Voices: The case for a healthy night’s sleep | Shannon MacLaughlan David, MD

The case for a healthy night’s sleep | Shannon MacLaughlan David, MD

There is nothing more glorious than sleeping in on a weekend. I have always found lazy mornings to be luxurious, and it still baffles my family how I left that out of the equation when forging my career path toward gynecologic oncology. Despite my passion for a good night’s sleep, I function pretty well without it. Or so I thought. Turns out that getting less than seven hours of sleep a night on a regular basis is associated with a ton of health issues, including, but not limited to, obesity, diabetes, metabolic syndrome, heart attack, stroke, depression and—wait for it–death. No wonder the American Academy of Sleep Medicine recommends adults get seven to nine hours of sleep a night. So is every gyn onc doomed to a premature death?

Shannon MacLaughlan David, MD

I find myself rationalizing. . . Most of the evidence linking sleep deprivation and mortality in humans is correlative and often confounded by sleep disorders like obstructive apnea. But, at least one prospective study demonstrated in healthy volunteers that sleep debt (four hours a night) for six nights increases night time cortisol, impairs glucose tolerance, and stimulates the sympathetic nervous system. Whether I like it or not, there is a compelling case to be made for getting a healthy night’s sleep.

In case you’re not worried about your own health and longevity, you can’t get around the fact that sleep deprivation is linked to compromised performance, productivity and, in our line of work, safety. Just as the Accreditation Council for Graduate Medical Education (ACGME) has rules about recognizing and mitigating fatigue in trainees, we should probably think about ways a gyn onc can sneak in some restorative sleep from time to time. I don’t have the answers, but I offer here some thoughts and discussion points.
Some people swear by the daytime power nap. Research suggests napping may benefit performance and memory outcomes for some people, but certainly does not replace night time sleep, which has a different physiologic purpose.

So what can you do to maximize the quantity and quality of night time sleep? For starters, put down your phone. And I don’t just mean turn off the ringer. Screen time is stimulating and addictive, and the blue-green light emitted from device screens suppresses the melatonin surge your body needs to fall asleep. This is why sleep experts recommend putting away the tech an hour before bedtime.
If you just can’t do it, at least turn on the Night Shift function in iOS (or Night Mode for Android). These apps minimize the blue light emissions from your smart phone based on the time of day. I also downloaded f.lux onto my laptop for this same purpose. There are also glasses that filter the blue-green light. But none of these things will protect you from whatever it is in the email you insisted on reading before bed, or in the middle of the night, when “you’re up anyway” because someone paged you.

Once you’ve put down your phone, find what helps you relax and declutter your mind. Meditation and deep breathing exercises that reduce your heart rate variability and literally calm your nerves have become very popular for this, and there are a million apps available (but then you risk picking up a device). If meditation isn’t your thing, try this mental exercise that is used by military and pilots to fall asleep in two minutes

1. Relax the muscles in your face, including tongue, jaw and the muscles around the eyes
2. Drop your shoulders as far down as they’ll go (i.e., open the space between your head and shoulder) and relax your arms, “scanning” your upper and lower arm, one side at a time. Allow them to feel heavy and weighted into bed (or whatever surface you’re on!)
3. Breathe out, relaxing your chest, emptying all the breath
4. Relax your legs, starting from the thighs and working down
5. Declutter your mind – Focus on one of these images (this can be tailored for what works for you!):

• You’re lying in a canoe on a calm lake with nothing but a clear blue sky above you
• You’re lying in a black velvet hammock in a pitch-black room
  -or-
• You say “don’t think, don’t think, don’t think” to yourself over and over for about 10 seconds

I am hopeful that the lifestyle of a gyn onc is not going to cause my early demise, but I do believe it’s important to sleep when I can. Remember those sleep-deprived volunteers? Their metabolic anomalies reversed when they were allowed 12 hours of time in bed for a week, during which they slept an average of nine hours. So maybe sleeping in on a weekend isn’t just a luxury, it’s a necessity!

Shannon MacLaughlan David, MD, MS, is a Visiting Associate Professor of Gynecologic Oncology at the University of Illinois at Chicago.