Radiologists and the Sawing of Zs

There is abundant folk wisdom out there about sleep, usually in terms of optimizing its quality and quantity. Go figure. Everybody has got their own experiences from which to draw their two cents. Going through a typical medical education adds some actual scientific info to the mix but by the time that happens, we have lived a couple of decades and are not likely to change our worldview much.

Sometimes the folklore and science overlap. I had heard anecdotes of sleep “hangovers” from instances of staying in bed later than usual and even experienced it firsthand. Finally having presence of mind to look into it, I found that “sleep drunkenness” is a legit thing and tied to disruption of one’s circadian rhythm.

I had never had difficulty falling and staying asleep. However, by the time I had been through internship, I daresay I was a champion snoozer. There are few things like working long hours — especially if they are unpredictable like being on call — to train you to lose consciousness when and where you safely can. Military folks, I think, are most well-known for this, but we probably come in second place behind them.

There are exceptions of course. I have known a doc or three who suffered from insomnia. I thank my lucky stars that I can’t even imagine having that problem outside of specific situations. If, for instance, I have to wake two hours earlier than usual to catch a flight tomorrow, it doesn’t matter if I compensate with an earlier bedtime or extra alarms. My eyes will flutter open every hour or two to glance at the clock, but at least I will doze off again fairly quickly.

I have had occasion to offer a few words of advice to those less sleep fortunate than myself. It is not stuff I claim to have completely invented but it is all through the filter of my own experience. That is especially relevant when talking to a fellow rad as I will discuss below.

Some of it is just common sense but like all common sense, it is easily forgotten or ignored. Many write-ups tell the importance of adhering to a regular schedule (in terms of your sleeping hours as well as when you eat/drink in relation to them, exercise, etc.). There is also plenty of info about why it is not helpful to watch TV or play on your cellphone while you are lying down and theoretically trying to lose consciousness. I find many insomniacs know these things but fail to abide by them.

There are some factors a little more specific to radiology. I consider it one of the more “sleep-adjacent” medical specialties. When not performing procedures (and a lot of us don’t do any), we work in quiet, dark rooms, often sans human interaction. You know, sort of like the conditions one might seek when trying to sleep? Some of us try compensating for that by ingesting lots of caffeine, not necessarily a helpful thing if we actually try to slumber just a few hours later.

Another issue with being in a sleep-adjacent occupation is that you might emerge from the end of a workday wanting to act more, well, awake. You just spent eight to nine hours in the rad zone. Your brain now craves more human interaction or just plain fun. What happens if you get done with work, eat a little something, and only have time for a bit of TV before ending the day? You might find yourself resisting going to bed, shortening your “horizontal hours.” Even if you force yourself to lie down, your brain might still be buzzing.

One of the hazards of spending a third of the day in front of a monitor is a lack of physical activity. Remember what I said earlier about the common sense of getting exercise as part of homeostasis? Some rads try to counterbalance their activity deficit with things like treadmill working desks. I have never personally known anyone who used them, so I haven’t heard about their effectiveness. Other rads make a point of getting out of their seat and walking around during the workday.

These little gestures are better than doing nothing at all, but anybody who thinks they are “good enough” is fooling themselves. Strolling down the hallway once every hour or two to grab a coffee or hit the bathroom isn’t anywhere near what we evolved to do. I have written before about the benefits of exercise. One of them is actually doing it to the point that you feel weary and thus sleep more readily later on.

Most health-care types inflict a special sleep challenge on themselves (and one another) in the form of covering call shifts or overnights. Unless one plans to work those hours for the long haul, switching between nocturnal living and otherwise is a mess sleep wise. I can’t say for sure if rads invented the seven-on, seven-off routine, but our specialty sure seems to have picked up that ball and run with it.

Nowadays it might be for extra income, but in the leaner job market of yesteryear, it was the price one paid for getting a teleradiology gig at all. Part of the hype was having 26 weeks off per year. However, realistically, a lot of rads, myself included, proceeded to take on other work to fill much of that time.

Meanwhile, one would work overnights. My typical hours were 9 p.m.-7 a.m. Then it was time to try sleeping during the day, not always an easy thing with most of society doing the opposite. If you didn’t live away from everyone else, you might wind up investing in things like blackout curtains and noise-canceling headphones.

Perhaps you wanted to retain some interaction with the non-nocturnal world, and you would nibble at the margins of your off-hours (seeing your kids off to school, meeting friends for dinner before you began working). Even if you didn’t, unless you planned to remain nocturnal for your off-week, sooner or later, you came up with a routine to transition between nights and days.

For me, that wound up meaning I effectively sacrificed a day each week and spending more than a few hours feeling fatigued or otherwise less than. It was not, as many rads who have done the seven/seven thing, sustainable over the long term. I think I did it for around four to five years before circumstances presented me with better options.

Gravitating toward more “normal” hours as one gains seniority is a very common thing. Some folks regard it as an earned privilege. Others see it as a fair trade-off: Having bought a home and otherwise gained a foundation for long-term financial viability, they are able to take work that perhaps pays a bit less in exchange for giving them the schedule they want.