Doctor – Are You Obtaining Enough Sleep?

A conversation between a surgeon and his patient the day before his surgery.

Doctor: Make sure you get a good nights sleep!

Patient: Speak more clearly doc – your mumbling.

Doctor: How long will you sleep tonight?

Patient: It is not me you should worry about doc. You are already having trouble speaking and it’s only nine-thirty in the morning. I think the issue is how much sleep will you get tonight?

Doctor: That is not your concern.

Patient: I think it is doc, I am the person you will be opening up tomorrow and you are already half asleep. I think it is time to ask for another surgeon, one that will be rested for the surgery.

Doctor: You need this surgery now. You cannot let this go for another doctor.

Patient: Doctor, unless you bring in another surgeon, you will be in trouble. I hope your liability insurance is paid up to date.

Doctor: I will see you at 10:00 AM tomorrow.

Patient: Not unless you have another surgeon doing the operation. I will not let a doctor that is this sleep deprived operate on me. So what is it going to be? Another surgeon or do I find another surgeon on my own?

Doctor: Have it your way – but don't expect me to give you a referral.

This is not what you want to have happen under any circumstance, but it did and to an individual I know. He was indeed lucky as the next day; the surgeon lost a patient because he was sleep deprived. Whether it would have happened to him, he does not care as he did locate another surgeon and had the surgery a week later. This time it was at the Mayo Clinic in Rochester. The surgery was successful and he is recovering quite well. There was a minor adjustment the surgeon had to take during the operation, but he said he had encountered this before and it was not life threatening.

This is a good lesson for anyone. Yes, the patient can always be very anxious before surgery and get very little sleep. This is not good for the patient, but is understandable. It is not understandable for a surgeon to be that way, yet this happens all too frequently. If this was a teaching hospital, we could expect interns to be overtired, but for a surgeon in a non-teaching hospital, this is unconscionable.

The study that got me started can be read here. It describes some of the effects of sleep deprivation, but cannot be relied on, as there were many parts of the study that caused no problems. I do understand the inability to actually follow practicing surgeons, as a study does not want to be responsible for actual harm. So all the study was done on simulators.

Obstructive Sleep Apnea Surgery

I don't know what it is lately, but apparently surgeons are trying to build their retirement fund before the Affordable Care Act gets before the Supreme Court. I am reading more and more about surgery being the solution for more and more health problems. That in itself sets off alarms about what is happening in healthcare that has surgeons operating everywhere they can.

Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.

Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.

I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.

Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery.  I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.

I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.