It was the first day of my clerkship—the 3rd year of medical school when you rotate through different hospital placements—and my first rotation was in pediatrics.
I showed up bright and early, wearing my brand new white lab coat, the pockets stuffed with handbooks, cheat sheets, and a variety of medical instruments, trying to look more confident than I felt. Our chief resident gathered us in the conference room and promptly handed out the call schedule, informing us that call would be starting right away. One of us, within our little group of clinical clerks, would be staying all night that night. I scanned the schedule to see who the poor bugger was.
That’s right. It was me.
I stared at the page knowing at the end of the (very stressful) day, I wouldn’t be going home. I’d be up all night, continuing to work on the hospital ward. And then, when everyone else turned up the next morning, I’d be staying all the next day, too. I was facing the beginning of a 32-hour shift. And I hadn’t even brought a toothbrush.
By the end of the following day I felt like I’d been in a car wreck. I had that hangover fog and malaise—without any of the preceding fun. I could barely see straight, let alone listen to the staff pediatrician who took no pity and didn’t let up one iota on his quizzing, questioning, and
After that, 32-hour shifts became normal. A weekly occurrence—sometimes twice a week. Each time I survived another one, I would go home, numbly eat a sandwich, try to stave off sleep for a few extra minutes and not drown in the bathtub before slipping into bed for several blissful hours. Only to do it all over again. For three years.
SURVIVING SLEEP WHIPLASH
Sometimes I would be awake for 32 hours straight, and then I’d sleep for 12. And then the next night was more normal: 8 hours or so. But then back to a 32-hour stint.
It was all over the map and it was not good. I came to think of it as sleep whiplash. Fortunately it was just a temporary phase: one year in med school like that, and then a 2-year residency…but it did, mercifully, end. And not all my rotations were so grueling.
Some of my rotations contained a more normal schedule. Long days, sure, but an END to the day, time to rest, and then back to it. More of a 24-hour routine.
Which is something I came to treasure. Never had I realized the value of regular sleep habits so deeply. Even when you’re not getting quite enough sleep, as long as it’s coming on a regular routine, your body can adapt.
At the university clinic where I work now, a lot of the students have sleep schedules that are all over the map. Sometimes they stay up until 4 am, studying or partying (or both?)…and sometimes they sleep from 6 pm to 11 am the next day.
Unsurprisingly, some of the most common reasons for my visits at the university clinic are: fatigue. GI complaints. Headaches.
Why is it so bad for us to live like this?
CIRCADIAN RHYTHM AND WHAT IT DOES
Well, it just so happens that there is an area in the brain that regulates our day-night rhythms, or circadian clock. When that center receives information it’s morning (primarily through an input of sunlight), that sets the clock, triggering a bunch of changes in the body: it raises body temperature, inhibits release of melatonin (the sleep hormone), and basically tells our system it’s time to be awake. Everything is then set on a cycle that will run roughly 24 hours. At night-time, there will be a set of changes set in motion that trigger a sleep cycle, and then the whole thing resets in the morning again.
But the circadian rhythm/body clock affects more than just our sleepiness/wakefulness. Other systems also operate on a daily rhythm: mood, stress, heart function, GI function, immunity, hunger…
For example, research has shown that the immune system and inflammatory compounds fluctuate over the course of the 24-hour circadian rhythm. The inflammatory response increases at night (explaining why fevers typically peak in the middle of the night). Hormones controlling metabolism and hunger wax and wane through the 24-hour cycle. Digestive functioning goes through day-night cycles. Blood sugar is influenced by our body clock; cortisol release is affected by our circadian rhythm.
Basically, our bodies are designed to function like a finely-tuned machine in sync with a 24-hour cycle. Or, as aptly put by an article in the Atlantic: your body wants to run like a Swiss watch.
HOW WE MESS WITH THE MECHANISM
Trouble is, things in our lives can seriously disrupt that system. Jet lag is one example. Shift work. A newborn baby. Even the adjustment to the one-hour shift of daylight savings time can have a significant effect we feel for days afterward.
But we also manipulate it ourselves—through electricity, using screens (ie. blue light), staying up too late sometimes (and not others)…basically interfering with our bodies’ own systems through our choices and lifestyles.
It comes back to the concept of sleep whiplash. Our bodies and minds do not do well when we don’t allow its natural circadian rhythms to function as it should. And I’m talking every day. Seven days a week. Your body does not care (or know) if it’s Tuesday or Sunday. It wants to do the same things, go through the same cycles, every 24 hours without variation.
What I often say to patients: if you don’t follow a sleep schedule, you’re basically subjecting your system to jet lag on a weekly basis—and most of us know how awful that feels.
Don’t get me wrong, a little flexibility is fine. Staying up late for a special occasion every once in a while? You’ll bounce back from that. But making it a habit, not respecting your body’s own needs…you’ll pay a price for that.
And what sort of price, you ask? Here’s what some of the research has shown on what circadian disruption does to us:
- worsens GI disease, like IBS, reflux, and peptic ulcer disease
- accelerates aging
- leads to body weight increase and obesity (by shifting food intake schedules and otherwise altering metabolism)
- increases the risk of car accidents & workplace injuries (as shown by stats on these when we spring forward at Daylight Savings and lose an hour of sleep)
- increases the risk of having a heart attack (as shown in people with heart disease, the week after the Daylight Savings time shift)
- may promote cancer genesis (research has demonstrated an increased risk of GI cancer, but there may be others)
Let’s face it, nobody wants any of that. So what to do to maintain a healthy sleep schedule and keep your body running like that Swiss watch?
HOW TO STAY IN SYNC
It starts with sleep hygiene—something I’ve written about many times on this site and others.
Here are some tips:
- adhere to a regular wake up time, and a regular bedtime
- ensure you’re getting enough hours (7-9 for most adults)
- minimize substances that can interfere with proper sleep (caffeine, alcohol)
- set up a sleep-promoting bedroom: sufficiently dark, cool, and quiet
These are just the basics, and there are many more things you can do to promote healthy sleep habits.