Denise
Denise came to see me after her third panic attack in two months. A senior vice president at a financial services firm, she was the kind of person who had spent twenty years building a reputation for being unshakeable. Denise ran a department of forty people, sat on two nonprofit boards, and still managed to show up for her teenage daughters’ track meets whenever she could. On paper, she had everything figured out.
In my office, Denise was fighting back tears and telling me she thought she was losing her mind.
The panic attacks had started coming out of nowhere, or at least that’s how it felt to her. She would be in a meeting or driving home from work when suddenly her heart would race, her chest would tighten, and she would become convinced that something terrible was about to happen. Her doctor ran every test and found nothing wrong with her heart, which should have been reassuring but somehow made her feel worse. If nothing was wrong, why did she feel like she was falling apart?
When I asked about her sleep, Denise waved the question away at first.
She told me she had always been a light sleeper and that she usually got about five hours, sometimes less, during busy seasons, and had trained herself to function on whatever rest she could squeeze in. She figured that was just how successful people operated. Besides, she said, she didn’t have time to sleep more. There was always another email, another presentation to review, or another problem that needed her attention before she could finally close her eyes.
What Denise didn’t realize was that the irritability she had been feeling for months, the way she would snap at her husband over small things and then feel terrible about it afterward, the difficulty concentrating that she blamed on getting older, the sense that she was constantly on edge even when nothing was actually wrong—all of it was connected to the chronic exhaustion she had normalized years ago. Her body had been sending her signals for a long time, and the panic attacks were just the loudest version of a message she had been ignoring.
Juan
Around the same time I was working with Denise, a law enforcement officer named Juan showed up in my office with a very different set of concerns. He was forty-three years old, had been on the force for eighteen years, and had recently scared himself badly enough to finally ask for help.
It started with chest pains that would wake him up in the middle of the night. The first time it happened, he drove himself to the emergency room, convinced he was having a heart attack. The doctors ran an EKG, drew blood, and kept him for observation, but everything came back normal. When it happened again a few weeks later, he went back, and again they found nothing. He didn’t keep the follow-up appointment with the PCP the ER had recommended because he generally “doesn’t like” doctors. By the third visit to the ER, he started to feel like maybe the doctors thought he was making it up, so he stopped going and started self-medicating instead.
With alcohol.
A couple of beers after his shift seemed to help take the edge off. Then it became three or four. Eventually, it became the only way he could fall asleep at all. His wife noticed and said something, which led to an argument, which led to him sleeping on the couch, making the whole situation worse. By the time he came to see me, he was averaging maybe four hours of broken sleep a night, drinking more than he wanted to admit, and genuinely worried that something was seriously wrong with him that the doctors just couldn’t find.
Juan had spent nearly two decades working rotating shifts, the kind of schedule that asks your body to be alert at 2 a.m. one week and asleep by 10 p.m. the next. He had never really thought about what that was doing to him because everyone on the job dealt with the same thing, and complaining about it felt like weakness. He pushed through the fatigue the way he pushed through everything else, and he assumed the chest pains, anxiety, and the drinking. were just the price of the life he had chosen.
The Pattern Underneath
Denise and Juan came from very different worlds, but when I sat with each of them and started asking questions, the same pattern emerged. Both of them had been running on empty for years, with symptoms that seemed mysterious until you looked at how they were sleeping. Denise buried herself in work while Juan reached for the bottle. Their coping strategies masked the issue just enough to keep them going while making everything worse underneath.
I see versions of Denise and Juan almost every week in my practice. The specifics change—different jobs, different families, and various reasons for walking through my door—but the story underneath stays remarkably consistent. Someone is struggling with their mood or their energy or their focus, and when we start peeling back the layers, we find chronic sleep deprivation holding up the whole thing like a crack in the foundation that no one thought to check.
What strikes me most is how long people wait before they connect the dots, not because they aren’t paying attention, but because no one ever told them to look there.
Who Gets to Rest
In the Black community, there is a long and understandable tradition around pushing through. We honor those who work doubles and triples, sacrifice their rest so their children can have more than they did, and who keep going when everything in their body is telling them to stop. This has been the untold sacrifice that has carried families through generations of obstacles that would have broken most people, and I would never dismiss it.
But somewhere along the way, exhaustion became a badge of honor, and rest became something we told ourselves we would get to later. After the promotion, after the kids were grown, after we had accomplished everything on the never-ending to-do list.
The problem that is being missed is that “later” never comes and is costing us more than we realize.
Ironically, the individuals I see who are most reluctant to prioritize sleep are often the ones who need it most. They come in with high blood pressure that won’t respond to medication, or anxiety that seemed to start of nowhere, or weight they can’t lose despite doing everything right. When I ask about their rest, I get the same response Denise gave me—a wave of the hand, a shrug, something like “that’s just how it is for me.”
But it doesn’t have to be this way. A lot of us have accepted (or have become accustomed to) a level of tiredness that we’ve mistaken for normal when it’s a pattern that’s quietly making us sick.
To be fair, there are external reasons for our disrupted sleep patterns, and we cannot pretend that barriers don’t exist. When you’re working nights, when you’re worried about rent, when your neighborhood doesn’t quiet down until well past midnight, when you’re the person everyone depends on, quality sleep can feel like a luxury that simply isn’t available to you. I see those barriers every day in my practice, and I see what they do to the body over time.
But I also see what happens when people start treating sleep like it truly matters, even when the circumstances aren’t perfect.
When you frame rest as something that changes your blood pressure and your mood and your ability to show up for the people who need you, protecting it stops feeling selfish and starts feeling like the most practical thing you can do for yourself and everyone counting on you.
Sleep As “Medicine”
When you sleep, your body is doing essential maintenance that cannot happen any other way. Your brain is processing emotions and consolidating memories, your immune system is resetting, your muscles are repairing, and your hormones are recalibrating in ways that affect everything from your mood to your metabolism to your cardiovascular health. When you cut the process short night after night, the effects accumulate quietly until they become impossible to ignore.
That’s why one of the first “prescriptions” I offer is a serious conversation about sleep and recovery, because I’ve found that most people have never had someone sit down with them and explain what they’re really losing when they sacrifice their rest.
In these conversations, I’m always clear that better sleep doesn’t replace medical care. If you’re on medication for blood pressure, anxiety, depression, diabetes, or anything else, stay on it and keep working with your doctor.
Improving your sleep isn’t a substitute for your prescriptions, but it is a foundational piece that makes everything else work better, and most people have never been told how much it matters.
I have watched people like Denise and Juan make meaningful changes in their lives simply by starting to pay attention to their rest in addition to receiving regular medical care. They didn’t need to start with expensive interventions or complicated protocols, just with awareness and intention and a willingness to take it seriously.
Sometimes the most powerful “medicine” is something you don’t even perceive as potentially medicinal, and the one you’ve convinced yourself you don’t have time for.
What Changed
Denise and I worked together over several months to rebuild her relationship with sleep. At first, she wanted hard data. She bought a sleep tracker and started monitoring her sleep stages, her heart rate, and her nightly score. Every morning, she would faithfully check the numbers before she even got out of bed, and if the score wasn’t good enough, her whole day started with a quiet sense of defeat and anxiety.
She was optimizing her sleep the same way she optimized everything else, and I could see it was making things worse. So, we decided together to take the tracker away, not permanently, but long enough for her to reconnect with what her body was telling her. I asked her to stop measuring and start noticing how did she felt when she woke up, not according to an app, but to her own experience of being in her body.
It was harder than she expected because Denise had spent years rigidly trusting metrics more than her own instincts. But over time, she learned to let go of the score and pay attention to signals she had been ignoring for a long time. The panic attacks became less frequent, and the irritability that had been straining her marriage started to lift. She told me recently that she finally feels like herself again, and that she wishes someone had told her years ago that she didn’t have to perform her way through everything, including her sleep.
Juan needed something different.
He didn’t trust feelings and did not particularly want to sit in my office talking about emotions. What he needed was something concrete that proved that the changes he was making were working, because otherwise, he wasn’t going to believe it.
So, we gave him a tracker, but with a different purpose than Denise had given hers. Every week, we would sit down together and look at his numbers (sleep efficiency, REM percentage, resting heart rate, and HRV trends), not to chase perfect scores but to look for evidence that his body was recovering even when he didn’t feel dramatically different yet.
And there was always something we could point to. Some weeks, his deep sleep was up; some weeks, his heart rate variability had improved, and having those concrete markers gave him something to talk about other than the chest pains he was so afraid of. This approach gave Juan goals to work toward, which fit the way his mind worked, and it showed him something he desperately needed to see. He needed to know that his body wasn’t failing him and that it was responding to the changes he was making–and that it was more reliable than he had feared.
The drinking slowed down and eventually stopped. So did the chest pains. The last time I saw him, Juan told me he was sleeping better than he had in years, and he seemed almost surprised by how much had shifted once he started paying attention.
The Recovery Revolution
Two patients who took very different paths to get to the same place.
Denise needed to stop tracking and start trusting her own experience again. Juan needed to start tracking so he could build enough trust to eventually let go.
They needed help to see that the exhaustion they had normalized was a problem worth solving, and that solving it was more within their reach than they had imagined.
I share these stories because I want you to know that if any of this sounds familiar and, if you’ve been running on empty for so long that you’ve forgotten what rested feels like, you’re not alone in that, and you’re not broken. You may just be carrying a kind of tired that has become so familiar you stopped questioning it.
The “medicine” I’m talking about isn’t in a bottle but in the hours you end up giving away to everything and everyone else, the rest you are postponing because something always feels more urgent, and the recovery you keep telling yourself you’ll prioritize once things settle down.
You don’t have to earn the right to rest. But if you’ve been waiting for someone to tell you it’s okay to take this seriously, I hope this can be that moment for you.
Why? Because this is serious. Did you know that a major meta-analysis of over 1.3 million people, published in the journal Sleep, found that those who regularly slept less than seven hours per night had a 12% higher risk of death from any cause? And for people consistently getting five hours or less, the risk climbed to roughly 15%.
Who knew?
A separate study in BMJ Open found that those prescribed common sleep medications had more than three times the risk of death compared to matched controls—even after adjusting for other health conditions.
The point isn’t to alarm you. The point is that how you sleep matters more than most people have ever been told. And addressing the root causes of poor sleep may be one of the most important health decisions you can make.
Start paying attention to what your body has been trying to tell you. Make one small change this week, and then another one next week.
Our bodies have been keeping score. It’s high time we started listening.
References
1. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585-592. doi:10.1093/sleep/33.5.585
2. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2(1):e000850. doi:10.1136/bmjopen-2012-000850
Derek H. Suite, M.D. is a board-certified psychiatrist and the founder of Full Circle Health in New York. He is the host of the SuiteSpot podcast and the author of the forthcoming book Sleep as Performance Medicine.
