Burnout het gevolg van verstoord slaappatroon?*

Volgens Zweedse onderzoekers is niet veel stress de oorzaak van een Burnout doch een verstoord slaappatroon. Behandelingen van een burnout door o.a. het slaappatroon te herstellen hebben veel succes.

Disrupted sleep causes worker 'burnout'

Worker ‘burnout’ is triggered by a drastic re-setting of sleep patterns, rather than high levels of stress per se, according to a study of patients in Sweden. A new treatment based partly on these findings is among the first to show clear success, researchers say.

Burnout is not recognised in the classic manuals of mental health disorders. But the main symptoms are taken to be long-term, excessive fatigue and cognitive impairment.

“It usually affects people who are very committed to work. One day they wake up and they just can’t get out of bed. Then they take a few weeks’ sick leave, but they don’t improve,” says Torbjörn Åkerstedt at the Karolinska Institute in Sweden, who led the new work.

While stress is clearly involved, the precise causes of the symptoms have been unclear. A high level of the stress hormone cortisol has been blamed, for instance. But based on his team’s recent work, Åkerstedt says: “We think that people can function quite well on high levels of stress - it’s only when their sleep is disrupted that you get burnout.”

The team took regular sleep EEG readings of 35 patients who had been off work for a minimum of three months. The tests consistently showed extreme sleep fragmentation and disruption. These patients were living on as little as four or five hours of sleep each night, with a 40% reduction in slow-wave sleep compared with healthy people.

High baseline

Åkerstedt’s team believes that long-term stress and worry about work can cause people to settle into this disrupted sleep pattern. And once this pattern is established, it takes more than just rest and relaxation to re-establish the individual’s pre-burnout sleep cycles, they say.

“If you experience stress for a long period of time, you establish a new high baseline level of physiological activation - and this interferes with sleep,” Åkerstedt says.

Increased workplace demands are driving an increase in cases of burnout, the team suggests. In Sweden, Åkerstedt estimates that long-term sick leave due to the problem doubled between 1994 and 2001.

Only a few per cent of people with burnout usually return to work. But the stress clinic at the Karolinska Hospital has been trying a form of treatment that combines strict sleep hygiene rules with cognitive behavioural therapy, which aims to change the patient’s views about their need for achievementand thereby reduce work-related stress. “After between six and 12 months, we find significant improvements in sleep duration, and 60% of patients returning to work,” he says.

But to prevent burnout in the first place, you need to know who is most susceptible and why, says Peter Cotton, an organisational psychologist who advises the Australian government on workplace mental health.

“The strongest predictor of burnout is personality,” he says. “People who score high on scales of emotionality experience more distress as a result of workplace pressures. That interaction is very important.”

The Swedish team’s work, as yet unpublished, was presented at a sleep symposium at the Woolcock Institute in Sydney, Australia (Dec. 2004) 

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