Wellness Matters

9 tips for better sleep during residency

Sleeping well during residency is challenging at best, but preventing chronic sleep deprivation is critical for your physical, mental and emotional health.

Sleep isn’t a waste of time. It’s an investment in your health.

Yet for many physicians and residents, maintaining a healthy sleep schedule is challenging at best, especially in light of regulations that allow residents to work for up to 28 hours straight.

The bad news is sleep deprivation, whether due to an erratic schedule or a sleep disorder, can increase your risk of developing a number of severe physical and emotional health problems. Lack of sleep has implications for job productivity and safety, as well your wellness during off-time with friends and family. Sleep-deprived residents are also likely to experience lower energy levels, higher stress levels and fatigue, which all have a negative effect on performance, and a reported increase in appetite and cravings for high-carbohydrate and high-fat foods.

Another concern is shift work disorder, which is common among those with night shifts, rotating shifts, or early morning shifts. It can cause chronic sleep deprivation, in which a person never catches up on sleep, carrying a “sleep debt” with them. Symptoms of shift work disorder are widespread, from insomnia to severe sleepiness, trouble focusing and difficulty with personal relationships.

Your internal clock governs your sleep and wake cycles. Get out of sync and you’ll be sleepy when awake and have difficulty sleeping when you want. If this is a permanent or long-term shift, you can learn to adapt.

Use these tips to maximize your sleep

  • Train your body to recognize bedtime by implementing a ritual. The clock can be “reset” if it is possible to maintain the same sleep times on work days and days off.
  • Get in bed 30 minutes before bedtime so you have time to wind down.
  • Lowering your core temperature can help you fall asleep faster and sleep deeper. Make sure the bedroom is cool, quiet, and dark (earplugs or white noise and a sleep mask may be beneficial). For optimal sleep, keep the bedroom between 60–67° F.
  • Avoid bright lights for the 3-4 hours prior to bedtime (wear blue-blocking computer glasses if needed). Conversely, get light exposure upon awakening. If you routinely wake up in the dark to start your day consider having a sun lamp or lightbox to wake you up.
  • Caffeine is acceptable as long as it is not within 8 hours of bedtime.
  • Sometimes a brief nap (15 to 30 minutes) may be of benefit. Napping during shifts (when possible) or off-hours may help.
  • Heavy meals and alcohol might make you drowsy, but they can disrupt sleep later. Avoid eating and drinking at least two hours before bed.
  • The light from electronic devices—like phones and tablets—activates the brain. Keep electronic devices out of the bedroom and read a real book instead.
  • Medication is the last resort, if all else fails.

While we sleep deeply, the brain experiences a transfer of fluids to remove waste proteins that have accumulated during the day. It is these same proteins, amyloid and others, that accumulate in Alzheimer’s disease. And, it’s during the deepest sleep that the brain does its housekeeping, storing and consolidating learned information and long-term memories. A recent study found that perhaps 15% of Alzheimer’s disease may be attributable to sleep problems during one’s life.

Problems can be exacerbated if long hours in the hospital are combined with an underlying sleep problem or with low quality sleep (multiple awakenings or inability to reach deep sleep).

Recent studies have shown that when subjects are not allowed quality sleep (subjects wore headphones while sleeping and when they were nearing deep sleep a tone was played to nudge them out of deep sleep) that levels of amyloid in the brain are significantly heightened the next day, especially in the hippocampus, and that mood and concentration was impacted negatively. These studies highlight the importance of attaining quality sleep and with working with a sleep specialist to uncover and treat sleep disorders, to maximize whatever length of sleep you are able to achieve.

Further reading:

Advice for incoming residents: 8 tips on professionalism, work-life balance, and more

Working and preparing for the night shift during residency

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