Clinical Mental Health

Why Should We Sleep Every Night?

By Mohamed Ahmed Abu Elainein

Sleep is a fundamental aspect of human life, often underestimated in its profound impact on our health and well-being.

In the midst of exams and busy schedules, the temptation to sacrifice sleep for extended work hours may arise, but understanding the inherent benefits of sleep is crucial to maintain a healthy and balanced lifestyle.

The Centers for Disease Control and Prevention (CDC) recommends that adults should aim for a minimum of 7 hours of sleep per night. [1]

This guideline is not arbitrary; it is rooted in extensive research that highlights the multifaceted advantages of adequate sleep.

Sleep serves as more than just a period of bodily rest; it is a vital process that contributes significantly to our physical, mental, and immune functions.

A cross-sectional study conducted from April 2013 to December 2014 examined the sleep patterns of night shift workers and found that those who slept fewer hours had a higher incidence of high body mass index (BMI) and weight gain. Remarkably, this association persisted independently of age and gender. [2]

This underscores the intricate link between sleep duration and metabolic health, shedding light on the importance of sleep in weight management.

Athletes, whose physical performance is paramount, also stand to benefit significantly from sufficient sleep.

A systematic review of the literature revealed that sleep extension positively influences athletes’ performance and enhances their recovery. [3]

This insight emphasizes that sleep is not only a recovery mechanism but also a proactive factor that can contribute to improved athletic outcomes.

A Review Article demonstrated the significant impact of sleep on enhancing athletic performance through various mechanisms. It helps the body restore its immune and endocrine systems, recover from the strain of waking hours, and supports cognitive development. Different stages of sleep, like REM and NREM, contribute to memory consolidation and physical recovery in their own ways. NREM helps save energy and recover the nervous system, releasing growth hormone and reducing oxygen consumption. REM is important for brain activation, localized recovery, and emotional regulation. Overall, quality sleep with its various stages is crucial for athletes, influencing memory consolidation and adapting to the cognitive demands of sports. [4]

Moving beyond the physical realm, the mental health implications of sleep cannot be overlooked. Studies consistently show that individuals who experience poor sleep quality are more likely to report mental distress and anxiety. [5]

The intricate relationship between sleep and mental well-being underscores the role of sleep in emotional regulation and cognitive functioning. Adequate sleep is not merely a luxury but a foundational element in maintaining optimal mental health.

Sleep is important for a healthy brain. Different sleep stages affect how we think and remember things. Research shows that sleep has a big impact on our emotions and mental well-being. Getting enough sleep, especially the type with rapid eye movement (REM), helps our brain process emotions. If we don’t get good sleep, especially the positive kind, it can affect our mood and emotional reactions. It’s not just that sleep problems can show up because of mental health issues; they can also be part of what causes these problems. [6]

Moreover, the influence of sleep extends to our immune system. Research demonstrates that insufficient sleep can compromise the immune system, making individuals more susceptible to infections. [7]

A study published on European Journal of Physiology demonstrated that Sleep and our body’s internal clock have a big impact on our immune system. When we sleep, certain immune factors peak, promoting inflammation and aiding in immune cell functions. Daytime wakefulness, on the other hand, is associated with different immune responses. Sleep seems to help immune cells move around and interact effectively. Research also shows that a good night’s sleep enhances our immune memory, especially during specific sleep stages. These effects are linked to the hormonal changes that occur during sleep, like increased growth hormone and prolactin, and decreased cortisol and catecholamine levels. [8]

The intricate interplay between sleep and immune function highlights the role of sleep as a protective factor against illnesses and underscores its significance in overall health maintenance.

In essence, sleep is a dynamic process that encompasses a myriad of benefits for both the body and mind.

The CDC’s recommendation of 7 hours per night is not arbitrary but a well-founded prescription for fostering a holistic state of health. Whether it’s the regulation of body weight, enhancement of athletic performance, or preservation of mental and immune functions, sleep plays a pivotal role.

Recognizing the importance of sleep not only dispels the notion that it is a form of time-wasting but prompts a reconsideration of its prioritization in our lives.

In the hustle and bustle of daily activities, acknowledging sleep as a non-negotiable element of self-care becomes imperative.

As we navigate the demands of modern life, ensuring that we allocate sufficient time for restorative sleep is a conscious investment in our long-term health and well-being.


1. How much sleep do I need? [Internet]. Centers for Disease Control and Prevention; 2022 [cited 2024 Feb 5]. Available from:

2. Brum MC, Dantas Filho FF, Schnorr CC, Bertoletti OA, Bottega GB, da Costa Rodrigues T. Night shift work, short sleep and Obesity. Diabetology & Metabolic Syndrome. 2020 Feb 10;12(1). doi:10.1186/s13098-020-0524-9

3. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep interventions designed to improve athletic performance and recovery: A systematic review of current approaches. Sports Medicine. 2018 Jan 20;48(3):683–703. doi:10.1007/s40279-017-0832-x

4. Fullagar HH, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: The effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Medicine. 2014 Oct 15;45(2):161–86. Doi:10.1007/s40279-014-0260-0

5. Blackwelder, A., Hoskins, M., & Huber, L. (2021). Effect of inadequate sleep on frequent mental distress. Preventing Chronic Disease, 18.

6. Mental health and sleep [Internet]. 2023 [cited 2024 Feb 14]. Available from:

7. 8 health benefits of sleep [Internet]. 2023 [cited 2024 Feb 5]. Available from:

8. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflügers Archiv – European Journal of Physiology. 2011 Nov 10;463(1):121–37. Doi:10.1007/s00424-011-1044-0

Emotion Empathy Law Public Health

Through the Green Lens

By Rana Moawad

When will we learn that children belong running around, not lying under the dirt?

School days are interrupted by loud bangs of shots and dead bodies hitting the hard ground. Only 150 days in 2023, and we had 263 mass shootings, but who is counting anyway? Mass shootings are becoming the new norm; we scroll past the news reports like we are scrolling through ads. I refuse to be negligent of our children’s plight. Wearing my medical student white coat means I have a duty to serve my community. I joined Promise Neighborhoods of the Lehigh Valley (PNLV) to end gun violence.

While interviewing community members at PNLV on their views of healthcare, I met “Green.” She embodies the story of many women before and after her. A daughter of an immigrant woman trapped in an abusive relationship, Green ran away from home when she was 11 years old. She survived the streets and bore two boys.  It was not long until the violence outside made its way into their home.  No mother should have to say a final goodbye to her 17-year-old son, gone too soon from the bullets. A child is gone and another is in prison. Yet still, guns here and there.

How much more can the fragile heart take before it shatters? They say they care about people like us, but all they see is a paycheck waiting to come. Never taking the time to listen, but they call themselves healers and changers. Listen to our pain and our hardships, and maybe then you will make a difference. Do this, do that, take this, take that; medicine is nothing but a to-do list, with practitioners needing to take the time to listen. They tell me I have this disease and that, but do they even know my name? If they took the time to listen, they would see the Green I embody. 

Inside her green eyes lie the stories of those before her and those to come: a warrior, a grandmother, a mother, and an activist. She stands for all those who do not have a voice.

When will we fight together to prevent gun violence? Gun violence is killing our youth, waiting for the next victim…would that be me or you?

Bullets are flying. Children are dying. We need to change this broken system. We need gun regulations. We need more robust background checks and decrease easy access to dangerous weapons. Green stands up for all mothers so they can hug their children to bed rather than their pillows, soaked with tears and what-ifs.

Green embodies the story of many women before and after her. She taught me the true meaning of medicine. We must advocate for our community to heal our children and invest in our future.

My time at PNLV taught me that just like Green’s life, our communities have the potential to be like newly green-cut grass with hope and potential waiting to flourish where our children can safely play instead of lying seven feet under.

Empathy General Mental Health Narrative Psychiatry

From Her Mind to Mine

By Jessica D Simon

Walking down the familiar dead-end hall of Psych 2, I nearly walked right past the thin woman almost drowning in her hospital gown as she calmly allowed the nurse to take her vitals. I stopped to confirm her identity and introduce myself. “Oh hello, how are you?” came the polite response. Stories of Betty had wafted down from the consult-liaison team for the past week with a macabre fascination. Her image was contradictory; it seemed implausible that the frail, proper lady sitting in front of me, hair pulled neatly back into a graying ponytail, had just a few days prior made the desperate decision to violently shoot herself in the chest with the intention of ending her life.

I held my breath in anticipation, unable to deny my excitement at being assigned to this case followed immediately by the familiar sensation of guilt. How can I be fascinated by someone’s dark tragedy? I would soon learn that this dissonance, walking the line between compassion and self-gratification, lies at the heart of providing effective psychiatric care.

We exchanged pleasantries as together we made our way to the optimistically named “comfort room,” home to one large battered upholstered chair, a modest wooden table, and a window with an AC unit, culminating in a poor excuse for a respite on Psych 2. Betty shuffled slowly, still healing physically from her wounds, until finally making it to the red armchair where she would spend much of her time over the coming weeks. She looked at us expectantly with a hollow stare. She had a defeated yet pleasant energy about her, and the gentle wrinkles surrounding her dead-set gaze told me that I was sitting in front of a woman whose life I knew nothing about.

Betty met her husband Steve in high school, forming an immediate infatuation that continued to blossom into 45 years of loving marriage. They had no children and spent their days attending church, going for long walks with their dogs, and volunteering together in the community. Their lives were filled with a beautiful simplicity that bestowed long-lasting contentment, a sentiment for which many spend their whole lives searching. When Steve was diagnosed with an aggressive glioblastoma on September 1, 2021, Betty’s life quickly evolved into an endless cycle of hospital appointments, research, and clinical trial investigation. Yet she helplessly watched as Steve’s condition steadily worsened, his movements slowing and memory fading. In May 2022, when Steve failed multiple clinical trials, Betty fell into a deep despair that ultimately pushed her past the precarious edge of desperation.

Betty’s hopelessness was palpable, leaving an icy chill hanging in the room. I was alarmed to find myself feeling her agony to the extent that I almost wished for her sake that she had fulfilled her wish to die. I knew I could not promise this woman that she would have a happy future, devoid of the comfort and love that she had shared with a now dying man for the greater portion of her life. I took a deep breath. Working with Betty, I would slowly realize the therapeutic power of carrying the hope that individuals have lost in the flooding sea of mental illness until they again emerge and attempt to swim.

On Monday, Betty’s third day of admission, we received news that Steve had passed away in hospice earlier that morning. I hesitantly approached her for our usual session, preparing myself for an explosive encounter. I was shocked to find her eerily calm, her tone level, her response rational, her composure unscathed. She stared at me with the same dead eyes and motionless face that seem to challenge me, now what?

Betty guarded her true emotions with years of protective layers built from privacy and stoicism, speaking slowly with stiff unmoving facial features. I spent hours sitting across from her, watching her sip her two vanilla ensures that she ordered for lunch and racking my brain for how to engage her in a therapeutic relationship. A two-hour session with her felt equivalent to about twenty minutes of meaningful conversation, and for days it felt like we were getting nowhere. One day she said, “No one actually cares. You come and talk to me, but you don’t think about me once you go home.” Remembering the numerous times I had neurotically checked Epic late at night, my immediate unfiltered reply came, “actually I do think about you when I go home.” I saw her face soften ever so slightly, yet immediately regretted responding with my own emotional response rather than creating a space for self-reflection.

This moment brought me face-to-face with my own humanity and its effect on my patients. My response had centered myself in her healing, needing her to see my goodness and selfishly wanting our relationship to be special to her. The real question was why had she made that statement in the first place? The grief of losing her husband had clearly left her in the depths of an extreme loneliness, and this statement had unveiled a desperate longing to be held. An opportunity to guide her towards conscious awareness of her deepest desires became instead a chance for me to prove my compassion, a band-aid for her depression. I began questioning my habit of spending two hours daily speaking with her. What expectations was I setting? Was I doing it for her or for me? Doctors of course are all human, affected by the accumulation of past life experiences with flaws and strengths alike. I now realized the extreme importance of having self-awareness and acknowledging my own emotional needs as a future psychiatrist.

Betty thanked me politely after each session, maintaining her image of a proper, well-brought up woman despite her circumstances. As we approached more difficult questions, her eyes would close tight with a wide grimace that displayed all her teeth, the veins in her face tensing with discomfort – a look as if she was about to break-down into heaving sobs. Yet I never saw her shed a tear. Over time, I slowly began to see changes in her as she learned to label her emotions, reflect on her self-isolating nature, and even display a forward-thinking attitude about what her future life may look like. Eventually, she entrusted me with the information that her suicide attempt had been a “joint act” with her husband, in a Romeo and Juliet moment where they had felt that life was not worth living without one another.

It is hard to know how to react to such information, and my mind swarmed with questions and wonder upon this disclosure. The juxtaposition of romance and violence was truly something out of a movie. I was struck by the commitment of their love, yet deeply saddened by the decision to which it had led. Is love dangerous? Is grief inescapable? Are parts of life worse than death? Betty’s story was a reminder to withhold assumptions, and in the world of psychiatry it is often better to ask questions than it is to demand answers.

On her day of discharge, I stared at the familiar phrase in Epic that I had copy and pasted many times: “Betty Wolff* is a 64-year-old female who presents after a self-inflicted gunshot wound to the chest s/p pulmonary wedge resection.” The brief summary evoked alarming images of the well-intentioned, loyal woman I had gotten to know intimately over the past couple of weeks. As I watched her walk out the door that day, neatly dressed in the button down and tennis shoes that her brother had brought, a wild mix of emotions swelled inside me. I felt proud to have played a role in her recovery process yet fearful of how she would respond to her new reality.

Psychiatry is wrought with uncertainty, with mistakes potentially resulting in devastating consequences that can keep you up at night. Yet I found solace in knowing that we had given Betty the potential to reclaim her life after unimaginable tragedy had left her in the dark sea of hopelessness. Everyone deserves that chance. I left my rotation with a deep appreciation for the complex nature of psychiatry with an increased comfort in relinquishing control over the unknown, acknowledgement of our shared humanity and limitations as clinicians, and an acceptance of the unpredictability of life and fellow humans.

And when Betty returned to the unit two days after her discharge having asked her brother to kill her, I learned to see this not as a failure but as a small stepping-stone in the complex journey to recovery.

* all names and identifiable information have been altered for patient privacy

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