Sleep: A Superpower of Executive Function and Performance
In emergency medicine, business, and leadership alike, we often glorify the grind. Maybe you’ve even said (or thought), “I’ll sleep when I’m dead”. Yet increasingly so, neuroscience has made it clear: chronic sleep deprivation doesn’t make us tougher. It makes us slower, less creative, and more prone to illness and to decision-making failures.
How about you? Burn candles on both ends?
I recently had the pleasure of engaging Dr. Jessica Payne, cognitive neuroscientist at the University of Notre Dame, as she led a workshop on how sleep fuels the brain’s executive functions. Through her research, she clearly demonstrated the very capacities that distinguish good clinicians and leaders from great ones: emotional regulation, problem-solving, adaptability, and moral judgment, and the impact that sleep deprivation can have on these attributes. In short, sleep is not a luxury. It’s leadership fuel.
Let’s Geek Out for a Moment: Neuroscience, Sleep and the Executive Brain
Executive function, our ability to plan, prioritize, regulate emotion, and make high-stakes decisions, resides largely in the prefrontal cortex. Payne’s research, along with that of other scholars, demonstrates that sleep actively restores and optimizes these systems.
During slow-wave sleep (deep sleep), the brain consolidates memories, pruning unnecessary neural connections and strengthening those linked to new learning. During REM sleep, emotional memories are integrated with logic and context. This process Payne calls “emotional recalibration.” It’s how we wake up with a clearer head and more balanced emotional tone.
In Payne’s words: “Sleep enhances memory, creativity, and insight by allowing the brain to reprocess experiences; sorting what’s useful, discarding what’s not, and seeing connections we missed when awake.”
That’s why, after even a few hours of rest, complex cases, difficult conversations, and strategic dilemmas often feel solvable again. Sleep literally reorganizes the brain’s architecture for higher-order thinking.
Do You Recognize the Cost of Cutting Sleep?
There is an opportunity cost to everything. For many of us, emergency physicians, shift workers, executives, and even parents, sleep deprivation feels inevitable. But the consequences are profound:
Cognitive Decline: The prefrontal cortex is among the first regions to go “offline” when sleep-deprived, leading to poor impulse control, reduced working memory, and impaired judgment.
Emotional Instability: The amygdala (our fear and threat center) becomes hyperactive, making us more reactive (even explosive) and less empathetic.
Physiological Damage: Inadequate sleep raises cortisol, impairs glucose metabolism, and increases cardiovascular risk. Chronic fatigue literally ages the brain and body.
Cultural Erosion: In high-performance environments, sleeplessness can masquerade as dedication — yet it quietly erodes safety, empathy, and effectiveness.
For emergency physicians and those in positions where critical decisions are made, this matters deeply. Fatigue is linked to diagnostic error, communication breakdowns, and burnout. This is the antithesis of the calm clarity we’re called to deliver at 3 a.m. when everything depends on it. And this isn’t about working nights. There are many professionals who do not prioritize sleep regardless of the work cadence.
Three Essentials for Better Sleep and Better Function
Protect Your “Sleep Architecture” (Routine Is Power)
Set consistent sleep and wake times, even on off-days. The brain thrives on rhythm. For shift workers, anchor your sleep to some consistent window, even if imperfect. Ritualize your pre-sleep environment — dark, cool, quiet, and screen-free for at least 30 minutes. Routine signals the brain: it’s safe to power down. If your schedule changes, establish a routine in whatever pattern you are in.Guard the First and Last Hour of Your Day
The first and last hours frame your neurocognitive state. Begin with light exposure, hydration, and movement; end with decompression, not deliberation. Research from Payne and others shows that late-night rumination keeps the limbic system active. Journaling, prayer, or gratitude reflection transitions the brain toward calm parasympathetic dominance.Reclaim the Nap — Strategic Rest as a Leadership Tool
A 20–30-minute nap boosts alertness and working memory without the grogginess of longer sleep. Payne’s lab and NASA studies confirm that even brief rest breaks enhance executive performance by up to 30%. In high-stakes work, that’s the edge between burnout and brilliance.
The Leadership Imperative
Simon Sinek reminds us that “energy, not time, is our most precious resource.” Sleep is the ultimate renewable energy source. As leaders in medicine, education, or life, modeling healthy sleep is an act of stewardship. It signals that high performance and wellness are not opposing forces, but mutually dependent.
We can’t lead well from exhaustion. We can’t innovate, mentor, or heal without rest.
The next time you’re tempted to trade an hour of sleep for one more email, one more chart, or one more call, remember: you’re not buying productivity — you’re mortgaging clarity.