Transcript Sleep well….Sleep fast!

Fatigue and sleep deprivation.
Michael Sannito, PhD
Departments of Family Medicine and Psychiatry
University of Oklahoma-Tulsa
School of Community Medicine
Where will we go today?




Definition of sleep deprivation.
Effects of sleep deprivation.
Sleep inertia and sleep debt.
Some adjustments for sleep struggles.
Fact
 Inadequate sleep, fatigue, excessive time
demands and poor social support represent
some of the major stressors in a resident’s
life.
Hillous, J.J., Adler, C.M., and Walters, D.N. (2000). A simple model of stress, burnout and symptomatology in medical
residents. Psychology Health and Medicine, 5(1): 64-73
What is the definition of sleep
deprivation?
 The shortage of quality, undisturbed sleep
that results in detrimental effects on physical
and mental well being.
 A form of psychological torture inflicted by
depriving the victim of sleep.
 An overall lack of the necessary amount of
sleep. A person can be deprived of sleep by
their own body, and mind. Sleep can be
actively deprived by another individual.
Sleep needs
 Humans on average need 8 hrs of sleep per
night
 < 5 hours mental performance deteriorates
Baldwin and Dougherty
 Surveyed 3604 Residents
 20% reported less than 5 hours of sleep per
night
 66% reported less than 6 hours of sleep per
night.
Baldwin, D.C., & Daugherty, S.E. (2004) Sleep deprivation and fatigue in residency training: the results of a national
survey with first and second year residents. Sleep 27, 217-223.
What are the effects of sleep
deprivation? (< 5 hrs per night)





Cognitive changes.
Mood lability.
More sensitive to slights.
Increase in Substance abuse.
Exacerbation of underlying psychiatric
problems (20 % of residents met criteria for
depression).
Effects continued
 Increased accidents: Motor vehicle or
otherwise.
 Exacerbation or initiation of professional
relationship discord.
 Reduction in reaction time.
 Potential for serious medical errors.
Baldwin, D.C., & Daugherty, S.E. (2004) Sleep deprivation and fatigue in residency training: the results of a national
survey with first and second year residents. Sleep 27, 217-223.
Deterioration of cognitive
performance
 After one night of NO sleep baseline
cognitive performance is decreased by 25%
 After two nights decreased by 40%.
 Studies using the Epworth sleepiness scale
show that sleep deprived residents score
the same as those with diagnosed sleep
disorders.
Jha, A.K. et al Fatigue, Sleepiness and Medical Errors. Chapter 46 In: Making Health Care Safer; A Critical Analysis of Patient
Safety Practices. Evidence Report/Technology Assessment: Number 43 AHRQ Publication # 01-E058, July 2001. Agency for
Healthcare Research and Quality. Rockville MD.
Sleep is not optional
 A real physiological need
 Impairs function without the necessary
amount.
Signs and Symptoms of Fatigue







Altered Mood
Apathy
Impaired memory
Inflexible thinking
Nodding off
Medical errors
Microsleeps
Signs of Fatigue (cont)
 Difficulty with focus.
 Repeatedly checking work.
Excessive sleepiness
 May call for an evaluation as it could be a
sign of…
1.Medical condition such as hypothyroidism.
2.Psychological disorder such as depression
3.Side effects of medication (beta blocker).
4.Primary sleep disorder
Fatigue as a normal response to
forced wakefulness.
 Cannot be eliminated but can be managed.
 Night float system seems to cause many
problems.
The challenge of night shift work
 Difficulty sleeping during the day.
 Difficulty staying awake at night.
 Recognize that no real adjustment to a
sporadic and variable night shift is possible.
 Unfortunately the literature suggests that up
to 95% of people scheduled on night shifts
do not adjust.
Prophylactic naps may help
 1 hour nap prior to the night duty may help
enhance awake activity.
 Experienced less stress
 Felt that work load was less burdensome.
Adjustment to night shifts
 Better to limit night work to 1 or 2 shifts.
 Sleep before night shifts (as much as
possible)
 Take mid/late afternoon naps.
 Nap when possible during on call hours.
When to nap




Nap prophylactically
During the afternoon
Brief naps (15-20 minutes) can be helpful
Be careful of longer naps (especially
nocturnal) as they may result in sleep
inertia.
Sleep inertia






Impaired cognition
Severe disorientation
Transitory hypovigilance
Confusion
Difficulty in fully awakening
Takes up to 30 minutes to fully clear
Sleep inertia (cont)
 Residents who manage to reach this stage
are particularly vulnerable as they are often
called on to function after being awakened
from a sound sleep. (slow wave
sleep..REM)
 Many overestimate their ability to function in
this state. Some of the most severe
cognitive deficits reported are secondary to
sleep inertia. Try to take 15 minutes to
awaken.
Sleep Debt
 The difference between the amount of sleep
needed (8+ hours) and the amount of sleep
received.
Sleep debt is associated with






Slower response time
Forgetfulness
Confusion
Depression
Lack of Motivation
Decreased Morale and Initiative.
 In sleep debt, the awareness of being
sleepy is blunted!
Strategies to fight fatigue
 Residency is like a marathon. Drink before
you become thirsty and run in a pack.
 Residency is like kindergarten. Hold hands
and take naps (care for your inner circle).
 Residency puts information in wet cement.
Be careful what imprints you make.
 Savoring.
 Doctoring is a sacred gift, give time to be
grateful and that end of every day,
regardless of how you feel.