It can turn you into a creep,
This business of getting no sleep
For all those who snore
You’ll be hurt to the core
If you’re lacking the slumber that’s deep.
There’s a tradeoff for money and time
The minutes get swapped for the dimes
There are those who expire
Before they retire
And the loss of the pension’s a crime
After I told a patient of my coming change of career plans, she talked about her deceased husband. He worked hard on the railroad for almost forty years and died of a massive heart attack four months before he would have retired. A friend of his had died three months before retirement. She told me she would miss me as her doctor, but she understood my decision. “You’ve worked hard,” she said, “it’s time for you to enjoy yourself. Have a good time.” I asked for, and received, permission to write about what she’d said.
We’ve known for a long time, observationally, that all work and no play makes Jack a dead boy, but this week the AMA daily email news confirmed that working overtime leads to heart attacks and shortens life expectancy.
The patient and I hypothesized that the railroads pay so much overtime because they know that if they work you hard enough you die before you can collect your pension.
I remembered the beginning of my Junior year in high school talking with a Senior, Jimmy Hopkins, who had worked much of the summer for the railroad. He got straight time for eight hours, time and a half for the second eight hours of the day and double time for the next eight hours. It sounded great at the time. Now it doesn’t sound so good.
I have a number of railroad employees in my practice and most of them suffer from sleep deprivation. They are well paid and badly overworked, like most doctors.
We learned nothing of sleep physiology in med school.
I did a month of high volume OB in my second year of residency, an externship at Los Angeles Women’s Hospital. One of the OB attending physicians there made some off-handed remarks about the effects of sleep deprivation. He said, “If you’ve been up all night you’ll do OK in the morning, your natural sleep/wake hormone cycle will carry you through till about noon. That’s when you have to start to be real careful.”
That’s all that I got taught about sleep in seven years of education.
Since then I’ve gone out of my way to read about sleep, and to try to keep abreast of the developments in sleep research.
In brief: you fall asleep, the sleep goes deeper and deeper, then gets lighter and lighter, then you go into rapid eye movement (REM), or dream sleep. You come out of REM sleep into light sleep, and the cycle repeats. As the night progresses, the time between REM cycles shortens. A person will go through between three and eight cycles a night.
Each sleep cycle might have the same apparent structure, but each sleep cycle in a night is different, and you must have enough of all components to function well. If you miss one cycle, it’s a lot like listening to your favorite song and missing one of the verses– not very satisfying.
You can postpone sleep indefinitely but REM sleep cannot be completely suppressed. People might think they’re awake but they start to dream with their eyes open; just another way to hallucinate.
People only make growth hormone during REM sleep.
Thus poetry in physiology: if you don’t dream, you don’t grow.