That Sleepy Feeling: How Fatigue Affects Understanding

Worked a long shift? You might miss your patients’ true emotions. For doctors and patients, such misinterpretation could have unintended consequences.

Communication is about how things are said and not just what is said, and if you’re sleepy, you might miss the real meaning. For doctors and patients, that might mean unexpected difficulty understanding each other.

“What we found was that sleep deprivation selectively impaired the ability to recognize happiness and sadness in facial expressions,” says William D.S. Killgore, Ph.D, a neuroscientist and researcher at the University of Arizona.

Killgore led a study into the matter published recently in the journal Neurobiology of Sleep and Circadian Rhythms. The data Killgore used were from something he began while working as a research psychologist on active duty in the Army. The military wanted to study how lack of sleep affected decision-making, which is important for soldiers in dangerous situations.

In the study, people saw photographs of the same male face showing different emotions, including some mixed expressions such as a combination of sadness and disgust. The results showed people had a slightly more difficult time recognizing subtle expressions of happiness and sadness after a bad night of sleep.

That could lead to communication trouble.

“It looks like when you’re sleep-deprived you read faces as being threatening even when they’re not,” Killgore says.

For doctors and patients, such misinterpretation could have unintended consequences.

“If a doctor is misreading a patient’s emotions because they’re sleep-deprived, they might not be as empathetic,” Killgore says, adding a patient might think the doctor does not listen or care. “If a patient is sad and is trying to communicate that to a physician, the physician might misinterpret that as anger or resentment.”

On the flip side, a sleep-deprived patient might see caregivers as threatening, especially in a hospital setting where medical staff members wake patients repeatedly during the night.

“If you misinterpret their emotions, you’re going to misinterpret their intent,” Killgore says.

The researchers have not tested their results in real-world settings such as hospitals, where residents might work shifts of 24 hours or longer, but Killgore says he would like to, adding his ideas about physicians and patients are simply extrapolations of the data.

That doesn’t change his advice.

“Get more sleep. People need to get more sleep on a regular basis,” Killgore says, adding people push the limits and the dependence on electronic devices does not help. “Everybody says we need more sleep, yet we deny ourselves that.”

Since more sleep isn’t always possible, Killgore has a recommendation.

“Challenge your assumptions when you’re sleep-deprived and ask, ‘Did I read that correctly?’ ” That might mean asking a patient more questions and having longer conversations with them. “You need to clarify,” he says.

Killgore says caffeine helps.

“If doctors were to drink a cup of coffee, it could be helpful in those situations,” he says. “For the average person, a cup of coffee seems to be helpful in restoring the emotional capacity.”

Tiffini Sherman is a freelance writer based in Florida.