Sleep Deprivation and Fatigue

  • Signs of fatigue and sleep deprivation must be taken seriously – if you notice a colleague who appears sleep deprived, you could be doing more harm than good by not speaking up.
  • Be on the lookout for other signs/symptoms that may be suggestive of something beyond sleep deprivation/fatigue – i.e. depression, hypothyroidism, medication side effect.
  • Most people (on average) require 8 hours of sleep every 24 hours – when people get less than 5 hours of sleep over a 24-hour period, their peak mental performance usually deteriorates. This can be disastrous in a medical setting.
  • Fatigue and sleep deprivation increase the chances of medical errors, needle-stick accidents, motor vehicle collisions post-call, and greatly affect patient and personal safety.

Helpful Tips

  • Leave “on time” when shift ends – to maximize time off and increase sleep time
  • During time periods off, catch up on sleep that was lost with work
  • Develop good sleep hygiene (when you can) – establish a set bedtime and awakening time, avoiding caffeine and heavy foods 4-6 hours before sleep, making sure the room temperature and bedding are comfortable, and resolving conflicts before attempting sleep
  • Prophylactic naps taken before the shift begins may be helpful (and again after night shifts)
  • Take shift naps when possible – they should be brief (15-20 minutes) and frequent (every 2-3 hours); longer naps may prevent sleepiness but may result in “sleep inertia” – impaired cognition, severe disorientation, transitory hypovigilance, confusion, and difficulty in fully awakening (often lasting only briefly like a few minutes, but can last longer). For night shift interns on the wards, the intern on the other team could hold your pager for a brief nap (and vice versa). Night shift senior residents and night shift 4200 residents could also hold each other’s pager for a nap. In the PICU and NICU, see if the fellow would be willing to hold your pager to allow a quick nap.
  • Measures to help with sleep inertia include standing up, turning on the lights, being physically active, showering, among others
  • Consider caffeine pharmacologically (not socially) – caffeine takes approximately 30 minutes for the effects to be felt and with the effects lasting about 3 to 4 hours (consider avoiding caffeine too close to sleeping opportunities)
  • Alcohol use should be avoided (due to rebound effect and other reasons!)
  • Napping before leaving the hospital after a night shift should be considered if you are too tired to drive home
  • Consider public transportation, taxis, or having someone drive you home after a long shift (especially > 24 hours) or if you feel too tired to drive after any shift
  • Sleep in a dark, quiet room with a comfortable temperature. Good blinds (e.g., blackout shades) or eye masks can be helpful. Be sure to turn off pagers and phones and consider turning on a fan or other soothing background noise to minimize disruptions.
  • Complete the SAFER, aka “Sleep, Alertness and Fatigue Education in Residency” (available in New Innovations)
  • Talk to someone if you’re having trouble (program directors, chief residents, class or personal advisors, colleagues, etc.)