Sleep...that magical, mystical and misunderstood process, which is as important as food and water, but often cast aside as a disposable commodity in our busy 24/7 world. Remember when you were 10 years old and could "sleep like a rock"? As Rudyard Kipling put it in Captains Courageous, "That 40-fathom slumber that clears the soul, the eye and heart, and sends you to breakfast ravening." I, for one, would like to experience that again--at least once in awhile!

Since the development of Edison's light bulb, our average nightly sleep period has fallen off steadily, dropping from about nine hours to about seven hours. We are a sleep-deprived society, and the medical profession is its "poster child," with pride in its legacy of long, sleepless nights caring for patients. Through our training and into our current practices, long hours and little sleep are often worn as badge of distinction. But at what cost to our patients and ourselves?

Memory, cognitive ability and performance are intimately linked to the quality and quantity of sleep. Who among us doesn't rely on these in daily duties? We pay the price for lack of sleep in many ways, some obvious and others quite subtle.

Most of us truly do need between seven and a half to eight hours of normal sleep (quantity, quality and timing) to feel and function at our best. Grandma was right! And current, evidence--based medicine proves it.

Recent, well-designed studies reveal that sleeping fewer than six hours per night over a period of 14 days produces the same neurocognitive and performance deficits as two consecutive nights of no sleep at all. (Remember what you were like the day after those all-nighters while studying for exams or being on-call?) Executive brain function, judgment and the ability to personally recognize the deficits in performance are astoundingly poor. Like the drunk behind the wheel, you feel like you still have it together as you drive off the road. Mood, family life and social interactions suffer. Immune function is impaired and metabolic alterations favor weight gain when we don't get enough sleep. Our quality of life suffers and we have a much higher suicide rate than the general population.

Recent polls show that doctors get an average of six-and-a-half hours of sleep per night and our average work day is ten to thirteen hours. We try to sleep more on weekends and days off. We drink more caffeine than the average American--but say it's just a "habit" and don't really need it to "keep awake."

So with all of that in mind, what does that mean for our patients? Despite our best intentions, even mildly sleepy physicians and nurses make mistakes and our patients may be suffering more than we recognize.

We are beginning to awaken to the problem. Recognizing that sleep deprivation is a way of life in medical training programs, and as such, is likely endangering patient safety, the Accreditation Council for Graduate Medical Education implemented some positive, though anemic, restrictions. These include an 80-hour work-week limit and a 30-hour limit on continuous shifts.

Yet there is much more we can do. Despite current manpower limitations in the health industry, clinics and hospitals could benefit by optimizing shift-work rotations, and implementing limitations on the total number of hours worked each week. Doctor coverage schedules could be adjusted to avoid the all-week or all-weekend shifts, when possible. Malpractice carriers could track work hours and sleepiness factors in their claims database, promoting good sleep habits as a reasonable way to reduce malpractice claims.

We know that when the call comes, we've got to be there for our patients. But for your own health and well-being, for your patients' safety and care and to limit potential malpractice suits, take the time--make the time--for sleep.