Trouble sleeping

Sleep - we can't live without it and we spend a third of our lives getting our fill of it. Or not, as the case may be for a few unlucky people that I've seen this week. For them, this is a huge problem, leaving them feeling exhausted, frustrated and miserable. Given my seemingly complete incompetence in dealing with it, I am left feeling much the same.

The conversation seems to go the same way each time. It starts

with me explaining that by suggesting that they try and improve their 'sleep hygiene' I don't mean that they need to wash more before bed. This is the part where we talk about not eating too late, cutting out caffeine and alcohol, having a warm drink before bed, reading a book etc etc etc.

Whether or not this works for anyone I don't know. If it does, those must be the people who don't end up going to their doctor, because the ones who see me are rarely interested. No, the people I see want sleeping tablets, and thus the next part of the conversation involves me trying very hard not to give them what they want. I usually fail.

As far as I'm concerned, going on sleeping tablets is, more often than not, a one way track to a monthly prescription for life, and one which I will feel very guilty about signing. It's not just that some of them are physically addictive drugs, but it's their complete psychological addiction that worries me. How do you stop taking them once you've started? You'll lie in bed and think to yourself, 'I'm not going to sleep tonight, I haven't taken a tablet'. And then of course you won't.

I suppose the question to ask is; does it matter? I cheerily commit Mrs Smith to a lifetime of blood pressure medication, so why not sleeping tablets? (I'm certain that this is what my patients must be thinking when I meanly try and hold them back)

I think for me it's because its 'medicalising' the non medical. To have to take a tablet each night to do something that should come so naturally seems wrong. It's ignoring an underlying problem and just treating the symptom.

Of course that's easy for me to say, I happen to be rather good at sleeping, but I'm sure there must be a better way at helping people who aren't, and I'm busy looking for it....

First Question

One of the best perks of being a GP is having the opportunity to meet a huge assortment of different people. It's not so much the variety in race, religion and culture that I find interesting, but the contrasts that you encounter in the way in which we all think, behave and express ourselves.

So this is 'amateur anthropology with a medical slant' part one, and the question that I have been mulling over this week is this; why do we lie to doctors?

There's a particular incident on my mind. I met Jim (a fictional name of course) for the first time on Monday. We were talking about his newly diagnosed Diabetes when the question of smoking came up. Happily, Jim doesn't smoke, and we both cheerfully agreed that this was great news. He did however look slightly awkward when I met him outside a cafe later that morning, drawing deeply on a cigarette! I don't suppose it was his first.

I wonder if there is anyone who hasn't done this? Who hasn't used the words 'occasional alcohol' and 'social smoker' to explain away a 20-a-day habit washed down with a couple of bottles of wine and a packet of pork scratchings?

Is it through shame of a bad habit or a desire to make a good impression? Perhaps there are some who just don't want the information recorded and others who are simply trying to avoid the lecture (I'll admit my 'smoking is bad for you' lecture is particularly unexciting). Maybe it's based on an element of denial and invincibility; 'I'll give up that morning bottle of Vodka soon, so the doctor doesn't really need to know about that'.

I wonder....