Orthosomnia (preoccupation about sleep)

Most nights I wake up around one or two in the morning and lie there—sometimes for an hour or more—before going back to sleep. I’d rather my sleep wasn’t broken, but I don’t worry about it. At times, during these wakeful periods, I’ve solved problems and come up with good ideas. I never get eight hours. It’s usually between six and seven.

One primary care physician writes that “good sleep, or the lack thereof, is one of the most evergreen concerns I hear about as a primary care doctor. My patients track sleep hours and sleep scores.” Apparently, there’s a new, unhealthy, preoccupation with achieving perfect sleep that’s driven by wearable sleep-tracking devices. This obsession is called orthosomnia.

Here’s what studies show about the relationship between sleep patterns, health, and mortality:

• There’s not a magic number below which health suddenly falls off a cliff.
• In studies that compare sleep duration and mortality, the lowest risk clusters around seven hours.
• Adults with the highest mortality rates are those who sleep nine to 11 hours a night. (People who are sick sleep more. So do those who are struggling with depression.)
• Getting less sleep is strongly correlated with living in poverty, working a job that requires night shifts, psychiatric conditions, and chronic pain and illness.

The hunter-gatherer Hazda people of Tanzania sleep an average of 6.25 hours per night, although they’re in bed for up to nine hours. During that time, they’re awake for two or more hours. My kind of people!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Doctor AI

Alert reader Caitlin Breen sent me a Substack article written by a doctor-friend of hers, Angela Thyer. The article, titled "Doctor AI will see you now," makes many points about the effect of AI on the practice of medicine. In this blog post, using lots of quotes, I’ll mention just a few of them.

By now we all know of the significant impacts AI is having on medicine, especially the fact that we can now track our health data online and instantly find information about our ailments and symptoms.  “Your AI doctor will know your allergies, conditions, medications, supplements, eating and exercise patterns, and family history.” Because AI is good at pattern recognition, it can notice deviations in your health. “And unlike your actual doctor, it won’t be running behind and burned out.”

While some aspects of AI are useful for doctors, such as providing them with the latest research and writing clinical notes, Dr. Thyer bemoans a new battleground: AI vs AI. “Your doctor submits a request for a procedure. The insurance AI denies it. Your doctor’s AI scours your records and resubmits an appeal. The insurance AI finds another loophole….”

It’s not just battles with insurance companies. “Physicians are exhausted by trying to get the care they want their patients to have. The patient is losing." Because of such struggles as well as the cuts in physician pay and increased responsibilities, Dr. Thyer tells us that we now have “a significant and growing shortage of primary care physicians.”

“Here is the thing nobody wants to say out loud: for a lot of people, it might actually be an upgrade. Doctor AI isn’t replacing the doctor who sits down with you for thirty minutes and knows your name. It’s replacing a seven-minute visit after a four-month wait with someone who has never met you, for a problem that has been bothering you for months. That is our current system.”

Oh my.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Daylight savings time: yes or no?

The House of Representatives is looking at doing away with our current, twice-yearly switching to and from daylight savings time. One bill they’re considering would make daylight savings time permanent. Another would lock the clock on standard time. Thus, we have three possibilities: permanent daylight-savings time, permanent standard time, or the seasonal clock-switching we have now. Here are some considerations:

• A network of clocks throughout the body coordinates everything from immune defenses to metabolism. Bright mornings and dark evenings (standard time) help keep the internal clocks in sync. If we shift an hour of daylight from the morning to the evening, we potentially disrupt our circadian systems.
• Pedestrian and motor-vehicle accidents occur more frequently in the dark, making the case for permanent daylight savings (lighter evenings). During the oil crisis of 1974, the country tried permanent daylight savings time. With the dark mornings, children were struck and killed walking to school in the dark. The idea was scrapped.
• Adolescents (and night owls) tend to fall asleep later and wake up later. Being forced to go to school in the dark (daylight savings time) affects both their safety and school performance. (One study in Indiana, where not all counties follow daylight savings time, found that SAT test scores were an average 16 points lower in counties that observed seasonal daylight savings time compared with those on permanent standard time.)

Scientific opinions are all over the place. A review of more than 150 studies found that the effects of resetting clocks “were not uniformly detrimental." The American Medical Association and other scientific organizations have endorsed permanent standard time. But other scientists vote for keeping the twice-yearly clock reset.

I’d vote for permanent standard time. I like lighter mornings.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A doctor’s touch

A recent online edition of The Journal of the American Medical Association features an essay by two doctors titled “The iPatient Meets the iDoctor.”  The authors acknowledge the time-saving benefits of AI, such as its ability to assimilate and consolidate clinical documentation, imaging, and laboratory results. They also tell us that AI gives less-trained health workers "the diagnostic performance of the most experienced physicians.” In fact, AI already matches or exceeds physician performance on standardized knowledge multiple-choice examinations. This advantage is particularly useful in under-resourced areas where patients may receive “expert-level care where none previously existed.”

But they mourn the accompanying losses, which include the “hollowing out of longitudinal patient-physician relationships,” as seen in the loss of primary care doctors and increased use of emergency departments, telehealth, and urgent care clinics.  Such short-term relationships are likely to overlook subtle changes in a patient’s health, such as a change in gait.  

Most important, perhaps, is the loss of physical touch. The ritual of the physical examination, the authors maintain, “…localizes the patient’s complaint on their body (and not on a laboratory printout, an inbox message, a biopsy report, or a radiologic finding) …When we care for patients without physical touch, we distance ourselves from their embodied identity and in time from our own.”

The authors, both MDs, are David Rosenthal and novelist Abraham Vergese, author of A Covenant of Water and Cutting for Stone. I recommend the latter. I’m sure it’s semi-autobiographical.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.