Sleepy Head: Sleep Deprivation & Early-Career Clinicians

For residents and early-career clinicians, a lack of sleep is an ongoing health hazard. Endocrine News looks at ways to help you cope with sleep deprivation so you can give your patients the best care possible, as well as take care of your own health.

Sleep deprivation has long been a hallmark of medical residents and other early-career physicians.

The term “medical resident” originated from Dr. John Osler, who developed the concept of the country’s first medical residency program in the late 1800s at the Johns Hopkins Hospital in Baltimore. There, trainees moved into an administration building affiliated with the teaching hospital where they learned for many hours a day, as much as possible, especially via bedside teaching.

Nowadays, while residents aren’t officially living at the hospital, it can still feel that way. With current clinical and educational work hours for training set by the Accreditation Council for Graduate Medical Education (ACGME) at 80 hours per week, long hours and sleep deprivation are still a prominent concern for early-career physicians. Meanwhile, the American Academy of Sleep Medicine (AASM) recommends all adults, including those in the medical community, sleep seven or more hours on a regular basis for optimal health.

“Sleep deprivation can impair the accurate recognition of emotions, per one study. Healthy sleep can enhance personal interactions and positively impact your conversations with patients.”

So how can residents and other early-career physicians get better rest while learning how to practice medicine?

Why Prioritize Sleep?

“It’s important for healthcare providers to realize that your own health is just as important as your patients,” says Fariha Abbasi-Feinberg, MD, FAASM, FAAN, board member of the American Academy of Sleep Medicine (AASM) and a practicing sleep medicine physician and medical director of Sleep Medicine with Millennium Physician Group, and board certified in sleep medicine and neurology, in Fort Meyers, Fla. “It’s especially important for physicians to prioritize sleep as part of a healthy lifestyle. Your ability to provide quality care for your patients is dependent on the vitality of your health and well-being.”

Research supports the argument for well-rested doctors in many areas, including physical, emotional, social, and intellectual health, among other aspects.

“Healthy sleep can help drive a positive outlook and a heightened sense of professionalism,” says Abbasi-Feinberg, citing research on sleep deprivation and increased anxiety and depression. Another study links better sleep to improved physical performance and stamina.

“A physician’s social skills play an important role in providing patient-centered care,” she says. “Insufficient sleep can hinder your patient-provider communication. For example, sleep deprivation can impair the accurate recognition of emotions, per one study. Healthy sleep can enhance personal interactions and positively impact your conversations with patients.”

The AAA Foundation for Traffic Safety suggests that an average of 328,000 car crashes in the U.S. involve a drowsy driver each year, including 6,400 fatal crashes. “These accidents are preventable with healthy sleep,” Abbasi-Feinberg says.

The National Safety Council reports that 13% of workplace injuries can be attributed to fatigue. “Healthy sleep can improve quality of work and help reduce fatigue-related errors, which is crucial in the medical field,” she says. “Sleep also helps individuals reach peak work performance.”

For those learning to be physicians, sleep’s influence on the intellect is crucial. “Sleep helps your brain function properly. As people sleep, the brain is forming new pathways to help them learn, process and remember information. It is important to recognize that insufficient sleep can impair your concentration and academic performance,” she says.

Additionally, a recent study of medical center nurses found a connection between insufficient sleep and symptoms of common sleep disorders. “According to the authors, nearly 100,000 deaths are estimated to occur each year in U.S. hospitals due to medical errors, and sleep deprivation and sleep disorders are significant contributors to this risk,” Abbasi-Feinberg says.

What Doctors Can Do

The ACGME is aware of sleep’s importance and urges medical schools to make rest a priority.

Medical education programs must educate all faculty members and residents to recognize the signs of fatigue, sleep deprivation, alertness management, and fatigue mitigation processes, and encourage residents to use those processes to manage the potential effects on fatigue on patient care and learning, notes Timothy P. Brigham, MDiv, PhD, the chief of staff and chief education and organizational development officer for the ACGME.

“Providing medical care to patients is physically and mentally demanding,” Brigham says. “Night shifts, even for those who have had enough rest, cause fatigue. Experiencing fatigue in a supervised environment during training prepares residents for managing fatigue in practice. It is expected that programs adopt fatigue mitigation processes and ensure that there are no negative consequences and/or stigma for using fatigue mitigation strategies.”

The ACGME guidelines emphasize the importance of adequate rest before and after clinical responsibilities, he continued. Strategies include, but are not limited to:
• Strategic napping
• The judicious use of caffeine
• Availability of other caregivers
• Time management to maximize sleep off-duty
• Learning to recognize the signs of fatigue
• Self-monitoring performance and/or asking others to monitor performance
• Remaining active to promote alertness
• Maintaining a healthy diet
• Using relaxation techniques to fall asleep
• Maintaining a consistent sleep routine
• Exercising regularly
• Increasing sleep time before and after call
• Ensuring sufficient sleep recovery periods

Finding time to sleep when away from work is beneficial, research finds. One small study, published in Academic Medicine analyzed 29 first year internal medicine residents. Researchers found that subjects who took a short midday nap of about 5-10 minutes showed better cognitive functioning and more alertness than a group who didn’t nap during the same time period.

“It’s important for healthcare providers to realize that your own health is just as important as your patients.”

The American Academy of Sleep Medicine offers a Sleep Health and Wellness Resource, a free online tool designed for medical students, residents and fellows. It gives information on how to evaluate the sleep you’re getting and how to improve it.

Ultimately, it’s important for residents and others to take sleep seriously.

“Sufficient sleep is one of the three pillars of a healthy lifestyle, along with good nutrition and regular exercise,” Abbasi-Feinberg says. Insufficient sleep can be a symptom of “several of today’s public health epidemics, including cardiovascular disease, diabetes, and obesity.”

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