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Resident Fatigue

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Facts about sleep

Sleep needs are genetically determined and cannot be changed.
Most individuals need 8 hours of sleep to perform at an optimal level.
Getting fewer hours of sleep creates a “sleep debt” which must be paid off.
Human beings do not “adapt” to getting less sleep than they need.
Sleep is a vital and necessary function, and sleep needs (like hunger and thirst) must be met.
A decline in performance starts after about 15-16 hours of continued wakefulness.
Sleepy people underestimate their level of sleepiness and overestimate their alertness. The sleepier you are, the less accurate your perception of your degree of impairment.

Causes of sleepiness during Residency

Insufficient or Fragmented sleep (pager/phone calls)
Circadian rhythm disruption (night float)
Primary sleep disorders (insomnia, obstructive sleep apnea)

Recognizing sleepiness

Falling asleep in conferences or on rounds
Feeling restless and irritable with staff, colleagues, family, and friends
Having to check your work repeatedly
Having difficulty focusing on the care of your patients
Feelings of apathy

Healthy sleeps habits

We recognize that these habits may be difficult to adopt, especially at the beginning of residency, but we hope that you can use them as general guidelines at least during less demanding rotations to help you function better during more demanding rotations. Our Office of Wellbeing and Resilience, wellness reps, chiefs, and program directors can assist with sleep resources.

Get adequate (7 to 9 hours) sleep before anticipated sleep loss.
Avoid starting demanding rotations with a sleep deficit whenever possible.
Go to bed and get up at about the same time every day.
Develop a pre-sleep routine.
Use relaxation techniques to help you fall asleep (wellness representatives can provide resources)
Protect your sleep time; enlist your family and friends!
Your Sleeping environment should be:
- Dark (eye shades, room darkening shades)
- Quiet (unplug phone, turn off pager when not on call, use ear plugs, white noise machine)
- Cooler temperature
Try to avoid heavy meals within 3 hours of sleep
Get regular exercise but avoid heavy exercise within 3 hours of sleep.

If sleepiness interferes with your performance or health, or you notice such interference in one of your colleagues, talk to your chiefs and/or program director. Importantly, if you feel unable to continue your shift due to fatigue, you should notify your senior resident or chief resident immediately, and another resident will be called in to cover your shift.