The growing specialty of sleep science has made a lot of people rethink our sleep schedules, and many of us know we should be getting more zzz’s. But for many physicians, the schedules of hospital and outpatient medicine don’t allow for optimum sleep habits. But what effect does this have on performance, patient care, and mental health? In this week’s article, we’ll talk about 5 science-backed reasons we should be prioritizing physician’s sleep.
We already know the standard wisdom of how to get a good night’s sleep. Aim for 8 hours, create a comfortable routine, ditch the phone and computer, etc. Yet even though these are the practices many physicians recommend for their patients, the average practicing physician’s schedule is not made with sleep in mind.
According to the American Medical Association, the average physician works an average of 40-60 hours per week. Almost a quarter work between 61 and 80 hours. Many physicians also work on-call, or change shifts between day and night. Resident’s schedules are even worse, often working for days on end with only a few hours between patient calls. It’s time that we think about this scheduling impact not only on patient care, but on physicians as humans who deserve good sleep and quality of life.
1. Sleep deprivation contributes to physician burnout
Burnout affects one out of every two physicians, as defined by the Maslach Burnout Index. It’s defined as a syndrome of emotional exhaustion, depersonalization, and feelings of low personal accomplishments. Not only can burnout lead to low morale, it’s been shown to double a physician’s risk of being involved in patient safety incidents.
A 2019 study confirmed the correlation between sleep deprivation and burnout. Researchers linked two causative mechanisms: chronic energy depletion, and the activation of the hypothalamic-pituitary-adrenal axis. The combined fatigue and stress of not getting enough sleep contribute to burnout not only in physicians, but nurses, medical students, and other medical workers.
Despite the evidence linking sleep deprivation and burnout, few hospitals and medical facilities incorporate sleep hygiene into their staff mental health programsEmployer-sponsored efforts to improve staff sleep could create better lives for staff, yet it may mean a decrease in the bottom line for healthcare systems.
2. Lack of sleep makes physicians prone to errors
We all have experiences of being tired while driving or performing regular tasks. Your mind wanders, your eyelids sag, and you may have to open the window to keep from falling asleep. For busy physicians, however, this fatigue can lead to medical errors that have serious effects on patient health. What’s disturbing is how much more likely errors are when clinical staff haven’t gotten the sleep they need.
One recent study published by Becker’s hospital review found that just moderate sleep deprivation made physicians 53% more likely to make a significant medical mistake. For physicians who had even less sleep, that likelihood jumped to 97%.
A literature review by JAMA Network laments the same conclusion. “Interventions for mitigating sleep-related impairment in physicians are warranted.” It’s time we think about the consequences of being drowsy at the wheel of patient care.
3. Chronic sleep loss is associated with major health consequences over time
Chronic sleep deprivation, as described by getting less than 7 to 8 hours of sleep per night, has long-term consequences on health. Research has revealed that several body systems are impacted by sleep health, and loss of sleep causes more problems than daytime sleepiness.
In fact, chronic sleep loss is associated with weight gain, diabetes, cardiovascular disease, anxiety, depression, and increased alcohol dependence. The WhiteHall II study found that getting less than five hours of sleep per night actually doubled the risk of cardiovascular disease.
In the short term, sleep deprivation is also linked to motor vehicle collisions and mistakes that can lead to serious bodily harm. According to the U.S. National Highway Traffic and Safety Administration estimated that in 2017, 91,000 police-reported crashes were associated with drowsy driving. These accidents led to 50,000 injured people and almost 800 deaths.
Physicians have a right to good health, just like the rest of us. They shouldn’t have to sacrifice their bodies to care for ours. Now that we know that sleep is so important for short and long-term health, why aren’t we incorporating these findings into medical practice?
4. We owe it to our frontline staff to get good sleep
After working nights myself, I know how sleep can impact quality of life for frontline workers. During the peak waves of COVID, healthcare workers have been asked to take care of more patients while getting less sleep themselves. It is my deeply held belief that we can’t care for others without being given the space to care for ourselves.
In May of 2021, surveyed healthcare workers reported a nearly universal decrease in sleep quality. One-third reported insomnia, and over half experienced burnout. Some also had sleep disruption because of nightmares and devices. A review published in 2020 confirmed an uptick in sleep disturbances for frontline staff. So not only are frontline workers getting less sleep, they’re getting worse sleep.
“Unprecedented” times have put real strain on healthcare workers, and have already contributed to a mass exodus from medicine. As we combat this next strain of COVID, I think it’s important to point out that frontline workers are people too. We’re not clinical robots who exist to treat patients. We need time away from work, we need relaxation in an uncertain world, and we need sleep.
5. Medicine has a culture of brushing off self-care
The culture of “going beyond” in medicine goes further back than COVID. Medical workers have long prided themselves on their dedication and tirelessness in patient care. Their passion for patients comes through in working long hours, doing more with less staff, and going above and beyond to provide the best care possible. This dedication allows hospitals to run despite offering lower wages, less benefits, and lacking support for clinical staff.
The beginning of the pressure to perform begins before internship and residency. Medical students tend to get less sleep than other majors. This lacking sleep contributes to a decreased sense of quality of life, and leads to depression and anxiety even before any clinical practice. In order to change this culture, we need to start seeing med students, interns, residents, and physicians as people, first.
I think it’s possible to achieve balance in medicine. As clinical staff, I don’t think we should have to string ourselves along on three hours of sleep to care for patients. I also don’t think compassionate healthcare workers should have to suffer from burnout and long-term health issues because of gruelling schedules. Patients shouldn’t have to pay the consequences of clinician sleep loss through medical errors.
In theory, many healthcare leaders would agree. Yet we don’t see these values enacted in the structuring of medicine. Even as healthcare workers are called “heroes”, they’re not treated as such by hospital systems. I’m worried about what will happen to medicine when we’ve burned through our compassionate and dedicated clinical staff.
For now, it seems that the best way to prioritize your own self-care and sleep as a physician is to ditch the healthcare system and forge your own path. This isn’t an option for everyone. Creating your own practice, and your own schedule, can be a terrifying proposition for clinicians. But I think it’s one way to regain control of your life and your practice.
If you’re a practitioner looking to get more sleep by saving time on content creation and marketing, get in touch. I’m passionate about creating quality medical copy, helping practitioners get more patients, create more streams of income, and get their lives back.