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SLEEP
MEDICINE

by exacerbating stress, reducing cognitive function, and impacting emo- Dr. Agrawal: While caffeine can be a useful tool for alertness, it should
tional well-being. However, burnout itself can also lead to sleep prob- be used judiciously. It's best to avoid caffeine close to bedtime as it can
lems, creating a vicious cycle. Stress and anxiety associated with burnout significantly disrupt sleep. As for alcohol, while it might seem like it
can make it harder to fall asleep or maintain restful sleep, further com- helps with falling asleep, it impairs the quality of sleep and can lead to
pounding the issue. fragmented rest. So, moderation is key, and avoiding alcohol close to
I've seen firsthand how sleep impairment can play a significant role bedtime is advisable.
in physician burnout. Recently, a colleague of mine, an intensivist, went
through a rough stretch both personally and professionally. His sleep Dr. Jyothula: The Dalai Lama says, “Sleep is the best medication.” Any
suffered quite a bit, and it showed in his work. He started coming to interventions you recommend for improving sleep hygiene?
work like a zombie, treating patient care as just a job, with no compas-
sion. Fortunately, he opened up to me, and we focused on improving Dr. Agrawal: Good sleep hygiene also involves regular sleep schedules,
his sleep quality. It was remarkable to see how better sleep brought back a comfortable sleep environment and pre-sleep routines that promote
the compassionate doctor we all knew. While sleep isn't the only factor, relaxation. Limiting screen time before bed, avoiding large meals and
it can significantly compound burnout issues. caffeine close to bedtime, and engaging in relaxing activities like reading
or meditation can greatly improve sleep quality.
Dr. Jyothula: In my professional role, I take calls from home. What is I often tell my patients that “your bedroom is your sanctuary.” I've
your advice for professionals like me who take home calls, and some of seen patients transform their sleep and, in turn, their lives by making
my colleagues who work shift-based work including night shifts? small changes. One patient started a nightly ritual of a warm bath and
reading, which helped her transition from the day's chaos to a peaceful
Dr. Agrawal: Managing sleep while taking calls from home or working night's sleep. Another patient found that simply changing his mattress
night shifts can be quite challenging. I recall a fellow doctor who fre- and pillow made a significant difference. This was a factor we discussed
quently took night calls. She realized that her sleep schedule was be- about making the bedroom environment most comfortable. It's about
coming erratic, impacting her daytime alertness. Her solution? On days finding what works for you and sticking to it.
she wasn't on call, she adhered strictly to a regular sleep schedule, almost
religiously. This regularity helped her maintain a balance. She also be- Dr. Jyothula: Finally, the trick question: What does Dr. Agrawal prac-
lieved in 'paying off sleep debt' — if she lost sleep one night, she'd find tice in regards to his sleep habits?
time later to catch up on rest. While it's not always possible to com-
pletely recoup lost sleep, this approach helped her stay on top of her Dr. Agrawal: I try to be disciplined about my sleep habits, though I'm
game both personally and professionally. It's a reminder that while our not perfect. My family knows I'm strict about bedtime and waking up
schedules can be unpredictable, making concerted efforts to balance at a consistent time. We've removed the large screen TV from our bed-
our sleep when we can is crucial. room and keep cellphones out of reach at night (except when I'm on
For those engaged in consistent shift work, like a week of night shifts, call). I also use a blue light blocker on my laptop and employ software
there are specific strategies to help them work more efficiently at night like f.lux to minimize blue light exposure in the evenings. These small
and transition back to a day schedule. It involves gradually adjusting steps help maintain my sleep hygiene, although I do slip up sometimes!
their sleep-wake cycle a few days before the night shift starts. This could
mean staying up a bit later each night and sleeping in longer in the Reference:
mornings. Using light exposure strategically is also key; bright light at 1. Trockel MT, Menon NK, Rowe SG, et al. Assessment of Physician
work during the night can help maintain alertness, while avoiding Sleep and Wellness, Burnout, and Clinically Significant Medical Er-
bright light when it's time to wind down aids in falling asleep. After the rors. JAMA Netw Open. 2020;3(12):e2028111
night shift cycle ends, it’s important to shift the sleep schedule back to
daytime hours. This can be done by gradually moving bedtime earlier,
in small increments, to re-sync the body’s internal clock with the day Soma Jyothula, MD, FCCP, is a practicing pulmonary and
schedule. critical care physician, and is the Chief of Pulmonary Medicine
and Lung Transplantation at Methodist Hospital. Dr. Jyothula
Dr. Jyothula: As one of my colleagues used to say, caffeine during the is a member of Bexar County Medical Society and serves on the Publica-
day and night caps at night are the secrets to a productive day. What is tions Committee.
your advice regarding food and alcohol intake?

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