How do you do it??

[jimmmmyi]

I am one of those people who absolutely LOVE and need my sleep. I can pull a few all nighters once in a while, but the day after I will crash and can sleep for 10+ hours.

So my question is, how do you handle the long hours and call, especially when your sick? Do all of you generally need very little sleep to begin with? I'm worried that I may not be able to survive residency hours. If there is anyone out there that was used to sleeping 7-8 hours a night, how did you survive the change?

Thanks!

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[Winged Scapula]

I'm one of those that doesn't need much sleep - usually 5-6 hours is fine. I like lying around, so don't necessarily get up at 0500 but it would be rare for me to actually SLEEP for 8 or more hours. Can't nap either. When I'm sick, its easier for me to sleep longer and I'll admit I was still tired during residency...you can't really recover very easily from long calls frequently, IMHO. But everyone does it...some easier than others; you'll make it through.

 

[Pir8DeacDoc]

I'll take the other side.

I definitely like my sleep. In medical school I never pulled an all nighter during the pre-clinical years. I always made sure to get 8 hours of sleep before planning a big study day (i.e. Saturdays or Sundays). Once I reached a saturation point with studying, I'd take a 45 minute or so nap to reset things.

During third and fourth year clerkships I slowly weaned down to getting less and less sleep. But, I would always try and catch up when possible (i.e. get 9-10 hours on a weekend if it were free).

During internship I probably averaged 5-6 hours a night on non-call nights. Prior to call I tried to get myself into bed earlier so I could make it. I managed fine. Sometimes it catches up with you and you just get in from work and haev dinner and basically go right to bed.

All in all, it's doable. You just have to sleep when you can and keep on truckin. You will manage like many before you have.

 

[Blade28]

I'm also a night owl. I've been fighting insomnia since high school, and have been pulling all-nighters since then as well. In college I frequently stayed up late to study, cram, etc. Same with med school.

In residency, my insomnious problems were cured as brutal, exhausting months of work took their toll. Like Kimberli Cox, I'm also lucky in that I don't require too much sleep - 4-5 hours a day and I'm good to go. It's hard for me to sleep any more than that. You just have to have great time management to fit in enough sleep, exercise, studying, and taking care of life.

 

[Doowai]

What worries me is I have not needed more than 4 or 5 hours a night for many many years, and within the last few months find I can sleep 7 or 8 hours with no problem. It worries me that all of a sudden I need and want more sleep.

 

[Winged Scapula]

In residency, my insomnious problems were cured as brutal, exhausting months of work took their toll.

Residency does have a way of correcting insomnia doesn't it? I never thought I could fall asleep sitting up while having a conversation...until internship.

 

[RTrain]

Residency does have a way of correcting insomnia doesn't it? I never thought I could fall asleep sitting up while having a conversation...until internship.

I think my low point was when I fell asleep during, uh, intimacy.

 

[Blade28]

What worries me is I have not needed more than 4 or 5 hours a night for many many years, and within the last few months find I can sleep 7 or 8 hours with no problem. It worries me that all of a sudden I need and want more sleep.

It's getting harder and harder for me to go with little sleep as well.

High school and college? I could pull an all-nighter no problem, no caffeine needed.

Med school? Tougher.

Now? Brutal.

Residency does have a way of correcting insomnia doesn't it? I never thought I could fall asleep sitting up while having a conversation...until internship.

I've fallen asleep:

*While driving
*At a stop sign/traffic light
*While my car was stationary in a parking lot
*Standing up in the shower
*Sitting down in the bathroom
*Leaning against a wall in the hospital hallway

Etc.

 

[orientedtoself]

So my question is, how do you handle the long hours and call, especially when your sick? !

you suck it up

 

[oompaloompa]

I think everyone has different tolerance levels of the sleep deficit, but almost all residents I know make it work somehow or another. After all, by definition we're bound to have more stamina than the average Joe if we've made it this far into the field of medicine. Those that are adament about their schedule tend to self-select themselves into a more humane routine(psych, path, rads) so it works itself out.

As for me, I developed a wierd sort of sleep cycle on certain difficult rotations. Since I get up at some absurd hour, say 4am, and tend to work at least a 12 hour day, I never get more than 5 or so hours of sleep. After a while on this schedule, I develop a sort of chronic fatigue where the affect is cumulative. Eventually, this will manifest in a breakdown event where I end up sleeping 16 hours post call or something. Then the cycle resets itself. I know its wierd, but does anyone else have this problem where they go to sleep postcall and can't seem to wake up until the next morning? (When, ironically, it's time for work again.)

 

[Winged Scapula]

I think my low point was when I fell asleep during, uh, intimacy.

Ouch...you win! Ha ha ha, I hope your partner was sympathetic.

 

[Winged Scapula]

It's getting harder and harder for me to go with little sleep as well.

High school and college? I could pull an all-nighter no problem, no caffeine needed.

Med school? Tougher.

Now? Brutal.

Wait until you're old like me...I'm lucky if I make it past 10:30!

I've fallen asleep:

*While driving

Yep done that.

*At a stop sign/traffic light

Its scary to wake up to honking horns isn't it?

*While my car was stationary in a parking lot

I remember doing that.

*Standing up in the shower

can't say I've done that.

*Sitting down in the bathroom

or that

*Leaning against a wall in the hospital hallway

or that

I've driven off the road while post-call and not remember it until I hit berm. Its really frightening.

 

[Bobblehead]

I think if it's between falling asleep driving and sleeping in your car in the parking lot you're better off sleeping in the parking lot, finding an unused call room, sleeping in your office, etc. Your fellow road users will thank you for it with their lives.

 

[smq123]

I've fallen asleep:

*While driving
*At a stop sign/traffic light
*While my car was stationary in a parking lot
*Standing up in the shower
*Sitting down in the bathroom
*Leaning against a wall in the hospital hallway

I've done some of those.

Fell asleep in the shower, and wondered why I didn't smell "clean" an hour later.

Sat down in the bathroom, rested my head on my knees "for just a second," and woke up 45 minutes later.

I also fell asleep while writing a progress note one morning at 5 AM. I sat down to write, put pen to paper, and woke up 5 minutes later with a huge ink smudge on my arm.

 

[Blade28]

I've done some of those.

Fell asleep in the shower, and wondered why I didn't smell "clean" an hour later.

Sat down in the bathroom, rested my head on my knees "for just a second," and woke up 45 minutes later.

I also fell asleep while writing a progress note one morning at 5 AM. I sat down to write, put pen to paper, and woke up 5 minutes later with a huge ink smudge on my arm.

Then you're all set for internship!

 

[Pir8DeacDoc]

I think my low point was when I fell asleep during, uh, intimacy.

ashamed to admit I've had that happen too.



My hospital offers a free cab ride if you're too tired to make it home safely post call. I never had to use it during intern year b/c I lived 2 miles from the hospital, but I can imagine there were those that did.

 

[Winged Scapula]

I also fell asleep while writing a progress note one morning at 5 AM. I sat down to write, put pen to paper, and woke up 5 minutes later with a huge ink smudge on my arm.

What even better is if you do the above and when you wake there's a large line trailing down the page with lots of drool on it. That would be another claim to fame.

 

[Blade28]

What even better is if you do the above and when you wake there's a large line trailing down the page with lots of drool on it. That would be another claim to fame.

I've been doing that since college!

 

[GoodMonkey]

Residency does have a way of correcting insomnia doesn't it? I never thought I could fall asleep sitting up while having a conversation...until internship.

seriously, a couple of months ago i was out with friends to see a band - we were in a crowded, loud bar with loud, live music and it was about 11pm and i totally fell asleep.

 

[GoodMonkey]

I can pull a few all nighters once in a while, but the day after I will crash and can sleep for 10+ hours.

this is what i do. post-call i sleep for >10hrs. i get home and sleep for about 4. get up, eat food, then sleep for like another 10. then the next night i go to bed at like 8pm. lots of my free time is spent sleeping. which is why my house is not picked up/cleaned regularly and i have piles of laundry to do all the time.

 

[Winged Scapula]

this is what i do. post-call i sleep for >10hrs. i get home and sleep for about 4. get up, eat food, then sleep for like another 10. then the next night i go to bed at like 8pm. lots of my free time is spent sleeping. which is why my house is not picked up/cleaned regularly and i have piles of laundry to do all the time.

I always found it a mistake to sleep immediately post call (unless of course we are talking about the old days of 36-44 hr calls).

I would go home, shower and then try and avoid sleeping. If I couldn't 90 minutes was my limit, otherwise I would feel logy the rest of the day.

 

[Winged Scapula]

I've been doing that since college!

Drooling?

 

[Blade28]

Drooling?

Falling asleep in lecture and occasionally drooling, yes.

I also try to do productive things immediately post-call if I can take it - run errands, buy groceries, work out, etc. Then I go to bed early.

Of course the rules go out the window when the call runs 34-36 hours (which unfortunately occasionally happens).

 

[Smurfette]

I think if it's between falling asleep driving and sleeping in your car in the parking lot you're better off sleeping in the parking lot, finding an unused call room, sleeping in your office, etc. Your fellow road users will thank you for it with their lives.

The problem with this is that sometimes you feel pretty awake and able to get home. Then you get into your car, and relax knowing you're finally leaving post-call. And the fatigue sneaks up on you, so you're sitting in traffic realizing you're dozing off, and at that point you can't do anything about it...

Like Blade, I've nodded off while driving, at stoplights, on the phone, in the bathroom, in a restaurant, etc. I've once had (what I was told) a completely coherent conversation on the phone with someone and had NO recollection of it whatsoever the next day. The other person had no idea I was even sleepy.

I actually am someone who goes home post-call, eats (assuming I didn't eat @ the hospital), then immediately goes to bed and sleeps about 4 hours. If I had a particularly rough or long call (maybe 1-2x/month), or am getting sick, I will just sleep through until morning unless I have to get up for something before then. I'm not a person who requires a ton of sleep (usu. 4-5 hours nightly or less, was always a person who functioned on little sleep), but residency can suck the life force out of you sometimes and you need to re-charge. I used to wake up to every little noise and be a light sleeper, could never sleep during the day, etc....residency cured that.

 

[Blade28]

The problem with this is that sometimes you feel pretty awake and able to get home. Then you get into your car, and relax knowing you're finally leaving post-call. And the fatigue sneaks up on you, so you're sitting in traffic realizing you're dozing off, and at that point you can't do anything about it...

This is very true.

I've also had multiple conversations on the phone with no memory of it the next day. Scary! I think I also once answered the door for the mailman, received - and signed for - a box, but didn't recall it the next day.

My silliest story involves driving post-call to a local, nearby dry cleaner's to pick up my laundered dress shirts. As I sat in the parking lot, I started to feel the tendrils of sleep creep up around me. Now I should point out that my dry cleaner's is located literally one block away from my apartment complex - just around the corner. And I knew that if I just quickly got out of my car, picked up my dry cleaning and drove home, I'd be in bed in less than 5 minutes.

But I just couldn't do it. Sat there, drifted off, and woke up 1 1/2 hours later.

 

[GoodMonkey]

I always found it a mistake to sleep immediately post call (unless of course we are talking about the old days of 36-44 hr calls).

I would go home, shower and then try and avoid sleeping. If I couldn't 90 minutes was my limit, otherwise I would feel logy the rest of the day.

i have to - i get home, shower, eat, check email, open mail, etc... then i sleep for a couple hours, get up and putter around, then go to bed early.

 

[Winged Scapula]

This is very true.

I've also had multiple conversations on the phone with no memory of it the next day.

Same here. I've found verbal orders from me in patient charts and wondered if I really did give them and just forgot or if they nurse's were just making them up.

Fortunately, none of them ever seemed crazy so I must have been somewhat coherent but its pretty scary not to remember the next day.

 

[RTrain]

Ouch...you win! Ha ha ha, I hope your partner was sympathetic.

He was pretty self-absorbed, I'm not sure he even noticed!

 

[RTrain]

...I also fell asleep while writing a progress note one morning at 5 AM. I sat down to write, put pen to paper, and woke up 5 minutes later with a huge ink smudge on my arm.

I went through a period of trying to ignore everyone else in the hospital, so I wore my iPod during times when I wasn't actually rounding or seeing a patient. I had a little microsleep while writing a note and awoke to find I had written a sentence in the chart containing lyrics from The Flaming Lips.

It occurs to me, we probably aren't making the OP feel any better with these stories!

 

[Faebinder]

Had one friend of mine. Post his 24 hour call at Trauma... came home at 9 am. Slept till 2 pm.... he thought that he didnt sleep enough so he tried to sleep another 2 hours till 4 pm.... woke up again... looked around frustrated wanting to sleep some more... then he noticed it was the 4 pm of the next day after.

 

[jimmmmyi]

It occurs to me, we probably aren't making the OP feel any better with these stories!

Haha so true! BUT at least now I feel comforted that not all residents are super humans that barely needed sleep to being with.

 

[KidDr]

Had one friend of mine. Post his 24 hour call at Trauma... came home at 9 am. Slept till 2 pm.... he thought that he didnt sleep enough so he tried to sleep another 2 hours till 4 pm.... woke up again... looked around frustrated wanting to sleep some more... then he noticed it was the 4 pm of the next day after.

that's impressive
my personal record is 18 hours straight through without waking up (post-call during residency)

 

[tr]

I'll take the other side.

I definitely like my sleep. In medical school I never pulled an all nighter during the pre-clinical years. I always made sure to get 8 hours of sleep before planning a big study day (i.e. Saturdays or Sundays). Once I reached a saturation point with studying, I'd take a 45 minute or so nap to reset things.

During third and fourth year clerkships I slowly weaned down to getting less and less sleep. But, I would always try and catch up when possible (i.e. get 9-10 hours on a weekend if it were free).

During internship I probably averaged 5-6 hours a night on non-call nights. Prior to call I tried to get myself into bed earlier so I could make it. I managed fine. Sometimes it catches up with you and you just get in from work and haev dinner and basically go right to bed.

All in all, it's doable. You just have to sleep when you can and keep on truckin. You will manage like many before you have.

Yeah, ditto. I'm a person of regular habits and I like to get 7-8 hours also. But you just get used to whatever you have to do. It's really not that bad.

On a typical call night I'll end up doing admissions till I cap at 2-3 AM, which isn't that bad - I've certainly stayed up till 2-3 AM partying. Then I'll crash for a few hours (usually there will be some paging in there but it's generally a quiet time; luckily we have a night float for cross-cover so I only get paged on my own patients). Waking up at 6 AM after that sucks but you get over it quickly; then you have so much stuff to take care of post-call that you forget how tired you are. Then you go home and crash. See? Easy.