What impact does sleep have on physicians and their patients?

Grace: Thanks so much for having me, Nicky. I’m excited to be here.

Nicky: We’re very excited to have you. Sleep is such a hot topic at the moment in general health and well-being. How did you decide to specialise in it?

Grace: At university, I only had one lecture on sleep. I remember walking out thinking, wow, that was incredible. It really stuck with me, but we didn’t have much training in sleep. I did a physiology degree. Later, when I was looking at PhD projects, one came up on sleep and firefighters. I thought, oh wow, I’ve got to do that. That sounded awesome — and the rest is history. Fifteen years working in sleep and shift work.

Nicky: Wow. It’s such an interesting topic. I’m really interested in health and well-being and follow a lot of podcasts — sleep is everywhere at the moment. People are starting to understand just how important it is.

Grace: Absolutely. You really can’t talk about health and wellness without sleep coming up.

Nicky: So, going back to basics: obviously we all know we need sleep, but what’s the science behind it? What happens if we don’t get enough?

Grace: One of the biggest misconceptions is that sleep is downtime, like the body is on pause. In reality, sleep is one of the busiest times for the brain and body. While asleep, the brain clears metabolic waste, consolidates memories, recalibrates neural networks, and at the same time the body repairs tissues, restores immune function, and regulates other physiological systems.

I liken sleep to the foundations of a house. If the foundation is solid, the whole structure stands strong. If it’s wobbly, every other part — mood, physical health, performance — starts to suffer.

Nicky: Sure. I think everyone’s felt that — sleep deprivation makes it hard to concentrate and you feel drained.

From what I understand, seven to nine hours is what most people need. Is that correct?

Grace: Yes, for most adults the target is seven to nine hours, but it’s not just about duration. Recent science shows regularity of sleep is really important. I often compare it to precision medicine — timing can be as critical as the dose.

Keeping sleep and wake times consistent supports the body clock, which influences everything. For healthcare professionals, regularity can be difficult, but even small adjustments — protecting an extra hour, improving the sleep environment — can make a big difference.

Nicky: So physicians working night shifts or rotations must be at higher risk of sleep deprivation than the general public.

Grace: Definitely. Shift work, overnight calls, unpredictable schedules, high cognitive load, emotional stress — all stacked against physicians. Data shows they have higher rates of insomnia, fatigue, and burnout compared to the general population.

Nicky: I recently spoke with an ophthalmologist whose research looked at sleep deprivation in vitreoretinal surgeons. Novice surgeons’ performance and speed were much more affected than experienced ones. Not surprising, given what you’ve just said.

Grace: Fascinating findings, and consistent with what we know. Neuroimaging shows decreased activation of the prefrontal cortex with sleep deprivation — that’s critical for complex decision-making.

Nicky: So what other consequences are there for physicians if they’re sleep deprived?

Grace: Cognitive performance is the biggest — decision-making and quick responses. But also mood regulation, immune function, and other health impacts.

I come from a family of doctors, so I’ve seen this up close. Everything in medicine is grounded in science, yet sleep is often neglected, sometimes through no fault of their own. Cultural challenges and systemic issues around rosters and hours make it incredibly hard.

Nicky: And what about patient outcomes?

Grace: It’s not just about errors, though they’re important. It’s also about the quality of care. I once spoke to an ICU nurse who said, “I can handle the long hours, but if I miss sleep for a few nights, my empathy disappears.” That really stayed with me.

Sleep fuels precision, empathy, and resilience. To put it in perspective: 17 hours without sleep is equivalent to a blood alcohol level of 0.05; 24 hours is equivalent to 0.1 — twice the legal limit in Australia. We’d never accept a physician operating drunk, but often accept them operating exhausted.

Nicky: That’s shocking.

Grace: It is.

Nicky: From your work, what strategies can physicians try to improve the little sleep they can get?

Grace: Two main things:

• Sleep environment: Light is the most powerful signal to the body clock. Bedrooms are often too light. A good test: if you can see your hand in front of your face, it’s too bright. Think “cool, dark cave.”

• Routine: Consistent pre-sleep activities signal to the body it’s time to sleep.

Reducing cognitive load helps too — keeping a notebook by the bed to offload thoughts can improve sleep onset.

Nicky: And what about fragmented sleep or naps?

Grace: Some sleep is always better than none. Think of charging a phone — two charges to 40% is better than being completely flat. Naps can help, but be aware of sleep inertia, that groggy feeling after waking. Short naps of 15–20 minutes help reduce this.

There’s also research on the “nappuccino” — drinking coffee just before a nap so the caffeine kicks in as you wake up, reducing grogginess.

Nicky: I love that. What about exercise?

Grace: Exercise and sleep have a bidirectional relationship. Any activity is beneficial, regardless of time of day. Even evening exercise doesn’t impact sleep as much as once thought, unless it’s very intense. My advice: fit exercise in whenever possible.

Nicky: And nutrition?

Grace: Timing is key. Large meals before bed interfere with sleep. Eating at night, when digestion is at its lowest, can impair glucose regulation and increase fatigue. For shift workers, lighter meals or snacks at night, main meals during daylight, works best.

Food type matters too — protein-rich foods with tryptophan (like turkey, potatoes), and tart cherry juice have positive effects on sleep.

Nicky: What about supplements like melatonin?

Grace: Melatonin can be useful in some situations but it’s not a magic fix. People can become reliant. There are many behavioural strategies to try first. Improving sleep is like training for a marathon — it takes consistent work over time.

Nicky: Are there long-term health effects of chronic sleep disruption?

Grace: Yes — strong links with cardiovascular disease, cancer, and other serious conditions. Shift work isn’t going anywhere, so the goal is to support physicians with strategies to minimise long-term risks.

Nicky: Tell us about your current research.

Grace: We just completed the Healthy Shift Work Project, which developed resources for people starting shift work. Physicians often don’t get training on managing sleep, nutrition, or activity during shift work. These resources — infographics and videos — are freely available at healthyshiftwork.com.

Nicky: I’ve looked at them and they’re very practical. I’ll include a link under this podcast.

Grace: That would be great.

Nicky: To wrap up, could you share your top three tips for physicians struggling with sleep?

Grace:

1. Optimise the environment — cool, dark, quiet, cave-like.

2. Reduce cognitive load — write a to-do list, have a routine.

3. Take opportunities to sleep or nap whenever possible.

Nicky: Amazing. Thank you for such practical advice. I’m sure our listeners will find this really useful.

Grace: No worries at all.

Nicky: And thank you to our listeners for joining us today. Don’t forget to subscribe to our channel on Spotify, Podbean, Apple Podcasts, or Amazon Music to hear our latest content.

Thank you, and goodbye for now.

Note: This transcript has been lightly edited to improve readability.