Sleepless in Missouri

Sleepiness only wins if you let it.
And we should.


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Location:Farmhouse

I spoke today with a very nice lady who has struggled with insomnia for years, knows she is hooked on sleeping pills, and has OSA but is finding her CPAP use limited by the time she spends awake at night, tossing and turning. Turns out she is drinking at least 24 ounces of caffeine every morning, which she didn't think was a problem because she USED to drink a whole pot of coffee daily and because she doesn't drink any later in the day. I explained the concept of a "half life" to her, and how only half of the caffeine is gone every 10 hours. 400mg of caffeine at 8am results in 200mg of caffeine floating around at 6pm and 100mg of caffeine still there at 4am. Caffeinated 24 hours per day.
And doing your ironing at 2am or watching TV at 3am does not help. The term we use to describe activities that help sleep (and do not hinder it) is "sleep hygiene"; not a lovely term but managing your sleep hygiene means better sleep. Regular bed times and rise times, skipping caffeine and alcohol and antihistamines, de-stressing before bedtime, avoiding light/exercise/mental activity in the middle of the night are all pro-sleep activities.

Time

Have noticed a curious thing about time. When I am seeing a patient, they never check their watch to see if they are over their alloted time. Our appointment slots are 15' apart but it takes 10' to check in (longer if you didn't fill out the 5 page history we need to do a good job for you), it takes 20' at least to do pulmonary function tests (longer if you can barely climb in & out of the booth or totter down the hall to the testing), and 10-40 minutes of interview time with my nurse taking history details before I even come in the room. Then I take 10-40 minutes per patient. Whatever is needed. Not 15 minutes. The whole thing can easily run 2 hours, especially for new patients. Many people are annoyed that they are "waiting" for me even when they have been busy the entire time, yet they don't exactly get up and rush out so the next person doesn't have to wait. I have to apologize for spending time with my patients. Constantly. Wish I could book one per hour but since so many cancel or fail to show up, we'd be out of business if I did that-and nobody would be seen. Yesterday a lady booked an appt. New patient who wanted a consultation, and left minutes after arriving because she'd booked another appt. 60 minutes after ours and couldn't "wait". This is not fast food.
Maybe we should book desk appts and pulmonary function appts. separately. Then doctor.


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