In the words of the acclaimed writer JoJo Jensen, “Without enough sleep, we all become tall two-year-olds.”

Many scientists have pondered the question of why sleep is of such vital importance. From an evolutionary perspective, it would be ideal if we could survive without sleep. After all, shut-eye leaves animals, including humans, vulnerable to predation.

If you travel quite frequently, you’ve probably succumbed to “first night effect,” or FNE. In simple terms, this means that many humans tend to have a difficult time sleeping during the first night in a new place. According to numerous evolutionary theorists, this reveals something interesting about the ways in which our brains function. FNE, they argue, is an evolutionary remnant rooted in our brains’ hardwired self-defense mechanisms. We sleep with “one eye open,” quite literally. It’s known as the unihemispheric effect. In new environments, we employ a 50/50 sleep system, where one half of the brain sleeps and the other half stays alert. We are on guard, primed to expect disturbances.  

Why is sleep so important?

Scientists think sleep is important for two reasons. First, sleep helps repair and restore our organ systems. This includes “cleansing” our muscles, immune systems, and brains. A function of sleep is to flush metabolic byproducts and toxins from the brain -- including the beta-amyloid plaques that accumulate in cases of dementia.

Furthermore, sleep plays a critical role in memory, especially retention and consolidation.  Although there is still a lot that we don’t know about the potential benefits of sleep, one thing is for sure: we simply can’t survive without it. Think about it, readers, we spend about a third of our lives sleeping -- so it must serve a function of real significance.

We have all fallen prey to sleep deprivation; diminished mental capacity, a lack of awareness and attention to the world around us, a warped sense of time, and a crippling sense of fatigue. We function poorly without sleep. Our eyes burn; our faculties for objective reasoning turn to mush; we snap and snarl; we lash out and act on impulse. The little bit of patience we have quickly evaporates. Humans need at least 7-8 hours of sleep to function at an optimal level. Although many of us are aware of this, millions stubbornly refuse to listen.

Deprived and Dangerous

According to the Centers for Disease Control and Prevention (CDC), more than a third of American adults are not getting enough sleep on a regular basis. The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults aged 18–60 sleep at least 7-8 hours each night to promote optimal health and well-being. Sleeping less than seven hours a night is associated with an increased risk of developing chronic conditions such as obesity, diabetes, high blood pressure, heart disease, stroke, mental distress, and chronic exhaustion. Medical professionals consider exhaustion a legitimate medical threat to the health of Americans.

Ironically, medical professionals are often the most overworked and exhausted of all professionals, often working shifts that are anywhere from 16 to 28 hours in duration.  If doctors’ careers end at 65 and they finish their residency at 29, they'll spend 36 years working almost 1½ times more than most other Americans. In other words, it would normally take 54 years to do the work that doctors do in 36.

According to researchers at the American College of Chest Physicians Sleep Institute (ACCP-SI), the average physician gets “between 5 and 6” hours of sleep each night. In simple terms, most physicians are not getting near enough sleep in order to perform optimally. Almost half of physicians believe their work schedules do not allow for adequate sleep. This should worry every single one of us.

When it comes to driving, according to AAA Foundation for Traffic Safety, getting five or six hours of sleep can leave drivers impaired to a degree that’s similar to drunkenness. Drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as those who got seven or more. Jake Nelson, AAA’s director of Traffic Safety Advocacy and Research, told NPR: “If you have not slept seven or more hours in a given 24-hour period, you really shouldn't be behind the wheel of a car.”

So, if sleep deprived humans are not fit to drive a car, how can millions of physicians be fit to make life or death decisions on a daily basis? This is not an insignificant question.

Sleep deprived physicians are more likely to experience lapses in memory and judgment that can prove fatal. This, of course, is not surprising. No matter how qualified the physician may be, he or she is still human. The brains of physicians are subject to the limits of physiology in much the same way as every other human on the planet.

The irony here is as obvious as it is painful. In medical school, students take classes on the importance of sleep cycles and, once qualified, they tell their patients about the importance of sleep. Why is the medical profession -- the one that should understand the importance of sleep better than any other profession -- so eager to forego this basic human necessity?

It’s an especially timely question. In 2017, the Accreditation Council for Graduate Medical Education (ACGME), the organization that makes the rules for medical trainees, voted to increase the number of consecutive hours that young doctors can work, from 16 hours to 28 hours.

Thankfully, some checks are in place. The New York State Department of Health Code, Section 405, also known as the Libby Zion Law, is a regulation that limits the amount of resident physicians' work in New York State hospitals to roughly 80 hours per week The law was named after Libby Zion, who died at the age of 18 under the care of what her father believed to be overworked resident physicians and intern physicians. Still, 80 hours a week is at least 25-30 hours too much, especially in a highly pressurized field like medicine. After all, a doctor working a 5 day, 80 hour week is working 16 hours a day.

The evidence that sleep deprivation harms patients couldn’t be any clearer. A 2009 study found an increased rate of complications among attending surgeons who operate after sleeping less than six hours. A 2006 study found that extended hours awake at night caused a 300% increase in preventable mistakes that led to a patient’s death. If, heaven forbid, you find yourself having to undergo serious surgery, you want the surgeon to be at his or her most capable. What if your surgeon has been working 20 or 25 hours straight? Would you trust his or her judgment? Of course not.

If you are entering hospital for surgery, even for something as “minor” as appendix removal, don’t be afraid to ask a few questions, such as: Who will be carrying out the procedure? How long have they been on duty? When was the last time they slept?

After all, these questions could save your life.

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