Ashar Khan, MD

I trained in psychiatry, and for a long time I practiced the way most psychiatrists do — a diagnosis, a medication, a follow-up in six weeks. It worked often enough. But I kept meeting people it did not work for, and when I looked closer the reason usually was not psychiatric. They were not sleeping. Their blood sugar or their thyroid had drifted. They were taking three medications that worked against each other. So I went back and trained in sleep medicine, then brain injury medicine, then integrative and lifestyle medicine. Those were the answers I needed.

There is a conversation that repeats itself in my office. Someone has seen four or five doctors. Each one examined a piece and found nothing clearly wrong with that piece. The bloodwork is normal. The scan is clean. The person is told, kindly, that they are fine — and they go home knowing they are not. What nobody has done is set the pieces beside each other and ask whether they are related. Often they are. Poor sleep raises blood pressure and flattens mood. A medication for one problem worsens another. None of that shows up when you look at one system at a time.

What gets missed most often is sleep — not as a complaint, but as a cause. Low mood, poor concentration, weight that will not move, blood pressure that will not settle: sleep sits underneath more of it than most people expect. The second thing missed is time. Fifteen minutes is enough to adjust a medication. It is not enough to find out why someone feels the way they do.