Healthcare Crisis: Sleep Disorders as a Microcosm of the Larger Problem (Part III)

We talked earlier about the human tendency for psychological blind spots and hinted at their potential positive value. Think about it this way: suppose as you were growing up you took to heart each and every piece of criticism directed your way? How do you think you would be functioning as an adult? If you speculated such a person would be indecisive, insecure, tentative, confused, and unable to consistently make clear decisions or sound judgments, then we are of like minds.

The fact is that we are all imperfect creatures, and we all suffer from many flaws and inadequacies in our personalities. During childhood and adolescence, we must rely on the natural tendency for blind spots to prevent ourselves from developing unhealthy defeatist attitudes about the direction we are heading and the accomplishments we are achieving. Childhood can be one of the most painful experiences, because we do not possess as much capacity for defense mechanisms and so, willingly or not, we take a lot of criticisms into our hearts and minds. As a result we may end up being confused about our own identity and personality for decades. By the time we reach adolescence, though, there is an innate tendency to develop psychological defenses. One of the most common defense systems shared by all humans is the use of blind spots, particularly within societies that coddle youth for longer and longer periods. To be sure, a blind spot could be either healthy if it fosters your development or unhealthy if it prevents you from seeing the chronic mistakes or anti-social behaviors that must be addressed sooner than later.

Not infrequently, when you turn 21, you may imagine you are an adult, but if the blind spots are still there (a strong probability), you are very likely to suffer repeated relationship problems with friends and family. These difficulties persist because you did not learn to self-observe your flaws and inadequacies so that you could use this information to better yourself. Keep in mind, many people do not achieve a rich and satisfying ability to monitor their own shortcomings until well past the age of 40, and honestly, some people never seem to learn anything about their own failings for reasons that go beyond the scope of these posts.

Bottom line: this unique process in human development retards our ability to understand ourselves and through this crippled functioning we are often unable to clearly examine our health problems in serious, accurate, and beneficial ways. More to the point of these posts, it is extremely common to develop not only a distorted picture of our own health, but sooner than later, we grow to fear looking at our health problems.

As you recall, I asked the question earlier about the difficulties people have in overcoming obesity, smoking, and alcoholism. Many in healthcare call these problems diseases while others call them poorly controlled behaviors. Yet, most in healthcare have very little knowledge on the deep-rooted causes of these conditions and how they are related to the inability to self-monitor or the outright rejection of self-monitoring skills. As the most superficial example of this conundrum, imagine markedly overweight individuals looking honestly at themselves in a mirror while eating food, or imagine a smoker hacking and coughing watching herself honestly in a mirror while continuing to smoke, or imagine an alcoholic looking red in face, blitzed out and disheveled watching himself honestly in a mirror as he continues to drink. Even when individuals suffering severe health problems due to obesity, smoking, or drinking are confronted in this face-to face manner, a logical expectation would be to sense either a feeling of disgust with the picture or an awareness of the failure to control these “appetites.” But in reality, this approach still does not consistently reverse the behavior, because it still does not get to the heart of the matter.

Why would this gross form of “self-reflection” not persuade people from overeating, smoking, or drinking to excess? Because the energy that drives these behaviors is the same thing noted in the first post; that is, emotional pain in general and usually some very specific feeling like fear. Earlier we discussed how fear prevents people from dealing with a medical condition because it may be too scary to contemplate. In the instances of overeating, smoking, or drinking to excess, the fear is so broad-based and unmanageable the individual adopts one or more of these behaviors to squelch the fear. Incidentally, the fear in many of these individuals may leak out in the form of anger periodically.

It can be stated with some certitude that when we choose or refuse to examine the inner workings of how we live our lives, we may be destined to adopt overeating, smoking, or drinking to excess for the expressed purpose of avoiding this self-examination. The “pleasures” gained from these out of control appetites work to prevent natural and daily doses of reality from entering into our consciousness, which over time would have offered us the potential to find healthier and happier lives. But in the short-term, which sometimes means decades, we choose to divert attention from our emotional pain and select habits that are quite efficient in preventing any unexpected outbursts of reality that might overwhelm our coping capacity.

When you understand this premise of how fear controls our ability and desire for self-reflection, then on a smaller scale you will begin to see how much this attitude or mindset governs what we do with many of our health issues, whether we are acutely concerned with them or not. It becomes very difficult to create a highly efficient healthcare system because individuals do not typically possess a strong inclination for self-reflection until much later in life. If the reverse were true, much of our modern healthcare crisis would disappear immediately, because patients would be hungry and thirsty for knowledge about any and all health problems and would actively seek solutions, all of which means they would be moving away from the passive relationships that people become accustomed to in dealing with insurance. Instead they would be moving toward health independence where active and energetic attention would be directed at solving or preventing health issues. When this scenario becomes mainstream, an enormous burst of innovation will occur—so grand that the entire insurance industry and much of the medical profession will see immediate and dramatic changes.

As an update to all of the above, we are seeing a seismic shift on this issue by the development of hundreds of different tech gadgets designed to facilitate self-monitoring. As you are probably aware, there are numerous gadgets to monitor your sleep on your wrist or forehead as well as any number of gadgets to monitor exercise efforts, dietary patterns, and related weight issues. More gadgets are on the way.

Unfortunately, the gadgets do not do as much as advertised. As the best example in sleep, people use these items to try to gauge the quality of their sleep, but all they really need to gauge for this aspect is to figure out (self-reflect, again) how do they feel after sleeping, when they wake up and throughout the day. One might think these points are easy to monitor, but they are obviously not because so many people normalize what they feel about sleep. They rarely look in the mirror and honestly ask: “should my sleep be better”, “should I feel more rested when I awaken”, or "should I be less tired and sleepy?” Instead, the single most common initial questions asked by people who show a little curiosity about their sleep is usually, “how can I get more sleep?” Does a gadget help answer this question? Possibly, but a visit with a sleep specialist and an overnight sleep test would offer a much greater insight into root causes that steered the individual toward a short sleep cycle.

The potential for people to learn so much more about their health creates enormous opportunities to help change the way healthcare is delivered. Nonetheless, until we see a greater emphasis within the individual to overcome and cope effectively with distressing emotions that almost always arise in confronting one’s health issues, we will remain mired in the current healthcare crisis, which wastes enormous resources through its top-down, “we know what’s best for you” framework. Still, we have only ourselves to blame—us humans, that is—for not realizing and adjusting our frequently minimalist or passive roles as patients.

Barry Krakow MD


Dr Krakow’s 27 years of sleep research have focused on the complex relationship between physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.

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