Sleep: A handful of thoughts for my fellow doctors

I have become fascinated by sleep ever since listening to a series of interviews with sleep-expert, Dr. Matthew Walker. After reading his blockbuster book, my interest grew and I decided to rotate in a sleep medicine clinic, which clinched the decision for me: When I grow up, I’m going to be a sleep medicine doctor.

That’s great, but why should you care?

The importance of sleep remains underrecognized in America today. And, to this day, there’s still a remnant of the chest-beating, sleep is for wimps, culture in healthcare.

As the health experts, we should know better, but the practical realities of the hospital environment force us to hit the next cup of coffee, put on our patient satisfaction smile, and power our way through absurdly long shifts.

To be fair, public awareness of the problem is growing and steps are being taken to move us in the right direction (at least for the resident physicians, not as much for our attending physicians).

But I can still detect a subtle hint of disappointment or contempt whenever I mention my future career path in the hospital.

Mr. Dangerfield expresses my feelings pretty well:

Seriously, sleep doesn’t get enough attention or respect from the medical community.

For example, after combing through my old PowerPoint slide decks, it appears that I only got 2 lecture hours dedicated to sleep while in medical school, maybe 3 if we account for the sleep-related topics that were sprinkled into other lectures across the curriculum.

But the importance of sleep didn’t really hit home for me until my experience working in the PICU at night. After my first night on service, I was beyond exhausted. It was a grueling mix of high acuity, lots of little decisions to make and details to keep track of, and constantly changing conditions.

Eventually, 7 am rolled around and my relief arrived with a smile on her face. Unfortunately, as I began my sign out, the smile vanished.

I could barely remember or communicate the details of what happened that night. I was so confused. It felt like I had too much to drink or something. My written notes looked like incomprehensible gibberish. I somehow forgot to check one of the morning labs that she specifically wanted to know about. She looked so (understandably) disappointed and frustrated.

After fumbling my way through this crummy sign out, I finally got to leave the building. But my troubled thoughts remained on the unit. I felt depressed and dejected, like a total failure.

How could I let that happen? I let my teammate down. And even worse, my failure could have hurt a sick child.

With these kinds of thoughts swirling in my head, it took me hours to fall asleep when I got home. But I resolved to do better next time and, thankfully, nothing bad happened to the patients.

The next night, I figured out a better system to keep track of all the little PICU details and I chugged WAY more coffee than usual to stay sharp. It got easier with each passing night. And by the end of the week, my circadian rhythm had adjusted… just in time to switch back to day shifts.

This story probably sounds familiar to many readers.

What happened? The answer was obvious: acute sleep deprivation.

When attempting to quickly switch my schedule from days to nights, I failed miserably. Rather than waking up 1 hour before my shift started (like normal), instead I woke up about 7 hours too early. (I’m still not sure why.) So, it’s no surprise that I felt like I was running on fumes by the end of that first shift; I had been awake for 20 hours by that point!

(I’m well-aware that 20 hours awake sounds like a piece of cake to many readers, but I’m just describing my own experience here. Feel free to describe yours in the comments.)

I kept thinking, “What if I had been forced to work even longer?” Simple: my ability to perform would likely have continued to worsen, linearly.

In his book, Dr. Walker compared acute sleep deprivation to drunkenness many times. Worse yet, he described how, like a friend who’s had too much to drink but insists that they are “fine” to drive home, the sleep deprived often don’t recognize how sleepy/impaired they really are.

When reading about this in the comfort of my armchair, I remember thinking something like, “Come on, this must be an exaggeration. A ploy to generate more media buzz around his ideas. A tactic to sell more books. Or maybe just an academic taking his field way too seriously.”

Nope, I was wrong.

Horrible things can happen in healthcare when we don’t get enough sleep. Sleep deprivation has profound negative effects on attention, memory, cognitive function, mood, and driving safety. Further, chronic inadequate sleep significantly increases your chances of developing poor cardiometabolic health, dementia, various forms of cancer, and it is well-known to increase all-cause mortality.

Sleep should be taken as seriously as the basic needs of food, water, or shelter.

My PICU nights experience was a big wakeup call for me. I intend to use it as a powerful motivator to serve my future patients, to help them get the quantity and quality of sleep that they desperately need.

To close, what are some helpful resources for the interested reader?

1. All of us can try to optimize our sleep hygiene; shift workers face particular challenges in this area.

2. Recognize and respond to signs of fatigue in our colleagues.

3. When appropriate, be sure to ask your patients about their sleep. There are plenty of user-friendly screening instruments for children and adults.

4. Talk to your primary care provider or consider seeking the help of a sleep specialist if you have persistent sleep issues.