them, as is the case of physicians, especially those who work
with mental health.23 Besides the risk of addiction, chronic
benzodiazepine use can result in cognitive effects, such as
sedation and drowsiness, mental slowing, and anterograde
amnesia. Further, it can impair driving and working performance
and cause accidents.24
Poor sleep was associated with an irregularity of hours of
sleep and lying down for long periods without sleep. Other
studies have shown a relation between sleep hygiene and
sleep quality.11,25 However, our study was the first to
observe this relation in psychiatry residents. Inadequate
sleep hygiene has been related to sleep problems that became
a diagnostic category in the International Classification of
Sleep Disorders.26 Although a recognized and commonly
used treatment option, there is no absolute consensus about
sleep hygiene treatment.27,28
This study showed an association between sleep quality,
anxiety, and social phobia symptoms. This finding is in
agreement with other studies that showed a relation between
anxiety disorders, social phobia, and poor sleep quality.29,30
However, this finding is unprecedented among physicians
and medical students. It is widely known that sleep problems
are associated with various psychiatric disorders.31-33 In
90% of severe mental disorders, there are reports of chronic
insomnia.32 In some cases, insomnia is considered the main
complaint, instead of other psychiatric symptoms. The relation
between sleep and anxiety is well established, and a
feedback cycle has been suggested. Generalized anxiety disorder
and social anxiety disorder seem most related to poor
sleep quality.18,19
One explanation for the poor sleep quality in psychiatry
residents is working time. Beyond the regular hours
devoted to the residency, some activities (such as preparing
lectures, writing clinical cases, or reading scientific
papers) are conducted outside of the official time of residency.
This is a common practice in many medical residencies
around the world. Maybe saving part of the
residency time for these activities could increase the
sleep time and leisure, and minimize the problem of poor
sleep quality.
In addition, the low value of the scholarship in some
countries (around US$1100) stimulates residents to work
in their free time, increasing the workload and reducing sleep
time and leisure. Thus, the creation of an exclusive dedication
regiment for medical residency with better pay and better
working conditions could be an attempt to minimize the
problem.
Some limitations to our study must be acknowledged. Our
findings are based on self-report scales. Thus, the personality
of the resident and his mood at the time of the interview may
influence the evaluation and impair the reliability of data.
Comparisons with medical residents in other countries or
with other specialties provide new and important conclusions.
Differences between the medical residency programs around
the world may limit the external validity of these data. However,
it does not diminish the importance of our findings.