Former veterinary practice owner and practice management consultant Steve Noonan, DVM, continues his quest to share the mindfulness, happiness and self-care tips that turned his life around with veterinarians and veterinary team members. This first column explores sleep. Join us next month for tips on keeping hydrated and well-fed (important for patients and important for you). And to see Dr. Noonan live on video and in person, check the related links below.
My experience—and that of many professionals I’ve known—is that in spite of higher education, many of us with postgraduate degrees (like a DVM) do not care for ourselves very well. So rather than optimum physical and mental health, we see reduced happiness and underperformance in the many arenas of life. We should know better. The maxim “Doctor heal thyself” rings especially loud.
Because of my own personal struggles with severe anxiety and depression, I’ve been fortunate enough to learn about and develop a personal system of self-care based on a combination of both scientific evidence and experience with what works for me. It’s my hope that you’ll find something here that either works for you or prompts a desire for further investigation and action on your part. It is you and only you who is responsible for your happiness.
Poor sleep leads to disasters—big and small
Abraham Maslow’s famous hierarchy of needs places basic physiological needs for survival at the bottom of a pyramid and emotional needs in the middle rising toward self-actualization at the top. So in order to get to better emotional and spiritual health, you, like every other organism, need oxygen, water, food … and sleep.
Lack of adequate sleep has been proven not just damaging to individuals’ personal health, but the cause of man-made tragedies. Two classic examples are Three Mile Island and Chernobyl. In both cases sleep deprivation from long continuous shifts and poor decisions made during the nadir of circadian rhythm (between 1 a.m. and 4:30 a.m.) were the issue. Fatigue either prompted a error in judgment or a failure to notice warning signs. The same problem played out in the Exxon Valdez oil spill.
Poor sleep yields bad results
Sleep deprivation in a laboratory setting manifests itself within a day, beginning with decreased visual acuity and progressing through moodiness, irritability, paranoia, hallucinations and fragmented thinking. As little as a one-day loss of sleep will impair immune function for up to three days. Chronic sleep deprivation and the associated stress is linked to the most common chronic illnesses, heart disease, cancer and diabetes.
The horrific manifestations of enforced sleep deprivation by Amnesty International are too disturbing to discuss in this forum. This same technique is used as an interrogation tool by law enforcement agencies and contract negotiators. It’s well known that reasoning, cognition and the ability to be creative declines as an individual continues to lose sleep.
The epidemic of sleep deprivation in America has been reviewed in detail by T.S. Wiley in Lights Out: Sleep, Sugar and Survival (Atria, 2001) and Stanley Coren in Sleep Thieves (Free Press, 1997).
Veterinarians are no different—we need adequate sleep! Long-working hours and continued exposure to high levels of stress are factors in the lives of many veterinarians. I have been a party to many discussions over 32 years where the ability to withstand these stressors to mythical proportions was either considered meritorious service deserving a badge of honor or simply a requirement of the profession. This profession continues to propagate a culture of overwork resulting in a lack of sleep and an abundance of stress. In fact, we’ve been selected for our resilience and ability to tolerate these conditions. They are forced upon us as veterinary students, interns and residents. But the cumulative effects of poor sleep will continue to take their toll until we do something different. It’s time for us to take a new path and make self-care a priority.
Poor sleep poisons your neural garden
Neuroscience has shown the presence of neural stem cells in the hypothalamus and lateral ventricles. Circumstances will dictate the outcome for these stem cells, which can range from cell death to differentiation into new functional neurons as part of a new neural pathway. It’s believed this is exactly what happens when we acquire new skills and abilities. Grey matter will thicken in an area directly related to the new skill acquired. The belief is, these are new neurons that have differentiated from stem cells.
The analogy of a seed in a garden is apt. These stem cells require adequate oxygen, water, food and sleep to survive and thrive. So in order to acquire new thought patterns—such as “I love my profession” and ”I’m willing and capable to take responsibility for my own happiness” and “I’m capable of creating effective solutions for dealing with stress”—it just makes sense to take the very best care possible of the neurons we do have as well as the one that potentially reside in our stem cells.
Let’s look at some evidence-based effective sleep strategies—along with what has worked for me—to see how we can start caring for ourselves better:
1. Say it out loud
This may seem so obvious yet should be stated. My experience as a professional coach is that once people decides to care for themselves, they begin to rapidly devise ingenious strategies to do so. To paraphrase the 13th-century mystic Rumi, “The mind will open and previously unknown forces and abilities will come forth.” The 18th-century philosopher Johann Wolfgang von Goethe states, “The moment one definitely commits oneself, then providence moves too.” Once you make the decision to develop a better sleep strategy, you’ll increase the likelihood of success. Say it. “I’m capable of developing a better sleep strategy.” Now let’s do it.
2. Set standard bedtime and wakeup times
Mine are 10:30 p.m. and 6 a.m. Humans need seven to 10 hours of uninterrupted sleep; it’s a rare to thrive on less. Those individuals who are so hardy that they intentionally sleep much less—like six, five or even four hours of sleep a day may be at risk for long-term health problems. Set a goal for sleep, and make it more than you’re currently getting. Reverse-engineer your day to allow enough time for this to happen.
3. Ritualize the experience
I use a hot shower, comfy jammies, a few entries in my gratitude journal and some light reading about positive psychology. Be inventive; pamper yourself with the best bed clothing and pillows, aromatherapy, calming meditation music, massage or whatever else works for you. I practice deep meditative breathing as I relax my body and close my eyes and for me that’s very effective.
When it comes to food and drink before bed, less is better. Avoid caffeine after mid-afternoon. The goal is to minimize the need to get up in the middle of the night. I try to only eat very lightly in the last three hours before bedtime. Alcohol will deepen sleep initially, but as it’s metabolized into sugar will lighten sleep due to the glucose surge.
4. Think dark
Our body’s natural response to reducing daylight is the secretion of melatonin from the pineal gland to help synchronize the body’s circadian rhythm. Any light, including glow from alarm clocks and other LED light sources, is absorbed through the skin and can disturb this rhythm. Blackout blinds are ideal. We cover alarm clocks with a towel and ensure that any other source of LED light is blocked. Ideally, you should have to “feel” your way through your bedroom. Our bedroom is completely dark, and it’s made a big difference.
It’s also important to gradually dim light as the evening proceeds to replicate the setting sun so that by bedtime you brain is ready for the lights to be turned out.
5. Avoid blue light
Blue light from phones, televisions, computers, tablets and smartphones is the most potent disrupter of melatonin. In an ideal world, exposure to these devices should be limited to two hours prior to bedtime. Blue-light-emitting devices in the bedroom are a sleep hygiene no-no. I make it a habit to avoid blue light for a minimum of 45 minutes before bed.
6. Keep it cool
We were designed to sleep in caves: cool, dark and quiet. Keep the windows open when possible or fans or air conditioners to create white noise. My wife and I use all three options, depending on the time of year.
Adequate sleep is not an option for good mental health—it’s a necessity. In order to reduce stress and begin to increase your happiness, I encourage you to develop your own strategy to improve the quality and quantity of your vital, health-giving sleep.