Got zzzz’s? Fighting sleep deprivation in veterinary medicine

July 28, 2020

Not getting enough sleep diminishes our focus and is detrimental to our health and wellbeing. Here’s why, and what to do about it.

No doubt you’ve been jolted awake with that dreadful 2 am call. You fumble for the phone, introduce yourself as professionally as you can with marbles in your mouth, and hear: “Hey, how do you tell if a dog is a boy or a girl?” Or worse, you lug yourself to the clinic for the frantic client who’s a no-show, and you’re left fuming and utterly incapable of falling back to sleep.

It’s no secret that many veterinarians suffer work-life imbalance—and sleep deprivation is a major contributor.

How much sleep do you need?

The National Sleep Foundation recommends 7 to 9 hours of sleep per day, a near impossibility for most veterinary practitioners. But those numbers are only half the story. What the body truly requires is restorative sleep, during which the brain cycles through all the sleep stages (1, 2, 3, 4, and REM) several times over. The magic happens during deep sleep (stages 3 and 4), which is rejuvenating and prepares you well for a day of challenges.

In each 8-hour period of continuous, healthy sleep, the body will ultimately compile 1 to 2 hours of deep sleep.1 Any interruption diminishes the body’s ability to function properly, with unhealthy alterations in hormone production, immune system regulation, and brain activity.

What exactly goes wrong?

When we don’t get enough sleep, the brain moves less learned information from the hippocampus to the neocortex, resulting in decreased memory processing and retention.2,3 In addition to diminished mental capacity (which was implicated in both the Exxon Valdez oil spill and the Chernobyl nuclear explosion2), sleep deprivation causes a host of physical abnormalities3:

  • The stomach produces more of the gastric peptide ghrelin (an appetite stimulant) and less leptin (a satiety hormone), increasing appetite and cravings for high-fat, high-carbohydrate foods once awake.
  • The pancreas releases higher levels of insulin after eating, overloading your fat storage and increasing your risk for type 2 diabetes.
  • The pituitary gland releases fewer growth hormones, thus inhibiting the body’s ability to repair tissue, increase muscle mass, thicken skin, and strengthen bone.
  • The adrenal glands produce more cortisol, increasing blood pressure and your risk for heart attack and death. Increased cortisol also breaks down skin collagen so you don’t look your best (let’s get practical here).
  • The body clears fewer circulating inflammatory cells and produces fewer natural killer cells and protective cytokines that aid in immune function.

Lack of sleep has long-term effects as well. Over the years, various studies on sleep deprivation (generally defined as 5 or fewer hours of sleep per night) have found that it4:

  • increases the risk for dementia by 33%
  • doubles the risk for death from any cause
  • increases the risk for colorectal cancer by 36%
  • increases the risk for obesity by 50%
  • triples the risk for catching a cold
  • increases the risk for cardiovascular disease by 48%
  • increases the risk for depression, anxiety, irritability, and forgetfulness.

But caffeine is the great panacea, right?

You know who has worse sleep deprivation than health professionals? The military. In fact, 40% of our troops get less than 5 hours of sleep, and that’s stateside. Their sleep plummets during combat. So the US military came up with an algorithm to determine how much caffeine one needs to stimulate wakefulness based on amount of sleep. Lest you all picket the Pentagon for the answer, the algorithm is still proprietary, but Uncle Sam has released a free app that gives general calculations for the average person.5

In the short term, caffeine may reduce how much you totter into walls, but it does nothing to immerse the body in that soothing stew of stages 3 and 4 deep sleep. None of the hormone imbalances self-correct with caffeine intake. All of the risks elucidated above remain. Worse, the more caffeine that is in your system, the more likely you are to perpetuate sleep deprivation through insomnia.

How can we achieve sleep nirvana?

Given that we’re not fruit flies (see Insight from the animal kingdom), we must master a few techniques to maximize our sleep:

  • Sleep in a cool room (between 60°F and 67°F).
  • Standardize the timing and activities of your presleep routine.
  • Avoid eating heavy meals 2 hours before bedtime to minimize discomfort from gastric reflux.
  • Avoid too much alcohol near bedtime because its breakdown products can interrupt sleep during the second half of the night.
  • Get up at the same time each morning, even on weekends and holidays.
  • Exercise regularly, but not right before bedtime.9
  • Avoid stimulants like caffeine and nicotine prior to bed. Recent research recommends a 2 pm cutoff for all caffeine products.10
  • Take a warm bath or shower 1 to 2 hours before bedtime. The external warmth opens capillary beds in the periphery (limbs), ultimately lowering core body temperature, which improves onset and quality of sleep.11
  • Turn off all blue-light sources, including phone and computer screens, 1 to 2 hours before bedtime.12

The moral of the story

It’s simple: Get deep, uninterrupted, restorative sleep. One of the surest ways to achieve that in the veterinary setting is to have a competent, compassionate registered veterinary technician answer your after-hours calls for you. Internal data suggests 75% of after-hours calls are non-emergent. By leveraging professional help to answer simple questions, generate next-day appointments, refer to the local emergency clinic, or call your phone for verified emergencies only, you can begin to take back control of your destiny … even when you’re asleep.


Dr. Sawyer is a regional veterinary consultant for GuardianVets Teletriage and Telemedicine Services.

References

  1. Leavitt J. How much deep, light, and REM sleep do you need? Healthline. October 10, 2019. Accessed July 27, 2020. https://www.healthline.com/health/how-much-deep-sleep-do-you-need#deep-sleep
  2. Sorrels M. 10 truly devastating disasters caused by sleep deprivation. Listverse. October 2, 2017. Accessed July 27, 2020. https://listverse.com/2017/10/02/10-truly-devastating-disasters-caused-by-sleep-deprivation/
  3. Watson S, Cherney K. The effects of sleep deprivation on your body. Healthline. May 15, 2020. Accessed July 24, 2020. https://www.healthline.com/health/sleep-deprivation/effects-on-body#4
  4. The effects of sleep deprivation. Johns Hopkins Medicine. Accessed January 31, 2020. https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-effects-of-sleep-deprivation
  5. Murphy B Jr. After 10 years studying sleep, the U.S. military just revealed something eye-opening about caffeine. Inc. July 24, 2018. Accessed January 31, 2020. https://www.inc.com/bill-murphy-jr/sleep-this-much-drink-this-much-coffee-says-us-military.htmlGannon M. Can any animal survive without sleep? Live Science. March 2, 2019. Accessed January 31, 2020. https://www.livescience.com/64873-can-animals-survive-without-sleep.html
  6. Geissmann Q, Beckwith EJ, Gilestro GF. Most sleep does not serve a vital function: evidence from Drosophila melanogaster. Sci Adv. 2019;5(2):eaau9253. doi:10.1126/sciadv.aau9253
  7. Rattenborg NC, Voirin B, Cruz SM, et al. Evidence that birds sleep in mid-flight. Nature Commun. 2016;7:12468. doi:10.1038/ncomms12468
  8. Sleep hygiene. Sleep Foundation.org. July 27, 2020. Accessed July 27, 2020. https://www.sleepfoundation.org/articles/sleep-hygiene
  9. Breus MJ. New details on caffeine’s sleep disrupting effects. Psychology Today. December 16, 2013. Accessed July 27, 2020. https://www.psychologytoday.com/us/blog/sleep-newzzz/201312/new-details-caffeine-s-sleep-disrupting-effects
  10. Sandoiu A. When’s the best time to take a warm bath for better sleep? Medical News Today. July 22, 2019. Accessed July 27, 2020. https://www.medicalnewstoday.com/articles/325818.php#2
  11. Gunnars K. Blue light and sleep: what’s the connection? Healthline. May 21, 2020. Accessed July 24, 2020. https://www.healthline.com/nutrition/block-blue-light-to-sleep-better