BLOG: Rest: Your life depends on it

ByJohn D. Kelly IV, MD

We live in a sleep-deprived world. More data are accumulating which indicate Americans do not get enough rest. Sleep deprivation will, in time, exact its toll on your body. Millions of years of evolution dictate that most of us need at least 7 hours of good restful sleep at night to optimally function. Sadly, few orthopedic surgeons hit this mark.

We learned to get by on less sleep during our training. We heard things like “Sleep is for sissies,” “Get used to it” or even “This is what you signed up for.”

True, residency and call nights demand much of us, but the mantra of “Show up, shut up, work through fatigue” does not serve our bodies well, especially in the long-term.

Sleep is a precious commodity

More basic science indicates sleep deprivation whacks our immune system, causes weight gain and increases the risks of diabetes, heart disease and cognitive decline. Furthermore, sleep loss is pro-inflammatory. Thus, a lack of shut eye may exacerbate pre-existing inflammatory conditions, such as metabolic syndrome and atherosclerosis. In addition, C-reactive protein levels have been shown to be elevated in patients with sleep apnea.

In addition, restful sleep is essential for processing and retaining new information. Consider the futility of staying up to the wee hours of the morning studying, only to find you are exhausted and nearly useless the following day. Moreover, that you have retained little of what you arduously studied the prior evening.

Sleep loss increases the odds ratio of depression. I have repeatedly written on the truth that happy doctors provide superior care. Happy doctors have more satisfied patients, are named in fewer malpractice suits and enjoy increased compliance by their patients. It is mere folly to sleep less to get more done, only to find that happiness has become elusive.

Rock bottom

It has been said that for meaningful change to occur in one’s life, a rock bottom must be realized. As a former sleep-stingy orthopedist, my epiphany occurred in 1999. As a young surgeon, I was trying to build my practice and still be a good husband and father. Sleep was considered dispensable until I developed a serious eye infection that threatened loss of vision. My infection was caused by an opportunistic organism called Nocardia asteroides. My eye surgeon was quick to mention that this bug was usually seen only in immunocompromised patients.

I simply was not getting enough rest. My immune system was in disarray. I had been subject to frequent colds, struggled with irritability, and mental clarity was a rarity. Since then, I have made getting more rest a priority. Needless to say, I rarely get sick.

Get more rest now

Indeed, it would be tragic to stumble through life on 5 hours of sleep feeling one was accomplishing much, only to succumb to a major illness at a young age. Most of the degenerative conditions many people succumb to at early ages are affected by immune competence.

Cancers, myocarditis, metabolic syndrome and diabetes can be averted, in part, by a sound immune system built on sound sleep habits.

We will accomplish more in a lifetime, if we attend more responsibly to our need for rest. The following suggestions have kept me going strong and helped me evade major illness:

Make sleep a priority. Aim for the 7-hour respite and adjust bedtime accordingly. If bedtime is 10:30 p.m., you will find you will get the essentials in your life accomplished well before this time.
Go to bed and arise at the same time every day. Studies show more restful sleep is attained with routine.
Exercise, preferably in the morning. Exercise deepens sleep, especially if done earlier in the day.
Keep cool. Lower body temperature promotes more restful sleep.
Avoid caffeine and alcohol late in the evening. Allow at least 2 hours for the “nightcap” to be metabolized.
Keep the bedroom for sleep. Resist the temptation to work in the bedroom. The bed should be associated with sleep only.

Adequate rest will help you enjoy the journey and enable you to be your best self to your family, friends and patients.

References:

Bonnet MH and Arand DL. Sleep. 1995;18(10):908-911.

Born J, et al. J Immunol. 1997;158(9):4454-4464.

Lustberg L and Reynolds CF. Sleep Med Rev. 2000;4(3):253-262.

Irwin M, et al. FASEB J. 1996;10(5):643-653.

Mullington JM, et al. Best Pract Res Clin Endocrinol Metab. 2010;doi:10.1016/j.beem.2010.08.014.

Shamsuzzaman ASM, et al. Circulation. 2002;105(21):2462-2464.