Coping with sleep deprivation for M3 year/residency/beyond

[deleted854547]

My clerkship year is starting this fall, and I'm hoping to solicit advice on how to best deal with the inevitable lack of sleep that I'll have to face. For med students who have gone through clerkship year, current residents, and attendings, what tips do you have for those of us to perform well and cope with lack of sleep next year?

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[M&L]

I am a current medical student, but I do have some tips for night shifts, - i worked in a healthcare facility where i would pull a 16 hour shift straight, and i would end up being up for 24-36 hours straight (from Sunday morning doing stuff, then pulling a 16 hour shift till 8 am on Monday, and then going straight to school till about 5 pm). So one thing i figured out, - it helps if you switch activities every hour or two. It tricks your brains and helps you stay focused. During slow times, when my patients did not need me, i went through school material, - if my brains were still fresh, i went through new material. If i was already tired, i would do practice questions. Frequent snacks and drinks help, - fruit, nuts, water, coffee, carbs. 2 am-5 am were always the hardest times, so i tried to schedule something that would require me to get up and frequently walk: for example, restock supply closet, or count medications, or something like that.

Hope this helps a bit. Cannot give you study tips yet, sorry.

 

[wanderingorion]

You just adapt to a lower amount of sleep because you have to. You'll do it as all that come before you have. Coffee, snack trips at 2 am, and other other things you come up with will help you.

 

[softball2344]

You shouldn't be too sleep deprived during third year. Depends on how your school's rotations are set up though. We had night float for obgyn for instance which was way better than 24 hour call for surgery. In fact I got 8+ hours for every rotation except surgery, but I am the type of person who prioritizes sleeping over studying lol

 

[deleted50541]

Everyone's different in how they respond to a lack of sleep. Do you consider that you have a healthy sleep schedule already? Do you drink a lot caffeine? Are there certain times of day you feel more energy than others, i.e. are you a "morning person"?

For starters, realize that going forward in your medical career you need to adjust to waking up earlier than you're probably used to doing. That means learning to readjust your whole sleep schedule. If you're used to going to bed at midnight, but now you have to get up at 0400-0430 for rotations, then you need to adjust back. It's hard, but maintaining a consistent sleep schedule is probably the most important thing you can do. Obviously that's not always possible with so many demands on one's time, but try to make it your priority to focus on getting enough sleep.

As for caffeine, don't let it be your crutch to substitute for poor sleep habits. I used to knock back 1/2 a pot of coffee every morning before I even went to class (a habit I picked up from my years in EMS and grad school). I could barely function without caffeine and it was ruining my sleep too. By the time I was a third year surgical resident, I quit most caffeine and never looked back. I sleep better these days, don't have pounding headaches from withdrawal, and am much less anxious overall. I'm not opposed to one's morning coffee or a cup or two during the day as a pick-me-up. Just be mindful of how much stimulants you may be using during the day and how it's affecting your mood and sleep.

At the end of the day though, sleep deprivation in this job is inevitable. I spent 8 years in training as a resident and CT fellow, so you do learn to adapt. I was on 24 hour call every third day as a resident and every other day as a fellow. I routinely went 30+ hours at a time every week without sleep and usually slept 4 hours a night at most. Naps are key when you can. Keep hydrated and have a snack every now and then.

 

[Candidate2017]

My clerkship year is starting this fall, and I'm hoping to solicit advice on how to best deal with the inevitable lack of sleep that I'll have to face. For med students who have gone through clerkship year, current residents, and attendings, what tips do you have for those of us to perform well and cope with lack of sleep next year?

Lack of sleep is not inevitable if you choose your rotation sites and specialty wisely. Had 5 overnights in med school (slept through all but 2 hrs) and about 10 in residency.

 

[Mass Effect]

At the end of the day though, sleep deprivation in this job is inevitable

No, it's not. If your health is important to you, you'll choose a specialty and residency programs that don't consider sleep a luxury. As a med student, very few rotations require sleep deprivation.

 

[AlteredScale]

My clerkship year is starting this fall, and I'm hoping to solicit advice on how to best deal with the inevitable lack of sleep that I'll have to face. For med students who have gone through clerkship year, current residents, and attendings, what tips do you have for those of us to perform well and cope with lack of sleep next year?

Go to bed at a reasonable time. Be efficient and learn time management skills and learn how to be flexible wit them because each specialty has different time requirements. Try not to stress eat too much or if you do watch out with the carbs/sugars since that'll just make you more tired. Try and do some exercise even if it is just a walk for 20-30 minutes if you can or something at home for 10-15 minutes that's intense.

Study habits and adult learning are pretty key to also saving you time and allowing you sleep.I think it's important to have a to-do list made by the time your done for the day. Just jot down things you want or need to review based on what you feel you're rusty on or may be pimped on the next day. Usually on the commute home I'd review that list and rearrange it to see what I knew was priority (what I'd be asked on) vs what was in then background (usually just general review). I saved weekends to review online med ed and do questions for the shelf and read maybe a research/review article on a topic I found interesting from the week.

My busiest rotations in terms of time was surgery and internal medicine which was 6-7am start to 5-6pm end for most days, sometimes 7-9pm on surgery (which obviously may be different for you but you can expect similar times). General surgery was really busy and really tiring. It is absoltlue true that you'll find yourself falling asleep while studying. Since you gotta get up so early, you just need to do small increments of studying like 1 hr maybe 2 at most. Between cases if you aren't rounding, you just need to read. It sucks but you get through it.

For internal medicine, it can be challenging to study because you can get overloaded with writing progress notes and H&P's in the afternoon if they expect you to do so. If not, you'll have a ton of time to study and alot of times the residents like to teach because it helps them learn as well.

 

[deleted50541]

No, it's not. If your health is important to you, you'll choose a specialty and residency programs that don't consider sleep a luxury. As a med student, very few rotations require sleep deprivation.

I agree. I mostly meant that the shift to clinical rotations and eventual internship/residency will come with more chances to experience sleep deprivation.

Thankfully as an attending in private practice, there aren't too many late nights or emergencies anymore and I'm sleeping better than I have in years.

 

[sanfran256]

As a third and fourth year student, you will rarely have to deal with sleep deprivation. You should have time to come home / work out/ eat/study for 30 mins - hour at night, and still get 8 hours no problem on most rotations. The only rotations where it was hard to achieve this was surgery/ob gyn for me.

The only people in my friend group who had trouble with deprivation thru med school had major sleep hygiene issues.

idk about residency, haven't started.

 

[softball2344]

For starters, realize that going forward in your medical career you need to adjust to waking up earlier than you're probably used to doing. That means learning to readjust your whole sleep schedule. If you're used to going to bed at midnight, but now you have to get up at 0400-0430 for rotations, then you need to adjust back. It's hard, but maintaining a consistent sleep schedule is probably the most important thing you can do. Obviously that's not always possible with so many demands on one's time, but try to make it your priority to focus on getting enough sleep.

^this!
On some rotations I went to bed at 830. I know people who would only get like 5 hours during the week and try to make it up on the weekend but 1) that doesn't work and 2) it wastes your days off

 

[Matthew9Thirtyfive]

Just a med student, but I’ve been in the military for 8 years and worked plenty of 80-100 hour weeks. You have to prioritize your sleep. You accumulate sleep debt quickly and at a certain point you can’t get it back, and it is linked to decrease performance, health, dementia, etc. I can tell you from first hand experience that you will feel like you are adjusting, but you’re really not. You will of course have to get less sleep at times, but you need to prioritize your sleep when you can.

 

[Oedipa Maas]

You shouldn't be too sleep deprived during third year. Depends on how your school's rotations are set up though. We had night float for obgyn for instance which was way better than 24 hour call for surgery. In fact I got 8+ hours for every rotation except surgery, but I am the type of person who prioritizes sleeping over studying lol

There is a lot of diversity in school medical student schedules. For us we had Q3 24 hour shifts for OB and 28 hour call for surgery. We had 16 hour shifts most days on IM and peds. I think the only times I didn't have to compromise sleep vs. studying were my outpatient rotations. Fully sleep deprived? Probably only on OB and surgery. But I definitely wasn't getting an ideal amount of sleep most nights on third year. It really wasn't until the second half of fourth year that I got into a good sleep hygiene groove.

OP you will get through it because you have to. It will not be fun but there are other aspects of the rotations that will make it so worth it. You can do it! You will find what works for you. Some of my classmates were rigid about working out/doing their normal routines and sacrificing sleep for it during these times. I chose to view OB and surgery as temporary time periods in my life where sleep was more important than my exercise and free time activities. Only you will know what is best for you and I promise you will figure it out.

 

[numbersloth]

No, it's not. If your health is important to you, you'll choose a specialty and residency programs that don't consider sleep a luxury. As a med student, very few rotations require sleep deprivation.

It this more specialty dependent (which specialties?) or program dependent?

 

[Mad Jack]

Aside from a few long calls on OB/Gyn my sleep was fine, and even then it wasn't particularly bad

 

[Mass Effect]

It this more specialty dependent (which specialties?) or program dependent?

It's both specialty and program dependent. I'm in psych and while I had a chill time in residency, I know other residents at other programs who didn't.

 

[jurassicpark]

It's both specialty and program dependent. I'm in psych and while I had a chill time in residency, I know other residents at other programs who didn't.

Very dependent on program and speciality. And generally med students are treated with more kiddie gloves than the residents and interns, but once again generally, not universal.

As a med student it's a way to break into the lifestyle of the specialty that you want to match in to. It's the same as how you learned to cope with medical school. At first it seemed daunting, but then as you gained your rhythm you realize those first two years of medical school were probably the easiest of the rest of your life. You will learn how to study, sleep and eat with just a few hours of sleep or read in between patient-related assignments.

I learned how to sleep anywhere and in any position.

Though while you may not study effectively until you learn your stride on certain high-demand rotations, one thing : DO NOT DRIVE IF YOU'RE TOO SLEEPY. Take a power nap, ask for a ride, etc. I tried driving to another city after a looooong call.. was NOT the best idea and thankfully didn't kill myself or others.

 

[Doggeronie]

My clerkship year is starting this fall, and I'm hoping to solicit advice on how to best deal with the inevitable lack of sleep that I'll have to face. For med students who have gone through clerkship year, current residents, and attendings, what tips do you have for those of us to perform well and cope with lack of sleep next year?

Tbh my 3rd year was chill. Especially since half of it was online
I easily have a sleep surplus

 

[deleted1038938]

Tbh my 3rd year was chill. Especially since half of it was online
I easily have a sleep surplus

hahaha. I had the more difficult rotations (surgery and OB) before we were online (just had neuro and IM left...although IM I was all inpaitent so that would've been 6 days a week 12 hours a day lol).
But now...100% have a sleep surplus. lmfao.
For surgery rotation, I kept some snacks because if I don't eat every few hours I get lightheaded and you don't want to be lightheaded during procedures!
But I left myself empty enough that I would still be a little hungry (had a couple 36+ hour shifts during surgery) If I'm full I fall asleep. So I didn't really eat a large meal I would eat snacks since less sleepy. Also after a certain point of being sleepy, you stop feeling tired lol. Drinking water helped me too.

My OB rotation was terrible. We had to come in at 3 am to ROUND like wtf. And apparently we couldn't count the time we waited between rounding and seeing patients as part of the 80 hour work week so most of us were just sitting there for hours waiting for the attending to show up before leaving at 6 pm. AND the residents wouldn't let us nap during those few hours. Lots of traffic so usually got home at 7 pm. And then had to somehow eat and study. Honestly there were so many times my eyes were nystagmus-ing in that rotation and I couldn't stop because I was so sleepy. terrible time. 0/10 do not recommend.

 

[ciestar]

hahaha. I had the more difficult rotations (surgery and OB) before we were online (just had neuro and IM left...although IM I was all inpaitent so that would've been 6 days a week 12 hours a day lol).
But now...100% have a sleep surplus. lmfao.
For surgery rotation, I kept some snacks because if I don't eat every few hours I get lightheaded and you don't want to be lightheaded during procedures!
But I left myself empty enough that I would still be a little hungry (had a couple 36+ hour shifts during surgery) If I'm full I fall asleep. So I didn't really eat a large meal I would eat snacks since less sleepy. Also after a certain point of being sleepy, you stop feeling tired lol. Drinking water helped me too.

My OB rotation was terrible. We had to come in at 3 am to ROUND like wtf. And apparently we couldn't count the time we waited between rounding and seeing patients as part of the 80 hour work week so most of us were just sitting there for hours waiting for the attending to show up before leaving at 6 pm. AND the residents wouldn't let us nap during those few hours. Lots of traffic so usually got home at 7 pm. And then had to somehow eat and study. Honestly there were so many times my eyes were nystagmus-ing in that rotation and I couldn't stop because I was so sleepy. terrible time. 0/10 do not recommend.

Holy hell. That belongs in the name and shame on reddit.

 

[ciestar]

My busiest rotation was my peds sub-i. I had the intern’s schedule, except weekends.

Surgery was 6-5, but i didnt stay until 5 most of the time. Three 24s, but i still got like 6 hours of sleep.

OB it depended on the service. 6-6 for gyn-onc, gyn was 7-5, clinic was chill, and then L&D was 7-5 with a week of nights.

My third year IM rotation was with Hahnemann residents which now means nothing

 

[deleted854547]

Thanks for the responses everyone! Definitely feel less intimidated by clerkships now.

 

[CITIZENSURGEON]

I was able to change my sleep patterns around by taking advantage of the morning. I read Miracle Morning by Hal Elrod and his SAVERS acronym helped me a lot. Silence, Affirmation, Visualization, Exercise, Reading, Scribing is a routine I have gone through every morning now and it has turned the tables on my efficiency. As a surgeon and graduate of general surgery and pediatric surgery training programs the morning has been the only time I can control. Also make an appointment with yourself to go to sleep at night, that extra chapter, instagram feed or netflix special isn't worth it.

 

[Osteosaur]

How much should you be studying third year? Or how is it different from M1/2? Are you given guidance of materials to read or is it all self-directed based on current patients?

No, it's not. If your health is important to you, you'll choose a specialty and residency programs that don't consider sleep a luxury. As a med student, very few rotations require sleep deprivation.

What specialties are these in your opinion?

 

[VA Hopeful Dr]

No, it's not. If your health is important to you, you'll choose a specialty and residency programs that don't consider sleep a luxury. As a med student, very few rotations require sleep deprivation.

That was not my experience. Every 3rd year rotation I had except psych either had overnight call or night float.

Now if you mean things were set up where when not on call you had a chance to get a decent night's sleep, that's different and I completely agree with you.

 

[Mass Effect]

How much should you be studying third year? Or how is it different from M1/2? Are you given guidance of materials to read or is it all self-directed based on current patients?

Depends on your seniors and attendings. But for me, on most rotations, I was able to study what I wanted, which was shelf review books and UWorld in preparation for Step 2. On IM, they gave reading almost every night, but it wasn't too bad. I'd also read up on things my patients had on every rotation, obviously.

What specialties are these in your opinion?

There are good and bad programs in every specialty, but I believe psych is definitely all about lifestyle and most programs are chill. Other specialties to look at are derm and PMR.

 

[Mass Effect]

That was not my experience. Every 3rd year rotation I had except psych either had overnight call or night float.

Now if you mean things were set up where when not on call you had a chance to get a decent night's sleep, that's different and I completely agree with you.

Yes, that is what I mean. You can have nightfloat or weekend call and still not be sleep deprived (past the first two nights of nightfloat when you switch your hours). I didn't have any rotations where as an MS 3 I was expected to do something crazy like q3 24-hour call or something. I think IM wards and surgery are the two that lend themselves to reduced sleep even without call just by virtue of being at the hospital at 5 or 6 am and sometimes not leaving until 8 pm or so. But even then, there will be times when you leave earlier and you just need to prioritize your sleep. You may still be sleep deprived though on these two rotations.

 

[goatmed]

I'm currently in my surgery clerkship and struggling with some of those same sleep issues. I have to wake up at 3 so I can make copies of the patient census with scribbled on I/Os for the residents and fellows and get out between 4:30 and 6 pm, a bit earlier on occassion if I get lucky. I go to sleep at around 8 but in reality don't fall asleep until 9 or 10 and then rinse and repeat. My only solution two weeks in has been saturating my blood with caffeine (about 400 mg worth spaced out throughout the morning) and having catch-up sleep on my day off. I also try to take breaks between surgeries to that end or else I will be pinching myself not to fall asleep the whole time (I hear pinching oneself is not good sterile form ). In my very limited experience you just learn to live with it however you can. I truly admire my caffeine free co-students and cannot possibly imagine how they do it.

 

[aldol16]

You adjust. I wouldn't worry too much about it. Your body does what your mind tells it it must.

Coffee will become your best friend. You might not have time to make a pot in the morning to get a few more minutes of sleep but after rounds or before OR cases, you can usually sneak a quick cup in. There have been times when I almost fell asleep standing during rounds. It's tough.

Just realize that when you're sleep deprived, you'll be crankier than usual and your mind works slower. It might not seem that way when you're in the midst of it but that is what happens. I've noticed a clear difference in my speed of thinking now vs when I was on a particularly sleep depriving rotation. Reviewing some of the things I wrote, I was even surprised by how sloppy I was. Your friends who aren't on those services will probably also notice that you have less patience and are crankier. Try to realize that and force yourself to be more patient with people even when all you can think about is your pillow.