Physician's Weekly Article - Inadequate Sleep: Not Just Your Patients’ Problem

       Doctors are failing to get the sleep they need to function at their best, but can the tides be turned?

      While much attention has been paid to addressing sleep problems in patients, less attention has been focused on the effect of sleep deprivation on physicians. “Sleep problems can affect physicians in all specialties, and they shouldn’t be considered exempt from these issues,” explains Rochelle Goldberg, MD, FCCP. “Studies have assessed the effect of sleep on physician work hours and call hours during training and in the practice of medicine, but the data show that the importance of sleep is often desensitized among physicians. Adequate sleep is typically considered optional or dispensable.”

      In March 2008, the American College of Chest Physicians Sleep Institute (ACCP-SI) released findings from a survey of physicians assessing sleeping habits among doctors (Table 1). A large proportion of physicians reported that they are not getting the amount or type of sleep they need to function optimally. The findings also indicated that physicians’ current work schedules may contribute to inadequate sleeping habits. Additionally, the ACCP-SI survey showed that many physicians reported making up for lost sleep on the weekends or their days off by sleeping more hours per night.

      Sleep Often Discredited

      “Most physicians sleep fewer hours than what they need to achieve peak performance,” says Dr. Goldberg. “While this isn’t earth-shattering news, this should sound an alarm for physicians. We know that sleep is important to the overall well-being of our patients, but physicians get, on average, about an hour less sleep during their work weeks. However, the survey showed that most physicians report requiring more than the usual 7 to 8 hours of sleep to reach peak performance. We recognize the need for adequate sleep, but there’s a gap between perceived need and what is achieved among physicians.”

      Analyzing Insomnia & Caffeine

      The ACCP-SI survey indicated that there were few reported cases of insomnia or difficulty initiating or maintaining sleep among physicians, but many respondents indicated that they did not feel refreshed upon waking at least a few nights per week. The prevalence of insomnia among doctors is relatively rare, but Dr. Goldberg notes that this is likely due to the fact that the chronic self-imposed sleep deprivation associated with the job eliminates most insomnia complaints. Other findings showed that most physicians indicated that sleep issues did not significantly impact their work performance or other daily activities, but nearly one of every five respondents reported missing at least one family or leisure activity due to sleep issues.

      The survey also compared findings with those from the 2008 National Sleep Foundation’s “Sleep in America Poll” to assess caffeine use. The comparison showed that caffeine was used more commonly among physicians than the general population, yet each averaged about 3 cups per day (Table 2). “Most physicians reported using caffeine out of habit rather than to ‘keep awake,’” says Dr. Goldberg.

      Physicians Report Living Healthier

      Interestingly, despite the findings of the ACCP-SI survey on physician sleep habits and caffeine consumption, the survey showed that doctors reported better overall health than the general population. “Physicians view themselves as having excellent health despite significant gaps in their sleep health,” Dr. Goldberg says. “Physicians are less likely to smoke, be obese, or be sedentary, all of which are lifestyle factors that can have a negative impact on overall health. Although physician sleep habits may not be ideal, doctors do recognize the relationship between behavior and health. The concern isn’t whether or not physicians are doing their job well or ensuring patient safety; the concern is that many physicians might not be talking to their patients about sleep issues because they fail to recognize it in themselves.”

      Eliciting Concept Changes

      According to Dr. Goldberg, the ACCP-SI survey findings can help raise awareness of poor sleep among doctors, but she cautions that this is just a start to conquering the problem. “Physicians seeking to improve their sleep habits need to look at the problem from both personal and professional aspects,” she says. “We should look at the results and ask where we fit in to the information that has emerged. It’s important to look at what is being sacrificed on a personal level and what is being done instead of sleep. At the professional level, it’s important to determine if the daily actions we take are in the best interests of our patients and our career. If poor sleep is related to work and job-related stress, then it may be necessary to look at issues surrounding efficiency to gain a better understanding. As a society, we often think that the longer we’re awake, the better off we are because we can do more and be productive. However, sustained nightly rest that is adequate can increase efficiency and perhaps enable physicians to focus more on sleep problems in their patients rather than in themselves.”

      Rochelle Goldberg, MD, FCCP has indicated to Physician’s Weekly that she has worked as a paid speaker for Cephalon and GlaxoSmithKline.