Beginning in your residency days, you started thinking of sleep as an afterthought. It’s something your patients should do, but not something you require. You might want to reframe that thought and realize that improving the quantity and quality of your sleep is something you owe to your patients. It will help you stay sharper, sustain your energy levels throughout your hectic day, and possibly promote better brain health into old age. Improving your sleep will make you a better doctor for your patients. Better sleep begins with better sleep habits. Many of us unwittingly sabotage our sleep throughout the day and at night. Here’s how to create a more sleep-conducive routine. Be mindful of sun exposure A great night’s sleep starts in the morning with exposure to the sun (for doctors on a more conventional schedule). Physicians who work overnight and sleep during the day will want to purchase blackout curtains and a good sleep mask. Doctors who work more traditional hours, however, may want to get as much safe sun exposure during the day as possible. As Harvard’s Division of Sleep Medicine explains, retinal photoreceptor cells communicate with the brain, letting it know whether it’s day or night. Taking daytime breaks to get natural sunlight in your eyes (don’t stare directly into it!) and limiting light exposure at night will help keep your internal clock running on schedule. Exercise during the day The added energy expenditure of exercise is a fantastic way to promote sleep. However, you may want to confine your exercise to the daytime. According to the Johns Hopkins Center for Sleep, we know that moderate aerobic exercise leads to increases in slow-wave, restorative sleep stages. There’s also an added benefit of mood stabilization. However, some might find that exercising late in the day makes it difficult or impossible to sleep. This could be because of the increased metabolic demand that exercise creates. Put work behind you Many of us have had the experience of being home in body but not in mind. We might be sitting at the dinner table, replaying a conversation with a superior that went sideways, or worrying about the packed schedule we’re facing tomorrow. Doctors who take call have the added stress of knowing that their reverie might be interrupted at any moment. Having a ritual that separates you from work will help prevent this stress from creeping in. We know that ritual sounds pretty woo-woo and new-agey, but hear us out. This can be something simple and discreet that won’t make your significant other and/or kids think you’re crazy. Dike Drummond, The Happy M.D., recommends this: When you park your car in your driveway, say to yourself (silently or out loud), “With this breath, I’m coming all the way home.” Draw in a deep breath and let it go, along with any concerns about work. And once you’re all the way home, if you can, put your work email away for the night. Move up dinnertime Now that you’re home, you’ll probably want to eat something. You should aim to eat earlier in the evening rather than later. A 2017 Current Biology study showed that meal timing plays an important role in regulating human circadian rhythms. Researchers demonstrated that late meals delayed plasma glucose rhythms and mRNA rhythms in adipose tissue. The researchers concluded that “human molecular clocks may be regulated by feeding time and could underpin plasma glucose changes.” This delayed metabolic activity could lead to sleep disturbance. The study would seem to indicate that having a consistent, earlier dinnertime, as well as consistent feeding times throughout the day, will keep your circadian rhythm moving steadily. Skip the booze Once you’ve eaten, you might find yourself reaching for a night cap. Or perhaps you enjoy a glass of wine with dinner. If quality sleep is your priority, then you might want to swap these out for a mug of herbal tea. Research on the subject of alcohol and sleep is pretty extensive and conclusive that the two don’t belong together. Take, for example, this overview from National Institute on Alcohol Abuse and Alcoholism. Research shows that while you might fall asleep faster after having a drink, the quality of your sleep will suffer. That wine, beer, or cocktail will disturb lighter, REM sleep stages in the second half of the night, after your body has metabolized the alcohol. Researchers call this the rebound effect. Remember, alcohol is sedatival. As any anesthesiologist will tell you, loss of consciousness and sleep are not the same. Put away devices It’s tempting to unwind with an evening of Candy Crush, or catching up on the happenings in your Instagram feed. But these seemingly harmless pastimes might be making it harder for you to fall asleep. Many devices, including tablets and smartphones, emit a high volume of blue-spectrum light. You’ll recognize the hue from modern LED bulbs. While this light is fantastic for high visibility in an OR, it’s so bright that it suppresses melatonin secretion in your brain, disturbing sleep onset. To avoid this, try putting your phone, and any other devices, away a couple of hours before bed. Read one of these books instead. If you must crush candy, most phones have a display feature that will limit blue light at night. Stick to a schedule You’ve gotten ample sunlight during the day. Made time for an early workout. You’ve put work behind you and skipped the booze. You had a healthy, early dinner, and you’ve cozied up with a good book. Now, it’s time to go to bed. But when, precisely? The key is to be consistent — both with when you sleep and when you wake up, even on weekends. A 2018 Scientific Reports study illustrates why, like children, adults should have a consistent bedtime. The study showed that irregular bedtimes lead to delayed sleep onset and daytime tiredness. Additionally, there was an increased 10-year risk of cardiovascular disease, obesity, hypertension, fasting glucose levels, hemoglobin A1C levels and diabetes. Irregular sleep timing may also have adverse psychological effects, the study says. Researchers saw increased perceived stress among the study participants, as well as depression. TL;DR Use this routine to start improving your sleep: If you work during the day, be sure to get some healthy sun exposure. If you work at night, get some blackout curtains and a sleep mask. Try to put work behind you when you get home. Avoid unnecessary email checks. Workout early in the day. Avoid late meals. Avoid that nightcap or wine with dinner. Limit screen time at night. Keep a consistent bed and wake time. Source
