During a discussion about wellbeing with practice managers, several participants described waking up in the middle of the night with work concerns running through their minds. Much head-nodding ensued in recognition of this common experience. Therefore in writing this, I am aware that the whole healthcare team may all be in need of a better night’s sleep.
Why does sleep matter?
Sleep performs a vital function in protecting our mental health, helping us to pay attention, to learn, to solve problems, be creative and make sense of our lives.
Poor sleep is related to a higher mortality rate in accidents that are more likely to happen during micro-sleeps.
Several catastrophes like Chernobyl were partly linked to sleep-deprived human error.1 Sleep deprivation is also linked to higher morbidity from diabetes, heart disease, cardiovascular accidents and obesity, infections and cancer.
Recent research suggests that adequate sleep plays a role in removing amyloid, so delaying the onset of Alzheimer’s.2 A lack of sleep predisposes us to depression and anxiety,3 to poorer decisions, and an increased risk of suicide. In the clinical setting, poor sleep leads to a reduction in the safety of care provided.4
When we have slept less well, our physiology changes such that we take longer to come down from stress.4 We are more likely to reach the end of the day still in a hyper-aroused state, meaning we are less able to switch off and sleep. So a vicious cycle of stress-insomnia-stress ensues.
Not only do we die earlier and suffer diseases as a result of poor sleep, but each day is a hard slog when we are unrefreshed and shattered.
How can I improve my sleep?
Keep regular wake and sleep times throughout the week. Try to get as much sunlight and physical activity as you can, especially early in the day, to enhance your circadian rhythm.
Keep a cool, dark, quiet bedroom that is only used for sleep, sex and dressing, with no electrical gadgets (too much light late at night disrupts the release of melatonin5).
Unwind earlier in the day, perhaps by talking to colleagues, pursuing a hobby or taking up mindfulness. Have an hour of quiet relaxation before bedtime – listening to music or reading. Avoid too much caffeine, particularly from mid-afternoon – its half-life is 7-9 hours.
Nicotine should be avoided! Alcohol is also linked to poorer quality sleep, so drink in moderation. If you are lying awake for more than fifteen minutes, do something relaxing away from bed to strengthen the connection between bed and sleep.
Often sleep problems become entrenched because our thinking and behaviour patterns make things worse - thoughts like 'I MUST get to sleep now', with anxious clock-watching, followed the next day with an obsessional awareness of how tired we are.
How can we get out of this trap?
Sleep comes naturally once we are relaxed and happy enough in life, and have let go of controlling our relationship with sleep. CBT and ACT (acceptance and commitment therapy) are two therapeutic modalities that are particularly useful.
It is worth taking into account the big picture of your life: make sure that you are in harmony with what matters to you. Are you getting enough friendliness and connection? Is your work-life balance good, so that you have a greater sense of perspective on the daily niggles?
These are some of the factors that lead to being the kind of person who doesn’t need to try to sleep.
- Dr Jennifer Napier is a GP with special interest in occupational medicine. She has researched wellbeing and workforce issues, and works through Contextualyse to train and consult on how to create healthy, productive workplaces.
- Mitler, M. et al. Catastrophes, Sleep, and Public Policy: Consensus Report. Sleep 1998: 11(1); 100-9.
- Lim, M. et al. The sleep-wake cycle and Alzheimer’s disease: what do we know? Neurodegenerative Disease Management 2014: 4(5); 351-62.
- Williams, P.G. et al. The effects of poor sleep on cognitive, affective and physiological responses to a laboratory stressor. Annals of Behavioral Medicine 2013: 46(1); 40-51
- Arimura, M. et al Sleep, mental health status and medical errors among hospital nurses in Japan. Industrial Health 2010: 48; 811-7.
- Duffy JF, Czeisler CA. Effect of Light on Human Circadian Physiology. Sleep Med Clin. 2009: 4(2);165-77.