Most winters, I teach a course on sleep for medical students. To complement lectures on sleep waves and the fundamentals of sleep-disordered breathing, my course emphasizes the science around sleep (quantity and quality). The students are, for the most part, young and energetic—still mostly unaware (at the lived experience level) of the profound toll that chronic sleep disruption or deep deprivation can take on their vitality. Yet, they already sense, with a tinge of foreboding, that such exhaustion is their inevitable fate, at least during the gruelling early years of training. Thus, they find the topic both intriguing and personally relevant. They are eager to explore how sleep – a lifestyle factor that touches nearly every facet of health – can dramatically influence not only their scholastic performance but also their overall well-being, health, and even their longevity.

In contrast, the reception from doctors in training (residency and beyond) is often less enthusiastic. And I get it: when you’re in the thick of it, battling the relentless demands of the profession with no immediate escape, a lecture on the virtues of rest might feel misplaced or even tone-deaf. But every doctor, regardless of their educational or career stage, stands to gain from a deeper understanding of the health benefits of sleep and the strategies for optimizing rest. As sleep researcher Matt Walker puts it (@sleepdiplomat): “Sleep is not an optional lifestyle luxury; it is a non-negotiable biological necessity.” Similarly, this critical truth was highlighted this way by a research team(1): “The challenges surrounding discussions of sleep, fatigue, and medical education stem from an ironic biological reality — physicians share the same physiology as their patients, including an absolute need for sleep and endogenous circadian rhythms that govern alertness and performance.”

This blog post on sleep (and the ones that follow) are a call to action to take sleep seriously. The evidence is clear: many healthcare workers(2-5)* — and a significant number of their patients — are not getting sufficient sleep to optimize their health and performance.

Action steps that every doctor can start to take now to be better rested tomorrow:

1. Become or remain educated on the long and short-term health impacts of insufficient sleep (see Sleep For Doctors, Part 2 for a list of these impacts).
2. Embrace good sleep as an essential element of a healthy lifestyle, for patients and for healthcare workers alike.
3. Reflect on your own sleep habits to get clear about how regular your sleep patterns are, and whether you are getting enough and sufficiently high quality sleep. How sleep sufficient or insufficient are you? If you are sleep insufficient, can you take a few minutes to atively imagine how your life and health could be improved by prioritizing regular, restorative sleep? (see Sleep For Doctors, Part 2 for more around how much is enough sleep, and what constitutes high quality sleep.)
4. If you are a doctor in a training program, consider: (a) asking your program leadership to review and discuss the data around sleep insufficiency and physician well being and patient outcomes, and (b) inquiring about the steps they are taking to promote healthier sleep habits for trainees.
5. As an attending physician, particularly if early in your career, it’s crucial to take ownership of your sleep habits. Protecting your rest will ultimately be up to you — your job will not do it for you. Employers often expect more, sometimes with fewer resources, year after year. Get clear on how you want to spend your career time and energy, and how your achievement and career management can be enhanced by safeguarding healthy sleep habits. It’s ok to work hard when you’re at work or when you are otherwise expected and compensated to do so, but don’t invite work into bed with you. And if you’re on call, consider adjusting your pre and post call schedules to help buffer the impact of potential sleep disruptions.
6. For doctors at every stage: How can you incorporate sleep education and counselling into routine clinical practice? This has the potential to profoundly improve the lives of our patients, transforming health outcomes on a large scale—this is a vital opportunity we cannot afford to overlook.
7. If you are involved in patient safety, the findings of this study(6) — which identified a dose-response relationship between sleep-related impairment and self-reported clinically significant medical errors — are nothing short of compelling. As the authors suggest, “strategies to mitigate wellness factors could reduce medical error.” A well rested workforce is not just good for employee well being, it is also essential to optimize the outcomes and experiences of patients.

In the following post (Sleep for Doctors, Part 2), I highlight some of the key data featured in my course, including a discussion of how much is enough sleep. While the findings are sobering, my hope is that they will inspire greater urgency in prioritizing sleep regulation for better health — not just for the benefit of our patients, but for our own well-being as well.

Thank you for tuning in, and here’s to good sleep in 2025!

• Several factors which contribute to insufficient sleep among healthcare workers, including rotating shifts and long working hours, are related to sleep impingement or sleep cycle alterations. Whether insomnia is an additional contributing factor remains unclear. Most of the existing research on insomnia among healthcare workers stems from studies conducted during the COVID-19 pandemic, raising questions about how applicable these findings are in non-pandemic times. This is a critically under-studied area of physician health.

REFs:

1. Buysse DJ, Barzansky B, Dinges D, Hogan E, Hunt CE, Owens J, et al. Sleep, fatigue, and medical training: setting an agenda for optimal learning and patient care. Sleep. 2003;26(2):218-25. https://pubmed.ncbi.nlm.nih.gov/12683483/
2. Coelho J, Lucas G, Micoulaud-Franchi JA, Philip P, Boyer L, Fond G. Poor sleep is associated with work environment among 10,087 French healthcare workers: Results from a nationwide survey. Psychiat Res. 2023;328. DOI: 10.1016/j.psychres.2023.115448
3. Gohari A, Baumann B, Jen R, Ayas N. Sleep Deficiency: Epidemiology and Effects. Sleep Med Clin. 2024;19(4):509-18. DOI: 10.1016/j.jsmc.2024.07.001
4. Mansour W, Knauert MP. Adding Insult to Injury: Sleep Deficiency in Hospitalized Patients. Sleep Med Clin. 2024;19(4):607-23. DOI: 10.1016/j.jsmc.2024.07.008
5. Scott H, Naik G, Lechat B, Manners J, Fitton J, Nguyen DP, et al. Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data. Sleep Health. 2024;10(1):91-7. https://www.sciencedirect.com/science/article/pii/S235272182300253X
6. Trockel MT, Menon NK, Rowe SG, Stewart MT, Smith R, Lu M, et al. Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors. JAMA Netw Open. 2020;3(12):e2028111. DOI: 10.1001/jamanetworkopen.2020.28111