alzheimer
08-09-2007, 10:25 PM
How Can I Get Enough Sleep During Training?
Daniel Egan, MD
Question
I am a medical student and I recently had insomnia for about 7 days, starting with the beginning of my exams. The problem got better for a while, but then it came back again. I spend hours in bed, so exhausted but unable to sleep. Can you give me some advice? I don't want to use medications
.
<table border="0" cellpadding="0" cellspacing="0" width="395"><tbody><tr valign="top"><td align="left">http://images.medscape.com/pi/global/hs/hs-egan-daniel.jpg</td><td align="left">Response from Daniel Egan, MD
Attending Physician, Emergency Medicine Department, St. Vincent's Hospital, New York Medical College, New York, NY</td></tr></tbody></table>
Sleeping is critical. If you are having as much difficulty sleeping as you describe, you really need to reach out and speak to someone at your school. Insomnia can be just that -- difficulty sleeping -- but it also can be a sign of other things, like depression, and I hope that if you are feeling any of those symptoms that you will find some help with that.
Medical school definitely takes its toll on you and your sleep patterns. We all know and can remember those days of all-night cramming for an examination. I have vivid memories of the first year of medical school, when I routinely went to bed each night at 2 AM and then was awake again at 7 AM in order to be ready for my 8 AM classes. I remember always being tired. As the year went on, I realized that I was not performing any better in my classes than my closest friends were who had a full night of sleep every night.
Second year arrived and I made a pact to myself that I was going to try to sleep more. The chronic exhaustion did not seem worthwhile. I still remember the advice our Dean gave us at the beginning of medical school. She told us that regardless of how many hours we studied, we would never be able to learn everything there was to learn. After finishing my first year, that was apparent to me. My well-being and good sleep were important, especially in the context of 2 more hours of studying not really making a significant difference in the long run.
So, that is what happens in the preclinical years. However, in the clinical years, things change dramatically. Depending on the structure of your school and your rotations, you will likely have many very early mornings accompanied by some very late nights. If you take call overnight, you will experience the joy of only a couple hours of sleep with almost a full workday ahead of you. In the United States, work hour regulations have dramatically changed the experience of working for 36 hours straight, which leads to pure exhaustion. However, long days persist, and waking up at the crack of dawn is somewhat regular.
It is important during these years to keep your primary goal in mind: You are there to learn. In some ways, you are there to experience what it is like to be a resident in that specialty. You also have responsibilities towards patients, which requires you to be awake and functioning. There is always a fine line between working hard and impressing your residents but also taking care of yourself.
Sleep problems will follow you for the rest of your life in most specialties. I am faced with constantly changing sleep patterns, given the rotating schedule of an emergency physician. However, even physicians in primary care will get calls in the middle of the night from patients and hospitals. At some point, you will begin to figure out what works best for you. In my case, I have figured out that on the day of a night shift, I try to get up a little earlier than usual so that by mid-afternoon I am tired. A 2-hour nap before going into the hospital tends to give me more energy and allows me to avoid the exhaustive feeling that is present if I have not slept.
Your question also raised the issue of medication. I would say that at this point, it is important to try to avoid using medication regularly. However, I have many colleagues who do need sleep aids when their sleep cycles are forced to change. In your situation, where insomnia seems to be paramount, I would address all of the potential psychosocial issues first. Is it a primary sleep disorder, or secondary to some other stressor? If you have determined that it is a primary sleep problem, then you should speak with a physician about possibly assisting you with medication, as it appears to be interfering with your ability to study and continue your education.
Daniel Egan, MD
Question
I am a medical student and I recently had insomnia for about 7 days, starting with the beginning of my exams. The problem got better for a while, but then it came back again. I spend hours in bed, so exhausted but unable to sleep. Can you give me some advice? I don't want to use medications
.
<table border="0" cellpadding="0" cellspacing="0" width="395"><tbody><tr valign="top"><td align="left">http://images.medscape.com/pi/global/hs/hs-egan-daniel.jpg</td><td align="left">Response from Daniel Egan, MD
Attending Physician, Emergency Medicine Department, St. Vincent's Hospital, New York Medical College, New York, NY</td></tr></tbody></table>
Sleeping is critical. If you are having as much difficulty sleeping as you describe, you really need to reach out and speak to someone at your school. Insomnia can be just that -- difficulty sleeping -- but it also can be a sign of other things, like depression, and I hope that if you are feeling any of those symptoms that you will find some help with that.
Medical school definitely takes its toll on you and your sleep patterns. We all know and can remember those days of all-night cramming for an examination. I have vivid memories of the first year of medical school, when I routinely went to bed each night at 2 AM and then was awake again at 7 AM in order to be ready for my 8 AM classes. I remember always being tired. As the year went on, I realized that I was not performing any better in my classes than my closest friends were who had a full night of sleep every night.
Second year arrived and I made a pact to myself that I was going to try to sleep more. The chronic exhaustion did not seem worthwhile. I still remember the advice our Dean gave us at the beginning of medical school. She told us that regardless of how many hours we studied, we would never be able to learn everything there was to learn. After finishing my first year, that was apparent to me. My well-being and good sleep were important, especially in the context of 2 more hours of studying not really making a significant difference in the long run.
So, that is what happens in the preclinical years. However, in the clinical years, things change dramatically. Depending on the structure of your school and your rotations, you will likely have many very early mornings accompanied by some very late nights. If you take call overnight, you will experience the joy of only a couple hours of sleep with almost a full workday ahead of you. In the United States, work hour regulations have dramatically changed the experience of working for 36 hours straight, which leads to pure exhaustion. However, long days persist, and waking up at the crack of dawn is somewhat regular.
It is important during these years to keep your primary goal in mind: You are there to learn. In some ways, you are there to experience what it is like to be a resident in that specialty. You also have responsibilities towards patients, which requires you to be awake and functioning. There is always a fine line between working hard and impressing your residents but also taking care of yourself.
Sleep problems will follow you for the rest of your life in most specialties. I am faced with constantly changing sleep patterns, given the rotating schedule of an emergency physician. However, even physicians in primary care will get calls in the middle of the night from patients and hospitals. At some point, you will begin to figure out what works best for you. In my case, I have figured out that on the day of a night shift, I try to get up a little earlier than usual so that by mid-afternoon I am tired. A 2-hour nap before going into the hospital tends to give me more energy and allows me to avoid the exhaustive feeling that is present if I have not slept.
Your question also raised the issue of medication. I would say that at this point, it is important to try to avoid using medication regularly. However, I have many colleagues who do need sleep aids when their sleep cycles are forced to change. In your situation, where insomnia seems to be paramount, I would address all of the potential psychosocial issues first. Is it a primary sleep disorder, or secondary to some other stressor? If you have determined that it is a primary sleep problem, then you should speak with a physician about possibly assisting you with medication, as it appears to be interfering with your ability to study and continue your education.