When you can't sleep - try this!

Posted on: August 17, 2023

Clinical Professor Leanne Rowe AM

Sleeping well naturally is fundamental to being able to function well, as it can significantly interfere with the quality and safety of our interactions with patients and colleagues and predispose us to mental illness.

Paradoxically, this statement is more likely to predispose you to poor sleep than cure insomnia. The more you worry about the impact of poor sleep, the more you will wake up worrying about it. In contrast, when your brain truly lets go of the importance of sleep, your body will naturally ‘fall’ into deep slumber.

Why is insomnia common in doctors?

We work at high pace, after hours, and on call. We often need to attend to our administrative work late in the day on a brightly lit computer. We seldom have time to relax, meditate or exercise during the day due to our heavy workloads. When we don’t have time to process experiences during working hours, it is common to wake up ruminating about our interactions with patients and colleagues, clinical decisions and exposure to trauma, suffering and conflict.

Periods of acute insomnia are common and normal under these circumstances. However, if we respond to acute insomnia in negative ways, chronic insomnia can become an unhealthy habit.

Why don’t generic sleep strategies work in doctors?

While it’s worth trying generic sleep hygiene interventions, do not be discouraged if these strategies do not work. Medical practice is not a generic job.

The following section has been written for Every Doctor by psychologist Dr Giselle Withers, who has developed a specialised online sleep course, A Mindful Way to Healthy Sleep Program2 (www.amindfulway.com.au). The program provides structured video-based modules teaching the five components of cognitive behavioural therapy for insomnia (CBTi), and includes formal training in mindfulness meditation. The program has been evaluated in an independent study by Monash University, 

1. A brain trick, called paradoxical intention, to break this frustrating repetitive thought, is to try NOT to fall asleep by keeping your eyes open for as long as you can.
2. Sleep hygiene strategies may include simple instructions such as avoiding caffeine and alcohol and reviewing environmental factors that may disrupt sleep – temperature, noise, light, etc.
3. Stimulus control strategies include avoiding non-sleep activities in bed (particularly reading, thinking about patients and exposure to screens), and getting out of bed if lying awake for more than 20 minutes, returning to bed only when sleepy after listening to a mindfulness recording.
4. Sleep consolidation or bed restriction involves limiting your time in bed to match your current average sleep time to increase ‘sleep drive’, provided you allow a minimum of six hours in bed each night. If sleeping patterns improve after a week, but there is a feeling of sleep deprivation, begin adding 30 minutes of extra time in bed and monitor for another four to five days. Continuing adding 30 minutes to your time in bed until feelings of sleep deprivation disappear.
5. Relaxation training involves focusing the mind on various relaxation techniques including progressive muscle relaxation, visualisation and breathing techniques, and can also reduce the anxiety associated with not sleeping. Reassure yourself you are benefitting from time taken to relax the mind and body, slow your pulse and breathing and lower your blood pressure even if you stay awake all night.

Compared to many of the complex illness and health conditions doctors treat each day, acute or chronic insomnia can be underestimated and its seriousness discounted. Often it is not until the conditions are personally experienced that the complexity of this disorder is recognised and fully appreciated by doctors. 

If these strategies don’t help, please consult an independent treating doctor or psychologist for an objective assessment. Please take care and seek support.

Taken from ‘Every Doctor; healthier doctors=healthier patient’ coauthored by Prof. Leanne Rowe AM, Dr Vihangi Abeygunawardana, Prof Michael Kidd AO, published internationally by Taylor and Francis www.everydoctor.org