On the last Saturday in March, while waiting for my children to finish ski lessons at Alpental, I had the most trivial and minor fall. As I went down, I felt a pop in both knees, and I was not able to get up without help.

A knee injury with a felt “pop,” followed by difficulty standing or walking, is a classic story for a ligament rupture—often the anterior cruciate ligament, or ACL, the thick band of connective tissue that stabilizes the knee by connecting the femur to the tibia.

But before I had even made it to the base of the mountain, the minimizing began.

A ski patroller who helped me get down to the base of the mountain, who was also a nurse, told me, with confidence, that if I had torn my ACL, I would not be able to stand or bear weight. In the patrol room, I was given ibuprofen and encouraged to walk. When I tried, the pain was excruciating.

Eventually, a physician on patrol—a retired radiologist—came in. He reassured me that I had not torn my ACL. He performed a makeshift exam maneuver with a clipboard, explained why my leg’s movement meant the ACL was intact, and added that my knee would be much more swollen and painful if the ligament had ruptured.

I wanted to believe him. I needed to believe him. I have two young children and I was trying to figure out how I would care for them, get medical care, and see my scheduled patients that week.

At one point, another patroller told me that if more injuries came in, I would need to leave the small evaluation room to make space. The message landed: my injury did not appear serious enough to justify the disruption. So I left. I limped to the lodge, sat alone at a table, cried intermittently, and waited for my children’s lesson to end.

The next day, my knee was worse—more painful, more unstable. I went to the emergency room, where the physician examined me and said I had sprained both medial collateral ligaments and was fairly certain I had also torn the right ACL based on the Lachman test. He initially said I did not need an X-ray, but after I pointed out that orthopedics would likely require one, he ordered it. The X-ray was normal except for a trace joint effusion.

I was discharged with crutches and a full-length knee brace—neither especially useful for a mother of two young children who still needed to drive.

Two days later, I saw an orthopedic physician assistant at a major hospital system. He made it a point to tell me he had 40 years of experience in orthopedics. He was kind, experienced, and thorough in explaining the anatomy of the knee. But at the end of the visit, he diagnosed a grade 1 sprain of both medical collateral ligaments (MCLs). When I asked for a referral to physical therapy, he hesitated and ultimately referred me for a single session, saying the injury was so minor, one instructional session would suffice.

I left the visit relieved that my injury was so minor, but unsettled by the discrepancy between my experience and the diagnosis. The pain and instability persisted. I kept thinking about the emergency physician’s concern for an ACL tear so I sought a second opinion from an orthopedic surgeon at a different practice, who noted a valgus instability of the knee and again clinically diagnosed an ACL tear. He ordered an MRI to confirm and referred me for twice-weekly physical therapy.

The MRI showed a full-thickness ACL tear, a full-thickness proximal MCL tear, partial tearing of the posterior oblique ligament, a lateral collateral ligament sprain, bone contusion, joint effusion, and hemarthrosis. There was no meniscus tear.

I did not want those results. But they affirmed what my body had been telling me from the beginning, this was not an insignificant injury.

What I keep returning to is not only the injury itself, but the experience of having it repeatedly minimized. I almost accepted reassurance that I was exaggerating my symptoms—partly because I wanted it to be true, and partly because it was delivered confidently, repeatedly, and by people who seemed certain that my pain did not match the severity of my injury.

Seven weeks later while trying to sort out what type of surgery I needed, I called a friend from medical school who is now the lead surgeon for an NBA basketball team. When I told her I had been underdiagnosed at the first orthopedic clinic, she said the story made her feel ill.

Looking back, I do not think this was about bad people, but a bad system. Medical gaslighting is a systemic problem.

The lesson, for me, is threefold.

First: trust yourself. Do not gaslight yourself. In medicine, too often we assume patients are exaggerating their symptoms. But it is just as often true that people minimize their symptoms because they are trying to avoid a more serious diagnosis.

Second: time and reassurance are not the same as accuracy. The person who spent the most time with me and gave me the most education was also the person who got the diagnosis wrong.

And third: when there is real uncertainty, expertise matters. In my case, the most accurate assessment came from the person with the most relevant training: the orthopedic surgeon who examined my knee, recognized the instability, ordered the MRI, and treated the injury as real.

The danger of medical gaslighting is not only that a diagnosis is missed. That is the part I keep thinking about. It is that the patient begins to doubt the most important data point in the room: their own lived experience. Medicine is at its best when it does not ask patients to choose between trusting themselves and trusting their doctors. In a perfect world it should be both.

Sleep disorders are not just “bad sleep.”

They can show up as fatigue, brain fog, mood changes, cardiovascular risk, metabolic problems, and in children, even symptoms that look like ADHD.

We talked about why sleep apnea is so much more than snoring, why chronic insomnia is so often treated incorrectly, how medications can sometimes obscure the real problem, and what it means to evaluate sleep through the lens of the brain, body, and behavior.

My hope is that this episode helps people stop dismissing poor sleep as stress, aging, hormones, or willpower — and start asking better questions about what may be happening during the hours they are not awake.

Thank you, Dr. Shah, for such a generous and wide-ranging conversation.

Watch and listen here:

#sleepmedicine #sleepapnea #insomnia #sleephealth #brainhealth #longevity #thesleepneurologist #sleepdoctor

Over the weekend I turned 49. I’m not a big “birthday party” person, but this one feels notable—the final year before a major infection point, a threshold into the second half of life. As I grow older, I re-examine the past more than I used to, perhaps simply because there is so much more of it to consider. When I was a teenager, I was fascinated by my dreams. I kept a dream journal, collected books about dream analysis, and hung a dream catcher above my bed. I never thought of dream analysis as an exercise in hard science, but it also seemed like a worthwhile form of self inquiry. Now that I am a sleep neurologist, I know there are scientists who know quite a bit about how and why we dream.

Approaching the midcentury marker, I’m noticing a monumental shift in my perspective. Some might attribute it to hormones and perimenopause; whatever the cause, I’ve noticed my dreams becoming more vivid —some of them tinged with anxiety, what we sleep physicians call “anxiety dreams.” When I recently woke up from an intense dream that occurred after a conflict with a family member, I asked Chat GPT to analyze it. Part of me was genuinely curious what it would say or if the analysis would be therapeutic.

Finding it difficult to fully describe the nature of the dream, I entered this small tidbit:

“Last night I had a dream that I was flying back from Asia. I was on the plane and I didn’t know which seat was mine but there was a group of friends from high school all sitting together and I realized they checked in without me.”

Here is what ChatGPT told me when I asked it to analyze my dream:

Core themes:

1) “I’m traveling back from Asia” = you’re in a transition zone
Planes in dreams are almost never about travel. They’re about in-between states: leaving one identity, returning to another, moving between versions of your life.

2) Not knowing your seat = “Where do I belong right now?”

Seats are roles.
They’re “your place.”

Not knowing which seat is yours usually shows up when someone is:

• re-evaluating their social world

• changing family structure

• rebuilding identity

3) High school friends sitting together = old belonging wounds getting activated

High school is basically the brain’s archive for:

• social ranking

• exclusion

• being chosen vs. not chosen

• humiliation you pretended didn’t matter

4) “They checked in without me” = the sharpest emotional punch

That detail is the whole dream.

It’s not “they forgot me.”
It’s “they made a decision that impacted me and didn’t include me.”

That’s the feeling.

It’s the emotional fingerprint of:

• being left out of decisions

• being treated as optional

• being expected to adapt after the fact

It is strange to say, but ChatGPT made me feel seen. The family conflict triggered a deeply seated wound of unworthiness and not belonging, both nearly universal experiences amongst transracial adoptees.

Dreaming, especially during REM sleep, plays an important role in emotional memory processing, emotional regulation, and adaptation after traumatic experiences. Dreams may help the brain reactivate, reshape, and emotionally digest waking-life experiences with high emotional salience.

Now that I am older and certainly wiser, and more willing to trust my own perception—I am able to process my dreaming experience differently than I might have ten or twenty years ago. And I have to say: ChatGPT helped me see myself with more self compassion and clarity. It did this simply by reflecting back what, in some ways, should have been obvious, yet remains incomprehensible to certain family members no matter how many times I try to explain it.

To me, that simple act felt astounding.

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There’s a viral trend happening on Instagram in which famous actors appear in a short clip under the caption, “Mom, what were you like in the 90s?” followed by a montage set to the Goo Goo Dolls’ iconic song “Iris,” written for City of Angels, the film starring Meg Ryan and Nicolas Cage. Courtney Cox and Julia Louis-Dreyfus brought me to tears. Monica and Elaine carried me back to college, to those golden Thursday nights of Friends, Seinfeld, and ER, when network television felt communal and comforting. It was a chapter of life when the future still felt vast and glittering, when all my hopes and dreams seemed not only possible but waiting for me, before midlife arrived with its quieter truths: that time moves in one direction, that horizons narrow, and that some versions of the future recede without announcing their departure.

It may seem surprising that, of all the memorable portrayals of medicine in film and television—from The Pitt to The Doctor—this is the one that stays with me as the truest. More than any other, City of Angels captures something essential about what I felt in my earliest years practicing neurology, and why I eventually made such a sharp turn toward sleep medicine: a field that is quieter, more preventive, often dismissed as less urgent, and asks us to take action on health signals before it turns into something irreversible.

In City of Angels, Meg Ryan’s character loses a patient on the operating table during open-heart surgery, her bare hands literally holding and massaging his heart. It captures the moment many physicians eventually encounter, when skill, training, and devotion collide with the humbling limits of medicine itself. Faced with that helplessness, she voices the question that haunts so many doctors in one form or another: “We fight for people’s lives in here… don’t you ever wonder who it is we’re fighting with?” It is a question about fate, about mortality, about whether there are forces beyond our grasp that make our most desperate efforts feel both profoundly meaningful and unbearably small.

Several cases still return to me, even now. The new mother who suffered a stroke and died before she could watch her baby take those first unsteady steps. The middle-aged veteran who came in with Horner’s syndrome, whose imaging was negative for carotid dissection, but later returned in a devastating ICA stroke syndrome—language gone, one side of his body paralyzed. And then there were the hundreds of others: patients with strokes, demyelinating disease, neurodegenerative disease, each one arriving at the point where something precious had already been lost.

In those early years of neurology training, one thought moved through me again and again: It’s too late.

Over time, that feeling transformed from a form of grief into a compass. I began to see future health as something that had to be protected far earlier than medicine often asks us to look—before illness had fully surfaced, before damage had hardened into destiny. That is what drew me toward sleep medicine. I wanted to live in that earlier window, while possibility still remained, and make my life’s work out of reaching people before the story had already turned.

What makes sleep medicine uniquely challenging is that it asks people to care deeply about a future they cannot yet fully see. It asks them to invest time, money, effort, and belief now, in the hope of delaying—or sometimes preventing—the kinds of losses that still feel distant and abstract in the present.

That is the work. To help people understand that catastrophe rarely feels imminent until it is already unfolding; that the future has a way of arriving all at once. And to gently show them that when that day does come, many would give anything to be returned to this ordinary moment—to have started sooner, to have taken their health seriously before it began to slip away.

I don’t have photos or videos of myself from the 1990s to show my kids the younger, more naive version of me—studying abroad in Australia, backpacking through Italy, learning to take care of stroke patients in the neuro-intensive care unit . But I do have the indelible memory of “Iris” and the feeling it held at that moment in my life: a reminder that to be fully human is to accept a finite life shaped by love, risk, loss, and impermanence, because those very vulnerabilities are what make life meaningful.

I recently finished reading the New York Times bestselling book Strangers by Belle Burden (which was recently announced as being adapted into a film starring Gwyneth Paltrow). I admire the way she follows the tradition of great American writers by making complex ideas feel clear and accessible, while centering the book on an experience so often associated with—and nearly universally experienced by women. How refreshing that we did not need to be transported to a dystopian apocalyptic world or the Wild West to discover that inner change happens gradually and often from obstacles and life experiences we did not wish for, see coming, or even fear.

In her book, she mentions sleep disorders several times. Her father (spoiler alert) died in his sleep and among many of the possible contributing factors, he had been taking Ambien to help him sleep. She also notes, almost casually, that one of her children uses a CPAP machine, since needing one has become part of modern life. And, in a similarly offhand way, she alludes to her own experience with insomnia while grappling with the emotional fallout of her husband’s affair, his abrupt abandonment of her and their children, and his financial exploitation of her.

The banality of sleep problems is deeply woven into our culture. We carry beliefs about sleep that are not always true, yet many people accept them as inevitable facts of life—especially women, older adults, and those with fewer socioeconomic resources. And yet among all areas of medicine where low-tech, low-cost interventions can meaningfully transform health, sleep stands near the top.

I highlighted a line from the end of the book, “Be Brave. Claim it. Say it. Break the cycle.”

That is why I hope you’ll follow along.

Being labeled a “bad sleeper” in childhood, or coming from a family of “bad sleepers,” does not mean you are destined to remain one. There is no quick fix. Transforming sleep is usually a slow, steady process, one that unfolds over time and requires peeling back many layers. But it is a deeply rewarding process, sometimes even lifesaving, and it is available to those willing to pursue it.