It's hard to say if this is in response to the email. I received it on paper through normal mail.
If it is a response to my email, it'd been nice if it included some information to the effect of "your conclusions about your sleep disorder are wrong and here's why" if not a "you're right, we're wrong." ...but, I believe I hope for too much. There's no way they're going to acknowledge anything I wrote about. The only response Dr. Reddy was able to make to what I had to say during the office visit was "but this report indicates an AHI of 2.3 and anything less than 5 is non-clinical." I am really starting to believe that sleep doctors don't know how to read the data themselves, but instead just feed it into a computer program and rely on the output of the computer.
Dear Mr. Cooper,
Dr. Reddy would like for you to work with me on a program for your sleep. It is not a mental health program. It is a process with a goal that we will work toward together to improve your sleep. It is called cognitive therapy.
The cost of the program is $120.00. This includes 5 meetings with the nurse, a book and other materials that are used to complete the program.
Enclosed you will find information on cognitive therapy for Insomnia, a booklet that talks about good sleep habits, and a sleep diary. If you are interested in the program, please contact me at the number listed on the enclosed business card.
Also, if you would keep the sleep diary for two weeks as I need the information from your sleep diary to help with setting initial goals with you.
I hope you will call me. I have helped other people improve their sleep. If you have any questions don't hesitate to call me. I am here to assist you in anyway I can.
Sincerely, Joyce E. Gray BSN, RN
The "this is not a mental health program" was included because I asked about that before I left the sleep center. "Cognitive therapy" sure sounds a lot like "cognitive behavioral therapy."
...and, from what I can tell, it isn't much different. Neither seems to be well defined, and consists mainly of talking to people to "figure out" what's wrong, then setting goals to fix those problems, then claiming any success to be a result of the therapy while claiming any setbacks to be unrelated to the therapy. In other words, it's a prime candidate for a placebo effect. Therapy continues until the problem is solved, or in other words, until the patient would have improved on their own anyway, but since they were receiving therapy at the time, we'll claim the therapy was the cause of the improvement.
Some excerpts from the pamphlet titled "Cognitive Behavioral Therapy for INSOMNIA" (look at that, apparently it is "cognitive behavioral therapy"):
Is the the SAME Old "Do's and Don'ts" of Good Sleep Practices that I Have Read?
No. While those "Do's and Don'ts" may be a starting point, the most effective forms of Cognitive-Behavioral Therapy for Insomnia go far beyond those simple suggestions.
HOW are these Factors Addressed by CBT for Insomnia?
CBT is based on two premises. First, that some (though not all) of the personal and physiologic factors can be directly altered. Second, that the maladaptive thoughts (cognitions) and behaviors (habits) are learned and that they serve to perpetuate insomnia. If they are learned, then they can be "unlearned" by the CBT process.
Sounds like a mental health program to me. Quite similar to the "you're not depressed for any legitimate reason, but rather, you just think about things the wrong way" hypothesis of depression.
Also included was a "sleep hygiene" pamphlet which includes all of the information anyone with five minutes on the internet can find, and thus, nothing that anyone with a sleep disorder hasn't already tried. ...and much of it shows all the signs of being meme-quality material, stuff which has no scientific basis, but just sounds reasonable and so anyone who hears it is happy to repeat it. Did you know that if you go swimming after eating that you can get stomach cramps and drown? The world is full of shit which everyone "knows" yet it isn't the least bit true.
My favorites are the things that directly contradict each other. For example, to signal the brain to wake up in the morning, supposedly even bright indoor lighting is insufficient, and bright sunlight is required. Yet, at night, apparently even dim indoor lighting can keep the mind from recognizing the approaching evening. Another example is the suggestion that you go to bed only when you are sleepy, since lying in bed awake will "train the mind that lying in bed isn't a signal to go to sleep," yet at the same time, you're supposed to go to bed at the same time every night in order to make sure that your mind knows what time it should go to sleep. It's plainly obvious that most of this information exists only because someone thought of it one day and other people agree that it sounds good, and so they repeat it. That's how memes come into existence.
Finally, a "sleep diary" was included. I absolutely despise these things. They basically have a list of questions that you're supposed to fill in for each day, yet the questions are difficult to answer without interfering with your sleep in order to collect the data.
"What time did you go to bed" and "what time did you wake up" assume you do these things just once, or at the very least, that one of your sleep periods is significantly longer than the others.
"How long did it take to fall asleep" can be quite difficult to measure without constantly looking at the clock, however, constantly looking at the clock makes it harder to fall asleep. Not to mention that you have to remember the last time you saw the next morning, thus you can't just glance at the clock, but rather, you really have to take note of what time it is.
"How many times did you wake up during the night" depends largely on the degree to which you awoke, as that determines whether or not you remember. ...and I've found that just trying to count awakenings causes more of them to happen. In my early sleep experiments I had a button I could push to mark awakenings so that I knew where to look for problems in my sleep recordings, but I quickly noticed that simply intending to push the button made awakenings more severe than they otherwise were. Without the button, I'd wake up, but being nearly asleep, just fall asleep again. With the button, I had to wake up enough to move around, find the button (which, despite being affixed to my bed, still required finding), push it, then return to a comfortable sleeping position. The best thing to do for awakenings is to not even think about them. Just go to sleep. However, trying to count them requires you to think about them, which doesn't help the problem at all.
"How many hours of sleep did you get" also requires you to stare at the clock, only now, not only do you have to do it when falling asleep, but also each time you awaken during the night, and again in the morning, if you're still tired and think you will fall asleep again, but you need to know when you woke up in case you don't. None of that helps with sleep.
Finally, "rate your sleep on a scale of 1 to 10" requires some extreme rating skill. I have a difficult time rating such subjective feelings on a scale of 1 to 5 with any repeatable accuracy. My Zeo asks me for a 1 to 5 rating each morning, and after two days I just decided to ignore the damn thing. I've done enough experiments with rating to know that there's no chance that the numbers I enter are going to have any value. "How alert are you" is in a similar position, except that having all day to think about it, it is possible to come up with a reasonable score if you carefully define what sort of attributes each point on the scale should reflect. However, no one is going to do that, and so expecting even 5 point accuracy is expecting a bit much. Without a carefully designed scale, it's far too easy for any placebo effects to squeeze their way in.
...and at the end of the diary is, of course, a copy of the Epworth Sleepiness Scale. I've written about this scale in great length before. So I'll just add that I can't help but think that what usefulness this scale has may well be limited to people simply deciding on their own what sort of score they think they should have, and adjusting their answers accordingly. It's rather easy to do, and anyone who is sleepy has a high motivation to answer "correctly" in order to make sure that they receive treatment. Someone who is quite sleepy might well put a "3" for "sitting and reading" even though, in reality, they'd stop reading and take a nap rather than fall asleep while reading. The instructions "even if you have not done some of these things recently try to work out how they would have affected you" leave a lot of wiggle-room. Might as well just say "rate your sleepiness on a scale of 1 to 10" and leave it at that.
I mean, fuck, I can probably design a better scale in five minutes. Let me set the timer and see what I come up with:
Rate your sleepiness on this scale from 1 to 5:
1. Hey, let's go to the gym and exercise!
2. I frequently engage in low-energy activities like watching television and browsing the internet rather than doing more enjoyable things like spending time with friends and family and engaging in non-sedentary hobbies.
3. I hate that my house is a mess, yet I still don't clean it.
4. I haven't had a shower in two weeks.
5. This is too hard. Why do I have to answer this?
There is no excuse for the Epworth Sleepiness Scale.