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Stress and sleep deprivation for dentists

20 April 2018
To sleep, perchance to dream…
Sleep disturbance is a well-documented response to stress. Dr Annalene Weston, dentolegal adviser at Dental Protection, shares her experiences from the dead of the night

I have not been sleeping well, as I have not been sleeping. I do not have obstructive sleep apnoea, nor a newborn baby (or puppy, or any other adorable sleep thief), my sleep hygiene is fine. I began not sleeping two weeks ago because of Mr K.

Although I work as a dentolegal adviser the majority of my week, I do, to the amusement of many of our peers, still practise. I practise because I love our trade, and because I love people, and it makes me feel like I am giving something back to the world if I can help people function and feel better. 

Practising part-time is great, and not spending every day bending over moving, emotive and incredibly unpredictable targets is, I believe, a great remedy to the stresses of practice.  However, practising as little as I do carries with it consequences: specifically that it is likely you will not be there when a patient needs you. This requires a lot of trust and confidence in your colleagues, and a lot of understanding from your patients.

Painful patient journey
Mr K presented with a heavy restorative burden with amalgam fillings that were 30+ years old, and several cracked teeth. He said he had not been to the dentist for ten years, and things were starting to niggle. Examination revealed several teeth requiring some attention, and we agreed to start by treating the one that was troubling him the most, as he was taking daily pain killers. 

Mr K was apprehensive and so didn’t reschedule straight away for the remainder of his treatment, as he didn’t want to have to see me too much. The pain went away, and then returned, which led to Mr K returning for another filling to be replaced (as planned). And another, and another; Mr K having to endure seeing me all of the time, the exact opposite of what he wanted. And the pain remained.

One of the advantages of being a dentolegal adviser is that you practise what you preach, and so I am pleased to report that at no time was Mr K confused or upset with me. He understood the journey he was on, and also that I am neither a magical nor an omnipotent being, and only time (and special tests) would dictate which of these teeth would ultimately require further treatment. He also understood I didn’t create his problem, and for that I am very grateful. 

However, I didn’t sleep, at all, for four nights. Four nights staring at the walls. Four nights turning things over in my mind. And although I am sleeping better now, I am still not really sleeping, as my anxiety is yet to abate.

Fear of the dark
Why is it that everything seems worse in the darkness? Why do I feel the need to punish myself by pulling out every secret fear; fear I have misdiagnosed, or that my work is subpar, or that my colleagues will see the treatment I have done; and the thing I have always feared to be true will come to light – that I am simply not good enough.

I believe it comforts our profession to know that we are not alone with our fears.

I am sharing this story, not for clinical advice, nor for sympathy, but because I truly feel we don’t share stories of this nature enough. I have genuinely learnt far more from my failures that I have ever learnt from my successes, and so I have welcomed those failures into my life (albeit grudgingly at the time). When I had my babies, and paced the floor at night with a fretful newborn, it gave me great comfort to know that people all over the world were experiencing the same thing at the same moment in time, and likewise I believe it comforts our profession to know that we are not alone with our fears. 

While we are all unique individuals, with individual belief systems and secret fears, many of us respond to stress in the same way, with grumpiness and sleeplessness. It affects our work and our home, and it affects us, because no-one ever woke up in the morning wanting to fail, or cause a patient pain, or have a patient angry with them.

They say a problem shared is a problem halved for a reason.


What I learnt from this
TALK – to someone, anyone, about how you feel. This can be a peer, or a family member, or perhaps a professional, but you need to talk it through and talk it out – they say a problem shared is a problem halved for a reason. And you can’t always see the solution if your filter is darkened by despair. 

BE KIND – to yourself. You are not superhuman. You are just a person, an excellent one, but a person nevertheless.

BALANCE – your life and work, so the latter does not consume the former.

PERSPECTIVE – can be gained through talking and seeking advice, both on the care of that patient and the care of yourself.

I am pleased to report that Mr K is now pain-free. He thanked me for my tolerance, kindness and for not being annoyed with him for creating his own problems and having to come back repeatedly until we could get him fixed. Somewhat ironically, he then told me I looked tired and needed a break! Thanks Mr K, I’m working on it!

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