I can't Sleep Post-Call

[DonStracci]

Does everyone sleep during the day following an up-all-night call night?

I have never been able to sleep post call, or really during the day at all. On the rare occasion that I fall asleep during the day, I feel so disoriented and lousy after waking up... I'd rather stay up. Right now I've been up for ~36 hours, and though I'm physically tired because of last night's hellish call, there's no way I could fall asleep- the sun's out!

I never worried much about this- I go to bed early that night, and I'm fine. However, this morning I horrified a colleague when I told them this. "You'll get sleep deprived, you'll get sick, it will catch up with you!"

I'm usually quite energetic as it is, and I've never felt sleep-deprived. Am I hurting myself by not sleeping post-call?

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[Trisomy13]

Sleep is your friend.

My routine - out the door post call at 7:05 a.m. Home by 7:15. Close the blinds, take a Tylenol PM, quick shower and sleep til 2 pm. Enough to feel rested, not so much I can't sleep that night.

If you're up for 36 hours and trying to stay awake, at least stay home and don't endanger people by trying to drive anywhere

 

[Doctor Bagel]

It seems like most of the surgery residents at my school had an Ambien prescription for this problem. I'm wondering how common that is in the resident community. But I wonder if just staying up and going to bed at an early time might be a more natural approach anyway. If you feel fine and aren't tired, why worry about it? By being awake, you get a free day off that you're not wasting sleeping.

 

[Winged Scapula]

I had the same problem as the OP. Well, I could fall asleep post-call most of the time, but I always felt groggy, lethargic and worse off than if I stayed awake.

I'm not sure you HAVE to sleep if you don't feel tired. Frankly, you can try Ambien or Tylenol PM but I always felt worse than if I just did some errands, had an early dinner and went to bed early the next day. Do some errands, whatever you want...why sleep if you don't feel like it?

On the rare occasions when I absolutely couldn't stay awake, I tried not to sleep any longer than 90-120 minutes. Just enough to see straight but not enough to make me feel like crap.

 

[medresident]

Exercise and then take warm shower. Let me know how this works.

 

[TysonCook]

....or don't sleep. I didn't post call, and I managed to remodel my house, take up road cycing.

Its really a personal thing, but I don't need a lot of sleep anyway.

Ambien can be your friend, but then you cant sleep that night.

Do a search as this was discussed a few years back.

Did someone steal my avitar? Dang. Thats okay as I guess I stole it 7 years ago or so

 

[hippiedoc13]

You'll find a routine that works for you. I agree that sleeping alllll day tends to make you feel crappy and then have trouble sleeping that night. I worked out a pretty good routine for myself: come home around 1pm, immediately take a shower, change into PJs, eat a light lunch (I am always starving post-call), in bed by 2pm with curtains drawn, sleep till about 4:30. Then get up and out of the house--usually I will make dinner plans with a friend for my post-call day (I need something fun to look forward to). Then back home and into bed at my usual time to get up at the crack of dawn again...

 

[dragonfly99]

I had the same problem when I was post-call as a medicine resident. I did the same thing you did w/often staying up post call.
In retrospect I think I hurt myself at times by building up a sleep deficit, which did affect my functioning on later days. Part of this might depend on your schedule. If you are going to be Q3 and Q4 for months at a time and do 30 hour calls, I think that you might end up very tired. This is because it's just human nature that you say you'll go to be early, but are you really going to go to bed at 7 or 8p.m. and really make up that sleep deficit? If you are like me you might just stay up until 10 or 11 anyhow, and then still be tired the next day.

In hindsight I wish I had tried harder to take some power naps on call. I always felt like I'd feel worse if I just had to get up again, but I think even a 15 minute power nap might have made me feel better in the a.m. during postcall rounding.

 

[psymed]

Get some black out curtains for your room. They are not that expensive. It is hard to sleep once you get that boost of sunlight going home. Before starting residency I was working 8 hour night shifts and had this problem. Tylenol PM worked for me.

 

[TaoistDoc]

I think as doctors, you gain a super power to be able to function semi-normally while sleep deprived. So while a normal person would almost certainly drop dead after 48 straight hours of not sleeping, you'll be fine...because you're a doctor .

 

[pillowhead]

It's also hard for me to sleep post-call (and I'm a PGY3 so theoretically should be cumulatively quite sleep deprived by now!). Some people just aren't good sleepers, no matter how tired they are. If it has been a reasonably good night in the hospital and you managed to get some sleep on call, staying up post-call probably isn't a big deal. I do it maybe once a month. But if you NEVER sleep post-call when you're q3 or q4 even if it's been a bad call night, the sleep deficit will eventually catch up with you and make you feel like crap.

Unless it was a really good call night, I always try to lie down and fall asleep. But if I don't drift off in 15-20 minutes, I just get up. I don't like taking sleeping pills in the middle of the day to get sleep. Even if it's been a bad night, I usually don't sleep more than 2-3 hours.

 

[galactica2001]

I was usually so tired running around all night I just kinda fell into bed and slept like a log. When not then I took some valeriana pills/tea (natural sleep remedy) - it helped. But even after sleeping 8 h after a busy night, I was feeling tired and sleepy in the evening.
I don't think it's good to stay up so long as 36 or 48 h. I noticed I was grumpy, intolerant and made stupid mistakes...

 

[Midwest Medic]

I never had a problem sleeping after call during residency/internship, but I would sleep too much after call then be up all night. When ended out working for me was to go home and sleep almost immediately (black out shades, fan on, earplugs in, and a pillow over my head...) and sleep for 2-3 hours. I would then force myself to get up, and try to do some things to keep myself busy and moving. That night I would then go to sleep at an ealry time if I could, like 8-9 at night. This also was based on me getting out of the hospital at 7-9AM. If it was at noon or beyond, I would go home and pass out, then usually sleep until about 3-4 AM and wake up, work out, and just drag butt all day long...

 

[deleted89854]

My rule is to try for 3-4 hours of sleep, unless I was somehow able to magically get 4-6 hours of sleep on call (It really happened once or twice!). The one thing to remember is that you have to get out of the house. Go running or to the gym. Otherwise you just lounge around your apartment watching TV and being a useless zombie in general.

 

[InvitroDerm]

It is interesting that everyone here agrees that if you don't sleep post call, the defecit will add up. I find it really, really sad how it "used to be," where residents were required to work all day post call. There was no room whatsoever to make up the defecit, as the book "The Intern Blues" about 1984 peds residents demonstrates.

 

[Winged Scapula]

It is interesting that everyone here agrees that if you don't sleep post call, the defecit will add up. I find it really, really sad how it "used to be," where residents were required to work all day post call. There was no room whatsoever to make up the defecit, as the book "The Intern Blues" about 1984 peds residents demonstrates.

NOT everyone.

I do not believe that its like a checking account - that if you are 14 hrs overdrawn that you need 14 hrs of sleep to replenish.

 

[pillowhead]

NOT everyone.

I do not believe that its like a checking account - that if you are 14 hrs overdrawn that you need 14 hrs of sleep to replenish.

I don't think anyone is claiming sleep is like a checking account...i.e. having 6 calls in one month means having 42-48 hours of sleep you must account for at the end of the month.

But if you never ever sleep post call, you might be okay after the 1st and 2nd call that month, but after the 6th, you're going to feel like complete crap unless you get in some extra nap time and make up for all those lost nights.

 

[Winged Scapula]

I don't think anyone is claiming sleep is like a checking account...i.e. having 6 calls in one month means having 42-48 hours of sleep you must account for at the end of the month.

None of US who have actually done it think that way, but the pre-med posting above, seemingly did/does.

But if you never ever sleep post call, you might be okay after the 1st and 2nd call that month, but after the 6th, you're going to feel like complete crap unless you get in some extra nap time and make up for all those lost nights.

Sure, although frankly I felt worse post-call as a senior resident with fewer calls than I did on q3 call (q2 is a whole 'nother matter, especially when not going home post call).

But maybe its just me or as the years pass by, my memory of being tired is waning.

 

[tkim]

I'm currently Q3 now in trauma. Just finished my third call and waking up post-call, I still feel like garbage. Oh well, five hours up and now back to bed to wake up for pre-call. So much fun.