Residents, sleep deprivation is dangerous: Watch out for these symptoms

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published September 5, 2023

Key Takeaways

  • Though many residents sacrifice slumber for their work, sleep is not a luxury but essential for remaining alert and performing your best.

  • Inadequate rest can compromise your focus, attention to detail, response time in emergency situations, and patient care quality.

  • It is of the utmost importance to prioritize your well-being—this means taking breaks, napping strategically, and seeking support when needed to ensure optimal patient care and your own well-being.

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.[]

In our field, the ethos of less sleep and more work has been a longstanding tradition. 

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

Research indicates that shorter shifts positively impact resident education while enhancing safety and well-being.

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.[] 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."

Alpana Mohta, MD, DNB, IFAAD

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. 

You might experience sudden outbursts of sadness or rage. Such emotional instability can strain relationships and erode the trust your patients have in you.[]

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.

Sleep-deprived doctors may display slower reaction times. For example, your response and reflexes at work might be delayed. This could affect urgent calls or emergency procedures, potentially leading to compromised coordination, such as shaky hands during delicate tasks like suturing.

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[]—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.[] 

You might procrastinate on tasks, such as updating patient charts; show reduced initiative; or hesitate to take the lead during emergencies, waiting for someone else to step forward.

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

Cortisol acts through cellular receptors, impacting gene expression, metabolic function, and immune response—all contributing to obesity. Exhaustion also reduces physical activity, lowering calorie burn. Over time, these factors contribute to weight gain and potential health issues.

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."

Alpana Mohta, MD, DNB, IFAAD

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.[]

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. 

What this means for you

As a resident, prioritizing adequate sleep is not just an act of self-care, it's an ethical obligation to your patients. Taking proactive steps, such as adjusting your surroundings or managing schedules, can be instrumental. By taking care of yourself, you will become a better physician, impacting countless lives. 

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