I would start with a few comments about the Daylight Savings Time change that occurred yesterday, though I try to be civil here. Let it suffice to say that I don’t enjoy my dark early mornings that are the “new normal” for a few more weeks again. I always whine a bit about this Spring change, particularly because the bases for it are weak at best. And while I seldom rail about sleep disruption from my travels, the energy drain I tend to experience from the time change is huge. And, of course, that has the potential to really impact my work.
Last month the Harvard Business Review published a terrific summary reviewing the link between effective leadership and getting adequate sleep. I do think that sleep piece is without a question a big piece of it, though I also believe that fatigue in general affects our ability to engage in the four types of leadership behavior that the authors describe. There becomes a domino effect where fatigue directly results in disengagement, and disengagement is intimately related to burnout. While a great deal of the discussion about residents and duty hours has been focused on the impact of adequate rest and safety, the truth is that the impact of sleep deprivation throughout medicine is far more insidious than we’ve previously estimated.
When I was in my 30s I honestly wasn’t as protective of my sleep- perhaps because I spent the first half of the decade finishing my residency before workhour restrictions went into place. As I’ve become a bit wiser (and, in association with that, a bit older), I have learned to better prioritize my rest, though I’m still not as skilled as I would like to be. No matter how much I look at all of the professional advice- get off of your screens, turn the lights down, don’t eat late, don’t exercise late- some of those things simply can’t happen for me all of the time. When I’m not faced with clinical demands I certainly do my best, but it’s a very imperfect best. And while I have been largely successful in creating a 10 + 10 (meditation + free writing, 10 minutes each) morning ritual for myself prior to my morning walks with Olivia , I really wrestle with what my evening ritual could and should look like. I’ve generally stopped sending emails after 830 pm. I’m generally off-line an hour or more before I plan to go to bed. I generally read for 10-30 minutes before bed, depending upon what time it is when I sit down with my book and when the alarm will go off the next morning. Nothing in the evening has stuck for me as well as 10+ 10 + dog walk, however. I’m still working on this concept to figure out what works for me.
I’ll close by saying that I’m a realist. I take call 1 in 3 averaged over the year, and when I need to take care of patients sleep becomes secondary. It doesn’t mean I don’t take a power nap when I get the chance (I love power naps!) or make a conscious decision about managing my energy in other parts of my life (yes, I do skip runs if I haven’t slept well). I’ve made a conscious decision that it’s okay to stop working at some point in the evening, especially because I’ve embraced that my do-to list won’t go away completely anytime soon.
And with that, I should close. It’s after 830 MDT, after all.