Sleep Deprivation in Doctors

Introduction

Sleep deprivation is a common problem among doctors and other healthcare professionals and can have serious consequences. Studies have shown that sleep deprivation can lead to several negative outcomes, including decreased cognitive function, impaired judgment, and an increased risk of errors and accidents. It can also negatively affect physical health, including an increased risk of developing chronic conditions such as heart disease and diabetes ^1,2.

Because sleep deprivation among physicians may be dangerous for patients and unhealthy for physicians, healthcare professionals must consider currently accepted principles of human sleep requirements, the repercussions of sleep loss, and ways to get adequate sleep to maintain their physical and mental health ^1,2.

Human sleep requirements

The average adult needs over 8 hours of sleep per night. While sleep requirements differ from person to person, they are genetically fixed, do not alter with age, and cannot be trained. Many doctors feel that motivation can influence this fundamental aspect of functioning. While a rapid adrenaline rush in an emergency may temporarily improve awareness, it does not change the underlying physiology ^1,2.

Consequences of sleep loss ^1-3

Some well-designed studies of physicians have shown that sleep deprivation has a number of consequences:

Increases the number of errors in an intensive care unit.

• Impairs language and math skills.
• Results in poorer quality intubations.
• Impairs ECG interpretation.
• Increases the time required to perform laparoscopy and the rate of errors.
• Increases motor vehicle accidents.
• Reduces empathy for patients and results in poor communication.
• Causes significant family and marital stress.

Adults who sleep less than 5 hours each night show a decline in peak alertness. A considerable cognitive decline may develop after just one missed sleep. Moreover, chronic sleep deprivation, defined as 2 to 3 hours per night less than ideal for an individual, results in sleep debt. Humans do not adapt to sleep debt ¹.

Cognitive decline, altered mood, reduced motor skills, lower motivation, and lack of initiative can all be observed after 5 to 10 days of chronic sleep deprivation ¹.

Though it is difficult to quantify the long-term health effects of chronic sleep deprivation, some evidence suggests poorer cardiovascular and gastrointestinal health and increased risk of breast cancer and early death ¹.

Research has shown that it might take up to four days to recover from a single hour of missing sleep and up to nine days to eliminate sleep debt ⁴.

Healthcare workers must begin to consider being impaired by chronic sleep deprivation, similar to alcohol. According to research, twenty-four hours of wakefulness results in impairment similar to a blood alcohol level of 0.1% ¹.

Several other studies have found that sleep deprivation significantly impacts physician performance and patient safety. One study reported that interns working a traditional schedule of more than 76 hours per week made 36% more serious medical errors than those working an average of 65 hours per week ³.

Siraj O. et al. investigated the effect of on-call sleep deprivation on physicians’ mood and alertness and found that more than 87% of participants slept 5 or fewer hours when working an on-call shift. The percentage of physicians who were alert after being on call was significantly lower than those who were alert before. The study concluded that acute sleep deprivation caused by working long on-call shifts reduces daytime alertness and has a negative impact on the mood state of physicians ³.

Fatigue has also become a concern in terms of patient safety. According to the Institute of Medicine report To Err Is Human, medical errors cause 44,000 to 98,000 deaths yearly. While there are certain caveats in interpreting the data, the figure is undeniably large: it is the equivalent of a jumbo jet crashing daily. It is difficult to determine the influence of fatigue on these errors. However, because fatigue impairs performance and decision-making, it is a likely contributor ².

How to deal with the problem?

Here are some steps that physicians can take to deal with the problem of sleep deprivation ^1,2:

1. Make time for sleep: One of the essential things physicians can do to improve their sleep is to ensure that they set aside enough time for sleep. This may involve creating a regular sleep schedule and sticking to it as closely as possible, even on weekends and holidays.
2. Create a sleep-friendly environment: Physicians need to create a sleep-friendly environment in their bedrooms. This may involve using a comfortable mattress and pillows, keeping the room cool, and eliminating as much light and noise as possible.
3. Practice good sleep hygiene: Good sleep hygiene involves a set of habits that can help you sleep better. Some things that physicians can do to practice good sleep hygiene include: avoiding caffeine, alcohol, and heavy meals close to bedtime; avoiding screens (such as phones, laptops, and TVs) for at least an hour before bed; and getting regular exercise.
4. Make use of naps: Based on sleep cycles, the optimal length is 45 minutes for a short nap and 2 hours for a long nap.
5. Seek medical help if necessary: If sleep deprivation is persistent and causing significant problems, physicians may need medical help. This could involve seeing a sleep specialist who can help diagnose and treat any underlying medical conditions that may be causing sleep deprivation.

Conclusion

The loss of sleep caused by long work hours can affect the health of physicians and the safety of patients. Healthcare professionals need to prioritize getting enough sleep and manage their work hours in a way that allows them to get sufficient rest. This may involve adopting healthy sleep habits, such as setting a consistent bedtime and creating a sleep-friendly environment, as well as finding ways to manage other stressors that can interfere with sleep. It is also essential for healthcare organizations to support their employees in getting the rest they need by providing appropriate schedules and policies that prioritize the well-being of both healthcare professionals and their patients.

References

1. Sleep deprivation among physicians. [Cited: 23 December 2022]. Available at: https://bcmj.org/articles/sleep-deprivation-among-physicians
2. Howard SK. Sleep deprivation and physician performance: Why should I care?. InBaylor University Medical Center Proceedings 2005 Apr 1 (Vol. 18, No. 2, pp. 108-112). Taylor & Francis.
3. Wali SO, Qutah K, Abushanab L, Abushanab J, Krayem A. Effect of on-call-related sleep deprivation on physicians’ mood and alertness. Annals of thoracic medicine. 2013 Jan;8(1):22.
4. Sleep Debt and Catching up on Sleep. [Cited: 23 December 2022]. Available at: https://www.sleepfoundation.org/how-sleep-works/sleep-debt-and-catch-up-sleep.