Daylight savings is the time of year that messes with our sleep patterns, especially in the spring when we move our clocks forward and give up a precious hour of sleep.
While losing that hour may be a minor annoyance for most of us, getting too little sleep is the norm for many physicians. Though this is not a new challenge, an increasingly large body of research supports the fact that it must change.
In this post, we address why getting enough sleep matters, where healthcare has gone wrong in its attitudes toward sleep, and what we can do to fix the problem.
Why Sleep Matters
Sleep is arguably the most underrated tool we have to maintain health, stay focused, and live a long life.
Something else that's underrated: the adverse effects lack of sleep has on our health.
People deprived of sleep may have trouble with memory, learning, social interactions, and cognitive performance. It causes metabolic disruption that can increase a person's risk for diabetes, is directly linked to atherosclerosis, and affects wound healing.
More to the point of this post, lack of sleep among residents can be a predictor for depression -- and extended shifts even put people at risk outside the hospital, increasing the likelihood of a hazardous driving event.
If that's not enough to convince you (physicians, we're talking to you), lack of sleep will even erode your DNA genetic code!
In his TED talk, Dr. Matt Walker, professor of neuroscience and psychology at the University of California, Berkeley, and author of "Why We Sleep," described a study where a group of healthy adults was limited to six hours of sleep per night for one week.
The study revealed two critical findings.
"First, a sizable and significant 711 genes were distorted in their activity, caused by a lack of sleep," he said. "The second result was that about half of those genes were actually increased in their activity. The other half were decreased."
According to Dr. Walker, genes that were switched off by lack of sleep were associated with the immune system functioning properly, while those that were upregulated by lack of sleep were associated with the promotion of tumors, chronic inflammation, and stress.
How much sleep is enough?
The National Sleep Foundation recommends seven to nine hours for young and median-age adults and seven to eight for older adults. Yet, researchers discovered that the percentage of working Americans getting short sleep is increasing, from nearly 31 percent in 2010 to over 35 percent in 2018.
The percentage is much higher for physicians. A SERMO poll found that nearly half (45 percent) get less than the recommended amount.
This evidence reveals that the dangers of sleep deprivation are substantive and real, but no matter how often we hear the warnings, we fail to make sleep a priority — and healthcare practitioners may be the guiltiest of all.
Where Healthcare Has Gone Wrong
The medical field has viewed lack of sleep as a rite of passage where exhaustion and overwork are considered badges of honor.
"[Physicians] have gone through an enculturation process, which focuses on hyperactivity and super high-level achievement," a writer for the blog KevinMD said in a post signaling the need for rest. "In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the least."
Dike Drummond, MD, writing about physician burnout (PDF), lays the blame squarely at the feet of medical education.
"We are not taught life balance skills in our medical education," he says. "In fact, our residency training teaches us just the opposite. We learn and practice ignoring our physical, emotional, and spiritual needs to unhealthy levels and then carry these negative habits into our career. You work until you can't go any longer, and then you keep going. To do otherwise could be seen as a sign of weakness."
He refers to residency as a "gladiator-style survival contest" where doctors become "hard-wired" for self-denial and burnout.
What We Can Do About It
Despite the hold that the “no sleep culture” has on the medical field, we can no longer shrug our shoulders and move on. We must take steps toward change and empower others as well.
Thankfully, medical schools and teaching hospitals are addressing the problem by closely monitoring duty hours, developing modules on proper sleep hygiene, and even providing sleep pods for learners to get some quick shuteye when they’re fatigued.
Hospitals can follow suit by adjusting physician staffing schedules to allow for better work-life balance. That includes avoiding shift changes that require doctors to be flip-flopped from day to night and back to daytime in short order.
If scheduling needs require doctors to rotate from day to night, group as many of the same shifts together as possible and ensure a suitable break in-between to give physicians time to rest and adjust their body clock before the next shift switch begins.
Physicians can also take proactive steps to promote their well-being. Ideas include:
- Having "beeper buddies" — colleagues who can take a doctor’s beeper for a window of time to allow for proper rest;
- Scheduling time for rest and making it a priority. "Rest should not be an afterthought," said KevinMD. "[T]ake the bull by the horns and plan rest and schedule rest and make rest a priority."
The American Psychological Association offers these tips for cultivating healthy sleep habits:
- Develop a consistent bedtime routine. The APA suggests dimming the lights a few minutes before bedtime and avoid surfing the web or watching TV immediately before bed.
- Don't drink alcohol within three hours of bedtime. It interferes with sleep.
- Take a power nap of no longer than 20 minutes during the day, if needed. That helps offset the mid-afternoon slump.
Other tips include keeping your sleep environment cool (65 degrees Fahrenheit is recommended) and only getting in your bed when you are ready to sleep so your brain relearns that it is the place of sleep, not wakefulness. You may even consider purchasing (or putting on your gift list) a white noise machine to help you fall—and stay—asleep.
Of course, it's essential to pay attention to your individual needs by assessing how you feel on different amounts of sleep.
The National Sleep Foundation suggests asking yourself these questions:
- Are you productive, healthy, and happy on seven hours of sleep, or do you need more?
- Are you experiencing sleep problems?
- Do you depend on caffeine to get you through the day?
- Do you feel sleepy when driving?
We can’t shift the sleep paradigm all at once, but hospital and health system leaders can set guidelines for work limits, and providers can establish personal boundaries to ensure they are continually performing their best and not suffering from physician burnout.
The most important step doctors can take is to make sleep a priority, recognizing that adequate sleep is not a luxury but a biological necessity.
So, doctors, get your ZZZZs. You deserve it and so do your patients.