Imagine a dim hospital ward, the scent of antiseptic lingering, with exhausted doctors poring over patient charts on their 30th straight hour of work. This is the reality for many medical residents—according to statistics, one in three resident doctors report poor sleep quality.

Jaradat R, Lahlouh A, Aldabbour B, et al. The impact of duty hour limits on sleep quality of resident: a cross-sectional study. Oman Med J. 2022;37(4):e403.

 

 

Perhaps the most important culprit is the 80-hour work week, a regulation that, despite its intent to manage workload, is the root cause of fatigue and compromised sleep. Other factors like demanding schedules, overwhelming patient care duties, and the juggling act of clinical and educational responsibilities also contribute to sleep deprivation.

 

A brief history of shift limits

 

 

As noted in a 2023 study report published in BMJ Quality and Safety, a 2004 trial demonstrated that capping resident doctors' shifts at 16 hours increased alertness and safety.

Weaver MD, Landrigan CP, Sullivan JP, et al. National improvements in resident physician-reported patient safety after limiting first-year resident physicians' extended duration work shifts: a pooled analysis of prospective cohort studies. BMJ Qual Saf. 2023;32(2):81–89.

A few years later, the Institute of Medicine of the National Academies declared shifts exceeding 16 hours as unsafe. The Accreditation Council for Graduate Medical Education (ACGME) then implemented a 16-hour limit for first-year residents starting from July 1, 2011.

 

However, the medical community had differing opinions.

Responding to their objections, in 2017 ACGME lifted the 16-hour limit, allowing up to 28 hours of continuous duty. Yet, the BMJ Quality and Safety study reaffirmed that the 16-hour limit notably decreased medical errors and preventable adverse events, including those leading to patient death.

 

Recognizing the symptoms

 

There are clear signs to tip you off when you or a colleague may be experiencing symptoms of sleep deprivation. Not getting enough sleep will stand in the way of your success, so be on the lookout for these telling traits.

Fatigue and drowsiness

Fatigue, the most evident sign of insufficient sleep, leads to a state where staying awake becomes a herculean task. 

You feel exhausted both physically and mentally. But as a resident doctor, you cannot afford to become mentally distant during critical interactions and tasks, or—even worse—doze off during ward rounds in the middle of a vital discussion. 

 

A tired mind is a compromised mind, which puts you and your patients at risk.

Mood swings

Sleep deprivation doesn't just rob you of physical energy; it also affects your emotional well-being. You may find yourself frequently snapping or shouting at coworkers or patients. 

 

Brain fog and slower reaction time

Sleep deprivation can hamper cognitive abilities, impacting attention span, memory, and efficiency in thinking. This might lead to difficulty recalling important patient details and maintaining focus during important discussions. Even recalling well-known medical information can become challenging.

 

Brain fog can also affect your life outside work. In a study of emergency department healthcare professionals, 34% admitted to dozing off while driving in the past three months

Ardizzone E, Lerchbaumer E, Heinzel JC, et al. Insomnia—A systematic review and comparison of medical resident's average off-call sleep times. Int J Environ Res Public Health. 2023;20(5):4180.

—a symptom whose dangers don’t need to be explained. 

 

Lack of motivation

Without adequate sleep, you might find it challenging to muster your usual enthusiasm for patient rounds and feel less excited about discussing cases with your team.

Eddy R. Sleep deprivation among physicians. BCMJ. 2005;47:176–180.

 

 

 

Other symptoms include negative self-talk, disengagement from work and colleagues, hindered learning, and diminished accomplishment satisfaction.

Unhealthy eating habits and weight fluctuation

Dutch authors of a review published in Current Obesity Reports state that poor dietary choices and a lack of self-restraint often go hand in hand with sleep deprivation.

van der Valk ES, Savas M, van Rossum EFC. Stress and obesity: are there more susceptible individuals? Curr Obes Rep. 2018;7(2):193–203.

Sleep deprivation and chronic stress stimulate the hypothalamic-pituitary-adrenal axis, prompting the release of cortisol. 

 

These factors, when combined, can erode your efficiency, hinder your professional development, compromise your mental and physical well-being, and put you at risk of burnout.

 

The importance of prioritizing your health

 

As residents, you are the backbone of healthcare, entrusted with the well-being of countless patients. To deliver the best care possible, you must prioritize your own health.

Every few hours, take a short break and step away from patient care responsibilities for a change of surroundings or a short stroll. Take strategic naps during extended shifts. In an article for the AMA, Rachel Salas, a sleep neurologist from Johns Hopkins, advises against long naps of 3 or more hours.

Murphy B. Maximize the power of your naps during medical residency shifts. AMA. May 1, 2019.

 

Long naps lead to deep sleep, causing sleep inertia and reduced alertness upon waking. She recommends short naps under an hour, or taking "caffeine naps," before which one drinks a caffeinated beverage, to boost post-nap energy.

And if the pressure starts affecting you, don't hesitate to lean on senior residents, respected faculty members, or your program director for guidance and support. There are a number of residency programs today that provide education about sleep techniques and access to sleep specialists.