At some point in adolescence or my early twenties, likely in the context of going out and drinking, I heard the phrase “I’ll sleep when I’m dead”. It was a justification for continuing to not only function but add insult to the body with alcohol over-indulgence, without the necessary rest (or any sense of moderation).
Medical training is this notion on steroids. By the time I was in residency (named that because of the expectation to live in the hospital), there was an 80 hour work week limit. The limit was imposed because prior to that it wasn’t unusual to work 120 hours. The 80 hour work week is an average, some weeks will be more and some will be less. There is no clocking in or clocking out in residency, at least in my experience. You have a salary and you’re expected to show up on time and stay until the work is done.
In addition to the rules, there’s medical culture. Even with the 80 hour limit, there’s an air of superiority of those who work more, sacrifice more, and sleep less (read: live less). There’s an air of superiority from attendings (supervising doctors) who trained prior to the 80 rule, leading to “back in my day” statements. Their argument is that an 80 hour work week doesn’t accurately prepare us for life after residency where there are no rules. The work needs done and patients need seen and that doesn’t have a limit.
We have a limit though.
I’m currently reading Outlive by Peter Attia, a former surgeon turned metabolic health and longevity doctor, and I’m into the chapter on sleep. When he was in medical training it was before the 80 hour work week rule and he opposed the inception of the rule at that time, though he suffered some severe incidents due to lack of sleep. He met his limit. It wasn’t until a friend asked him, “If sleep is so unimportant, then why hasn’t evolution gotten rid of it?” that the importance of sleep dawned on him. It was his light bulb moment. Every animal has a form of sleep or rest. It’s non-negotiable, as he now says.
How does this relate to you as a midlife woman?
Up to half of midlife women report difficulty sleeping.
An analysis was done on the Study of Women’s Health Across the Nation (SWAN study) to assess sleep quantity and quality and heart health later in life. These were women in their late 40s and early 50s and were not taking hormone replacement therapy. This analysis found that those with insomnia (difficulty falling asleep, multiple waking episodes) and persistently short sleep duration (about 5 hours) were associated with increased heart risk later in life. Increased cardiovascular events can include heart attack, stroke, heart failure).
Another common pain point for midlife women is weight gain, often times despite efforts to do the opposite. While it isn’t the only cause of such weight gain, lack of sleep is a contributor. An analysis on the Nurses’ Health Study found that five and six hour sleep duration were associated with increased weight gain and obesity. The five hour duration had a higher risk.
Tips for Improved Sleep
Quantity
As an obstetrician both quantity and quality are compromised for me. Just last night on call I was called at these times: 8:01 pm, 10:33 pm, 3:53 pm, 5:22 am, 6:16 am. That’s a rough schedule but certainly not the worst I’ve had. The longest stretch of sleep was about five hours and that’s if I fell immediately asleep after the call, which is unusual.
A five hour stretch isn’t enough. As we discussed, this is a short sleep duration associated with increased cardiovascular risk and weight gain.
Magnesium
Late last year I started using magnesium bisglycinate before bed. I love this one from Thorne and use other Thorne supplements because some are NSF certified and they have transparency with a list of “no” ingredients that will never appear in their products.
I put one scoop in my water around 7 pm and though it’s unflavored, I actually like how it tastes. It took a couple of weeks to notice any difference but once I did, I thought “is this what sleep feels like?” Between being an obstetrician, having two toddlers who were once infants, going through medical training, to years of parties before that, I was probably headed towards “I’ll sleep when I’m dead” faster than I realized.
The great thing about the magnesium is that I can wake up feeling rested, even if I have to get up for call during the night. I can’t take antihistamines like Benadryl as a sleep aid because I feel groggy for a long long time.
Magnesium in my nightly routine is now a non-negotiable.
Decrease Blue light
Not only do I have my two phones on my nightstand at all times while on call but I’m looking at the blue light every time I get called plus any chat messages I have from work. I wear glasses the vast majority of the time and I have a blue light filter added to all of them when I order at the optometrist. If you don’t wear glasses, there are blue light filter glasses like these that you can buy.
All of this is to say I can’t sit here and tell you that I’ve prioritized sleep. I can say that I’d like to.
When I’m not on call, I’ve recently started tucking my phone in a drawer and I dusted off my old alarm clock to use instead. That way, if I wake up and want to look at the time I can look at the clock rather than my phone. My alarm clock is one that slowly lights up before the actual alarm sound starts which is to mimic daylight. It’s called a sunrise clock which tries to honor our circadian rhythm. Plus I just find it more pleasant. I use this one from Phillips.
Decrease Alcohol
There’s also a deep-seated notion of alcohol helping with sleep when in actuality it harms it. Somewhere in my early 30s when I was still drinking, even what’s considered an appropriate amount, one glass of red wine a night, I started to notice a change in my sleep. I may have fallen asleep easier but I couldn’t stay asleep.
Turns out this is exactly in tune with studies on alcohol and sleep. The time to falling asleep may be shorter but total rapid eye movement sleep is reduced.
So,
I’m doing what I can within the confines of my circumstances to prioritize sleep. Why? Because if I don’t, “I’ll sleep when I’m dead” may become reality sooner than I’d prefer. Sleeping while I’m alive is my preferred alternative.
Resources:
Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.
I can earn commission on affiliate links.
This is not medical advice.
https://pubmed.ncbi.nlm.nih.gov/38284249/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3496783/
https://pubmed.ncbi.nlm.nih.gov/23347102/
https://academic.oup.com/sleepadvances/article/3/1/zpac023/6632721#
