My Sleep Evolution


NaBloPoMo 2018:  What I’m Learning

How often do you look back and really appreciate how far you’ve come in a short time?  It could be a skill, an understanding…  Maybe lightning struck and you made a sudden, significant transformation, or maybe it was a slow, plodding trudge to the current state.  For me it started out small and organic, and grew with increasing momentum toward a sort of AHA! confirmation today.

I can honestly say that 5 years ago I did not pay much attention to sleep.  I have always been a night owl, often staying up late reading or writing.  When I started this blog, I routinely published posts around 2:00am.  But when I started talking to patients in more detail about their health habits, I started to learn the importance of sleep.

Here is the timeline of my Sleep Evolution, c.2014-present day.  Where along the arc live your thinking  and habits on sleep?

Personal Evolution

  • 2015: Regularly staying up past 1:00 or 2:00am posting to blog
  • Feeling the cost of this in my body more and more
  • 2017: 11:00pm bedtime commitment kept on and off, not staying up as late, as often posting to blog
  • Early 2018: Recommit to 7 hour goal after accepting new leadership role at work. “Put your own mask on first before helping others.”
  • (Read) Gretching Rubin’s Better Than Before, in which she lays out the evidence for the Foundation Four habits, in order of importance: Sleep, Exercise, Nutrition, and Order (decluttering)
  • Recommit (again) to protecting my own sleep because this helps me maintain healthy habits of exercise and nutrition (this was a small epiphany of the obvious)

Professional Evolution

  • 2016: Observation: Young healthy men who eat healthy and exercise but who have elevated glucose levels tend also to sleep less than 6-7 hours per night, average.
  • Start structuring patient interviews around “The 5 Realms of Health”—Nutrition, Exercise, Sleep, Stress, Relationships
  • Presenting to groups on physician health and well-being using the same framework for self-care
  • Patients asking, “Should I get up an hour earlier to work out or stay in bed?” Not sure how to answer
  • Reading more about myriad downstream effects of chronic sleep deprivation
  • 2017: Start calling them the “5 Reciprocal Domains of Health”
  • Understanding that though the 5 habits affect one another inextricably, sleep deprivation impacts all of the others disproportionately negatively
  • 2018: Resolve to tell patients: Stay in bed.  Because you can only sleep when you’re sleeping, and you can always move more while you’re awake
  • Start to wonder if I should reprioritize the list–rather than Nutrition, Exercise, Sleep, Stress, Relationships, maybe Sleep, Exercise, Nutrition, Stress, Relationships?
  • (Read) Gretching Rubin’s Better Than Before, in which she lays out the evidence for the Foundation Four habits, in order of importance: Sleep, Exercise, Nutrition, and Order (decluttering)
  • Decide to change the order of my list
  • (Read) Brené Brown’s Dare to Lead, in which she labels “rewarding exhaustion as a status symbol and attaching productivity to self-worth” as one of 16 examples of ‘armored leadership,’ whereas ‘daring leadership’ “models and supports rest, play, and recovery.”

What makes this the most exciting for me, though, is to hear real results from others.  I spoke to an acquaintance today, a fellow leader.  About a year ago he decided to take control of his sleep habits.  He started going to bed at a regular time, minimizing screen use at night, and making a nightly wind-down routine.  He adopted a brain dump practice with a diary at the bedside to keep ideas, challenges, etc.    Now he notices that he is able to focus better in the mornings.  He feels more alert, more relaxed in his outlook, and more resilient to acute stressors.

Most importantly, his relationships at work are improving.  A couple of times a week he notices a transformation in his interactions.  When frustrated with another’s mistakes or lack of engagement, he used to come at them with criticism and blame.  These days, he is able to notice this escalation in real time, and redirect his thoughts, words and actions to come alongside others instead, staying in curiosity and compassion.  With better sleep he is able, in real time (the key), to see how his needs are not the only ones worth meeting.  He can hold the space to ask what the other person needs to engage and perform better.  He sees more clearly opportunities to be his best self, to reach those around him at a deeper level.  This fosters self-fulfilling confidence in his leadership skills, not to mention trust and loyalty among his direct reports.

All of this simply from better sleep?  I imagine he has also done work in other domains (stress management, relationships).  But they are reciprocal domains, remember, so as habits in one area improve, others soon follow.

What benefits do you notice when you get enough sleep?

Here are some articles that explain more about consequences of sleep deprivation and how to foster better sleep habits:

You Need More Sleep. Here’s How to Get It, Harvard Business Review

The Simplest Way to Drastically Improve Your Life: Get More Sleep, New York Times

How to Get a Better Night’s Sleep, New York Times

Time to go to bed.

Ode to My Dawn Simulator


NaBloPoMo 2017: Field Notes from a Life in Medicine

Did you notice the photo on my post Gratitude Again?  That was the view out my office window around 5:30pm last week.  These days I appreciate the winter dusk a lot more than years past, mostly because the physically hardest years of training and my kids’ lives (for me) are over.  My intern year I rotated in the medical intensive care unit (MICU, or MICK-you, or just ‘the unit’ for short) in November.  Usual days started by 6am, and finished whenever my patients were stable enough for me to leave, usually past 7pm.  I really never saw the sun that whole month—not from outside, anyway.  Every third night on call, my resident and I covered the whole place.  The longest I ever spent in the hospital was 5am until 10pm the following night—41 hours straight, only to be back again the next morning at 6.  And that was nothing compared to the generation of doctors who trained before me.  Thinking back on it now, I can still feel the saturating fatigue, the utter hopelessness of ever seeing the call room, let alone lying down on a bed.  Thank GOD those days are over.  They weren’t all bad, though.  Residency was one of the hardest things I’ve done, and it was also intensely rewarding.  The friendships I made those years, the unique shared experiences—I carry these with me also.  They made me strong and gave me confidence.

But if I thought getting up in the dark during intern year was hard, somehow doing it as an attending with two little kids was even harder—go figure.  The sleep deprivation of working motherhood is a completely different animal from that of residency, its toll multiplied on family.  The blaring alarm clock, the utter blackness of the bedroom, the contrast of cozy warmth under the blankets with the cold still air above.  They all conspired to make me peevish, sullen, and supremely unpleasant to be around every morning—an additional cost to my soul every time I lashed out at the kiddos out of my own exhaustion.  To borrow a phrase from Vee over at Cute Kids, I might well have died of a bad mood or something worse if that situation continued.

So Husband staged an intervention: He bought me a dawn simulator for Christmas.  It’s an ingeniously simple device: An alarm clock with a built-in light dimmer that comes with its own full-spectrum light bulb.  All you have to do is connect it to a bedside lamp.  Then you set sunrise time, as well as duration of rise (I set mine to 6:45, 15 minutes).  Every morning for the past 7 years I wake up naturally from a steadily brightening, gentle and warm glow from one corner of the room.  It’s infinitely more pleasing; no blaring involved.  Of course now I have my iPhone ‘by the seaside’ alarm as back up, especially for this month as I stay up too late writing blog posts.  And I’m not a morning person in general, so no Mary Poppins songs bursting forth with domesticated mechanical birds on my windowsill.  But life is infinitely more tolerable between Halloween and Easter each year now—for all of us.

Thanks, Husband.  Ya done good.