This harmful health issue can influence your practice of medicine

The coronavirus is bad enough on its own. More than 18 million Americans have been infected and well over 300,000 have died, with thousands of new cases, new deaths, and new long-term side effects piling up daily.

Following the horrifying burden of sickness and death are the near-constant undercurrents of anxiety and insecurity. The pandemic has spiked unemployment numbers and complicated food security among children, with the estimated number of food-insecure kids jumping from 11 million to an estimated 18 million, according to Feed America. 

Many unemployed wonder when they’ll return to work. Many who have kept their jobs fear for their safety while on the clock. And on top of that, many are feeling all this pressure weigh on their mental health, as demand for mental health care overwhelms providers.

It’ll be a long time before we understand the full scope of consequences the coronavirus has wrought. But there’s one consequence that nearly all of us have felt since the virus descended on the United States back in March: sleep deprivation.

In fact, sleep loss has become so prevalent in the pandemic era that it’s earned its own name: coronasomnia. “It’s a problem everywhere, across all age groups,” said Angela Drake, a health clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of California-Davis. “Insomnia was a problem before COVID-19. Now, from what we know anecdotally, the increase is enormous.”

But how is sleep loss affecting physicians, and how can they confront it, considering the extraordinary burden of care and high expectations that characterize their jobs during the pandemic? In this article, we’ll explore the problem and solutions.

Consequences of sleep deprivation

There’s no shortage of data to illustrate the dangers of sleep loss. Sleep disruptions have substantial adverse short- and long-term health consequences. In the short term, they can lead to stress responsivity, somatic pain, reduced quality of life, emotional distress, mood disorders, and cognitive, memory, and performance deficits.

The long-term effects are more dire. They include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes, and colorectal cancer. If that weren’t enough, some studies have shown that all-cause mortality is increased in men with sleep disturbances, and that in people with underlying medical conditions, sleep loss diminishes health-related quality of life and increases the severity of common gastrointestinal disorders.

Any physician who’s had a rough night has seen the effects in real-time the next day—you may have felt on-edge, grumpy, and mentally slower or foggier than you would have if you had slept peacefully through the night. A new study, published in JAMA Network Open, quantified and qualified such sleep disturbances on physician performance, and found some harrowing results.

In a cross sectional-study, researchers collected data from 11,395 physicians through wellness survey data from 11 academic-affiliated medical centers between November 2016 and October 2018. Then, they measured associations between sleep-related impairment and occupation wellness indicators like work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment.

They found that sleep-related impairment had statistically significant correlations with burnout and professional fulfillment. What’s more, in a model adjusting for gender, training status, practice specialty, and burnout, sleep-related impairment was associated with much higher odds of self-reported clinically significant medical error when compared with low sleep-related impairment. Those with moderate sleep deprivation reported 53% more medical errors, while those with high and very high sleep-related impairment saw 96% and 97% greater odds of medical errors, respectively.

Need more reasons to pay attention to your sleep cycles? Sleep deprivation kills sex drive, increases depression, ages your skin, and makes you forgetful.

How to get the rest you need

It’s helpful to know the risks of sleep deprivation—especially when you’re a physician and stakes are high. But what can you do to ensure you’re getting enough sleep and lowering your risk of medical errors?  

First, familiarize yourself with this list of 15 scientifically-debunked sleep myths. Then, keep these time-tested sleep-improvement strategies top-of-mind.

• Be careful what you put in your body before bed. Food can make or break sleep. Caffeine and nicotine are well known for their stimulating effects, but even alcohol, a widely consumed depressant, is more likely to disrupt sleep than improve it. The best foods for catching Zs tend to be natural—think nuts, fruits, whole grains, and herbal teas. Fried items like chips and other tough-to-digest foods can kick your digestive system into overdrive, leading to less restful sleep.

• Make a habit of cruisin’ towards a snoozin’. At least 30 minutes (or better yet, an hour) before bedtime, start calming things down. Do activities or routines that help you decompress. Lower the lights and when it’s time for sleep, keep the room quiet and dark.

• Practice the art of relaxing. We tend to think that relaxation is a state in which we don’t have any immediate responsibilities. But anyone who has felt the Sunday Scaries knows that the future can put quite a damper on the present even when you’re in your happy place on the couch. “Spend five to 10 minutes doing a calming routine—such as deep breathing, guided imagery, or progressive muscle relaxation—before you turn in,” the National Sleep Foundation advises. “These decompression techniques can help you feel less stressed and reduce your blood pressure and heart rate.”

• Talk to someone. Sometimes sleep deprivation springs up from a deep well. In these cases, cognitive behavioral therapy (CBT) or medication could be the answer. The American College of Physicians recognizes CBT as a first-line of treatment for sleep problems. It may require six to eight sessions to reach its full potential, but even a single session of CBT has been shown to reduce insomnia severity.