RxZZZZZ: Sleep solutions for pharmacist burnout

Welcome to the last post in this 4-part series on how M.E.D.S (Meditation, Exercise, Diet, and Sleep) can impact symptoms of burnout. As a reminder, the WHO defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. Burnout is characterized by: Feelings of energy depletion or exhaustion; Increased mental distance from one’s job, feelings of negativism or cynicism related to one's job; and Reduced professional efficacy.1 You don’t have to be a pharmacist to see how poor sleep impacts all three of these criteria. Several studies have shown that sleep-related impairment is associated with increased burnout, decreased professional fulfillment, and clinically significant medical errors.2 This should come as no surprise as we regularly see how poor sleep affects our patients and ourselves. Do you struggle to get out of bed in the morning? Do you repeatedly hit your snooze button? It is estimated that 40% of people aged 40-59 report that they are getting less than the recommended amount of sleep.3 Not only has the amount of sleep people report decreased over the years, but the quality has also diminished. In a recent study, 37.9% of people reported unintentionally falling asleep during the day or at work in the last 30 days.4 These numbers are only exacerbated by pharmacists who not only have increased levels of stress while at work, but also those dealing with late night shift work. When I started my career as a full-time pharmacist I was employed at a chain store that was open until midnight. When working a midnight shift, I would leave the pharmacy at 12:15 a.m., drive 35 minutes to get home, eat something, and then drift off to sleep around 1:30 a.m. Although the pharmacy manager tried not to schedule me to open the next morning, it happened more than a few times. As a young pharmacist I dealt with it, but nobody should have to work that way. As pharmacists, it is important we have enough rest to stay healthy, be more engaged with our work, and prevent medication errors. It’s challenging to write a single article on a topic as broad as sleep. I have tried to distill ideas down to simple, actionable steps that you can take yourself and share with your patients. As we know, many sleep agents available over the counter or by prescription are not effective long-term solutions. Some come with side effects including prolonged drowsiness and anticholinergic effects. Long-term use can lead to dependence and cognitive decline. In terms of efficacy, they offer only a modest benefit for sleep latency, and most negatively impact sleep quality. The most appropriate clinical uses of prescription sleep agents are for short-term periods to help people through a challenging time such as the death of a loved one or during the onset of depressive symptoms. Medication reviews provide opportunities to deprescribe these agents after such periods of time. Patients also often look to pills to solve their sleep issues without addressing how they process and cope with external stressors. As clinicians, we need to look upstream and help patients uncover and address the behaviours that are contributing to their sleep issues. The benefits of restful sleep extend beyond an increase in energy and improvement in mental focus. Regular, adequate sleep reduces the risk of diabetes, heart disease and obesity. It can also improve athletic performance, fine motor skills, reaction time, and muscular endurance while helping regulate hormones that control appetite and metabolism.5 As pharmacists, we are well aware of sleep hygiene recommendations because we counsel patients on these daily. I won’t bore you with the obvious. I like sharing and implementing the easy-to-follow 3-2-1 rule: 3-2-1 Rule • 3 hours before bed, no food/drink • 2 hours before bed, no work • 1 hour before bed, no screens Eating within 3 hrs of sleeping increases nocturnal awakenings and sleep latency,6 while decreasing sleep quality7 and next-day recovery.8 During digestion, your metabolic rate increases, causing an increase in your body temperature. Studies indicate that higher core body temperatures during sleep are associated with decreases in restorative slow-wave sleep and subjective sleep quality.9 Working before sleep also decreases sleep quality. The monkey mind is good at replaying the past and worrying about the future. Doing breathwork exercises, yoga nidra or meditation before sleep can help relax and center us. I have also found keeping a notepad and pen next to my bedside table is an effective way to close ‘mind loops.’ It is not uncommon to have thoughts come to us just as our heads are hitting our pillows. So. when you remember you have to follow up with Mrs. Tan about her new CGM sensor, you simply write this down on your notepad, let it go, and deal with it tomorrow. Screens emit blue light and stimulate a part of our brain that suppresses melatonin production. As a result, blue light delays the transition to sleep and leads to less restful sleep even when we are engaged in a soothing online activity.10 When you don’t have a choice and have to use LED screens later at night, I would consider getting blue light-blocking lenses for your glasses or purchasing red tint glasses here. This is a simple, yet effective set of rules that are easy to explain, yet challenging to follow. There are also many trackers for monitoring sleep quality and duration. I have an Oura Ring. This stylish wearable measures your resting heart rate, body temperature, heart rate variability, movement, and time spent in specific sleep stages, including light, deep, and REM sleep. It uses an algorithm to provide you with a sleep score and you can track how interventions impact your sleep. By being more intentional with our nightly routines, we can significantly improve our sleep duration and quality. Try some of these suggestions and check in with how you feel. Subscribe to my weekly newsletter here. References https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773777 'Has Adult Sleep Duration Declined over the last 50+ years?', National Center for Biotechnology Information Morbidity and Mortality Weekly Report. 2011;60(8):233-238. https://www.healthline.com/nutrition/10-reasons-why-good-sleep-is-important https://www.sleepfoundation.org/nutrition/is-it-bad-to-eat-before-bed https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215804/ https://www.whoop.com/us/en/thelocker/eating-before-bed-affects-sleep-recovery https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839336/