{"id":49612,"date":"2021-02-17T10:04:48","date_gmt":"2021-02-17T09:04:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49612"},"modified":"2021-02-24T16:31:27","modified_gmt":"2021-02-24T15:31:27","slug":"sleep-the-underhyped-secret-to-success-and-safety-in-medicine","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/02\/17\/sleep-the-underhyped-secret-to-success-and-safety-in-medicine\/","title":{"rendered":"Sleep: the underhyped secret to success and safety in medicine"},"content":{"rendered":"

\u201cI think\u2014being a medical student\u2014you almost feel guilty for sleeping at any point of the day, even at night,\u201d said Anisha on the <\/span>latest episode of Sharp Scratch<\/span><\/a>.<\/span><\/p>\n

The pressure to minimise sleep through medical school is (at least) twofold: first, the tension between perfectionist tendencies and the bottomless well of facts to learn; and second, the virtue or success associated with early mornings. \u201cThere\u2019s always this thing about morning people having the morning high ground, compared to those who prefer to sleep in\u2014regardless of how late they may have stayed up being very productive, they are often branded as being lazy because they had a lie in,\u201d said Nikki.<\/span><\/p>\n

The reality is that\u2014because the brain continues to develop through adolescence into the twenties\u2014most undergraduate medical students need as much sleep as teens. Mike Farquhar, consultant in sleep medicine at Evelina London Children\u2019s Hospital, joined Sharp Scratch as an expert guest and explained that the mean hours of sleep that adolescents need is around 9.5 hours a night; and, that up to the age of 25, most of us need 7.5 to 9.5 hours a night.<\/span><\/p>\n

Regardless of age, though, Mike emphasised that sleep is an individual thing. \u201cPeople expect there to be simple straight forward answers, but there isn\u2019t. The only person that really knows how much sleep you need is you.\u201d And getting the amount of sleep that is right for you is precious. \u201cIf you are chronically sleep deprived\u2014if you are cutting off the last two or three hours of sleep every night of your life\u2014the bit of sleep you are missing out on is the bit that is most important for learning and memory, and being a nice person actually.\u201d<\/span><\/p>\n

Knowing the benefits of adequate sleep, I often wonder about night shifts and the rota that awaits me in six months\u2019 time, when I become a newly qualified doctor. I used to dread it. But since the first episode of Sharp Scratch (<\/span>How to survive a night shift<\/span><\/a>), I\u2019ve seen Sharp Scratch friends survive their first years of doctoring, I\u2019ve read Mike\u2019s <\/span>guidelines for managing the effects of night shifts on health<\/span><\/a>, and I\u2019ve spent one night shift putting all the tips into practice\u2014naps, snacks, caffeine, and all. \u201cCome back to me after you\u2019ve done six months of nights,\u201d said Mike with a smile after I proudly listed my efforts.<\/span><\/p>\n

He explained that my experience of a night shift is common: to feel at your worst around three or four in the morning, \u201cwhen every single cell in your brain and your body is telling you to be asleep,\u201d followed by a \u201csecond wind\u201d of feeling better the closer it gets to the morning. Although we feel more alert around this time, our reaction times and other markers of fatigue continue to decline, putting us at risk of making mistakes. \u201cThe reason that I started doing that work [calling for organisational awareness of the importance of sleep, rest, and breaks] when I became a consultant is because, very sadly, we lose doctors and nurses every year, who, after working a night shift, fall asleep behind the wheel of a car and they die. And that is a risk that we should talk about a lot more, and we should be doing a lot more to actively reduce that risk.\u201d<\/span><\/p>\n

Night shifts are essential to healthcare, and hostile to our physiology, but the effects can be mitigated. There is an organisational responsibility to maximise our capacity for sleep, too, such as designing rotas that lessen the “jet lag” of changing shifts. \u201cSome of that is in things like <\/span>the BMA\u2019s Fatigue and Facilities charter<\/span><\/a>. Some of it is wired into the junior doctor contract. There are certain standards when we\u2019re thinking about making rotas,\u201d said Mike. \u201cIf you then find that you\u2019re in a rota that you think doesn\u2019t meet or follow those guidelines, then your usual escalation in through your junior doctor\u2019s forum, your BMA [British Medical Association] representatives, and whoever you\u2019ve got to amplify your voice.\u201d<\/span><\/p>\n

Finally, he advised us to tell your organisations if you miss your breaks or stay late to finish your work. In the UK, the mechanism for this is exception reporting.<\/span> \u201cI promise you, because this is universal, as new junior doctors\u2014you will get to six o\u2019clock when you\u2019re meant to be going home [\u2026] and tell yourself that the reason that you\u2019re not going home yet is that you\u2019re not good enough [to have finished your tasks in time]\u2014and that\u2019s not your fault, that\u2019s not your problem, you are there to learn as you do the job. But if you\u2019re not going home at six o\u2019clock, whatever the reason, you need to tell us that\u2014because otherwise all that happens is that this is institutionalised, enshrined. So, using those protective mechanisms helps. But it needs everybody to do it.\u201d<\/span><\/p>\n

Individually, the key to managing the effects of night shifts\u2014on your health, and on your safety\u2014is maintaining a good core sleep routine. Now is the best time to start. \u201cAs medical students you feel guilty if you\u2019re not up burning the midnight oil,\u201d said Mike, \u201cbut actually, from a learning point of view, you are much better in prioritising your sleep. Sleep is absolutely fundamental to learning.\u201d<\/span><\/p>\n\n\n\n
See also<\/strong>:<\/p>\n