Burnout and sleep

Abstract

The overall aim of this thesis was to describe the physiological characteristics of sleep in persons with burnout and the relation between sleep and a number of physiological stress markers. The aim was also to evaluate the diurnal pattern of subjective sleepiness and fatigue across workday and weekend, and to describe the experiences of time preceding burnout from a life world perspective.

This thesis focuses on burnout in white-collar workers; one group on sick-leave (I, II) and one with high burnout scores (pre-burnout) but still at work (III, IV). The Shirom- Melamed Burnout Questionnaire (SMBQ) was used for selection of participants with a mean of >4,75 on the total score (range 1-7) as upper limit and <2,5 as cut off for the two control groups.

A combination of methods was used – interviews, sleep and wake diaries, questionnaires, blood and saliva samples, and polysomnograpic (EEG, EOG, EMG) measures of sleep. The analyses included; t tests, χ2, analysis of variance, ANOVA, and covariance, ANCOVA, correlations, Pearson’s r, stepwise regression analyses (study II-IV), and phenomenological analysis (study I). Study I describes the complex interaction between the person and his/her life world during the process of burning out. Study II evaluated whether subjective sleep complaints in burnout individuals on sick leave was related to disturbed sleep architecture and impaired homeostatic processes. Physiological and subjective aspects of sleep before a workday and a day off were investigated in study III. The diurnal pattern of sleepiness on workday and weekend was evaluated in study II and III, and the diurnal pattern of mental fatigue was evaluated in study II as well as occupational fatigue. Additionally, the burnout groups (II III) were described with respect to work stress, mood, recovery and burnout related variables. Study IV was a correlation study where the relation between sleep fragmentation and a number of physiological stress parameters, as well as possible predictors in daily life was evaluated.

The most important finding is that sleep was impaired on all essential sleep variables in the burnout group on sick-leave (II). In the pre-burnout group (III) the main findings was an increased frequency of arousals, and the relatively moderate sleep fragmentation was related to a number of risk factors for CVD and the metabolic syndrome (IV). Also unclear boundaries between work and leisure time and tension/irritability were associated with the sleep fragmentation. The burnout group on sick leave was sleepier than the controls for most point in time, with levels comparable to night or early morning shifts, and mental fatigue was equally elevated (except for weekday evenings). The pattern of sleepiness and mental fatigue was consistent across days. The high and low burnout groups were equally sleepy during workdays but differed during days off, indicating impaired recovery in the high burnout group. The time preceding burnout (I) was experienced as being trapped between never-ending demands on the one hand and stimulating challenges on the other. “Cutting off” important areas of life enhanced the strong focus on responsibilities, protected their ‘self-images’ and impeded sleep and recovery. Acceptance of the situation was the turning point from where a new reconstruction of life could emerge.

These findings suggest that sleep disruptions and impaired recovery seem to be characteristics of burnout, resulting in fatigue, and that inability to unwind the stress system may be a mediating factor. With this knowledge interventions for sleep improvement on company or population level seems important, and effective treatment of sleep disorders in order to prevent or relieve burnout is needed, as is a deeper understanding of how fatigue is experienced in health and illness.