HealthApril 06, 2020

The dangers of sleep deprivation in medical residents

By: Kunal Sindhu, MD

Sleep is essential to human life. According to the National Heart, Lung, and Blood Institute, "Getting enough quality sleep at the right times can protect mental health, physical health, quality of life, and safety." Of all people, those who promote health and heal the sick should strive to obtain sufficient sleep.

Yet the rigors of residency can make it challenging for residents to sleep as much as they need to. This is particularly unfortunate because sleep deprivation in medical residents can compromise their own wellness as well as their patients' health. Here's why the problem happens and how to ensure you're getting adequate sleep in residency.

Too many hours, not enough sleep

Medical residents work long hours navigating stressful clinical scenarios, leaving little time for personal pursuits and self-care. As a result, resident physicians generally don't sleep enough, particularly interns. A 2017 study in Sleep found that internal medicine interns and residents slept just 6.93 and 7.18 hours per night on average, respectively. Even worse, interns slept just 2.19 hours on average on call nights. The problem is undoubtedly worse in surgical specialties, as I discussed on Medscape.

This status quo is highly concerning. According to Nature and Science of Sleep, in the long term, sleep deprivation raises the risk of burdensome chronic diseases, including cardiovascular disease and diabetes. In the short term, it adversely impacts mental health, cognition and performance.

A lack of sleep can harm patients, too. Writing in The Lancet, Dr. Matthew P. Walker noted that "junior doctors working a 34 [hour] shift will make 460% more diagnostic mistakes than when well rested."

6 Ways to get more sleep

Because of the negative consequences of acute and chronic sleep deprivation in medical residents, it's essential to get enough sleep. But how much is enough? According to the National Sleep Foundation, adults aged 18 to 64 require seven to nine hours of sleep per night.

On busy rotations and nights on call, residents may find it especially challenging to get anything close to seven hours of sleep. That said, there are several steps you can take to maximize your ability to obtain sufficient sleep.

1. Choosing food and beverages carefully

Caffeine is a stimulant and can keep you awake, so minimize coffee, soda, tea and other sources of caffeine before bedtime. Also try to avoid heavy meals and alcohol before bed. While these may initially make you drowsy, they may interfere with your sleep later on.

That's not to say you should eliminate caffeine entirely during residency — in fact, caffeine may prove especially helpful during fast-paced shifts that begin early in the morning. Instead, strive to decrease your caffeine intake as your day starts winding down. Aim to avoid caffeine at least three to four hours before bedtime.

2. Exercise regularly

While the long hours of residency can make it difficult to get regular physical activity, you should try to exercise daily if possible. Exercise may in fact improve sleep quality and duration, according to Advances in Preventive Medicine.

However, beware of exercising too close to bedtime. Sports Medicine notes that rigorous exercise ending an hour or less before bedtime may actually impair sleep. On long call days, consider a shorter, light workout.

3. Optimize your sleeping environment

Make sure you have a comfortable bed and a quiet bedroom to sleep in at home. If you're able to control your bedroom's temperature, make sure to set it to your preferred level before going to bed.

When you're on call overnight, controlling these factors may be impossible. In these situations, head to your residency program's call room for a nap whenever you have a break. While these are imperfect locations for sleeping, they're usually quiet and have beds.

4. Avoid electronics before bed

During residency, you'll be inundated with new information. You may want to learn more about the medical conditions you're seeing daily, but you probably also want to decompress from work. Whichever path you choose, you're likely to use a variety of electronics to do it.

While wanting to learn more and wanting distraction are common in residency, using electronics can stimulate your mind and interfere with sleep. So, when you're at home, it's best to try to avoid using phones, tablets, computers or televisions before bed. Keeping these outside of your bedroom altogether will help ensure that you don't get distracted while trying to fall asleep.

5. Develop a routine

One of the most challenging parts of residency in regard to sleep is the variability in your work schedule. In internal medicine, for example, it's not unusual to have to work a long call shift every fourth or fifth day. You're also likely to have to work on some weekend days. This day-to-day inconsistency in your work life can make it challenging to establish clear routines, especially when it comes to sleep.

That said, it's not impossible. Try to go to bed at the same time each night and wake up at the same time each morning, even on weekends. By creating a routine, you'll be able to exert more control over your sleep schedule and maximize your ability to get seven hours of sleep a night.

6. Nap when you can

You'll likely find it impossible to follow these strategies on nights when you're on call, especially if you're being paged frequently. On these nights, your goal should be to get as much sleep as possible, even if it's likely to be far less than seven hours. During breaks in the action, prioritize naps. Other tasks can wait.

Getting the sleep you need is challenging in residency, but by adopting these strategies, you can increase your odds of being as rested as possible.

Kunal Sindhu, MD
Lippincott® Medicine
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