Sleep Advice

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I was scheduled to take the test today, but I got zero sleep so I didn't show up at prometric, thereby canceling my exam. I have to reschedule for a later date (and pay a huge fine), and was hoping for some sleep advice. I feel prepared with a 79% overall with Uworld and four nbme's/uwsa's all greater than 250, but I can't seem to shake the anxiety. Any advice would be greatly appreciated.

Originally Posted by CALLR001

I was scheduled to take the test today, but I got zero sleep so I didn't show up at prometric, thereby canceling my exam. I have to reschedule for a later date (and pay a huge fine), and was hoping for some sleep advice. I feel prepared with a 79% overall with Uworld and four nbme's/uwsa's all greater than 250, but I can't seem to shake the anxiety. Any advice would be greatly appreciated.

How is your sleeping schedule (sleep late/early, wake up late/early)? Are you able to sleep consistently every night? Was this only the night before the exam due to anxiety?

If you don't have a consistent sleeping pattern, try fixing it so that you go to bed around 10pm and wake up around 6 or 7am.

If its due to anxiety, perhaps just try to tell yourself that this test isn't all that important, that you're well prepared, you did all you could, and whatever happens, happens, you gave it your all. Sorry that wasn't much of advice, since I think each person deals with anxiety in their own way.

By the way, how does rescheduling work? Do you have to go through the whole registration process again?

Best of luck to you!

Thanks for the advice. I historically have difficulty falling asleep before big tests despite sleeping well at other times. I think I just let my nerves get the best of me. To reschedule I just have to pay a fine and reschedule within my eligibility time frame.

I've heard the important nights to sleep are the week leading up to the exam, not just the night before. It's tough to sleep enough when you're so stressed out.

Your school should have a counselor. See them as they have probably dealt with similar cases.

Try some binaural meditation music. If I'm too stressed to sleep, I just leave the music on while I fall asleep and whatever sleep I do get is super-restful. You'll be fine! Hang in there.

At all the testing centers I've looked at you can schedule your exam on different days at 8am, 12:30pm or 2pm. If you're having a hard time falling asleep and can't do the 8am, why not do a later one?

Originally Posted by LRAccord624

At all the testing centers I've looked at you can schedule your exam on different days at 8am, 12:30pm or 2pm. If you're having a hard time falling asleep and can't do the 8am, why not do a later one?

Yea, that is what i have decided to do. I found a 12:30 appt for this Friday, which I think better suits my insomnia.

Originally Posted by CALLR001

I was scheduled to take the test today, but I got zero sleep so I didn't show up at prometric, thereby canceling my exam. I have to reschedule for a later date (and pay a huge fine), and was hoping for some sleep advice. I feel prepared with a 79% overall with Uworld and four nbme's/uwsa's all greater than 250, but I can't seem to shake the anxiety. Any advice would be greatly appreciated.

That sucks. Atleast you have more time to study/review. Next time try taking some nyquil. That should help but don't take too much.

take some melatonin or benadryl the night before the exam as a quick fix.

but for the figure out what relaxes you and helps you sleep. having a fan on? listening to a boring path lecture? listening to some hypnosis relaxation stuff? etc

Originally Posted by red10

take some melatonin or benadryl the night before the exam as a quick fix.

but for the figure out what relaxes you and helps you sleep. having a fan on? listening to a boring path lecture? listening to some hypnosis relaxation stuff? etc

Just be careful not to make yourself groggy with these things. It would be best to test these out sometime other than the night before boards. If you want to go this route, I'd say try it tonight and see. That way if you're groggy all day Tuesday, no biggie, but Wednesday and Thursday will now be your last days to review, so you probably don't want to be groggy then (and obviously grogginess Friday would be no bueno either).

I'm sure we all have LOADS of boring podcasts we can put on...maybe biochem? "Glycogenesis, glycogenolysis, glycolysis, zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzz..."

Melatonin works wonders personally, but I would never do it prior to a big test unless I allotted myself like 11 hours to sleep. I've tried to wake up before after allotting less than 8 and woke up in a dissociative state (got up, showered, got dressed, went back to sleep - no recall of any of it).

The sleep still feels like quality sleep, but I wouldn't use it regularly. Only personally use it to try to reset my sleep schedule when I screw it up badly

I personally wouldn't use drugs. Instead I would do a huge increase in exercise the day before, which will help you sleep at night.

I would try doing 3-4 x your normal amount of exercise. If you can exercise for an hour, then I would try doing 3 hours of pretty good intensity exercise over the entire day. Make sure you get up early and don't take any naps. Another thing you could do is sleep 2 less hours the that morning which should make falling asleep that night easier. Last thing, a huge healthy meal could also aid you in falling asleep (with lots of healthy fats).

I can't sleep before big events either due to anticipatory anxiety.

I once read an article about some Iowa state wrestler preparing for a major tournament. He was asked how he slept the night before and he said he's never able to sleep before big tournaments. So he said he just lies in bed with anticipation and positively visualizes how the day will go. Anyway, the guy won.

After that I realized one night without sleep is not so bad. Now I just lie in my bed going over material and picturing myself rocking the exam, sleeping with beautiful women afterward, etc, and head off feeling great. It's a much more positive experience walking in with the mentality of, "I'm so psyched to rock this that I didn't sleep!" vs. "Crap! I didn't sleep so I'm going to do poorly!"

Moral of the story, sleep is overrated. If your adrenaline is running high and you attack the test you'll be fine even without sleep.

I have a pretty inconsistent sleep schedule, so I was worried about the night before the test too. Two days before the test, I intentionally slept about 3-4 hours. I figured that'd help me build up my sleepiness for the next night.

The night before the test, I stayed in a motel near the Prometric center in downtown Chicago. I walked around downtown for about an hour, ate a big burger, and went back to my motel room to review a few more Fast Facts from FA. Then I watched TV for about half an hour and went to sleep around 6pm. I woke up at about 5:30am the next morning and was ready to go.

mind telling how much the fine?i might need in the future,just in case in a situation like u

by the way,take a good rest,believe that u can crush the board.good luck
cheers

Originally Posted by Leon22

mind telling how much the fine?i might need in the future,just in case in a situation like u

by the way,take a good rest,believe that u can crush the board.good luck
cheers

For a US medical student it is $104. Thanks everyone for the advice!

Originally Posted by shan564

I have a pretty inconsistent sleep schedule, so I was worried about the night before the test too. Two days before the test, I intentionally slept about 3-4 hours. I figured that'd help me build up my sleepiness for the next night.

The night before the test, I stayed in a motel near the Prometric center in downtown Chicago. I walked around downtown for about an hour, ate a big burger, and went back to my motel room to review a few more Fast Facts from FA. Then I watched TV for about half an hour and went to sleep around 6pm. I woke up at about 5:30am the next morning and was ready to go.

So you flew from Australia to Chicago to take your test? If yes then Damn. I would be way too stressed.

No caffeine the day before and exercise a ton.

I struggle with this issue too. I have zero problems sleeping , I can fall asleep anywhere and anytime, except for the night before exams!!! It is horrible , even if I'm dead tired, I will have 'dreams' while I'm actually awake. It is the oddest experience.

Most of the time, ALL night long as I try to sleep, I find myself reciting some random facts or 'quizzing' myself as I have random exam material run through my head. So I may get ~ 1hr sleep before a test, even though I'll be in bed for 8 + .

At this point, since this lack of sleep before exams has become so consistent, the anxiety due to being scared of not being able to fall asleep further perpetuates my inability to fall asleep, perhaps even more so than the anxiety due to the exam. It's insane.

Anyway, if anyone has any recommendations that'd be great. I've tried melatonin and the benedryls/tylenol PMs, sometimes they help but often times not - and yes the benedryls can and do make me groggy. I've tried the exercising and no caffeine and exhausting myself, but still doesn't work.

One thing that has worked for me is stopping to study several hours before bedtime to 'shut your mind off', that helps a lot, but I'm not sure it would be equally effective for an exam with as high of anticipation as boards! It didn't work for the MCAT. True, convincing myself the exam doesn't matter is the most helpful thing, and for shelfs this can (sometimes) be done, but not for something like the boards!

Any advice for techniques or medications would be great, because it is difficult to find a doctor sympathetic to 'medical school stress' as they have all been through it and tell me to find healthy ways to deal with it because it is not going to be ending anytime soon, and most drugs are for long-term anxiety/sleep problems

I generally have trouble falling to sleep (not just prior to tests). Not severe/pathological, but say 20 minutes in bed on average before dozing off. To try and improve it, in addition to basic sleep hygiene, I try to clear my mind (quite literally, try to think about nothing at all) while I try to fall asleep, on a daily basis. It's harder than it sounds, but I feel like I improve with practice. Definitely helps with the racing thoughts

For the past week I had immense trouble falling asleep... was awake until 3 or 4 am most nights... duration of sleep was also awfully low and it was sadly not resulting in more study time.... never had this trouble before...

like one of the posters said before... i told myself that this exam is important but there are 1001 other factors which will decide my future... i slept yesterday for 12 hours and 10 hours the night before.... i had accumulated so much sleep debt...

Originally Posted by RedSoxSuck

So you flew from Australia to Chicago to take your test? If yes then Damn. I would be way too stressed.

No, I was staying with my parents during my 2-month study period... they live about an hour out of Chicago. I just took the train into the city for my test. I'll take Step 2CK in Sydney, since I'm not taking any time off for that.

Originally Posted by loveoforganic

Melatonin works wonders personally, but I would never do it prior to a big test unless I allotted myself like 11 hours to sleep. I've tried to wake up before after allotting less than 8 and woke up in a dissociative state (got up, showered, got dressed, went back to sleep - no recall of any of it).

The sleep still feels like quality sleep, but I wouldn't use it regularly. Only personally use it to try to reset my sleep schedule when I screw it up badly

That's great. I've tried melatonin before but didn't work for me. Maybe the dose was too low. What dose do you use?

5 mg is what I remember offhand, though my mom has success with 1 mg (which may be why I've dissociated on trying to wake up prior to 8 hours of sleep). It's something you have to use as directed though - take 30 min prior to intended fall asleep time, get in bed right away, and start trying to sleep. It doesn't seem to do anything if I'm sitting at a desk or something

If you are going to take melatonin which in my opinion does very little, you can just drink warm milk instead. milk has tryptophan in it and heating it up will help convert it to melatonin.

I also have this problem and what I try to do is set my schedule right a week before my exam if not earlier. For 24 hours I don't sleep (NO NAPS) until I am able to pass out at 12am (I know its late but its the only time I can reasonably sleep without waking up an hours later). Then I have an alarm set at 7am. Usually that does the job. Ill be continuously tired at 12 if I keep waking up at 7 and this will naturally fix my clock by test time.

i cant sleep the night before test always...then i'd like to listen some music..maybe you know a singer named Maximilian Hecker..

I had the same problem the night before mine and ended up getting 4 hours of sleep maybe. I'm pretty decent on 4 hours (even made a 5 hour drive after the exam to visit some friends without dozing off at the wheel and managed to stay out until 2am that night), but it was pretty nerve-wracking and I would have much preferred 8 hours. My sleep schedule was pretty much on point the week before (in bed no later than 12am, waking up no later than 8am), but I just felt it the night before.

I know most people are advocating against pharmacological approaches here, but I think in the future I may go see a doctor about getting a short-term script for Lunesta or one of the other short-half-life Z-drugs for insomnia. The problem with most of the other recommendations (benadryl, nyquil, etc.) is that they have incredibly long half-lives and significant anti-cholinergic effects which wouldn't be ideal to have creeping into your test day.

i'm against any sleep medications
i'd say get yourself tired night before: exercises, 5 miles run or even better - good sex

I have this exact same problem. Only happens when big events are the next day. I was worried what it would do to my MCAT score but I ended out happy with my score (+1 from my highest practice AAMC).

My strategy: wake up at 6am for the entire week prior to the MCAT. No caffeine the day before. Exercise as much as possible day before. Eat as much as possible day before, especially fatty foods. Night time: Took melatonin 5mg fast release, Unisom (active ingredient: doxylamine succinate 25mg) 9 hours prior to desired wake up time. Positive thoughts (e.g., I can always retake it if it doesn't go well, MCAT score is not the only factor on the application, adrenaline on day of test will counteract the sleep deprivation).

This strategy managed to bring me from what would have been probably anywhere from 0-3 hours of sleep to 6 hours. The Unisom makes me very groggy the next morning. How I counteracted that: Starbucks Doubleshot energy drink and the test day adrenaline. I would strongly recommend to experiment with Unisom prior to using it the day before a test - the drowsiness can affect your ability to think clearly. How to do that: take practice passages the morning after using it on a random day at home. (also wise to use caffeine that morning if you are planning on using it on test day).

Originally Posted by JackShephard MD

I personally wouldn't use drugs. Instead I would do a huge increase in exercise the day before, which will help you sleep at night.

I would try doing 3-4 x your normal amount of exercise. If you can exercise for an hour, then I would try doing 3 hours of pretty good intensity exercise over the entire day. Make sure you get up early and don't take any naps. Another thing you could do is sleep 2 less hours the that morning which should make falling asleep that night easier. Last thing, a huge healthy meal could also aid you in falling asleep (with lots of healthy fats).

If you have the ability to work out 3-4 times harder than normal than you're not exercising right...

Any OTC anti-histamine should do the trick. Benadryl or Unisom work. I had mad test anxiety all throughout my SMP year, but I always slept like a baby about an hour after popping a unisom. Woke up 8 hrs later like clockwork without any headaches or tiredness. This is also what ER docs I've shadowed take to adjust to their sleep schedule. If you want to make sure you're out, take a shot of NyQuil with it. I would experiment the week before though because I've read that some people oversleep on antihistamines.

Gonna go against the grain here: I take non-benzodiazepine sleep aids on an as-needed basis, and they work wonders for me. I feel INFINITELY better than when I take H1 blockers, which leave me groggy and in a mental fog until about 3pm. I know they have some weird side effects in some people, so a trial run the night before might not be the best of ideas, but for sure look into them, they might be worth a shot.

Originally Posted by amakhosidlo

Gonna go against the grain here: I take non-benzodiazepine sleep aids on an as-needed basis, and they work wonders for me. I feel INFINITELY better than when I take H1 blockers, which leave me groggy and in a mental fog until about 3pm. I know they have some weird side effects in some people, so a trial run the night before might not be the best of ideas, but for sure look into them, they might be worth a shot.

Completely agree. I pop a zolpidem before tests and sleep like a baby. No sleep inertia, like with benadryl. A trial run is always a good idea.

Meditation will get you through med school! The stress can be unbearable at times and meditation can really keep you grounded. It may sound silly but it honestly works. I like to turn on the "zen" or "nature sounds" Pandora station and quietly sit for about 20 minutes before an exam. Pick one thing to focus on and clear your mind of everything else. This relaxing meditation music also helps me sleep. It's unbelievable how much of an affect this has on anxiety. Try it!

Summary of best points sofar:

1. Consistent sleep schedule leading up to exam
2. Good sleep hygiene (no caffeine, dark and cool room, quietness etc)
3. Meditation - mindfulness, pandora station ZEN, whatevs
4. Weight training in the morning/day on the day before exam (increased adenosine released from muscle has an inhibitory effect on the brain)
5, Melatonin
6. If all else fails just accept it and stay awake and spend your time doing positive visualization, to manipulate the fear in others you must first master your own (totally ripped that from batman begins)

Curious question, as you probably know from studying the behavioral and psychiatry sections of first aid trouble falling asleep stems from too much norepinephrine (maybe also some serotonin if there is frequent awakenings and early morning awakening). Would propanolol help? I mean it helps in controlling fear during a public speaking presentation, what about falling asleep when you are nervous?

Here's just my experience:

Melatonin: 10-15mg slow-release 30 minutes before bed time lets me sleep through the night, feel great the next morning and is dirt cheap, not to mention easily available without an Rx. I add some 5HTP if the 10mg is not enough. Make sure you're in the darkest your bedroom can be and your head is actually on the pillow as soon as possible after taking this.

Doxylamine: 25mg every so often when I have a lot on my mind and can't sleep. I usually feel kind of punch-drunk the next morning if I take it with less than 6 hours of sleep. I can't take it before an exam or I won't make it through the whole thing. It's also cheap and available without an Rx.

Binaural Beats: There are many you can buy or download, but the key is to train your ears and brain to actually respond to them and this takes time and being totally focused on the sound doing its work. Some free stuff is available at the following link to sample, just make sure it's loud enough to hear well but no louder. This really, really works once you've got yourself trained.
http://healingbeats.com/play.html

Ambien: Post a few video cameras around the house because you won't believe you did what your roommates said you did. Two hours after I take this and on a regular basis, I will be up teaching histology to my pet, deep-frying a hearty Caesar Salad for myself then almost drive to a large body of water to eat it next to in my boxers. It's for this reason and possible retro and anterograde amnesia (the last thing a med student needs) that it is called a hypnotic drug and needs an Rx. It is about $20 at the pharmacy if you're absolutely desperate. I'm usually still drunk the next morning, and fairly unproductive for the day.

Lunesta: A great bet if you have really good insurance as it's still pretty expensive and keeps me asleep for most of the night and I feel great the next day. I do have to be careful that I have more than 6 hours to sleep and it's good for those occasional sleepless nights, even before an exam if I time it right.

Again, I'm just giving my experience; you'll have to hit Lexi-Comp and UpToDate if you want actual prescribing information. Definitely stay away from the heart medications without a doctor involved to titrate and monitor your progress.
Good night!

Originally Posted by AreUKidding

Here's just my experience:

Melatonin: 10-15mg slow-release 30 minutes before bed time lets me sleep through the night, feel great the next morning and is dirt cheap, not to mention easily available without an Rx. I add some 5HTP if the 10mg is not enough. Make sure you're in the darkest your bedroom can be and your head is actually on the pillow as soon as possible after taking this.

Doxylamine: 25mg every so often when I have a lot on my mind and can't sleep. I usually feel kind of punch-drunk the next morning if I take it with less than 6 hours of sleep. I can't take it before an exam or I won't make it through the whole thing. It's also cheap and available without an Rx.

Binaural Beats: There are many you can buy or download, but the key is to train your ears and brain to actually respond to them and this takes time and being totally focused on the sound doing its work. Some free stuff is available at the following link to sample, just make sure it's loud enough to hear well but no louder. This really, really works once you've got yourself trained.
http://healingbeats.com/play.html

Ambien: Post a few video cameras around the house because you won't believe you did what your roommates said you did. Two hours after I take this and on a regular basis, I will be up teaching histology to my pet, deep-frying a hearty Caesar Salad for myself then almost drive to a large body of water to eat it next to in my boxers. It's for this reason and possible retro and anterograde amnesia (the last thing a med student needs) that it is called a hypnotic drug and needs an Rx. It is about $20 at the pharmacy if you're absolutely desperate. I'm usually still drunk the next morning, and fairly unproductive for the day.

Lunesta: A great bet if you have really good insurance as it's still pretty expensive and keeps me asleep for most of the night and I feel great the next day. I do have to be careful that I have more than 6 hours to sleep and it's good for those occasional sleepless nights, even before an exam if I time it right.

Again, I'm just giving my experience; you'll have to hit Lexi-Comp and UpToDate if you want actual prescribing information. Definitely stay away from the heart medications without a doctor involved to titrate and monitor your progress.
Good night!

great post!

I've tried all of your suggestions (except for the music). I tend to get very nervous on the night before an exam, so my issue is falling asleep, not staying asleep. I am therefore a huge fan of ambien. You are spot on with what could happen when on ambien (I've had pretty lengthy conversations with my cat), so I typically take 10 mg and will jump into bed within 5 minutes tops (i.e. I won't sit around waiting to get drowsy). I've noticed that my tolerance for ambien develops quickly, so I will only take it on the night before an exam, i.e. in M2 that was roughly once a month, which worked out perfectly. For some reason, it will never work for me unless I take it on an empty stomach. People I know have tried using ambien on the night before an exam, and it puts them in a "foggy" mood the next day, so they don't take it. I don't feel that way at all though.

I've tried melatonin and a plethora of herbal stuff, but nothing worked. If I'm trying to fall asleep AND stay asleep, I like to take 5 mg ambien with 0.5 mg lorazepam. Obviously, both are obtained only via rx, and my doc is 100% always in the loop.