Why Don’t Doctors Get Enough Sleep? Is it a Toxic Training?

Sleep Equity for Global Health. Do doctors need sleep?
Why don’t the Government and Medical Education systems the world over explain why diminished capacity because of poor sleep is not a problem for healthcare workers?
Why is there no Sleep Equity for healthcare workers? Why is it okay to ignore the elephant in the room in this case? Why do students and residents everywhere end up thinking it’s okay to sacrifice sleep for work or play? Why is there no real talk about sleep equity? On this world sleep day we discuss the very topic, that makes me hope things will be better.

In 2024, I wish there would be a worldwide rethink about the need for sleep hygiene to be at the center of good health. The 2024 World Sleep Day Theme ‘is “Sleep Equity for Global Health.”
Sleep is essential to health, but measurable differences in sleep health persist across populations across the world, creating additional burdens and reinforcing health inequities.

Hello isn’t this the perfect theme to write about? This is one reason I gave up a well-paying stable Government job in a Medical College.I was tired of being without sleep for 3 days a week.It got to be too much and I was on the way to becoming a basket case before each of those days. Sometimes it was 48 hours continuous on call and that didn’t work well with a toddler in tow.

But let me start at the beginning. As a medical student, I was used to long hours of study. But I always liked my 7 /8 hours night sleep. I slept well. Things changed when it was our internship when sleeping became fragmented and scattered and we were welcomed into the torture of sleepless nights with no day-off the next day. There is a day off theoretically, but you are supposed to finish all pending work and report to your superiors and by the time you go home, you are so high on adrenaline and stress hormones that falling asleep is next to impossible. But I took naps here and there, keeping it like a relay with a close group of friends. Plus, my boyfriend, now husband was very helpful and when I was ill or not able to manage a night, he exchanged with me. That was very kind of him. That debt of kindness is impossible to repay. But his health suffered too. So my guilt was there manning the fort.

But during the PG days, that benefit was absent because now we were in two different medical colleges and work was hard, but once we got married, things got better somewhat. Also, night duties in my UG and Pg involved being with a group of friends, seniors, and consultants only a phone call away. There was work and sleeplessness, but not too much stress. Duties could range from 90 hours to 120 hours a week depending on the year of residency. I managed.

In between I was lucky to find a low-pressure consultancy during which I became a mommy.

But then things got worse with my posting in a district medical college where the horror of horrors, you don’t know it till it faces you , there was no restroom for doctors, but only for students and nurses. So I had to either sit in the ward or keep visiting from the rental I was staying at. Other than the problem of drunk ambulance drivers, drunk people on the streets, and drunk patients in an emergency, the horrifically barking groups of stray dogs kept my emergency duties sleepless in more ways than one.

The worst part was that the stress was so bad that it started giving me nightmares two days before the duty was scheduled. There was no backup, no team, no support system. Only inappropriate behavior, lawlessness disregard for the truth, turning a blind eye to the problem and just blaming the messenger. Some of my senior colleagues were helpful and it was because of them that my night duty loads were less gradually and theirs and my husband’s support helped me do a job that I loved but couldn’t live with anymore. Not with sanity at least.The time was coming for a change and winter was not far behind.It was Septemeber of 2018 when my husband and I resigned.

After working for around seven years, I gained back my sanity and resigned from a permanent government job for which I had always dreamt, planned, and worked. I still have PTSD when I remember those nights.

I have been a private practitioner since 2018, and I choose my work with care. I can be a good doctor and do my best only when I am also a healthy, well-rested doctor. It is important to never compromise certain things in life. One of those is sleep (both quality and quantity) and the second one is inner peace.
You cannot have the second one without a good night’s rest.

Medical Conditions Precipitated by Sleep Deprivation[1,2,3]

• Diabetes mellitus & insulin resistance
• hypertension
• obesity
• obstructive sleep apnea
• depression, and anxiety.
• Higher risk for heart attack and stroke.
• Increased mortality & morbidity from all causes
• Poor performance on waking: increased accidents & injuries
• lower self-reported quality of life
• Reduced family well-being,
• Reduced use of healthcare

The best method to sleep better is to sleep on time and wake up on time according to the circadian rhythm. Late nights, excessive social media scrolling, too much screen time, heavy meals, late at night, and too much excitement before bedtime can all cause disturbed sleep. For doctors though,it will need regulations be implemented by straight-thinking, non sleep deprived people.

What Governments can do to ensure Sleep Equity for Doctors and Other Healthcare Workers?

• Recruitment in adequate numbers so that the emergency services are not affected.
• Avoid overworking sleep-deprived healthcare workers citing emergency. Instead, try number one.
• Maintain soundproof, hygienic, gender separate, safe on-call restrooms.
• Ensure adequate time off for the sleep cycle to become regular. Sleep debt is serious.
• Night duties need to be in a safe space to avoid additional stress.
• Access to clean drinking water, clean, healthy food, toilets, and safe transportation while on night emergency duties.

Hope you sleep well at night , because nothing’s worth losing your sleepover.

References:

1.Sleep Deprivation
Joseph A. Hanson 1, Martin R. Huecker 2
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
2023 Jun 12.

https://pubmed.ncbi.nlm.nih.gov/31613456/#:~:text=Excerpt,apnea%2C%20depression%2C%20and%20anxiety.

2.The Dangers of Sleep-deprived Physicians https://www.amnhealthcare.com/blog/physician/locums/the-dangers-of-sleep-deprived-physicians/

3.Sleep deprivation and physician performance: Why should I care? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200708

Writing this for UBC and Blogchatter blog hop