You have been awoken by a resident, fellow or nurse about patient questions every night you’ve been on call. You can sense your grumpiness and fatigue rising up in your voice. What they do not know is that you have not slept very well for a long period of time due to your high workload, patient complications and logging late into the work computer to stay current with your clinical notes. You know the importance of sleep, but just can’t seem to get a solid night’s rest. This is becoming the norm rather than the exception.
You are a resident or fellow and notice you are getting to sleep later and later because of research projects during the evening and wanting some time for yourself, and at times find it hard to fall sleep because of having so much on your mind. You know the intermittent sleep is creating fatigue for you.
What does these two scenarios have in common? The encroachment on the precious commodity of sleep! Whether you are a physician, nurse, health care practitioner, resident or fellow, sleep contributes to having a clear focus and concentration, experiencing a positive mood state, feeling productivity, and engaging in good interpersonal skills in clinical encounters. If you’re concerned that your talents and strengths might be compromised through inadequate sleep, then read on.
James Hamblin, M.D., writer and senior editor with Atlantic magazine, was a guest on Wisconsin’s National Public Radio in December 2016 when a caller asked, “I remember 30 years ago in a human physiology class, it seemed like there was a good understanding then of sleep cycles and how harmful it can be to mess them up. I wonder why the medical profession — the one that should understand this best — seems to be the one that kind of abuses this the most?”
Similarly, the Institute of Medicine reported in To Err Is Human that medical errors caused 44,000 to 99,000 deaths a year, which is in part attributable to fatigue impacting performance, where sleep is one of the culprits.
No doubt, it’s complicated. But, doctors, nurses, APPs and residents/fellows are notorious for not getting enough sleep and convincing themselves they’re doing just fine.
It takes only one or two Google clicks to uncover numerous incidents on the negative effect that intermittent or little sleep has over time on health care professionals. In fact, various articles suggest asking your health care provider how long he/she has been up.
Not only were you taught to ignore or override your sleep need(s) but it’s more than likely you didn’t receive training in sleep hygiene, creating good habits and setting up the environment designed to help you get the best sleep possible.
Below are five essential sleep tips, besides eating well, regularly exercising, taking a warm soothing bath or shower, stress management, and avoiding stimulants such as caffeine or alcohol near bed time.
How many of these proactive strategies are you practicing now?
- Create a consistent time to go to sleep and to get up. The body responds to routines. The routine is based on looking at your weekly, biweekly or monthly schedule and developing a consistent sleep program, which includes incorporating weekends, of when you will shut off the lights, and close the eyes to sleep. Even in the midst of having a variable schedule which may be based upon work and call schedules. Pre-planning becomes important.
- Nighttime routine and rituals. Adults need what we create for children — time to unwind and focus on topics or activities that are calming rather than stimulating. Do you take the hour or 30 minutes prior to sleep to lean toward quiet and calm time, and disconnect from electronics?
- Develop your way for shutting down the mind-brain. When you listen to something calming like classical or instrumental music, or audio books on a calming subject, it allows the mind and brain to settle. It takes the mind off the concerns of the day, providing an opportunity for the body to decompress.
- Beds are for sleeping. Other than sleep and sex, the bed should not be used for watching TV, reading, or doing any kind of work. Associate your bed with sleeping.
- Create a soothing physical sleeping environment. A cool room supports the drop in core body temperature, which supports sleep. Make the room as relaxing as possible. If need be, declutter. If you’re bothered by noise and natural light, try ear plugs and an eye mask. Remember, an hour before bed, begin slowing down and lowering lights.
How did you do on this impromptu review of your sleep habits?
You are thoughtful and perhaps over the years you’ve learned to make adjustments. Now, you work longer hours and push yourself harder. Have you become good at hiding the fact that not sleeping enough is a sure way to decrease productivity and happiness, especially over the long haul? You can “get away with” not taking the best care of your sleep needs, but it may be at the subtle or overt expense of your family, patients and most importantly, you.
LEAD coaches are oriented to helping dedicated health care professionals let go of stress, gain insight and take action in areas you consider most important in order to be the best health care professional and human being you want to be. We work with some of the busiest physicians, nurses and residents/fellows who wish to follow their highest professional code — do no harm — and might we suggest adding “to you” to that code.
For more information please visit the Duke Professional and Personal Development Program (PPDP) and Leadership and Enhancement Development (LEAD) Coaching and Consulting Services website or contact Program Director Judith Holder at Judith.Holder@duke.edu or (919) 286-1244.
Articles are written by experienced executive, leadership, performance, communication, interpersonal, wellness and life coaches with behavioral health backgrounds and training in social and emotional intelligence, work-related stress and life span development.