Your Best Life: Unlock More Time in Your Day for Rest and Relaxation—That’s an Order

Orthopaedic surgeons cannot cheat Mother Nature when it comes to exercise, nutrition, and rest. But we sure as heck do try.

In July 2017, the Accreditation Council for Graduate Medical Education amended its restrictions on duty hours for residents, raising the limit to 24-hour shifts plus 4 hours “to manage necessary care transitions” [5]. The revision occurred on the heels of study published in the New England Journal of Medicine [2], which found no substantial differences in patient outcomes between centers with strict caps in work hours and those with less-stringent duty-hour restrictions. Some safety indicators even favored those who worked longer shifts.

Still, it is intuitive that sleep deprivation negatively impacts surgeon performance and can lead to patient harm. We cannot ignore a landmark study by Williamson and Feyer [21] that found little difference between an intoxicated physician and one who has not slept in 24 hours. We also know that a lack of sleep is far more detrimental to one’s health than originally recognized [16]. While patient safety is an obvious concern, we must also consider the health of the sleep-deprived surgeon. Sleep deprivation impairs memory consolidation [8], plays a role in the skyrocketing prevalence of metabolic syndrome and glucose intolerance [13], leads to increased levels of c-reactive protein, a general marker of bodily inflammation [15], and can raise one’s blood pressure, with even a half a night of sleep loss leading to hypertension in pre-disposed individuals [14].

The amount of sleep one needs is variable, but generally, healthy adults need 7 to 9 hours of sleep a night [9]. I would wager that most physicians do not reach the low end of 7 hours, and this lack of sleep can lead to major long-term health problems. Drawing attention to the fact that physicians are overworked and not getting enough sleep is not exactly breaking news. But should we so easily dismiss this as simply the nature of the job?

Value Your Time

Orthopaedic surgeons must be willing to find the time in their schedules for required rest and relaxation. One alarming report showed that medical interns averaged only 3.7 hours of sleep a night [8, 17]. Another study found that more than 40% of practicing US physicians work longer than 80 hours a week [1]. I know colleagues who openly brag about their sleep deprivation, as if staying up 30 hours straight or working an 85-hour work weeks means they care more about their jobs than those of us who value rest. This is delusional. It is well-documented that in an effort to become more productive, we ironically become less efficient because of sleep loss [4, 7].

I have written before about shedding unwanted emails, texts, and social media notifications [12], listening to your body for indicators of stress, anxiety, or burnout [10], and practicing mindfulness to increase well-being [11]. The one factor that hangs over all of these suggestions is time management. One cannot practice mindfulness, and thus work on his or her own well-being, if instantly replying to every email, accepting every paper review invitation, and squeezing in a few extra patients in a clinic are the day’s only priorities. Indeed, in order to unlock more time in our schedules for rest, we must first value ourselves enough to appreciate that our time is precious and should be spent in ways that promote our long-term health. If made a priority, 7 hours of restorative sleep is attainable.

Unlock More Time in Your Schedule

More than likely, there is time in your schedule for additional rest—it’s just a matter of finding it. Imagine it’s a weekday. You might normally read for pleasure before bed; you might go to the gym just before work or on the way home. There is a third option: Use some of that discretionary time for a short nap after lunch. It doesn’t have to be a pipedream. We all make times for the things we enjoy, things that matter to us, and things we know are good for our health. Good sleep hygiene is one such thing, but too often it gets the short shrift. Indeed, a brief daytime slumber (less than an hour) may improve alertness, productivity, and mood, especially under sleep deprivation [3], and right after lunch may be the best time [20]. Naps also promote health with one study demonstrating that those who napped once or twice a week had appreciably lower incidence of cardiovascular events. I make it a point to indulge in a brief nap after office hours. This greatly enhances my ability to tackle the emails and demands that await me.

Establish a New Routine

This is not about finding one night’s rest; one 7-hour night of sleep does not “re-charge the battery”—not when you go back to sleeping 3 to 4 hours the next 2 to 3 weeks in a row. This is about establishing a new routine that prioritizes rest and relaxation. There is no short cut to ensuring adequate rest. Quantity and quality of sleep matters. Research has shown that regular bedtimes promote more restful sleep, as does a cool and dark room [19]. In addition, a light snack, late afternoon exercise, avoidance of caffeine or alcohol close to bedtime, and elimination of a bedroom clock have been shown to be sleep promoters. Finally, do not bring work to the bedroom; your bed should send subconscious associations with rest, not work [19].

Have your schedule work to your advantage. Go through your work week and then run through your routine at home. Where can you be more efficient with your time? Perhaps make small changes like saying “no” to writing opportunities you don’t find particularly rewarding (I especially dodge book chapters), decreasing the clinic load by a patient or two, or declining to participate in an upcoming lecture series. Maybe you’d like to make a more fundamental change to your schedule to increase your productivity. Instead of working 10-hour days and eating lunch at your desk, which more than one-third of employees do [18], experiment with working in 90 minute bursts with a designated break in-between [6].

Tomorrow, Try This

• Commit to getting 7 hours of restful sleep.

• Find the inefficiencies in your work and home schedules to unlock additional time that can be used for rest and relaxation.

• Consider turning down new commitments. Your sleep (and your life) may be at stake.