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  • Writer's pictureRyan Allen

Prioritizing sleep and breaking the cycle of poor sleep

Going into medicine as a career path, I acknowledged the unfortunate, ironic truth that many doctors are compelled to adopt several unhealthy habits. In particular, the field as a whole is notorious for long hours and subsequent sleep deprivation. While I understand this won’t always be something I can control, I am determined to resist it as much as possible. And in fact, thus far I actually feel I have been relatively successful. For the most part, I stick to a regular, 8-8.5 hour window of sleep per night. Unsurprisingly, the benefits have been apparent, as I have felt pretty consistently refreshed, energized, and my overall cognitive function and metabolic health have trended in positive directions.

I know the majority of my colleagues sacrifice sleep in favor of investing more time in their work and professional endeavors, and express a lot of doubt over my habits with regards to this sleep-work tradeoff. I would argue that this notion of a tradeoff is actually a false narrative. I have not noticed any decline in my net productivity, competence, or professional performance, and I would suspect that it is because of my markedly improved efficiency when I do work as a result of a good night’s sleep. This is the same concept posed by proponents of shorter work weeks for greater economic productivity and efficiency in addition to improved health and wellbeing. It is also frequently cited by sleep expert Dr. Matthew Walker, as he advocates for shortened school hours with later start times to allow for more sleep for students. In particular, he mentions studies demonstrating higher rates of grades and attendance, improved behavior, and even decreased motor vehicle accidents and subsequent increased life expectancy of students at schools with such schedules. So for me, it’s a no-brainer to prioritize a full night of sleep, from both a health and productivity perspective.

Like anyone, though, I have days where I just mess up, or things don’t go as planned. Additionally, I hear and feel for my colleagues as they speak of issues they have with sleep. I have heard of others experiencing both sleep-onset and sleep-maintenance insomnia, the former referring to difficulty falling asleep and the latter to difficulty staying asleep. Some speak of immense trouble focusing and retaining knowledge, which we all undoubtedly experience from time to time, but many subjectively find it to disproportionately affect them as a result of poor sleep. Others just frequently note excessive fatigue and lethargy. A common cycle that most of these colleagues experience is what you might imagine: staying up late to do work, increasingly depending on tools like sleeping in, caffeine, and naps to get them through the next day. If you recall our post on sleep pressure, you’ll know that this then makes it really difficult to sleep at their normal time, and the cycle repeats itself.

The question then becomes, how can we break this vicious cycle? In my view, the first step is to hammer down when one’s optimal sleep window actually is. In an ideal world where you had no work, no priorities, and no social influences, when would you actually go to sleep and wake up? It is true that this will genetically differ between people; it is a phenomenon known as our “chronotype,” essentially referring to our preferred sleep-wake period (some may phrase it as being a “morning person” or “evening person”). Within the confines of your daily life, try to make your sleep window as close to this time period as possible.

Having this sleep window established and, most importantly, sticking to it consistently, will allow one to effectively regulate their circadian rhythm. In other words, your body will get to know your routine very well, and adjust such that your regulatory systems will know when to feel tired and when to feel energetic, when to be in “sleep mode” vs. “wake mode,” and so on. In my view, consistency of one’s sleep-wake window is among the easiest and highest yield of the four pillars of sleep to tweak.

Another key concept is to think in terms of sleep pressure. The analogy to actual mechanical pressure made in that post is a really good one to envision the chemical effects of various influences like caffeine and naps. This is a basis for using these circadian-modifying tools to your advantage rather than your detriment. For example, it’s critical to understand that the timing of caffeine consumption matters just as much (if not more) than the dose. Caffeine has a long half-life of 6 hours in the body, which is why for sleep purposes it is best consumed at the start of your day when you want to be most awake and alert. An afternoon cup may be helpful to get you through the day, but around half of that cup will still be left in your system when you least want it: as you lie down in bed to sleep.

The next tool to utilize: naps. Yes, these will eat away at the healthy sleep pressure we want to build up throughout the day, but they can be useful to alleviate the fatigue we may feel from previous poor sleep, or to push forward our circadian rhythm. Be mindful of how long you nap. A 15-minute nap might be just enough to remove that bit of tiredness and sleep pressure you need to alleviate in the afternoon. Meanwhile a 90-minute nap can allow us to get a full sleep cycle with REM sleep, potentially permitting us to push back our sleep time that night if we wish to shift our schedule, say, for travel or daylight savings purposes.

Just as naps and caffeine are tools to promote wakefulness, many utilize drugs and supplements to promote sleep. Previously, I’ve detailed why you want to avoid many of these substances, which remains the case. However, I would say that if you are really struggling to reset your circadian rhythm to a favorable schedule, using melatonin or a more benign sleep-onset drug can be useful on occasion. The important thing is that you do not let this become much of a regular occurrence at all, but rather it is something to be used in exceptional circumstances when you have exhausted other avenues.

This can be a difficult topic, and experiences are certainly variable among people, even those who practice the same healthy or unhealthy sleep habits. Though it does not guarantee ideal sleep, in the long run, taking care of our sleep hygiene with these steps will give us the best chance of having restful, restorative nights.


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