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Too Little Sleep Can Mean Too Little Empathy

If there’s one thing every clinician working in healthcare understands down to their bones, it’s what it feels like not to get a full night’s sleep.

Sleep deprivation is a chronic problem across the adult population in the United States, with 70% of adults reporting they don’t get enough sleep at least one night a month and one in 10 Americans saying they never get enough sleep. But healthcare support staff—PAs, nurses, NPs, home health aids, therapy assistants, and similar careers—are among the professionals who get the least sleep. Those whose hours are governed by changing shifts can experience even more difficulty getting enough sleep.

The health risks of inadequate sleep are well understood, such as an increased risk of depression, insulin dependence, heart disease, type 2 diabetes, obesity, poor immune functioning, and other health problems. But fewer people realize that the consequences of too little sleep affect others around you as well. Research into the effects of sleep deprivation on empathy reveals how getting too little sleep can affect patient care.

Scientists have known for a while that inadequate sleep can affect your mood and emotions, causing irritability and making it more difficult to make decisions and brush off small slights. But aside from those challenges, inadequate sleep also makes it more difficult for you to recognize and identify with what others—including coworkers and patients—are feeling.

A study from 2014, for example, assessed how empathetic 37 healthy college students were in three different scenarios. One group was tested before and after a usual night of sleep at home, one group was tested twice on the same day, and the third group was tested before and after a complete night of sleep deprivation, with the students being forced to stay up all night. The assessment involved showing the students images of people in different situations showing different emotions, such as having fun, relaxing, or experiencing pain. The participants had to describe what the people in the images were feeling and then how strongly the participants themselves felt while looking at the photos.

The results showed that sleep-deprived students felt less empathy for people in negative situations, such as experiencing pain or sadness, compared to the groups who had a full night’s sleep or were tested twice on the same day.

That study examined an extreme situation, with participants completely deprived of a night’s sleep, but subsequent research has similarly found that having chronically poor sleep reduces empathetic responses to others. The same researchers who conducted the study above published another study in 2016 that compared participants’ performance on a similar empathy test with their sleep quality based on sleep questionnaires and actigraphy. ”Lower subjective sleep quality was associated with lower empathic sensitivity to negative stimuli,” the researchers found, and “shorter sleep durations [were] associated with lower average empathic responses.”

The researchers go on to say, ”These findings may have important implications for individuals employed in professions requiring social interaction and empathic experience coupled with schedules that interfere with nighttime sleep.” Healthcare professions certainly fit the bill for that combination. And in fact, the same researchers focused explicitly on one group of healthcare workers in a later study. Their 2018 study compared empathetic responses among 12 paramedics who had at least three years of experience and were currently working full-time, 13 paramedic trainees who didn’t have any other emergency services or patient care experience, and 16 college students who weren’t training for paramedics and had no emergency services experience.

First, the participants completed a sleep survey assessing their sleep quality in the month before the study began. They also completed surveys that assessed their symptoms of anxiety, depression, and PTSD. Then each participant viewed 180 sets of images that showed neutral or negative facial expressions and was asked on a scale of one to four how strong their empathy was for those in the images. Unsurprisingly, the working paramedics had significantly worse sleep quality than the trainees and the non-paramedic students, whose sleep quality was similar to one another.

Analysis of responses to the images showed that the working paramedics also empathized with those in the images significantly less than the trainees and college students. Of course, anyone in healthcare knows that it’s possible to become habituated to others’ suffering or experience occasional numbness toward others over time simply because of how much pain you see each day. However, the researchers accounted for that by comparing the sleep quality questionnaires specifically to the empathy scores. Poorer sleep quality scores correlated with lower empathy scores, but the same relationship wasn’t seen with depression, anxiety, or trauma scores. That result suggests that sleep deprivation plays the biggest role in reduced empathy among the paramedics who slept most poorly.

So what does all this mean? If you’re not getting enough sleep, your empathy meter may be suffering, which can affect patient care, even if it’s simply being able to recognize how much distress someone is in.

The big question, though, is what to do about it. Here are some things to consider:

Do a self-assessment: Are you getting enough sleep? If you’re unsure, track it for a few weeks, either with an activity monitor or pen and paper. Note whether you feel well-rested—or how not-well-rested you feel—each morning on a consistent scale, such as one to five or one to ten.

If you’re not getting enough sleep, try to identify the reasons. Is it because of your work schedule? Responsibilities at home, such as caregiving for children or someone else? Staying up late to have time to yourself? Having trouble falling asleep or staying asleep? Talking with a sleep physician or therapist may help you pinpoint the causes, and there are likely multiple reasons.

Explore what kinds of interventions may address the causes. Some things, such as caregiving responsibilities, may not be possible to change. But you may be able to ask others for help or speak to your supervisor about a different schedule. If you’re not getting enough time for yourself, see if you can find a way to schedule an hour here or there during the week just for you so you’re less inclined to stay up. If you’re experiencing insomnia, talk to a sleep doctor or therapist, or check out online cognitive behavioral therapy-insomnia treatment, the gold standard for treating insomnia.

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