No matter what time of day or night, the er is always awake, providing much needed support to patients with any and every kind of ailment or injury. Doctor George Russo works in a New York hospital emergency room. The margin for error in this line of work is razor thin, and since the er never closes, finding time to sleep and sleep properly is a daunting challenge for George and his colleagues.
There's no plans, appointments. It's whatever comes in comes in. Sometimes you're lucky enough to get a notification over the phone from the EMS, but that doesn't happen every time, so you always got to be ready to jump to it. It's a fast paced environment, so you could be seeing somebody that's having a heart attack or that is extremely sick with something, and then you get a trauma notification and something's coming in, and now the doors never closed.
I wondered, with all of the chaos and urgency of the er, how someone like George is thinking about sleep and how it impacts his performance. So I asked him to recall one of his more hectic shifts and what role sleep played in its success or obstacles.
All right, so it was a Monday. It was Mayhem walked into a lot of sign outs from the night prior because it was a busy Sunday night already had to handle those, but we also had new patients coming in for seven am sharp, and then patients were coming in from the clinics as well, because sometimes they have extremely high blood pressure, they get dizzy and faint when they're getting blood taken, and I'm dealing with all of
those people. And then a stroke alert comes in with EMS, so you have to do all the protocol for that because time is brain, as they say.
And then we had.
A stab wound to the chest come in shortly after,
so there is a lot of things happening. And then there was also COVID patient's coming in, so they're taking up the isolation rooms so you don't have exam rooms for the other patients, and there was there was just a tremendous amount of things going on, and we had to transfer patients for some emergencies that our hospital didn't have the specialists, so you're on the phones as well, and it was it was a day, and I think I was lucky enough that I had had like a
good eight hour to sleep the night prior, like I went to bed, I don't know, probably ten pm. And since I was there at seven, I woke up at six and I felt pretty refreshed. And it wasn't one of those nights where I had to split up my sleep or I wasn't switching back and forth from days to nights. And I think it really helped me get
through the day. And let me tell you that night, I certainly slept well again because I was in bed I think at nine point thirty and I didn't wake up till the next day at six.
It was great.
What role does our sleep play in our long term health? How deep does healthy sleep go into our biology? And how do you get consistent rest and healthy sleep when your bedtime is constantly in flux? Find out on this episode of Chasing Sleep Urgent Rest. Hi, I'm Anahad O'Connor, and this is Chasing Sleep and iHeartRadio production and partnership with Mattress Firm.
So there's definitely a stress that comes with the high stress environment that's very difficult to wind down or to just leave at work. Everyone says, don't take it home, but sometimes it's not possible. I mean, when things are life and death, and when maybe there's a bad outcome of something, it's gonna stay with you.
It just doesn't go away.
With the intensity. There must be some payoff when things are life and death. The downside is that when something goes wrong it can be very grim, but when things go right, it must feel pretty rewarding.
The most rewarding part of what I do is when family members or a patient feel better in front of you, whether it's you give them antibiotics or you give them something that helps bust a clot that is causing a stroke in their brain, and you can see them go from not being able to move one side of their body to them being able to move it within hours of them being in front of you, and family members are crying so happy, the patient's able to talk to
you afterwards. That's happened a couple times, and it's extremely rewarding when you can actually change somebody's life in a matter of minutes to hours.
From bustling cities to sparsely populated rural areas. Emergency medical care is a NonStop job. Hospital staff are on their feet hour after hour without respite because accidents and injuries don't follow a schedule.
Yeah, the physical aspect of the job, especially after a twelve hour shift, wear and tear is absolutely there. I mean there's muscle aches that felt like I was back playing sports. It's very difficult to find time to work out after a twelve hour shift, especially if you have a commute, and sometimes these twelve hour shifts go to thirteen fourteen hours if something terrible comes in rank before the end of it, and it was just it was exhausting.
I mean, it was very difficult to get in a good rhythm of things as things were changing so often throughout the pandemic, and also just to get a good routine at home, to get to bed at a normal hour, to also find a way to eat in there and watch a show with your loved one, or if you have kids, to find time to be with them because they were home all day too. It's hard, it's grueling, it's fast paced, it's long days, long nights, and the schedule is constantly changing. All of that does a number
on our mental functions. It's difficult enough working when you're exhausted. It becomes even more challenging when the stakes are as high as they are in emergency medicine. I wanted to learn more about what's happening inside our bodies when our sleep schedules change, and what the impact is on medical professionals. So I called up doctor Sema Cosla.
I'm doctor Sema Cosla.
I'm a sleep medicine physician and the medical director of the North Dakota Center for Sleep and Fargo.
So you have a really extensive background in sleep, and first off, I think sleep is really challenging for a lot of people. So I wanted to get your thoughts on what do you think actually constitutes healthy sleep.
So there's you know, when we think about healthy sleep, we have to consider quality, quantity, and timing, and so we want to make sure that we're getting enough good quality sleep at the right time time.
Seema emphasizes the importance of consistent schedules for shift workers, and she's even gone as far as to petition hospitals to provide consistent shift schedules for their employees. There are so many people who have no choice but to have these unusual sleep schedules, you know, like our study subject today, George, who's an er doctor, and he and others like him have no choice but to work the night shift at times?
How common is this And do you see a lot of patients who have to work these unusual sleep schedules and what are some of the common complaints that you get from these patients?
Yeah, so you're right.
In the medical field, also manufacturing, you know, we see a lot of overnight workers. I think the challenge about an er shift is that it's not consistent. You know, sometimes they'll be kind enough to give you, you know, a week of days and then a week of nights, but oftentimes it isn't like that, so you're constantly switching.
And so a consistent shift, even if it is night shift, is better than a variable shift, right, because at least you can give your body some semblance of a circadian rhythm, right.
I was wondering about that.
Yeah, yeah, And so I've written letters before just asking can you please, like, pick a shift. We don't care what the shift is, just make it consistent, please.
But picking a shift is easier said than done, especially in a field to where your day changes wildly with no control over what might walk through the hospital doors.
So the schedule of an er doctor is not the average schedule. It is not a Monday through Friday, it is not a nine to five, So the average r doctor does about twelve to fifteen shifts a month, and they can be anywhere from eight to twelve hour shifts. Some in rural places do twenty four hour shifts and even thirty hour shifts, depending on the amount of patients that the hospital sees.
And these shifts can.
Be the morning the swing shift, or they can be the overnight shift, night to day shift. It's one becomes more difficult to get to bed in a normal hour because if you go to bed at the same hour that you did when you had to wake up at seven am, you'll wake up around seven and then you don't work again until seven pm. So I would find myself trying to push myself and stay up a little later, maybe till midnight two in the morning, as if it was a Saturday night.
Frequently changing schedules, while necessary in fields like this one, makes for challenging sleep. So the switch back and forth from day to night is never easy with sleep and sleep. Especially in the emergency medicine world. We tend to be the most sleep deprived or have the most issues with sleep because of the shift work and jumping around in
the schedule with twelve hour shifts. Found that it was difficult sometimes to keep a nice sleep routine because my significant other, she would get home later and I would want to stay up to see her, But then that would affect my work or my sleep pattern because I would be up till midnight and then have to wake up again the next day at six am. I found out pretty quickly that that wasn't sustainable. And then switching over to nights.
We all have our different ways of trying to normalize it, but you're always going to feel kind of awful when you're switched over to nights or when you switch back today.
It's because it's just like jet lag.
It's like we flew, but you didn't even get the nice francifaication out of it.
Nurses and doctors are so vulnerable to life threatening mistakes when their sleep is jeopardized. A tired doctor in an er or an operating room becomes a danger to a patient. My sister in law is a doctor in London, and I was quizzing her about, you know, how she gets through this, working these night shifts and going back to a regular shift, and she mentioned that at her hospital they actually won't let the doctors perform any complex procedures
or surgeries overnight unless it's an emergency. If someone comes in with the gunshot or you know, a stab wound, then they have to do something thing. But if it's a surgery that they can push off till the morning or daytime, you know, they will try to do that rather than operate on someone in the middle of the night, just because of the risks involved.
So I think it's important to recognize that some people do great at night. That's sort of where they really perform well, and they're just naturally better at night, and some people don't. So my background is pulmonary and critical care. And so then when I would go into the ICU in the middle of the night, you write a little adrenaline so that to kind of combat the sleepiness that occurs, and you have to be sharp, and I think you
push yourself to be sharp, if that makes sense. You know, people in these fields are usually high achievers, high performers, and they put a lot of demands, like I'm sure you know in the er that adrenaline also helps.
You, right, And there's been a lot of research on this topic of sleep deprivation among healthcare workers. So, for example, I saw that the British Journal of Anesthesia published a study that found more than ten percent increase in life threatening events that happened in surgeries that were performed at night.
Yeah.
Well, and it's risk of operator error, but also support in a hospital if something goes bad, you're minimally staffed at night. And so we used to have this lore in the world of pulmonary that if you have fluid around your lungs, it needs to be taken out before the sun sets.
Was kind of what we were always taught.
And then it turns out if you start doing these things at nine o'clock at night or ten o'clock at night, when no one else is in the hospital, that's not great for patients. Yeah, because then you may convert it into an emergency procedure or something like that, and calling people in from sleep, right, calling people in from their beds to help you. And so I applaud where your sister works that they recognized this.
We'll be right back after a brief message from our partners at Mattress Firm, and now back to Chasing Sleep. Throughout our series so far, I've learned a lot about how sleep impacts our physical and mental performance and our endurance. I've deepened my understanding of how stress and anxiety can adversely impact our sleep as well. But speaking with George and Seema gave me a completely new perspective on just how much sleep impacts our overall and long term health.
You know, it's so funny.
We talk a good game in our world of sleep. Right we're saying, yep.
You should be in bed at the same time every night and get.
Seven to nine hours of good restorative sleep. And so what we've seen over the years is sometimes people who are night owls, we call them delayed sleep phase coronotype, So just meaning that you're just biologically right, you like to say up late and you like to sleep in. Sometimes they will find themselves in a night shift position just because it sort of fits with their circadian rhythm. But not always. We do see that there is a
higher risk of cancer in night shift workers. They did a study of nurses, for example, and they had a higher incidence of breast cancer. And so it's really it's kind of amazing. I remember years ago we were giving this conference and I reached out to a cancer researcher and I wanted to talk to her about, you know, how we think sleep is super important, you know, for cancer and that sort of thing, and she kind of
laughed at me. She was very kind, but I thought we were so smart thinking about this, and she's like, oh, yeah, we've considered poor sleep a carcinogen for decades.
So yeah, they were way ahead of us.
As Sema says, poor sleep is a carcinogen, a mood destabilizer, and it causes many other issues and diseases. I wanted to learn more about the ways sleep is constantly affecting our health, so I asked Sema to explain the biology of sleep and everything that's happening inside us as we snooze.
So rem is important for mood regulation, right, slow wave sleep or delta sleep. This is this lovely slow wave sleep. Kids get tons of this. This is where they where they grow, and where they you know, sleepwalk, do all of those things. That's probably important for us to download short term memory into long term memory. And then rem is important for us to organize and edit those memories
that's just in the mind. And so if you can imagine, the brain has right all those little ups and downs and on a cellular level if you imagine it, and I'm going to borrow this from one of my.
Colleagues, doctor Chuck Seisler.
He was the the expert witness at the Michael Jackson trial, and this is how he described it. So if you picture it like a big city like New York City, right, You've got these big, huge, tall buildings, and then you've got these alleys, and all day long, the garbage truck is, you know, cleaning debris out of the alleys, right, and people are tossing stuff out of the windows. And so when you sleep, the buildings shrink and the alleys get really wide, and so all of that debris gets swept
away much more efficiently. And when you analyze that debris, it is beta amyloid, which is one of the things that builds up in Alzheimer's right, And so sleep is really really important to that, you know, for all of that. So to your point about you know, why does sleep impact cancer growth and why does it impact ourselves? You know, we know it's important for immunity. We learned a lot
with a pandemic, right. We know that if you were well rested the night before your your vaccine and the day before that you had better vaccine responsiveness, and probably just because needs to recover.
Wow, So it's not just the long term, it's these immediate effects have an impact on your response to a vaccine. Fascinating analogy. So when we sleep and we have our very own sanitation department clearing the streets in our brains, think about what that debris entails. It's imperative that George has time to clear out those beta amyloid proteins in his brain so that he can get back to work and be on top of his game, saving lives and
helping people when they need it the most. With so much of our health writing on sleep, I was curious about the unique obstacles that er workers like George face when they're trying to get adequate sleep. Battling this news button for an early morning shift is one thing, coming home when the sun rises, and trying to get healthy sleep in the middle of the day is an entirely different challenge.
So it's actually easier to get more sleep during the winter.
During the summer is when it's said it's artists and I have to keep the sunglasses on after an overnight shift. Actually, that's one of the big things on the way home. If I forget my sunglasses, I get really messed up because my circadian rhythm wants to be awake.
So you got to keep it dark.
And if you can get out at a time where the sun still hasn't come up, I try and like rush home as if I'm a vampire or something like. I have to get there before the sun comes up, because it can absolutely throw you for a loop once the sun comes up.
You know, our impetus to sleep is driven by a couple of things. So one is that circadian rhythm right when we're biologically programmed to be awake and to fall asleep. But the other is what's called sleep pressure. So sleep pressure builds up from the minute you wake up until you go to bed. So if you are at your typical sleep schedule, they both peak to push you to sleep. But now when we're asking people to work night shift, these work against each other, right, and so then we
have to accommodate. We need to drill just say, okay, well, how can we make sure that the sleep you're getting is as good as we can make it. And so we really focus on the sleep environment. Make sure the room is cool and dark, especially and quiet.
So especially with these ever changing shift schedules and the on the job stresses that are the norm and the er George, what other tools are there besides caffeine? Can strategic napping, for example, help to bridge the gap to getting rest?
Went on twenty four hour shifts.
Now, we don't necessarily do this in the ers everywhere, but some more rural places do have to do twenty four hour plus shifts. During residency, I had to do ICU rotations that did have twenty four to twenty seven hour shifts. Doesn't sound possible and I didn't think it was, but somehow you make it through it.
Now, one of the.
Main ways was after the whole day to day was done, when everyone else had left you and somebody else and you would try and take shifts where you could get to nap or sometimes even get.
To sleep like four hours, and it really helped.
Because you had already been up since six am, and then it was about whether it was eight pm ten pm.
You got to even sleep for two hours.
It was lovely because at that time bed feels the best and you just want to lay down. Sometimes it's a little more difficult to kind of wind down and then you end up staring at the ceiling for a while. But to get that rest and again step away from everything, it was so necessary. I don't I'm sure there was sometimes that people couldn't do it because it's just too busy for those twenty four hours. But the exhaustion really takes a toll.
And so now let's say, for like a healthcare professional who you know, maybe works in a rural area and is working overnight shift pretty consistently, what can napping do for them?
Oh, so this is a really important strategy. You know, if they are on call twenty four hours a day, they can't count on being able to sleep at night, can they. And so it's important to have a strategy where if they do have some downtime, perhaps they will be able to nap. Now, normally a shorter nap is better, meaning twenty to thirty minutes, just because you don't go into all of the sleep stages. Right, But that's for
people who are able to sleep at night, right. But for our er colleagues that work those twenty four hour shifts, probably the single most important thing is that they have a place where they can sleep that is away from the er, not far enough away that they can't jump up and help. But it is dark and cool and quiet, right, Like when I would leave the ICU, I'd be like, Okay, I'm gonna go and try and sleep.
Please let me know what you need now you know, I'm gonna go.
I'll be back in ten minutes, like, don't page me, right, And a lot of the time the nursing staff was really protective of that time. You know, they wouldn't wake the dock up unless they needed something. And so twenty four hours of duty is a long time, and so it has to be protected as much as you can absolutely, you know, with parameters of only wake me up if you know X, Y and Z occur, and then that is devoted time, okay.
And so you want to set your alarm potentially to make sure you're not going past thirty minutes.
It sounds like, well, the thirty minutes isn't necessarily for this scenario. This would be we wanted to sleep whenever you can capture as much sleep as you can, right because ideally if we can get seven hours in that twenty four period, that would be amazing. Okay, you know the realities that you may not Okay, and so then a lot of the time they just they truly go
without sleep for twenty four hours. And so if you have, it's a little bit like the advice we give new parents, right sleep when you can.
That's all for this episode. Join me again next week when we learn about the global stage of professional video gaming, where round the clock gameplay fuels high stakes tournaments and gaming content on streaming services.
To our brains, these developers and these games are so good that they create real experience.
You feel like you.
Were in the deserted compound, surrounded by zombies trying to figure out how to kill them and get to this next place where all the other players are like when in fact, no, you're just sitting in a chair in your bedroom looking at a box of light.
We want to hear from you. Leave a rating a review for our show on your podcast player of choice. You can find me on Twitter at Anahad O'Connor. Until next time, hoping you're living your best while sleeping your best. Chasing Sleep is a production of iHeartRadio in partnership with Mattress Firm. Our executive producer is Molly Sosha. Our EP of post is James Foster. Our supervising producer is Keia Swinton. Our producer is Sierra Kaiser. This episode was written and
researched by Eric Lejia and Jess Kapadia. Our show was hosted by me Annahad O'Connor