The Instigator
Pro (for)
2 Points
The Contender
Con (against)
6 Points

Doctors Should Learn About Sleep Disorders

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Voting Style: Open Point System: 7 Point
Started: 5/28/2012 Category: Health
Updated: 4 years ago Status: Post Voting Period
Viewed: 2,832 times Debate No: 23881
Debate Rounds (3)
Comments (17)
Votes (2)




No semantics or trolling.

R1: Acceptance and argument
R2: Debate arguments and rebuttal
R3: Closing

*To counter last word advantage, in the last round CON will only be able to use 5,000 characters.


Thanks for the debate Contra.

== Definitions ==

From the comments section, it is clear that by "doctors" Contra meant GP's (general practitioners).

In medical school, there are NO specialties. Doctors are required to study a variety of disorders. After graduating, doctors start a residency program during which they specialize in a certain field of medicine. Certain medical schools, like Stanford and Harvard, have special sleep clinics where doctors specialize in sleep disorders.

In this debate, I will generally defend the current specialization system among doctors, whereby GP's don't learn a great deal about various specialties - instead they refer you to a specialist. If you come into your GP's office complaining about skin problems, he or she will refer you to a dermatologist. If you come in complaining about bowel problems, he or she will refer you to a gastroenterologist. If you come in complaining about sleep problems, he or she will provide you a referral to go to a sleep clinic and have your sleep patterns monitored.

== Burden of Proof ==

Pro and instigator has the burden of proof. I'd like to hear Contra's justification for why GP's should have specialized knowledge in the field of sleep disorders. And why JUST sleep disorders? Why shouldn't GP's train in psychiatric disorders? Or bowel disorders? Why are sleep disorders so uniquely important? Who will pay for the additional training? Will insurance still cover seeing specialists if GP's are trained in diagnosing sleep disorders? What sleep clinic will the GP use? Will he just buy an EEG and monitor you in your own bed? Pro needs to answer all these questions.

In addition, it is important to remember that if you have a PPO for your health insurance, you don't even need to see a GP. You can instead immediately go see a specialist. So if you know you have trouble sleeping or you put your symptoms into WebMD and think you have a sleep disorder, you could just go immediately to a sleep clinic. There's no reason to see a GP.

I have no problem with the 5,000 character limit, but only because the character limit for this debate is 3,000. Just thought the readers should know that.

I turn the floor over to Contra.
Debate Round No. 1


Thanks for accepting Bluesteel, you're a formidable opponent. I ask in R3 would you accept a cap of 2,000 characters?

Sleep rejuvenates the body and mind.


C1: Sleep is Overlooked

Medical schools currently spend barely any time educating future doctors about sleep. The National Institutes of Health regards the topic of sleep disorders as "poorly covered in medical education." [1] They also correctly say that "a major consequence is that the manifestations of the many sleep disorders now identified are likely to be misinterpreted as other clinical conditions of a physical or psychological nature."

Furthermore, empirical evidence from a study in the UK proved that the average time devoted to sleep disorders in medical school was a whopping — 5 minutes. [3] There is zero reason to believe that things have improved since then. Horribly enough, this prevalance is not corrected in many high specialties with high rates of sleep disorders, including paediatrics and psychiatry.

Not surprisingly, since medical professionals are for the most part deficient in knowledge about sleep disorders, they are usually not likely to inquire symptoms as a result of a sleep disorder, [4] and therefore, treatment is usually for the symptoms, not the sleep disorder itself. Furthermore, 30% of Americans at any given time are being affected by a sleep disorder, and usually not treated. [2]

C2: Sleep is Uniquely Important to Health

There is no other biological state like sleep, which creates a perceptual wall between conscious mind and the outside world, and can be immediately reversed.

The puzzle for good physical health is healthy sleep, diet, and exercise. We are constantly reminded about the latter two, but are not usually informed of sleep. The American Cancer Society did a massive study in the 1950s as well that found that healthy sleep is important in determining longevity, more influential than diet, exercise, or heredity. [5]

Many patients are left untreated because of the deficiency of knowledge. [6] Consequently, many children are misdiagnosed with attention deficit disorder instead of a sleep disorder, and many sleep apnea patients are treated for depression instead of sleep apnea! [6]


In our current society, PCPs are not trained in sleep disorders to a degree that is necessary. Since sleep is extremely critical to health, it must be incorporated into the medical field, so the 30% or so of Americans have a chance at a better life, since the vast majority are currently undiagnosed, or misdiagnosed.


[3] Stores G, Crawford C. Medical student education in sleep and its disorders. J R Coll Physicians Lond. 1998;32;149–153.

[4] Namen A M, Landry S H, Case D. et al Sleep histories are seldom documented on a general medical service. South Med J 2001. 94874–879.879.
[5] Dement, Dr. . The Promise of Sleep. New York City: 1999. 262-263.
[6] Dement, Dr. . The Promise of Sleep. New York City: 1999. 354.



==Character Limit==

I don't know about 2,000. That's short. And because you only gave me 24 hours to respond, I have only 50 min right now and thus don't have much time to research many of your claims.

R1: Sleep is Overlooked

Contra's first source, the one which says that sleep is poorly covered in medical education, also says, "sleep disorders are among the most common complaints seen by general practitioners." If someone complains to a GP about a sleep disorder, he or she would be referred to a specialist (a sleep clinic).

The article says that many GP's failed to correctly recognize narcolepsy, for example, but the condition WAS later correctly diagnosed by a sleep clinic in 100% of the cases. Doctors, under the referral system, do a good job of knowing what they DON'T know and referring patients to specialists.

The 30% stat includes missing sleep (because you work the night shift) and jet lag as "sleep disorders." The article never proves that people with sleep disorders are "usually not treated." My opponent still needs a stat to prove this.

The study about medical schools in England is flawed because England lags behind everyone else in sleep medicine, according to the Guardian. [1] The director of the Imperial College Healthcare Sleep Centre in England says that England lacks a general training and certification program, unlike the US which has one administered by the American Academy of Sleep Medicine.

Anyone who attends Harvard or Stanford would do a rotation at the sleep clinics at those medical schools. At Stanford, here is a professor that teaches sleep sciences at the med school. [2]

R2: Sleep is important

I agree. Since I don't have access to this book though, you need to quote in full the sentences you are citing so I can check that they really say what you're saying. How many children are misdiagnosed, for example? And how many by GP's, as opposed to psychiatrists?

Unanswered questions:

1) Why is sleep more important than anything else? One in ten Americans suffer from clinic depression. Why shouldn't GP's get more psychiatric training instead? Isn't this a slippery slope to forcing GP's to be experts in everything, which is the opposite of what a GENERAL practitioner is supposed to be?

2) Who pays for the training? How do we do it? If a medical school has no sleep clinic and no professors that study sleep, who teaches the course?

3) How do we require current GP's to get trained?

4) Most people forget what they learn in school, honestly. What guarantee is there that if they spent hours on sleep disorders in medical school they'd remember this training if they didn't specialize in sleep medicine?

5) Why not educate the general public instead? If we can recognize our own sleep disorders, we can immediately ask for a referral to a sleep clinic or if we have a PPO, just go ourselves.

Why do we bother training experts in sleep medicine? Use them, not GP's.

Debate Round No. 2


R1: Sleep is Overlooked

"We analyzed our records, and only 2% of our patients were referred by GP's." [1]

We both agree time spent on sleep disorders is nearly nonexistent. The GP's are the first to see patients, but with the vast deficiency in knowledge based on sleep disorders, the vast majority of health professionals are not able to help their patients. Frequently and consequently, the patient is misdiagnosed with another disorder, and the primary problem — a sleep disorder, is left to get worse over time. [1]

Bluesteel says that once people are referred to a sleep center, 100% were cured. This is false, but it is missing the main point.

Overall, over 40 million Americans suffer from chronic sleep disorders. [3] Sleep disorders cause more than $16 billion in medical costs a year.

In America only about 2 hrs. are devoted to sleep disorders, in a 4 year course! [4]

And, the professor you cite (Dr. Dement) is somebody I highly respect, enough to use his book for my evidence.

The description of this problem is not made up. It is serious. Dr. Dement, the Professor, was the head of a Commission on Sleep Disorders in the 90's. They scanned millions of patient records to see how often patients were diagnosed with sleep disorders.

"The sets of data convinced me that, for all intents and purposes, somewhere between 95 and 99 percent of sleep disorder sufferers remain undiagnosed and untreated or misdiagnosed and mistreated. That is millions and millions of people." [4]

This evidence alone should serve as a crushing blow. Millions are allowed to suffer because GP's are unaware for the vast part about sleep disorders.

R2: Sleep is Important

1) "Sleep is the most important predictor of how long you will live, perhaps more important than your exercise [or nutrition] levels." [2]

The American Cancer Society concluded "Sleep time had the best correlation with mortality." [2]

And, as I said earlier, sleep problems are highly prevalent, and since sleep is THE MOST important in factor for good health, it is absolutely justifiable that doctors have a better understanding of this field.

Further evidence shows that GP's need training in this field. Dr. Dement wrote,

"After scanning more than 10 million patient records, we found a grand total of 73 diagnostic codes for OSA, 7 for narcolepsy. No specific sleep disorder diagnosis was found. It might as well have been a big fat zero." [1]

GP's are certified, and learn new info. frequently. Put sleep disorders in the curricula, and demand for sleep specialists will increase.

— Dr. Dement is the world's leading expert in sleep medicine and sleep science


Concluding, GP's should learn about sleep disorders, at a basic level of understanding. Over 40 million Americans suffer from chronic sleep disorders. GP's rarely diagnose sleep disorders. With the training, they could do so much better.

[1] Dement, Dr. . The Promise of Sleep. New York City: 1999. 353-6.
[2] Ibid, 262-3.



Thanks for the debate Contra.

R1: Sleep is Overlooked

Contra cites a quote from Dr. Clement saying that only 2% of patients were referred by GP's. However, Clement is a unique expert in sleep disorders and sees mostly patients with unique disorders, such as narcolepsy, wherein people often fall asleep while standing up. Since these diseases often involve neurological symptoms, it is not surprising that most of his patients were referred by neurologists, not GP's. We know someone had to be giving them a referral or their insurance wouldn't have covered the sleep clinic.

In addition, Contra's own evidence from Round 2, from the Journal of Neurology (source 1) said that most people complain about sleep disorders to their GP's; it said that in a study of narcolepsy diagnosis, many of the referring physicians were GP's and the sleep clinic correctly diagnosed narcolepsy in 100% of cases, even if the GP wasn't sure what was wrong.

We have experts in sleep medicine and should be using them. The referral system solves.

My opponent says that 40 million Americans suffer from sleep disorders. His own source lists "insomnia" as the most common sleep disorder. Insomnia, an inability to fall asleep, is quite easy to recognize for GP's, since the patient will report an inability to fall asleep.

Contra's 95% stat is just guesswork. Clement "scanned records" and found too few cases of narcolepsy and other sleep disorders, so he assumed doctors must be missing these disorders (see contra's last quote for methodology). Yet, many patients never go to doctors with their medical complaints. This is not a reason to blame doctors if the patient never complained about the disorder.

R2: Sleep is important

I once again agree with this. I like sleep.

==Unrefuted Arguments/Questions==

1) There is a tradeoff - if GP's spend hours studying sleep medicine, there are other things they can't study. My opponent's own evidence from Dr. Chris Miller (source 4) says there is NO MORE TIME in an already crowded med school curriculum to add sleep disorders. It would mean some other important subject, like psychiatry, wouldn't be taught. And suicide kills more people than lack of sleep.

2) Who pays for additional training? The federal government is broke. Med school tuition is already high and raising tuition (to pay for hiring additional staff and setting up a sleep clinic at that school) would deter people from becoming doctors.

3) How does a GP confirm his diagnosis? Only a sleep study at a sleep clinic can confirm a sleep disorder diagnosis. If the person must go to a sleep clinic anyway, why does it matter whether the GP knows the exact correct diagnosis? It only matters for bragging rights.

4) This defeats the purpose of having lower cost GP's if they must specialize in everything.

5) People forget what they learn in school anyways.

6) Educating the public about sleep disorders would do more because then people can ask to see an expert immediately.

^ALL dropped
Debate Round No. 3
17 comments have been posted on this debate. Showing 1 through 10 records.
Posted by Contra 4 years ago
My bad.
Posted by Wallstreetatheist 4 years ago
That would be coincidentally not ironically.
Posted by bluesteel 4 years ago
what was our last one?
Posted by Contra 4 years ago
Wow I got it in 50 seconds before time ran out.

And Bluesteel, ironically this debate revolved around health like our last debate.
Posted by Contra 4 years ago
It was meant to be a short type of debate.
Posted by bluesteel 4 years ago
also Contra, you didn't respond to anything I've said yet, which means I don't really have first mover advantage. I need character space to respond to your responses. Had you devoted part of your Round 2 to refuting what I've said or answering the questions posed, then I might say okay to a limit.

oh lol, and it's 12 hours not 24. Kind of ridiculous.
Posted by BlackVoid 4 years ago
3000 character limit, lol wow.
Posted by Contra 4 years ago
I never thought of that idea before. I'll try it.
Posted by BlackVoid 4 years ago
This is just my suggestion, but if the normal rounds are 8000 characters, a limit on Con's final round of 5000 seems like a decent way to mitigate the problem. Just my 2 cents.
Posted by Contra 4 years ago
Ok I changed it.
2 votes have been placed for this debate. Showing 1 through 2 records.
Vote Placed by AlwaysMoreThanYou 4 years ago
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Total points awarded:23 
Reasons for voting decision: Close debate. In the end, arguments to Con because he showed that there are specialists that should be preferred to the GPs. Sources to Pro, as his were better.
Vote Placed by darkkermit 4 years ago
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Reasons for voting decision: PRO had the BoP to show that doctors should learn more about sleep disorder. He did not demonstrate the necessary trade-offs that would have to occur or why GP specifically had to learn this stuff when there are specialists.