Can I Get 8 Hours of Sleep?

Sara Cohen, MD

Disclosures

February 04, 2013

Question

During medical school, does 8 hours of sleep per night cease to exist?

Response from Sara Cohen, MD
Fellow, Department of Physical Medicine and Rehabilitation, Harvard University; Fellow, Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts

There's a popular saying in college: "Social life, sleep, good grades: Pick two." Unfortunately, in medical school, you may only get to pick one.

Some of my colleagues in medical school used to brag about how little sleep they needed, but I always felt that I needed at least 7 hours per night to function well, so I made it a priority. Yes, it is possible to get 8 hours, but you must plan ahead.

During the preclinical years, many of my classmates would pull "all-nighters" or late nights in the days right before an exam. Considering how many exams there are in medical school, this can add up to a lot of late nights and sleep deprivation. Because I valued my sleep, I would generally start studying for exams earlier than my classmates did to ensure that I'd feel comfortable going to sleep at a reasonable time on the night before each exam.

Why bother to get a good night's sleep? Aside from the fact that I just felt better on a full 8 hours, evidence suggests that students perform worse on cognitive tasks when they're sleep deprived.

For example, a 2000 study showed that people who had gone 17-19 hours without sleep performed similarly on cognitive testing to people with a blood alcohol content of 0.05%, which is roughly the equivalent of having 2 alcoholic beverages.[1]

Additional evidence suggests that not getting enough sleep over a prolonged period can result in accumulation of profound neurocognitive deficits.[2]

Considering that you are trying to perform to the best of your abilities, it makes sense to try to maximize the amount of sleep you get.

Sacrificing a few hours of studying the night before an exam may actually help you to perform better. Admittedly, you may have to limit your social life a little, but achieving sleep and good grades is not impossible.

In the Clinic

During the clinical years, it can be an even greater challenge to get enough sleep. You probably won't have an issue during rotations with more regular schedules, such as psychiatry or family medicine, but other rotations require long hours.

On my surgery rotation, I usually set my alarm for 4 AM every day. In order to get 8 hours of sleep, I would have had to go to sleep at around 8 PM every night -- when the sun was still up!

Moreover, I was told on my surgery rotation that although the Accreditation Council for Graduate Medical Education (ACGME) limited resident shifts to 30 hours, restrictions were entirely different for medical students. The Liaison Committee on Medical Education (LCME) states that work-hour rules in medical school are dictated by the committee responsible for the curriculum, so it is technically possible for a school to allow 36 hours in the hospital or more, especially because students don't make decisions that affect patient care.

Of course, as a medical student, even if you are not at risk of harming patients due to lack of sleep, you're still at risk of harming yourself or performing poorly.

Studies show that fatigued interns have a greater chance of incurring percutaneous injury such as needlesticks, as well as a greater risk of being in a motor vehicle accident.[3,4]

Sleep deprivation also negatively affects performance in surgical exercises,[5] so you may fail to impress your attending if you haven't gotten enough sleep.

Generally, there isn't much you can do to get 8 hours of sleep per night on rotations that require you to be at the hospital before dawn. However, on rotations with long hours, you can at least try to maximize the sleep you get on weekends and days off.

And, of course, if you feel very fatigued, either call for a taxi or find a quiet room and take a nap before you attempt to drive yourself home.

The good news for medical students who feel upset about not being able to sleep 8 hours per night is that you can tailor your residency search to find programs to suit your needs. Of course, nearly every residency has overnight call, but some are more strenuous than others. During my own residency in physical medicine and rehabilitation, I had an opportunity to sleep 8 hours on the vast majority of nights. If sleep is your priority, 8 hours can be the rule rather than the exception.

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