HOW BURNOUT IS AFFECTING YOUR SLEEP QUALITY

It is well known that sleep and mental health go hand in hand. A lack of sleep can lead to low energy, drowsiness and reduced cognitive ability, leading to underperformance in daily tasks.

There are many factors that can get in the way of a good night's sleep, such as work-related demands, family conflicts, and overall high levels of stress. An individual experiencing these types of stressors is more likely to experience disrupted sleep and wake up feeling ill-rested. What's more, is that a pattern of poor sleep quality makes someone more susceptible to burnout. Sleep and burnout have a bi-directional relationship, meaning that poor sleep can affect burnout as much as burnout can impact sleep. Improving your sleep quality can help fight off burnout and support other body functions that promote health.

What is burnout syndrome?

The 11th Revision of the International Classification of Diseases (ICD) classifies burnout as an occupational phenomenon resulting from workplace stress that has not been successfully managed, with three distinct aspects:

1. Feelings of energy depletion or exhaustion.
2. Increased mental distance from one’s job - feelings of negativism or cynicism related to one's job.
3. Reduced professional efficacy.

Burnout essentially means that you're running on empty, lacking cognitive energy to perform at work, emotional energy to feel good, and physical energy to keep your body moving.

An important note is that burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

The difference between stress and burnout

Burnout can be difficult to detect as it comes on gradually rather than quickly and intensely, as does stress. Moreover, individuals who are stressed usually imagine feeling better once they get everything under control. Stress is often experienced as drowning in responsibilities and tasks whereas burnout is an experience of exhaustion and a feeling of resources being dried up. Burnout involves feeling unmotivated and depressed, often lacking compassion for oneself.

• More specific characteristics differentiating stress from burnout are:
• Stress is characterised by over-engagement whereas burnout is characterised by disengagement.
• Emotions are overactive in stressed individuals but blunted in individuals who are burnt out.
• Stress causes a sense of urgency and hyperactivity whereas burnout leads to hopelessness and helplessness.
• Stress results in a loss of energy while burnout results in a loss of motivation and hope.
• Stress can lead to anxiety disorders whereas burnout can lead to depression.
• Stress primarily manifests as physical problems (i.e., cardiovascular disease) whereas burnout manifests as emotional problems (i.e., depression).

Individuals who are stressed and under a lot of pressure at work are often over-stimulated and appear to always be "on". Most stressed individuals are hyper-alert and remain so until they have completed their work. Those who are burnt out on the other hand often feel apathetic and dissatisfied with their work. Their mental exhaustion wears them down and they begin to lose hope of positive change in their situation.

Signs and symptoms of burnout

Burnout does not happen overnight. It occurs slowly, beginning with subtle symptoms that worsen over time. Early signs of low energy and disengagement can be seen as a warning to slow down and refocus your energy. Symptoms are manageable in the early stages, but if left unchecked, may escalate to burnout. The most common symptoms of burnout can be distinguished by physical, psychological, and behavioural manifestations:

Physical

• Feeling tired or exhausted.
• Lowered immunity, frequent illnesses.
• Frequent headaches or muscle pain.
• Change in appetite or sleep habits.

Psychological

• No enthusiasm, energy, or motivation to perform daily activities.
• Increasingly cynical and negative outlook.
• Decreased satisfaction and sense of accomplishment.
• Sense of failure and self-doubt.
• Feeling helpless, trapped, and defeated.

Behavioural

• Alienation and social isolation.
• Withdrawing from responsibilities.
• Isolating from others.
• Procrastinating, taking longer to get things done.
• Using food, drugs, or alcohol to cope.
• Taking frustrations out on others.
• Skipping work or coming in late and leaving early.

Causes of job burnout

Job burnout occurs gradually. Certain work conditions leading to burnout may seem small and surmountable in the short run but can lead to energy depletion and wear someone down long-term. These factors include:

• Feeling like you have little or no control over your work.
• Lack of recognition or reward for good work.
• Unclear or overly demanding job expectations.
• Doing work that’s monotonous or unchallenging.
• Working in a chaotic or high-pressure environment.
• Working too much, without enough time for socialising or relaxing.
• Lack of social support (i.e., co-workers, friends, family).
• Taking on too many responsibilities, without enough help from others.
• Poor work-life balance.
• Not getting enough sleep.

Some personality traits may also make someone more predisposed to burnout.

• High-achieving, Type A personality.
• The need to be in control; reluctance or difficulty delegating to others.
• Pessimistic view of yourself and the world.

Is it burnout or bore-out?

Burnout and bore-out have similar symptoms, both of which leave individuals feeling exhausted, empty, and unable to cope with the demands of work and life. What sets the two apart is not their symptoms, but the workload that triggers them. While burnout results from feeling stressed or overwhelmed at work for long periods of time, bore-out occurs from a mental under-load at work as a result of an inadequate quality or quantity of work, resulting in a lack of interest and motivation.

In both cases, individuals are poorly stimulated at work, causing energy, productivity, and creativity to be low. These circumstances can occur if there is a chronic imbalance in an individual's work demands, resources, and effort. If, for example, an individual has too many work demands and not enough support from their co-workers, they may eventually develop burnout symptoms. On the other hand, an individual who perpetually does not have enough challenging work to match their skill level might eventually experience bore-out due to their low-stimulating work environment. When individuals are not mentally challenged at work they feel detached and disconnected. Bore-out, like burnout, can lead to frustration, apathy, fatigue, anxiety, and depression.

What does bore-out look like at work?

Bore-out is a state of mental idleness characterised by feeling unstimulated, unfocussed, and restless with a lack of engagement. At work, bore-out can look like doing repetitive work on autopilot, struggling to find enough work to fill your day, and taking longer on tasks that would normally take you less time just to stay occupied. Individuals with bore-out get stuck in their comfort zones, leading their professional, and eventually personal, development to a standstill.

Bore-out is more than boredom. Whether there's not enough work to stay stimulated or that the work itself isn't stimulating enough, bore-out causes irritability, cynicism, and can lead to feelings of worthlessness in the workplace.

Common symptoms of bore-out include:

• Lack of purpose: feeling disconnected from your job and your potential at work.
• Lack of intellectual challenge: not having enough opportunities to use your knowledge and skills at work.
• Lack of career progression: feeling a sense of stagnation and lack of professional development opportunities at work.

How sleep and burnout are related

Many things contribute to burnout, one of which is sleep. Sleep deprivation, chronically sleeping less than six hours a night, is one of the best predictors of job burnout. Although sleep is one of the most important things for our body, we often neglect our sleep, prioritising more stimulating or fun activities such as watching TV or spending time with friends. While these things may feel good at the moment, a lack of sleep can lead to increased anxiety and health problems.

How to determine your sleep quality

You might be getting enough hours of sleep, but that doesn't necessarily mean you're getting the most restful type of sleep. Sleep quality, a measure of how well you're sleeping, differs from sleep satisfaction. While sleep satisfaction refers to the subjective feeling about your sleep, sleep quality addresses how restorative your sleep is. Sleep quality is more complicated to measure than sleep quantity, but can be assessed by looking at certain elements of sleep.

1. Sleep latency: Measurement of how long it takes to fall asleep. Falling asleep within 30 minutes or less after going to bed is an indicator that your sleep quality is good.
2. Sleep waking: Measures the frequency of waking up during the night. More frequent wakefulness can be a disruption to the sleep cycle and reduce sleep quality. Waking up once or not at all indicates good sleep quality.
3. Wakefulness: Measures how many minutes are spent awake in the night after initially going to sleep. Good sleep quality is associated with 20 minutes or less of wakefulness during the night.
4. Sleep efficiency: Measures the amount of time spent actually sleeping in bed. A measurement of 85% or more indicates good sleep quality and promotes good health.

It is important to note that there are some individual and age differences in these factors. As we get older, we require less sleep, and it is more common to wake up frequently throughout the night.

Why is sleep important?

Sleep is important because, without it, our cognitive functionality including memory, decision-making, and creativity would suffer. After 20-21 hours of being awake, we are as cognitively impaired as someone who would be legally drunk behind the wheel. As such, eight hours of sleep after 16 hours of wakefulness tends to be the golden formula for having both a productive day and a restorative night. While we sleep, our body engages in many functions vital to our overall health and well-being.

Sleeping activates systems in the body that support physical and emotional health. These systems include the glymphatic system. This system works during the deepest stages of non-REM sleep to clear out metabolic toxins such as beta-amyloid, one of the leading candidate causes of Alzheimer’s disease, that builds up in the brain throughout our waking hours. Sleep's promotion of the immune system also allows cancer-fighting immune cells to work. One night of four hours of sleep will drop these cells by 70%.

The body releases growth hormones during deep sleep stages and carries out tissue, muscle, and bone repair. Sleep also helps regulate glucose metabolism, hormone release, and memory.

Sleep is essential for the process of learning. While we sleep, we transfer information from our short-term to long-term memory and strengthen memories by connecting new memories together and linking them with pre-existing ones.

During sleep, the emotional circuits of the brain are also modified. Connections between the amygdala, the emotion centre of the brain, and the prefrontal cortex, responsible for executive functioning, are strengthened when we sleep. When we are sleep deprived, this connection is weakened, causing our emotional processing to be dysregulated.

Lack of sleep can be detrimental to one's health and well-being. Sleeplessness leads to a depletion of resources including energy, coping skills, and problem-solving abilities. Sleep deprivation is a major predictor of all-cause mortality including cancer, Alzheimer’s disease, heart disease, stroke, diabetes, depression, and suicide. People who get inadequate sleep are more likely to:

• Take on less-challenging problems.
• Produce fewer creative solutions.
• Exert less effort when working in groups.
• Lie, cheat, and engage in deviant behaviours.
• Be less charismatic leaders.

Stages of sleep

Sleep stages can be divided into two types, REM and non-REM. REM, or rapid-eye-movement, is characterised by the random rapid movement of the eyes with low-muscle tone in the body. REM sleep is a lighter stage of sleep whereby brain activity increases to a level like during wakefulness. Non-REM sleep refers to the sleep stages in which individuals fall asleep and move from light sleep to deep sleep.

Throughout the night, we cycle multiple times through all sleep stages, with each complete cycle lasting approximately 90 minutes. The stages are:

• Stage 1 (Non-REM): Individuals are just starting to doze off, whereby heartbeat, brainwaves, and breathing begin to slow down.
• Stage 2 (Non-REM): Light sleep with continued slowing of heartbeat and breathing with a reduction in body temperature.
• Stage 3 (Non-REM): This is the deepest stage of sleep when body functions are at their slowest. This is believed to be the most critical stage for regenerating the body and brain throughout the night.
• Stage 4 (REM): REM sleep is essential for cognitive functions like memory. Dreaming occurs in REM sleep as a result of the increased brain activity, and muscles that you normally control, such as arms and legs, can't move.

How to get a good night's sleep

As being well-rested is so important for every function of the body and brain, investing in your sleep is the ultimate form of self-care. Here are some strategies to promote a good night's sleep:

• Set a routine. Set a bedtime that is early enough for you to get at least 7 hours of sleep, and stick to it. Going to bed and waking up at the same time every day results in a consistent sleep/wake schedule that your body can get used to.
• Don’t go to bed unless you are sleepy, and get out of bed if you don't fall asleep after 20 minutes.
• Associate your bed with sleep and sex. Not work, eating, or TV. By doing other activities in bed, your brain creates the association that your bed is about being awake rather than asleep.
• Keep your room cool. A temperature of 18.5°C is optimal for most people. In order to initiate sleep, your body needs to drop its core temperature by 2-3°. A hot shower or bath before bed can also help. The heat from the water leads to vasodilation, opening blood capillaries near the surface of the skin, and allowing heat to be radiated away. This helps lower your core temperature, promoting the onset of sleep.
• Avoid bright light around sleep hours. Darkness causes the production of melatonin, a hormone involved in the onset of sleep. Too much light exposure in the evening will trick your brain into thinking it's daytime and can interfere with your circadian rhythm. In order to promote the release of melatonin, dim your lights in the evening and avoid bright screens in the last hour before bed. Make your bedroom dark, quiet, and relaxing to get the most out of your sleep space and promote a good night's rest.
• Be conscious of your evening food and beverage intake. Stop eating about three hours before going to bed in order to give your body time to digest the food you ate without disrupting your sleep. Reduce or stop caffeine intake after noon and limit alcohol intake in the evenings. While alcohol can make you feel sleepy, it causes you to wake up multiple times throughout the night. These interruptions may be so brief that you don't remember having woken up, but result in nonrestorative sleep throughout the night.
• Avoid napping if possible. Napping may help fight off initial feelings of sleepiness, but won't help with higher-level cognitive issues like decision-making, learning, and memory. What's more is that throughout the day, we build up a chemical pressure of adenosine. Adenosine gets washed away throughout the night and builds up throughout the next day. More build-up leads to more feelings of sleepiness, leading individuals to normally fall asleep quite quickly after 16 hours of wakefulness. Napping relieves some of this pressure, thus making it harder to fall asleep or stay asleep at night.
• Sleep medicine can be a good tool for individuals suffering from sleep disorders or other short-term stressors and sleep problems. These work to slow down the nervous system and initiate feelings of sleepiness. It is important to note that sleep medicine should not be used as a long-term solution for insomnia. Sleeping medications are at high risk for abuse and can be associated with unpleasant side effects.
• Physical activity promotes sleep. Moderate to vigorous exercise can increase sleep quality by reducing sleep latency and decreasing time lying in bed awake throughout the night. Physical exercise can also help alleviate daytime sleepiness through its release of endorphins. Exercise can also reduce the need for sleep medications in some individuals.

Dealing with burnout or bore-out

There's a misconception that people can make up for a lack of sleep by sleeping more the next night. Unfortunately, sleep debt can't be accumulated throughout the week and paid off on the weekend.

While sleep is an important player in terms of fighting off burn/bore-out, there are other ways to cope with these phenomena:

• Build and enforce work-life boundaries. Job burnout is common when we struggle to say "no". While technology can be great, it allows us to be accessible around the clock, often allowing work notifications to interfere with our personal life. By not having a separation between work and home life, we allow ourselves to get caught up in work-related thoughts and pressures, preventing us from fully resting and refuelling for the next day.
• Build breaks into your schedule. Block off time for yourself in your schedule. Whether that time is spent doing some quiet work, getting a glass of water, or grabbing an energising snack, blocking off time for yourself can help refuel your resources, making you more apt at dealing with incoming demands.
• Reconceptualise rest. Sleep has a bad reputation. It's seen as lazy and unproductive. People tend to wear lack of sleep as a badge of honour, receiving praise for their "hard-working ethic" and "career-focused mindset". What many don't understand, however, is that sleep actually is productive. Sleeping hours are when most biological processes happen. The systems involved in cell renewal, energy restoration, and hormone production, among others, are at their highest during sleeping hours as the body is not otherwise occupied with other tasks such as processing incoming stimuli or executing physical and mental tasks.
• Think of your energy level as a gas gauge. When you start to feel tired, uninterested, or under-or-over-stimulated, slow down and consider how you can refill your energy tank before you shut down.

Care for your mental health

Just like neglecting the fuel-reserve light in your car, continuing to push yourself through a state of exhaustion can lead to more emotional and physical damage. Keeping an eye out for signs of burn-or-bore-out and stopping to take care of yourself can help you feel good and healthy again. When you feel good, your sleep quality improves, and vice-versa.

Cognitive behavioural therapy for insomnia (CBTI) is beneficial for individuals with sleeping problems. Sleep medicine can lead to rebound insomnia and other side effects. CBTI can help maintain positive sleep attitudes and behaviours in the long run, working as a protective factor against burnout and bore-out.

The Kusnacht Practice specialises in treating mental health conditions such as burnout, anxiety, depression, trauma, and more. Our psychiatric and medical teams are dedicated to your well-being, providing personalised treatments tailored to your individual needs and goals. Whether it be for help establishing a work-life balance or managing symptoms of other mental health concerns, our team is there to support you.

The BIO-R® Sleep Restoration programme involves a combination of coaching, measurement of the autonomic nervous system, tracking of sleeping phases, and practices such as yoga, mindfulness, and aromatherapy. This programme can help re-establish regular sleep patterns and help achieve a state of restorative sleep to help you achieve your best potential self.

Consider reaching out if you are experiencing symptoms of burn-or-bore-out or wish to improve your sleep quality.