I heard it again, this time with respect to the problems of the NHS. 'We are working tirelessly, night and day, to sort this out,' the Minister said. It brought back distant memories of actually working night and day, but 'tirelessly'? Not that I can remember! Nor, I suspect, will other doctors from the bad old days when spending the night looking after emergencies was always followed by having to continue with normal duties for the next 12 or more hours. A 36-hour shift is not compatible with tirelessness – indeed, after 12 hours of continuous work, mental or physical, most of us will feel exhausted. You will not be surprised to learn that I wondered about the origins of the use of this adverb.
The word tire
has many meanings and several apparent derivations but as a verb its origin is from an Old English word, tëorian
, of which the origin is unknown. However, the use of the adverb, tirelessly
, seems to come from the mid-19th century, which brings to mind a picture of a mill owner working tirelessly in opposition to the introduction of Acts of Parliament intended to mitigate the effects of long hours of work of children in his factories. This was of course the period of reaction to the peak of exploitative capitalism in Britain, a time when enlightenment ideas derived from Francis Hutcheson and Jeremy Bentham (Robin Downie, 11 January 2023
) aroused the conscience of some legislators, notably the 7th Earl of Shaftesbury, to the plight of workers.
It could hardly have been those child labourers in mines and mills to whom the word tireless would have been applied. Indeed, in the early 19th century, official reports of surveys of the labouring classes stress the effects of fatigue as a justification of shorter working hours. It is common experience after a careless night out, perhaps exacerbated by overconsumption of alcohol, that the next day is a write-off in terms of productivity. You have the same symptoms following a night working in hospital after a full day in the wards – you are not really able to concentrate and become a risk to your patients. It was for this reason that the working hours of doctors and nurses are now regulated.
After eight to 10 hours of work, you need a rest and a sleep before restarting. There is no such thing as tirelessness. Those who use the term are not people who do physical work and they do not really understand its implications. They are simply trying to persuade us of their commitment to an objective or, in the words of an ex-Prime Minister, to fix something. Equally vacuous.
The opposite of tirelessness is sleepiness, something which in contrast is universal. It hits us every day at some time around midday and again in the evening. If you are Italian or getting old, you may well give in to the desire to sleep after lunch – no harm in a siesta. And if you are lucky, you will sleep for seven to eight hours each night as well. This is the normal pattern for Homo sapiens. You will remember the Ancient Mariner's thanks for the relief it brought him:
Oh, sleep it is a blessed thing,
Beloved from pole to pole.
To Mary Queen, the praise be given,
She sent the blessed sleep from Heaven,
That slid into my soul.
But lack of sleep or disturbance of sleep patterns can sometimes be sufficiently troublesome to be regarded as illness requiring treatment by medicines or psychotherapy. In Lady Macbeth's case, it was induced by a bad conscience, but she also recognised its healing powers. Never will sleep's role be put better:
Methought I heard a voice cry 'Sleep no more!
Macbeth does murder sleep.' The innocent sleep.
Sleep that knots up the ravell'd sleave of care,
The death of each day's life, sore labour's bath,
Balm of hurt minds great nature's second course,
Chief nourisher in life's feast.
To return to my younger days, we junior doctors were often asked by the nurses on night duty to sign patients up for sleeping pills – it was for a time the practice to give these to almost every patient in hospital. We resisted, as it was being recognised that this led to a great deal of barbiturate habituation, and most patients fell asleep naturally despite the inevitable noise in a ward of 30 sick people. The nurses had to stay awake but they worked shifts and had the next day to sleep.
Long-term night shift working is now recognised to have adverse effects on health and most employers running a 24-hour service recognise this by rotating workers through three eight-hour shifts. However, all shift work is unnatural and, as far as I know, no animal or plant has anything other than a natural 24-hour cycle of activity and rest related to the sun's movement.
Shakespeare and Coleridge were spot on with their understanding of sleep's purpose as balm. I'm sorry to say that as doctors we took too little interest in sleep until quite recently. We learnt to ask patients lots of questions about their lives, but rarely enquired about sleep. Two things drew my attention to its importance. First, my asthma patients told me that the night was often the time when they had attacks of breathlessness, and we found that their lung function (and everyone else's) varied in a cyclical manner, reaching a nadir in the early hours. Second, chest physicians came to recognise the harmful effects on health of heavy snoring at night in disturbing sleep patterns, reducing oxygen levels and causing daytime drowsiness. A good night's sleep is essential to healthy life.
Now there are ways of delving into the reasons for this, and a combination of neurophysiology, neuropsychology and brain imaging has allowed researchers to examine the changes that occur in the brain during sleep and its influences on health and on learning. Sleep has a regular pattern, a repeating 90-minute cycle between deep and lighter sleep, with longer periods of deep sleep initially and then, before waking, longer periods of the light, so called rapid eye movement (REM) sleep during which dreams occur. So, while we sleep our brains are intensively active, registering the previous day's activities, sorting out memories which it stores in the cortex during the periods of deep sleep. That deep sleep is fundamental to memory.
The lesson from this research, engagingly described by the neuroscientist Matthew Walker in his book, Why We Sleep: The New Science of Sleep and Dreams
(Penguin Books 2019), is that there are adverse consequences if our sleep pattern is disturbed, most notably to memory and creativity. Two opposite effects will be familiar to most readers of this essay. First, after a badly disturbed night, you will have found your ability to remember things has been impaired. Second, after a good night's sleep, you will have found that the solution to the last clue in the crossword puzzle that eluded you yesterday has suddenly become obvious. Many of you will have gone to bed with a problem that you find in the morning you have solved.
While you sleep soundly, your brain is working for you. But, sadly, if you are an insomniac or if you are someone who believes you can get by with five or six hours sleep, I'm afraid you may well be increasing your risk of Alzheimer's disease. There is now good evidence for this, and anecdotally a number of notable politicians who were famous for not needing much sleep did develop this condition.
All life works in a rhythmical pattern, called circadian from the Latin for around the day. We humans are diurnal but half of all animals are nocturnal. The evolutionary variety of animals stems from our willingness to eat each other, and some use the day to hunt and others the night. But whichever the time of rest, our brains do not sleep, they get rid of toxic amyloid (the waste product of their cells) and sort out the chaotic events of the day, leaving us with useful memories for the next one. Disturbance of this pattern by excessive working hours, nocturnal clubbing, drug-taking or irregular shift working – burning the candle at both ends – makes us less able to cope, less efficient human beings.
The current problems in the health and social care sector are undoubtedly giving many care and ambulance workers sleepless nights. At the lower paid end, worries about the costs of food and energy are adding to the worries engendered by inability to give the service their patients expect. When this is exacerbated by awful stories of the owners of care homes for old folk paying themselves millions every year when their employees are on the minimal wage, it is no surprise that some are driven to strike. Exploitative capitalism is again a reality in the UK.
What we do in our free time is largely our business, but we must be aware that the pressures on the lower paid to take on extra jobs or hours will impair their health and productivity. As with many other important human factors, Gross National Product does not take account of this. Remember, there's no such thing as working tirelessly. To try to do so has causes and consequences that our governments need to take notice of.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own