“There is only one thing people like that is good for them; a good night’s sleep.” – Edgar Watson Howe (1853 – 1937)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL, MC, USA
E.W. Howe was wise well beyond his time. This spring, as I mark another birthday that has placed me way on the wrong side of 40, I note with frustration that all the things I like seem to be unhealthy. Like so many middle-aged Americans, I fight a continuous battle with the things I love.
My status as a carnivore is constantly under threat due to weight and cholesterol numbers that are not fit to print. I often think Bugs Bunny would be more interested in my lunch than I am, as I crunch another carrot rather than a beloved potato chip. I love working in the yard and chopping wood for home heating, but my back regularly reminds me that I am not 18 anymore. My knees and shoulders protest ever more loudly after a long day of sailing.
I enjoy my work as an academic writer, although the hours spent at a computer do nothing positive for my expanding “bottom” line. I am fortunate to be free of tobacco, though I understand the allure. I work to keep alcohol in moderation, though many weekend parties in our neighborhood can make that a challenge.
In short, I have my share of unhealthy vices and quote with pride Mark Twain, who stated, “I haven’t a particle of confidence in a man who has no redeeming petty vices.” Sadly, I must admit, those prized vices come at such a greater cost now than when I was much younger.
Howe must have had me in mind when he turned his phrase on sleep. I do enjoy a full night’s rest, although I, like so many federal medicine providers, find getting a full night of sleep an elusive goal. My days are necessarily long, and the issues of three healthy teenage girls make bedtime a moving target. I begin every morning at 0500 hrs, rising early to either exercise or rush off to work when I am seeing patients, which puts me in the “six or less hours of sleep a night” club.
According to a Harvard Health Publications press release on the importance of sleep, 75% of Americans have sleep difficulties a few nights every week.1 Chronic sleep deprivation is gaining increasing attention within the medical community as the list grows of health problems associated with sleep loss. The Harvard Health Publication listed six health-related areas that were negatively impacted by sleep of less than six hours nightly, including reduced cognition, poor metabolism leading to weight gain, attention deficits leading to accidents, irritability, increased stress and impaired immune function.“There is only one thing people like that is good for them – A good night’s sleep.”
Like many federal medicine providers of my particular vintage, I can recall days during my training when 36 to 40 hours of continuous work were not uncommon. Admittedly, I am guilty of using stories of those days as a badge of courage or laudable rite of passage around young residents and fellows I have trained. I now sheepishly admit the sanity of limited work hours that have finally been enforced on the medical training system.
What I, like so many others, endured was likely just setting me up for the health challenges I face today. Too many patients have suffered at the hands of sleep-deprived physicians trying to adhere to a training system established by William Halsted in the 1890s that viewed the need for sleep in young physicians as a weakness. Only later would we learn that Halsted’s legendary propensity for long work hours was fueled by a cocaine habit.2
Beyond all the reasons a proper amount of sleep is a vital prerequisite to perform in the complex world of federal medicine, this issue recently became more personal when I learned about a sleep study by Watson et al. (2012)3 and the team at the University of Washington. They sampled 1,088 twins who self-reported their body mass index (BMI – mean BMI was 25.3 kg/m2 SD=5.4) and mean habitual sleep duration (mean sleep duration was 7.2 hr/night SD= 1.2). Interestingly they found a significant (p < 0.05) association between longer sleep duration and decreased BMI. More importantly, the heritability of BMI between twins was twice as large in subjects where sleep duration was less than seven hours. The authors concluded that “shorter sleep duration increases expression of genetic risks for high body weight. At the same time, longer sleep duration may suppress genetic influences on body weight.”
Since I consider myself a prime target of America’s war on obesity, I found this research sobering. In my personal “battle of the bulge,” I have made significant changes in my habits of late. I exercise regularly, walk rather than ride when possible, eat considerably lower on the food chain and have even purchased a walking desk for work. All of these things have come at some personal cost: Exercise feels too much like work, riding is so much more fun, I dream of cheeseburgers in paradise and I am not sure I can write or read and walk at the same time.
More sleep? That is a recommendation I can handle. If only modern life in America could be an ally, rather than an enemy, of getting a good night’s sleep.
I applaud the medical researchers who are beginning to understand the importance of sleep to human function at the genetic level. Armed with this information, federal-health providers can offer new recommendations to their patients struggling with weight issues. Additionally, we should heed our own advice. Federalmedicine leaders should make adequate rest a priority for co-workers. Our patients deserve an alert, awake healthcare provider. Notwithstanding the bravado of those heady days of 80- to 100-hour workweeks, I am thankful that science is finally providing good reasons to put that silliness to bed.
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1www.health.harvard.edu/press_releases/importance_of_sleep_and_health (accessed 2 May 2012).
2www.nytimes.com/2011/08/07/magazine/the-phantom-menace-of-sleep-deprived-doctors.html?pagewanted=all 9(accessed 3 May 2012).
3Watson NF; Harden KP; Buchwald D; Vitiello MV; Pack AI; Weigle DS; Goldberg J. Sleep duration and body mass index in twins: a gene-environment interaction. SLEEP 2012;35(5):597-603.
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