use of sedative/hypnotics such as benzodiazepines, ethanol and zopiclone it is refreshing to get useful non pharmacological techniques.

  11. I think this one question is useful from a number of standpoints. Most importantly to me, it gives me an indication of how disrupted this person’s day to day life is; and as an ER doc, boiling it down to one question appeals immensely.

  12. a helpful approach to fairly common problem

  13. A good question to ask that I had forgotten about. I will add this approach to my first line of questioning — before starting to throw antipsychotics at them…

  14. sleep efficiency sounds like a good approach to insomnia. I will use it instead of prescribing so quickly.

  15. I’m not a doctor, but recently started using FitBit, which is one of several fairly inexpensive ($99) tools for tracking your activity during the day – and sleep. It measures your TIB and SE automatically, and i’m quite amazed at how much more sleep I’m getting than I had thought! If patients struggle to do this on their own and with guessing SE, a device like FitBit (and there are others, such as Jawbone’s Up and more) would probably help them – and provide the doctor with actual data, as well. And it would probably cost less than drugs, right?

  16. I read a study by an anthropologist about sleep. He pointed out that before artificial light, people lay in “bed” for the dark hours. They didn’t have a lot of choice, as it was dark. So for an average of 12 hours (seasonally averaged) people long ago just lay around for a long time each night, dozing on & off throughout the long night. This was probably what we evolved to do and so our present sleep problems may have to do with the fact that we don’t spend enough time in bed.

  17. I am not sure whether this question has been answered by sleep researchers, but if it has, I’ve been unable to find the answer:
    Does an increase in sleep efficiency lead to a subsequent increase in total sleep time?
    Unless the answer is a clear “Yes”, there is no point in attaching significance to sleep efficiency. Most of us would agree that an arm is a more useful limb than a leg, but it doesn’t follow that it is good idea to cut off a leg in order to increase the proportion of limbs that are arms.
    I average 5 hours sleep, and am in bed for 8 hours, with a sleep efficiency of 62.5%. I recently took part in a CBT course, which restricted my hours in bed to 5, as advocated above. My sleep efficiency rapidly rose to 80%, but after 5 weeks rose no higher. My total sleep time was thus reduced to 4 hours per night. Not surprisingly, I felt terrible, until abandoning the course and getting back to 5 hours per night. A rise in sleep efficiency is a loss, not a gain, if it is associated with a fall in total sleep time.

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