REST - Week 1

The Benefits of a Good Night’s Sleep and Mindful Breathing

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Weekly Sleep Topic

Sleep is an essential function that allows the body and mind to recharge. When we get the proper amount of sleep, we wake up feeling energized, invigorated, and mentally alert.

But how much sleep do we really need?

The National Sleep Foundation recommends that people of all ages get a minimum of seven hours of sleep each night. Despite this advice, 30% of Americans fail to get the proper amount of sleep. As a result, the Centers for Disease Control and Prevention (CDC) has actually declared sleep deprivation a public health problem.

Sleep deprivation can negatively affect a person’s physical health, mental wellbeing, and cognitive functioning. Side effects of not enough sleep typically include sluggishness and exhaustion. Sleep deprivation can also trigger or exacerbate more significant health issues such as chronic pain, high blood pressure, anxiety, and depression. Without quality sleep, it also becomes difficult to concentrate, remember, or retain information. For more detail on the effects of sleep deprivation, click on the links below:

Residents and Sleep Deprivation

Residents face numerous safety risks related to sleep deprivation, both personal and patient related. Sleep deprivation is the 2^nd leading cause of motor vehicle accidents (MVAs) and many studies have found an increased risk of MVAs among residents working long hours. Residents who work more than 5 extended shifts in a month have a higher risk of falling asleep while driving and of falling asleep while stopped in traffic. Another study found that ~ 4% of residents reported being involved in a motor vehicle collision caused by falling asleep before starting residency compared with ~19% who reported being involved in the same type of accident during their residency years. Sleep-deprived residents are more likely to experience needle-stick or laceration type injuries with exposure to potentially contaminated blood or body fluids. Fatigue is a contributing factor in 1/3 of these types of incidents and injuries are more likely to occur on a day after working the previous night than on a day after not being on call.

Sleep deprivation also presents many potential risks to patient safety. In the US, one half to 1 million patients die annually from medical errors, and inadequate sleep among physicians may be a factor. Many studies have shown that sleep deprivation is associated with poorer patient outcomes. First year residents committed significantly more fatigue-related medical errors resulting in adverse patient outcomes during rotation months with 5 or more overnight call shifts, compared with rotation months with no extended shifts .

Another study assessed the attentiveness of 20 first year residents working in critical care units in a randomized crossover controlled trial, with interns working both a traditional schedule (e.g., 1 in 3 nights on call) and an intervention schedule with a maximum shift length of 16 hours. Under the new schedule, residents worked 61 hours per week rather than the traditional 77 to 81 hours per week. Residents slept more with the intervention schedule (7.4 hours per day vs 6.6 hours per day). and those with the intervention schedule were significantly less likely to have attentional failures during working hours. When this same cohort was assessed for the incidence of medical errors observed by independent observers, those working under the traditional, rather than the intervention schedule, committed ~36% more serious medical errors, 57% more non-intercepted serious errors, and 5.6 times as many serious diagnostic errors. Clearly sleep-deprivation poses risks to both residents themselves as well as to their patients.

The Sleep Cycle

Not all sleep is created equal, and over the course of a night the body will experience as many as four different stages of sleep. These stages repeat themselves, with the entire cycle (stages 1-4) lasting between 90-120 minutes. Each stage plays an important role in preparing the body and mind for the day ahead, with the first three stages consisting of non-REM (rapid eye movement) sleep and the final stage being REM sleep. Scientists believe that the first three stages are more physically restorative, while REM sleep is associated with memory, thinking, and emotions.

Benefits of Quality Sleep

Getting the proper amount of sleep and adhering to a regular sleep schedule are two ways to dramatically improve your physical health and mental wellbeing. This Monday, learn about how quality sleep can benefit your cognitive functions, physical health, energy levels, and mood.

Cognitive Functions

Evidence suggests that sleep enhances most types of cognitive functions, including memory, problem-solving, creativity, emotional processing, and judgment. These abilities are all necessary components of learning and retention which are particularly important when you are a resident or fellow in training. A history of insomnia or sleep deprivation can have negative long-term consequences on mental acuity, which makes improving the quality and duration of your sleep even more important.

Physical Health

The relationship between sleep and physical health has been thoroughly documented. Sleep deficiency can disrupt normal bodily processes and weaken the body’s immune system and its defense against chronic diseases. Sleep deprivation has been linked to a disruption in hormone production, which can affect appetite and insulin levels, leading to higher rates of obesity and type 2 diabetes. And since blood pressure is generally reduced during sleep, not getting the proper amount of quality sleep time can lead to a higher daily average blood pressure, which in turn may increase the risk of heart disease and stroke.

Mood

Research shows that partial sleep deprivation has a significant impact on mood. According to a study from the University of Pennsylvania, subjects who were limited to only 4.5 hours of sleep a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. When study participants returned to their normal sleep schedule, they reported a dramatic improvement in mood. Implementing a sleep routine or schedule that involves a regimented bedtime, “screen ban,” and comfortable sleep environment can help make falling asleep easier.

Energy Levels

Sleep helps conserve and restore energy through the regulation of two important chemicals—glycogen and adenosine. Glycogen is involved in energy storage in the brain; its levels decrease during wakefulness but are restored during sleep. Adenosine, on the other hand, accumulates during waking hours and promotes sleepiness. The two chemicals work together in that glycogen reduction leads to a build-up of adenosine, promoting sleepiness. When a person fails to get enough sleep, the levels of these chemicals are thrown out of balance, which can lead to fatigue and sluggishness.

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