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Screened & Examined: Cognitive Molasses After the Night Shift

Ballard, Dustin MD

doi: 10.1097/01.EEM.0000398963.47397.1f
Screened & Examined
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In the great green room

There was a telephone

And a red balloon

And a picture of —

The cow jumping over the moon.

So begins the final chapter of a ritual played out in bedrooms across the land. “Goodnight room, goodnight moon, goodnight cow jumping over the moon.” The soothing repetition of Goodnight Moon and similar verses is employed by millions of parents each night as they send their kids off to dreamland.

For many parents, myself included, this is but the penultimate step in an extended bedtime routine. Dinner, bath, pajamas, warm milk, books on the couch, clean teeth, a wave to the stars, a march upstairs, a tuck into bed (making sure to get the pillows propped just so), Goodnight Moon and songs, and, finally, a kiss goodnight. Phew.

I know I'm not alone in performing a regimen of this sort. In fact, I know many moms and dads who practically obsess about the timing, ritual, and quality of their children's sleep. Why is it so important? Because, as everyone knows, sleep matters. Children whose rest routines are irregular are irritable, transforming them from adorable puddle jumpers into barely bearable brats.

This parental common sense is backed by strong science. Rats that don't sleep don't just become brats, they become dead (within four to five weeks.) And the data aren't just about rats. Studies demonstrate that sleep-deprived people have delayed reactions, difficulty concentrating, and impaired cognition and judgment. This, of course, explains the rationale for sleep deprivation interrogations. And it explains why many emergency physicians feel trapped in cognitive molasses at the end of a night shift. Given all this, why is a nation so meticulous about its children's sleep so careless when it comes to properly resting its adults?

You may have heard about the recent Centers for Disease Control and Prevention (CDC) report on sleep. Based on a telephone survey of more than 70,000 adults, including some 11,000 Californians, more than a third of Americans get less than seven hours of sleep a night. This, as you may know, is less than the minimum amount recommended by the CDC, the National Sleep Foundation, and the Sleep Train (yes, I checked with them, too). An even more concerning finding in this study is that 38 percent of respondents reported nodding off unintentionally in the past 30 days, and five percent of these people admitted that this had occurred while driving. This suggests that the National Highway Traffic Safety Administration data indicating that driver fatigue is responsible for an estimated 100,000 motor vehicle crashes and 1,500 deaths each year may actually be an underestimation.

As shift workers, emergency physicians have personal experience with this. Driving home after a night shift can be terrifying. Sometimes it seems like my consciousness is on the verge of automatic shutdown. For shift workers like us (and parents of young children), some level of sleep deprivation is inevitable, but for many others, sleep deficits are preventable and should — for health, safety, and sanity — be prevented.

There's no shortage of advice about sleeping to be found via Google, but to save you the time of sorting through it all, let me give a less than exhausted, I mean, exhaustive review. What follows (with the help of the good people at Quoteland.com), is a quip-based guide to getting good sleep.

“The sleeping fox catches no poultry.” — Benjamin Franklin

I am a big Ben Franklin fan, and while he may be technically right on this one, his advice is not applicable to most human beings. Franklin, famously, required very little sleep. And while there are certainly in-born differences between individuals in sleep requirements, there are not too many Franklinesque 30-minute-cat-nap types out there. Far more common is the burn-it-at-both-ends type who ignores her sleep needs, piling onto a deficit that can only be repaid at the bedtime bank. To not settle up is to play chicken with health and longevity.

“The two best physicians of them all — Dr. Laughter and Dr. Sleep.” — Gregory Dean Jr.

I might have to throw Dr. Feelgood into the mix, too. But seriously, we are just beginning to understand the physiological functions of sleep, which include encoding memories via nerve-signal repetition; increased cellular production of proteins that are likely involved in repairing damage from stress, ultraviolet light, and dietary toxins; and spikes in growth hormone release in young people. Sleep is good medicine.

“You can't stay married in a situation where you are afraid to go to sleep in case your wife might cut your throat.” — Mike Tyson

Practical advice indeed from Mr. Tyson. How about some other suggestions for ensuring a restful night? The CDC has a list of sleep tips that include sticking to a regular sleep schedule (just like your kids!), sleeping in a dark and relaxing environment (we know this one!), removing all computer and other gadgets from the bedroom (but keep the white noise machine), and avoiding alcohol, caffeine, and large meals within a few hours of bedtime. Another important suggestion is to just say “no” to pharmaceutical sleep aids unless you're making a sleep transition (such as coping with abrupt shift changes or the disorientation of being “sprung forward”).

As we all recognize, some over-the-counter medications have significant side effects. Instead, mindfulness exercises and yoga might be useful for the sleepless, and a comfy mattress seems like a no-brainer.

“Drop, drop in our sleep, upon the heart sorrow falls, memorys pain, and to us, though against our very will, even in our own despite, comes wisdom by the awful grace of God.” — Aeschylus

I am not sure exactly what this means, although it sure sounds pretty and I think it may be referencing the germination of inspiration. Guess I'll try sleeping on it.

Comments about this article? Write to EMN atemn@lww.com.

Dr. Ballardis an associate emergency physician at Kaiser-Per– man-ente in San Rafael, CA, and the chair of the CREST ED Research Network. His writing credits include co-authorship with Angela Ballard of the award-winning travel narrative A Blistered Kind of Love: One Couple's Trial by Trail and authorship of The Bullet's Yaw (IUniverse, 2007). Dr. Ballard writes a biweekly-medical column for the Marin Independent Journal, which he posts on his blog:http://incisionanddrainage.blogspot.com.

© 2011 Lippincott Williams & Wilkins, Inc.