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Sleep Deprivation

"We shouldn't take it lying down"
By: Stef dela Cruz, MDSleep Deprivation

Not-so-fun fact: Doctors who are supposed to be proponents of health – and, by default, of good sleep – are also unwitting proponents of a widespread professional culture of sleep deprivation.

As doctors, we know it is unnatural and unhealthy to ignore the urge to sleep. We know that always staying up late or, worse, foregoing a good night’s sleep altogether, eventually takes its toll on the body.

The stubborn mules that we are, we deprive ourselves of sleep, anyway. The sun sets and rises with us never catching a wink. Patients come and go with our sleep-befuddled brains trying to cope, chugging along like neglected trains long in need of maintenance.

Predictably, we soon find ourselves giving in to slumber. Sleep, after all, sings to us like a siren, beckoning us to lay our weary heads on its lap and savor the offered respite. You will then find us sleeping where our brains choose to shut down: in a chair in the emergency room, on the floor of the operating room, or in front of our laptops, drooling and snoring heartily, our e-reports sadly unfinished and still waiting for our next keystroke.

Make no mistake: We are bad, bad examples of how healthy people should sleep.

The problem is that we don't think it's a problem – at least, not one we need to address and share with the world. If our eyelids feel heavy during the night shift, it's nobody's problem but ours.

Understandably, the rest of the world begs to differ. A sleepy doctor, especially one who eventually gets a bit of shut-eye while still on call, is an issue that patients don't want to sleep on.

In 2015, Mexican blogger Erica Rojas Juarez published an article about a specialist-in-training who took a nap while on the job. The author criticized the snoozing physician: Why should a doctor sleep while still ministering to patients in the hospital?

Complete with incriminating pictures, the blog post elicited a worldwide reaction – well, probably not the kind that the blogger expected.

The internet proverbially broke down, but not from irate patients demanding that doctors stay awake. No, it was the entire medical community that revolted, taking up arms in the most in-your-face way possible, and using the most potent yet peaceful weapon they could find: social media.

Are medical errors attributable to sleep-deprived doctors? Findings have raised more questions than answers. But where there is a dichotomy of opinion, evidence can provide direction. After all, doctors are good at using evidence to come to an educated conclusion.

Let's start with what happens when someone is deprived of sleep.

1. After sleeping for less than five hours, an otherwise-healthy adult will no longer be as alert as his peers. According to a 1982 study by Mary Carskadon and William Dement published in the Journal of Sleep Research & Sleep Medicine, participants’ Multiple Sleep Latency Test scores showed different degrees of daytime sleepiness depending on the number of hours they slept at night.

2. After foregoing an entire night’s sleep, a person will experience a decline in cognitive function. Staying awake for 24 hours had the same effect as having a blood alcohol level higher than 0.08 percent, the legal limit for people on the road, reported Drew Dawson and Kathryn Reid in a 1997 study published in Nature.

3. Fatigue, such as that from sleep insufficiency or chronic sleep deprivation, contributes more to motor vehicular accidents than drinking. This is according to a 2000 consensus statement by a group of sleep researchers, compiled by Torbjorn Akerstedt and published in the Journal of Sleep Research.

4. Pretty much like financial debt, sleep debt is hard to forget. Chronic sleep deprivation of even just two hours each night leads to sleep debt that human beings have yet to successfully adapt to, according to a 1997 study by David Dinges and colleagues published in the journal Sleep.

5. Among doctors, sleep deprivation leads to compassion fatigue, marital problems, and suicide. During a five-year period, more than 50 percent of training programs for internists granted leaves of absence to their residents due to emotional impairment, according to a 1986 study by Jay Smith and his colleagues published in the Journal of the American Medical Association.

A 2010 article by Milton Kramer published in Frontiers in Neurology said there was no strong evidence that chronic sleep loss caused medical errors. In the study, although junior doctors thought they could work better without sleep deprivation, the care they provided their patients was purportedly no better if they worked fewer hours.

Does that mean doctors are, for some strange reason, unlike the rest of the human race?

Could it be that the question of whether sleep deprivation leads to medical errors or not is beside the point? There is no question that without good sleep, we are putting doctors’ physical, social, emotional, and mental health at risk. Claiming that doctors can brave sleep deprivation and emerge unscathed is tantamount to thumbing our noses at our own findings about sleep physiology, findings which we wholeheartedly acknowledge to be true.

Will doctors tell their patients it's okay to keep losing sleep? Will physicians soon tell pilots it's okay to fly a plane even after staying up all night? Trying to prove (or disprove) the value of quality sleep in doctors’ lives, although a scientific query, is quite possibly a move to discredit our own science.

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