By Doug Brunk, San Diego Bureau
Holly J. Kramer, M.D., finds it ironic that, given the emphasis in recent years on medical residents getting enough sleep to perform optimally, no one seems to be thinking about the well-being of attending physicians when it comes to getting adequate shut-eye.
“If you think about most people who are in private practice, they have to get up in the middle of the night, go to the emergency room and see patients, and then go to clinic [the] next day,” said Dr. Kramer, an epidemiologist at Loyola University Medical Center (LUMC) in Maywood, Ill.
“They don't have anyone saying, 'You haven't gotten 8 hours of sleep. You need to go back home.' We're putting so much emphasis on residents, yet there's no emphasis on all the other people who are taking care of patients [and] also might be sleep deprived,” she said.
The issue hit home earlier this year when her department chair invited a sleep expert to talk to the attending physicians about the dangers of sleep deprivation. Dr. Kramer was pregnant with her first child at the time, and she began to wonder how the lack of sleep that accompanies a new baby would affect her practice when she returns from maternity leave.
“It made me worried about what it's going to be like to juggle all of this and go to work on very little sleep–[like] going through a 'pseudoresidency' all over again–yet I'm not going to have anyone telling me I need to go home and get rest,” she said. “It's something that a lot of attendings have to deal with. No one talks about it.”
Michael J. Sateia, M.D., president of the board of the American Academy of Sleep Medicine (AASM), agreed that sleep deprivation among attending physicians has been neglected.
The larger medical organizations to which physicians belong really have not focused on this adequately,” said Dr. Sateia, who also directs the sleep disorders center at Dartmouth Hitchcock Medical Center, Hanover, N.H.
“At the AASM, we have been a part of trying to provide the education for residents, [as well as] for staff physicians. I think we still have a long way to go in terms of outreach,” said Dr. Sateia.
Daniel F. Dilling, M.D., of the center for sleep disorders in the pulmonary and critical care division at LUMC, likened significant sleep deprivation to having a blood alcohol level of 0.1, “whether that is an inability to concentrate; problems with dexterity, memory, and recall; or problems with reason and logic,” he said. Sleep deprivation makes things worse.
Shift workers and physicians who are on call for long periods of time tend to struggle the most when it comes to getting adequate sleep.
About 20% of the American workforce is engaged in shift work. This segment of the population generally gets 5–7 hours per week less than nonshift workers, mainly because they “are often faced with the task of sleeping out of sync with their biological clock,” Dr. Sateia said. “Physiologically, that makes it more difficult to sleep. Some people adapt to this reasonably well; [others] adapt to it very poorly. The result is that they are sleep deprived.”
Being on call presents its own hazards with respect to sleep, Dr. Sateia added. “Not only if you have to work, but also the fact that you are in a sense 'on alert.' For many physicians, just knowing that they may be called can interfere with sleep. For others, being called and having their sleep interrupted [is another challenge]. The interruption may only be 5–10 minutes, but then they face difficulties returning to sleep. That can rob them of a good night's sleep.”
Individual sleep needs vary greatly, noted Rebecca Smith-Coggins, M.D., of the division of emergency medicine at Stanford (Calif.) University.
“It's hardwired,” she said. “You're either a person who needs 7 hours, 8 hours, or 9 hours. A lot of times we fool ourselves into thinking, 'I'm getting good at getting away with just 6 hours, because I've been doing it for years.' That's not really true. You're probably functioning with a sleep debt, and you'd feel much better if you start sleeping enough to fulfill what your sleep need is.”
She and other physicians interviewed for this story offered the following advice on how to secure a good night's sleep:
▸ Keep a consistent schedule. Prior to her night shift duties a few times a month, Catherine A. Marco, M.D., tries to get 3 hours of sleep before the shift begins and 3 hours afterward.