The Walking Tired

Vickie Morrish Posted by Vickie Morrish on 13 Nov 2017 / Comments

How much sleep are you getting? On Thursday 9th November, the Undergraduate Lifestyle Medicine Society (ULMS) hosted a talk on the Importance of Sleep in Health and Disease by Dr Michael Farquhar. Here’s what he had to say on the matter. Spoiler alert: we all need to sleep more.

How much sleep are you getting? It’s a question we don’t usually think about. And why should we? We’re constantly reminded that life is 24 hours now, after all. We have the night tube, 24-hour gyms and a FOMO-inspired nightlife just waiting for us to stay out of bed for. There’s no time for sleep. And chances are, you’re probably already sleep deprived as you read this.

Big deal? Well, sadly yes. That’s what Dr Michael Farquhar concluded in his lecture on the Importance of Sleep in Health and Disease. Sleep is a big deal. It’s one of the biggest deals because about 1/3rd of our time is spent sleeping, and ultimately, the human body has not evolved to endure late-night Netflix marathons or impromptu 3am trips to KFC (or equivalent fast-food haunt). The average Brit gets around 6 hours sleep a night, which doesn’t sound too bad when you think we should be getting 7-8 hours sleep a night. But missing one hour of sleep a day for every day of the week, means we essentially miss one whole night of sleep per week. No wonder we’re all so tired.

To understand the consequences of sleep deprivation, it’s useful to think (briefly) about some basic sleep physiology. Put simply, we have five cycles of sleep per night, with each cycle lasting roughly 90 minutes and moving through various phases: REM sleep (dream sleep); light sleep (non-REM stages 1 and 2) and deep sleep (non-REM stage 3). Both stages 1 and 2 are easily sacrificed, but stage 3 – our deepest sleep – is the recharge battery bit of sleep. It’s the part of sleep where growth hormone is secreted (the hormone crucial for repair and growth) and is fundamental to our learning and processing of memories throughout the day. When tired, the sleepy subject prioritises this stage, but to compensate, the body will tend to skip REM. Without REM, however, we tend to become short-tempered and ratty, with a depleted capacity for empathy. So if sleep deprived, you are selectively handicapping yourself of REM and putting your relationships at risk (but don’t expect your partner or friends to empathise if they’re also sleep deprived).

But aside from making you crabby, there are a whole host of other symptoms that can be attributed to sleep deprivation. In fact, it can cause almost any symptom from pain and gastrointestinal disturbances to impaired cognitive function. And for healthcare professionals, it’s the latter symptom we need to lose sleep over (although, ideally not). Because according to Dr Farquhar, being awake for 16-18 hours is the equivalent of being at the drink-driving limit. Our reactions will be slowed, and the effects will increase exponentially the more time we stay awake.

Working relentlessly is also dangerous; sustaining function for 12-13 hours without a break is simply not possible. Doctors and nurses need regular and restful breaks to protect patients from the effects of their own fatigue. It’s no secret that tiredness makes us more susceptible to making mistakes, and if that mistake happens to involve a drug calculation and an erroneous decimal point, well, that mistake can be lethal. The Highway Code advises drivers to take a break every two hours, and this thinking needs to be applied to the NHS. We would never let a doctor work if we even suspected them to be over the limit, so why do we insist healthcare workers treat patients when they are literally drunk on tiredness?

The problem is, our sleep cycle is an example of a circadian rhythm; it’s a 24-hour cycle we’ve expertly evolved to stay awake in the day and asleep at night. But it’s a sleep cycle that simply doesn’t gel with 24-hour living and the shift work that comes with that. Working late-night shifts against the body clock is like working jet lagged. And while you might feel strangely awake at 6am after a long, hard night, this feeling is sadly false. You might feel psychologically and physically ready to face the day and drive home, ready to dive into Netflix headfirst – but actually, sleep pressure is still high and you’re just as likely to crash on the drive home (sorry for the reality check). Importantly, after a night of sleep deprivation, it’s an individual’s insight that’s impaired. Confidence levels in decision making remain high, despite the individual making riskier decisions. This, again, can have frightening consequences when it comes to patient care.

What can be done? It’s up to the NHS as an organisation to tackle the issue, but as an individual there are few sleep hygiene habits you can adopt to ensure the best quality kip:

  1. Sleeping environment: bedrooms should be dark, cool, quiet and comfortable.
  2. Regularity: go to bed at the same time and wake up at the same time. And this includes at weekends (sorry).
  3. Avoid screens after 10pm: even if the screen has night shift mode, it’s still emitting light that will suppress the naturals secretion of melatonin (the sleepy hormone).
  4. Get some daytime light exposure to make sure your body is awake and perky at the right time.
  5. Exercise but not too close to bedtime.
  6. Limit alcohol and caffeine.
Sleep is fundamental to all human beings. And as Dr Farquhar rightly notes, doctors are not exempt from basic human physiology – as much as they might like to don the superhero cape. Prioritising sleep is key because low quality sleep ultimately leads to low quality patient care. So what are you waiting for? Stop reading the article, turn off your screens and get some much-needed zzz’s.

Vickie is a 2nd year graduate medical student studying at UCL. Her previous degree was in English Language and Literature at Oxford, where she became interested in healthcare journalism and the role of lifestyle in preventing and managing disease. Vickie is currently preparing a new Lifestyle Medicine Society at UCL!

Follow Vickie on Twitter @vickiejamorr

Are you an undergraduate and interested to learn more about Lifestyle Medicine? Remember to sign up to the BSLM’s free student membership and find the Undergraduate Lifestyle Medicine Society on Facebook.