Don’t skimp on sleep: The consequences of sleep deprivation

I grew up in a small town in northwest Indiana and, while I was never any good at basketball, I certainly carry with me a healthy respect for the game. Because of our proximity to Chicago, I considered the Chicago Bulls to be my team. It’s probably for that reason that after reading a recent blog by Jonathan Cabin, MD, entitled “Surgeons are High Performance Athletes,” I started humming the theme to the old Gatorade “Be Like Mike” ad (readily available on YouTube for those too young to remember it).

Dreams of NBA finals aside, I think Dr. Cabin has a point in that we, as surgeons, are more similar to athletes than we think and we should probably start treating ourselves more like that. Let me give you an example.

It was 7:30 a.m. and I was post call. I was sitting in the surgeon's lounge with a cup of coffee in one hand and a half-eaten breakfast sandwich in the other trying to psych myself up for my 8:00 a.m. case. Think Michael Phelps before he gets in the water but with less of a six-pack and no frown. Unlike Phelps, who adheres to a strict training regimen, not all nights on call are the same. I've had nights where I made it home for dinner and the pager never went off. Then there are nights like the one I am thinking about where I never made it home, did four cases, and felt like I was run over by a train.

But I have a big case to do today. Does my lack of sleep matter?

In residency, I put in the time for training, learning the anatomy and the steps required to do the case. I reviewed the patient’s anatomy the day before and spoke with our OR nurse coordinator to ensure we had all of the proper gear available. My preparation was thorough – in some ways, I prepared no differently than Usain Bolt does for the 100m, except I’m a bit shorter and a tad slower out of the blocks.

But then I stayed up the entire night before the case and now I have an overcooked high-fat sausage sandwich in my hands.

In residency, that kind of night was the norm. We may not have operated all night every night, but with the census of sick patients that we had, something was always going on and sleep was elusive at best. Having a few years of experience in the real world now, I realize that even though the controversy surrounding residency work hours may make the press more frequently than other fields, medicine is not the only field where the issue of work hours crops up.

When I was in the Navy, we would drill all night until the correct way to handle a scenario was not only known by the entire crew, but the correct answer simply became the way you did it. You reacted almost without thinking. And you reacted without emotion or stress; you just did the job. My brother-in-law is a firefighter in Detroit and he talks of the same kind of training. I’m in no way implying that one situation is identical to the next, but when the alarm or pager goes off, you respond-regardless of time of day or whether your job is to run into a burning building or to alleviate a burning sensation by removing a stone.

Next: The data

How about the data? Is there anything in the literature to suggest that sleep affects performance?

A consensus report from the Association of Professional Sleep Societies shows a strong link between lack of sleep and increased risk of vehicular accidents (falling asleep at the wheel) as well as performance accidents, especially in the nuclear community. (The incidents at Three Mile Island, Oak Harbor, and Rancho Seco were all compounded by operator errors attributed to lack of sleep). A military study involving F-117 pilots deprived of one night of sleep showed that the number of pilot-related errors doubled. Additionally, the data suggests that 28 hours of sleep deprivation results in motor performance decline equivalent to a blood alcohol level of 0.1!

So, what am I going to do? Start going to the gym at 4:30 every morning and doing laps? Join my girls in gymnastics lessons so I can compete against Simone Biles in Toyko in 2020? Not likely. I think instead I’ll work with my call scheduler to ensure that on days before big cases, I’m not on call. I’ll pay a little more attention to what I eat, especially on days when my performance needs to be perfect. I’m not going to go so far as to say I’ll start working out; there are only so many hours in the day and anyways, chasing four kids under 5 around the house seems like enough of a workout.

Most importantly, the lesson I took from Dr. Cabin’s article was not that I am an athlete, but rather I am human. But like an athlete, my performance in the OR and in clinic can be influenced by what I do outside the hospital. And since my patients stake their lives on my performance, I need to be at the top of my game.