rotations and waking up

[epsilonprodigy]

Hi, my name is Epsilonprodigy, and I am an MS-2 with a sleep addiction.

Okay, that's a misnomer. I'm actually a naturally early riser, but I've found that, especially as I get older, I will assuredly sleep right through any alarm/ruckus/natural disaster if I am sufficiently sleep deprived. This is particularly true if I have to be up before 6 am. Obviously, I'm going to have to find a way to correct this before my surgery and OB rotations, when we'll have to arrive at 4:30 or 4:45 am (and I live 40 minutes away) and on some days, won't leave until after 7 pm.

Now, I know that being late pretty much spells the end for us short-coated folks. I'm not complaining about the need to get up early: once I'm up, I'm up and will get moving accordingly. The problem is being in control enough to actually get myself in a vertical position and stay that way. Putting my alarm across the room and setting multiple alarms has NOT worked. It seems (although I never remember doing it) that I somehow manage to get myself across the room to turn it off, and hop right back into bedBefore you ask if I've ever held a job, or how I get to class, etc.... the answer is that I generally don't exist in a sleep-deprived state for long. This is merely a problem I've noticed when I'm ridiculously sleep-deprived.

Has anyone had success with those wake-up lights, wristbands or any other new-agey products?

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[mercaptovizadeh]

Hi, my name is Epsilonprodigy, and I am an MS-2 with a sleep addiction.

Okay, that's a misnomer. I'm actually a naturally early riser, but I've found that, especially as I get older, I will assuredly sleep right through any alarm/ruckus/natural disaster if I am sufficiently sleep deprived. This is particularly true if I have to be up before 6 am. Obviously, I'm going to have to find a way to correct this before my surgery and OB rotations, when we'll have to arrive at 4:30 or 4:45 am (and I live 40 minutes away) and on some days, won't leave until after 7 pm.

Now, I know that being late pretty much spells the end for us short-coated folks. I'm not complaining about the need to get up early: once I'm up, I'm up and will get moving accordingly. The problem is being in control enough to actually get myself in a vertical position and stay that way. Putting my alarm across the room and setting multiple alarms has NOT worked. It seems (although I never remember doing it) that I somehow manage to get myself across the room to turn it off, and hop right back into bedBefore you ask if I've ever held a job, or how I get to class, etc.... the answer is that I generally don't exist in a sleep-deprived state for long. This is merely a problem I've noticed when I'm ridiculously sleep-deprived.

Has anyone had success with those wake-up lights, wristbands or any other new-agey products?

Are there any electroshock devices that might work?

I'd suggest multiple alarms (very nasty ones too), but you say they don't work. Fortunately I live with family so they can wake me up when the alarms awaken them (if I'm not awaked by them myself).

 

[Kaustikos]

Things changed for me in third year, honestly. I was like you and didn't want to wake up early to go to class. But that's because it wasn't beneficial and motivational. My family med rotation - I wanted to get up early and get to the clinic/hospital. I'd spend hours upon hours doing that and then studying at night - getting 4 hours of sleep and doing the same thing. But I enjoyed it so much the feeling of early wakeups washed away.
Surgery was the same. The thing I liked about surgery/hospital work was that the morning involved doing manual tasks/whatever that woke me up. Trying to get round reports as soon as possible gave me some kind of an adrenaline rush that kept me going throughout. To me; if I have some sort of goal/objective to accomplish in the morning, then I'm fine. If, on the other hand, the wake up call is for something trivial like class...I'm gonna take my time and get there when I can.

So, I'd honestly wait until third year to really worry about it. Because to me; it's about finding a reason to wake up early and most of my rotations offered just that. Inpatient peds was different... but that's another story.

 

[Kevin Baker]

Multiple alarms in different rooms staggered for different times has worked for me. I miss out on a good 15 mins of sleep because of it but once I'm up for that long, I'm up. The multiple rooms thing is important as sleepy self will occasionally turn off the same room alarms set for later but when they're spread around, it takes me enough effort to find them that I am fully awake by then. If I know I'm going to be super sleep deprived I'll brew a cup of coffee before going to bed, set it next to bed, take it as soon as alarm #1 goes off, and stagger the alarms over 30 mins so by the time the last one goes off, the caffeine has hit.

 

[PB n J]

Multiple alarms in different rooms staggered for different times has worked for me. I miss out on a good 15 mins of sleep because of it but once I'm up for that long, I'm up. The multiple rooms thing is important as sleepy self will occasionally turn off the same room alarms set for later but when they're spread around, it takes me enough effort to find them that I am fully awake by then. If I know I'm going to be super sleep deprived I'll brew a cup of coffee before going to bed, set it next to bed, take it as soon as alarm #1 goes off, and stagger the alarms over 30 mins so by the time the last one goes off, the caffeine has hit.

Geez, man. You might want to get this checked out.

 

[JoshSt]

I have to set an alarm across the room and literally set >20 alarms on my phone (in about a 45 min timespan). Coffee is a must, if too tired to make coffee, have an arsenal of your favorite energy drinks in the fridge. Turning the lights on really helps too.

 

[Winged Scapula]

I (sort of) wish I could sleep as deeply as you guys.

 

[group_theory]

Alarm Money Shredder. If you don't wake up in time, it starts to shred money

http://mashable.com/2011/05/29/money-shredding-alarm/

 

[InGen]

Multiple alarms in different rooms staggered for different times has worked for me. I miss out on a good 15 mins of sleep because of it but once I'm up for that long, I'm up. The multiple rooms thing is important as sleepy self will occasionally turn off the same room alarms set for later but when they're spread around, it takes me enough effort to find them that I am fully awake by then. If I know I'm going to be super sleep deprived I'll brew a cup of coffee before going to bed, set it next to bed, take it as soon as alarm #1 goes off, and stagger the alarms over 30 mins so by the time the last one goes off, the caffeine has hit.

I'm guessing you don't have roommates...

 

[DocWinter]

I'm not calling you a liar, OP, but I just don't understand how you couldn't be awake after hearing the alarm, getting up, shutting it off, and making your way back to bed.

I'm known to incorportate the alarm into my dreams for a minute or two, but the old fashioned bell alarms crashing about loudly next to my bed usually brings me to a heart-pounding awakening. Make it LOUD and it works for me.

 

[evilbooyaa]

Don't really have a good answer for you. Multiple alarms in multiple rooms is all Ican suggest. If I get less than 4-5 hours of sleep, I am apt to sleeping through alarms, but otherwise I'm generally able to be woken up by my phone laying in bed next to me.

 

[MedWonk]

Sleep in a room that gets plenty of sunlight and don't close your shade/blinds entirely to allow at least some light in.

 

[alpinism]

Hi, my name is Epsilonprodigy, and I am an MS-2 with a sleep addiction.

Okay, that's a misnomer. I'm actually a naturally early riser, but I've found that, especially as I get older, I will assuredly sleep right through any alarm/ruckus/natural disaster if I am sufficiently sleep deprived. This is particularly true if I have to be up before 6 am. Obviously, I'm going to have to find a way to correct this before my surgery and OB rotations, when we'll have to arrive at 4:30 or 4:45 am (and I live 40 minutes away) and on some days, won't leave until after 7 pm.

If you only have this problem when you're sleep deprived why not just go to bed earlier (9 or 10pm) if you have to be up at 4am?

Then just get one of those annoying alarms that won't shut off and put it on the other side of the room.

 

[alpinism]

Multiple alarms in different rooms staggered for different times has worked for me. I miss out on a good 15 mins of sleep because of it but once I'm up for that long, I'm up. The multiple rooms thing is important as sleepy self will occasionally turn off the same room alarms set for later but when they're spread around, it takes me enough effort to find them that I am fully awake by then. If I know I'm going to be super sleep deprived I'll brew a cup of coffee before going to bed, set it next to bed, take it as soon as alarm #1 goes off, and stagger the alarms over 30 mins so by the time the last one goes off, the caffeine has hit.

I have to set an alarm across the room and literally set >20 alarms on my phone (in about a 45 min timespan). Coffee is a must, if too tired to make coffee, have an arsenal of your favorite energy drinks in the fridge. Turning the lights on really helps too.

Sounds like some sort of sleep disorder (delayed sleep phase, insomnia, etc…).

Alarm Money Shredder. If you don't wake up in time, it starts to shred money

http://mashable.com/2011/05/29/money-shredding-alarm/

Lol.

 

[KnuxNole]

Alarm Money Shredder. If you don't wake up in time, it starts to shred money

http://mashable.com/2011/05/29/money-shredding-alarm/

I'd be broke in no time

 

[Kaustikos]

I'd be broke in no time

Right?

 

[JoshSt]

Sounds like some sort of sleep disorder (delayed sleep phase, insomnia, etc…).

Sigh... agreed... Maybe it's a med student specific one. Who wants to do sleep medicine and have a disorder named after them?

 

[neusu]

Hi, my name is Epsilonprodigy, and I am an MS-2 with a sleep addiction.

Okay, that's a misnomer. I'm actually a naturally early riser, but I've found that, especially as I get older, I will assuredly sleep right through any alarm/ruckus/natural disaster if I am sufficiently sleep deprived. This is particularly true if I have to be up before 6 am. Obviously, I'm going to have to find a way to correct this before my surgery and OB rotations, when we'll have to arrive at 4:30 or 4:45 am (and I live 40 minutes away) and on some days, won't leave until after 7 pm.

Now, I know that being late pretty much spells the end for us short-coated folks. I'm not complaining about the need to get up early: once I'm up, I'm up and will get moving accordingly. The problem is being in control enough to actually get myself in a vertical position and stay that way. Putting my alarm across the room and setting multiple alarms has NOT worked. It seems (although I never remember doing it) that I somehow manage to get myself across the room to turn it off, and hop right back into bedBefore you ask if I've ever held a job, or how I get to class, etc.... the answer is that I generally don't exist in a sleep-deprived state for long. This is merely a problem I've noticed when I'm ridiculously sleep-deprived.

Has anyone had success with those wake-up lights, wristbands or any other new-agey products?

Wake up, go to the gym, make it a routine.

 

[Venko]

I did a couple of things...

1. The year I failed and had to repeat, I felt that going to class was not worth waking up for like Koustikas suggested. The years I honored, led the curve, etc, I went to class relatively rested. That was my experience and maybe controversial...

2. When (and it happens frequently in my career as an EM doc) I have to wake up when sleep deprived or wake up after a small amount of sleep, I pick an uncomfortable place to sleep. This may be the back killing futon, the floor, the bathroom floor, etc.

3. On surgery, when I was a student, I had a friend with whom I agreed to have wake up calls with. For you, maybe find someone who has a difficulty you can help with in your class for whom in return they can make sure you are awake in time. You may even give them a key to your place if needed. Obviously someone you trust.

4. Lastly, I did my very best to minimize the frequency of being so sleep deprived. This may mean sleeping without studying, without eating dinner, etc. find ways to shave time in your day by tracking what you do when for a week and evaluating afterwards how you could make it faster.

Good luck,
Venk

 

[Dharma]

I see some really bad advice up there. I won't single you out…

OP, best bet is to make whatever amount of sleep one is getting of the highest possible quality. 4 hours of high quality sleep (which most don't get, even on 8 hours in bed a night) will leave you feeling great. The quality is mostly the result of what goes on beforehand coupled with some hacking of one's surroundings.

There should be NO light in the room. NONE. Black that ish out! Cut disruptive sound too. If you live in a city with traffic noise or obnoxious neighbors, use a white-noise app. No caffeine past 2 during the day. No exercise late night, but try in the AM as someone suggested is clutch. And I don't wanna hear about not having time. 20 minutes of HIIT… anyone has time for that (but do you have the willpower? That's another question). Late night, when home after hospital, NO more blue spectrum light. Use f.lux app on the computer screen, invest 10-15 bucks in some blue-blocker sunglasses (these should both help with endogenous melatonin release, something light in the blue frequency tends to inhibit). Don't eat late. Learn how to calm your mind. (That's right, learn to meditate. It will help with the career too). Then hit the sack and make those 4 hours count.

As for the not waking up part… I think it's the lack of QUALITY sleep, not so much the overall time spent in bed. That said, hit up a sleep doc dude. May be something serious going on there.

If you want to track/hack your sleep, I highly suggest checking out the sleep cycle app. 99 cents. Coupled with some self-observation and consistent tracking you can decipher which methods best help you achieve the highest quality of sleep in the shortest amount of time. Good luck.

 

[Venko]

I see some really bad advice up there. I won't single you out…

OP, best bet is to make whatever amount of sleep one is getting of the highest possible quality. 4 hours of high quality sleep (which most don't get, even on 8 hours in bed a night) will leave you feeling great. The quality is mostly the result of what goes on beforehand coupled with some hacking of one's surroundings.

There should be NO light in the room. NONE. Black that ish out! Cut disruptive sound too. If you live in a city with traffic noise or obnoxious neighbors, use a white-noise app. No caffeine past 2 during the day. No exercise late night, but try in the AM as someone suggested is clutch. And I don't wanna hear about not having time. 20 minutes of HIIT… anyone has time for that (but do you have the willpower? That's another question). Late night, when home after hospital, NO more blue spectrum light. Use f.lux app on the computer screen, invest 10-15 bucks in some blue-blocker sunglasses (these should both help with endogenous melatonin release, something light in the blue frequency tends to inhibit). Don't eat late. Learn how to calm your mind. (That's right, learn to meditate. It will help with the career too). Then hit the sack and make those 4 hours count.

As for the not waking up part… I think it's the lack of QUALITY sleep, not so much the overall time spent in bed. That said, hit up a sleep doc dude. May be something serious going on there.

If you want to track/hack your sleep, I highly suggest checking out the sleep cycle app. 99 cents. Coupled with some self-observation and consistent tracking you can decipher which methods best help you achieve the highest quality of sleep in the shortest amount of time. Good luck.

Dharma...

Maybe I and others misunderstood the OP, but this is only a problem on those days or time they are sleep deprived...as opposed to a daily problem.

Maybe it was unique to my experience and the OP but there were day that even though I sleep easily and well normally, due to rotation demands studying life etc I was not able to get enough hours in. Four hours was very common for my surgery ICU month and if you think most people require eight to ten...by the end of the week even the highest quality four hour hours puts you 28 to 42 hours in debt.

As you go further like this the body can be hard to wake up.

I agree with you that if this were a common occurrence for te OP all the tricks being suggested may be masking a serious sleep disorder but given my understanding of this being an issue selected times I think it likely he is not suffering from a major disorder and can do without the sleep hygiene lecture.

Its possible i misunderstood the OP, but that was my take

 

[Dharma]

i

Dharma...

Maybe I and others misunderstood the OP, but this is only a problem on those days or time they are sleep deprived...as opposed to a daily problem.

Maybe it was unique to my experience and the OP but there were day that even though I sleep easily and well normally, due to rotation demands studying life etc I was not able to get enough hours in. Four hours was very common for my surgery ICU month and if you think most people require eight to ten...by the end of the week even the highest quality four hour hours puts you 28 to 42 hours in debt.

As you go further like this the body can be hard to wake up.

I agree with you that if this were a common occurrence for te OP all the tricks being suggested may be masking a serious sleep disorder but given my understanding of this being an issue selected times I think it likely he is not suffering from a major disorder and can do without the sleep hygiene lecture.

Its possible i misunderstood the OP, but that was my take

Improving sleep quality could help anyone, especially for those looking to increase efficiency, spend less time in bed, and without losing quality. Do it the right way, and 4-5 hours becomes the norm, without deficit. What I mentioned does not pertain to any sleep disorder (except the sleep doctor thing).

 

[Venko]

I'm not aware that most people can have four hours of high quality sleep as considered a full night sleep. Is this shown somewhere? If so it would free up a lot of time for us all.

 

[Dharma]

No, I don't have any info regarding 4 hours being "enough" according to another's standards. I'm not sure the common thought of needing 8 hours is backed by much either though.

http://health.ucsd.edu/news/2002/02_08_Kripke.html

That said, I think it's on the (well-informed) individual to decipher what works best for himself and not rely on generic advice for the average individual. The methods I mentioned are extremely easy to apply, cheap, and allow one to experiment a bit. Biohacking. It's the future, and not just with sleep.

 

[Venko]

No, I don't have any info regarding 4 hours being "enough" according to another's standards. I'm not sure the common thought of needing 8 hours is backed by much either though.

http://health.ucsd.edu/news/2002/02_08_Kripke.html

That said, I think it's on the (well-informed) individual to decipher what works best for himself and not rely on generic advice for the average individual. The methods I mentioned are extremely easy to apply, cheap, and allow one to experiment a bit. Biohacking. It's the future, and not just with sleep.

Fair enough. I got curious because of your statement that other people's suggestions were bad.

It made me think you may be speaking from a position of more knowledge

 

[Dharma]

Fair enough. I got curious because of your statement that other people's suggestions were bad.

It made me think you may be speaking from a position of more knowledge

Nah, I'm still learning and experimenting, but so far, so good. (My originally comment wasn't referring to you btw). I still think simple tweaks could help improve sleep, so we can get more out of less when those times arrive when less is the only option. Worth trying at least!

Since we're on sleep, how do you handle the shift work at an EM doc? I've read some of the things folks do in the EM forums and there's a pretty wide range of approaches (from medication, which kinda scares me, to simple stuff like blacking-out rooms). That has to do a number on the circadian rhythm if one doesn't approach it tactfully.

Two interesting (and quick) reads for anyone interested:

AMA response regarding light exposure at night: http://www.ama-assn.org/resources/doc/csaph/a12-csaph4-lightpollution-summary.pdf
Quick article by Harvard Health about blue light: http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/May/blue-light-has-a-dark-side/

Ok, OP, sorry to hijack the thread. Just stirring the pot a bit

 

[Venko]

how do you handle the shift work at an EM doc? I've read some of the things folks do in the EM forums and there's a pretty wide range of approaches (from medication, which kinda scares me, to simple stuff like blacking-out rooms). That has to do a number on the circadian rhythm if one doesn't approach it tactfully.

You're right its quite a challenge. I also work exclusively nights now so that presents its own uniquenesses.

When I did varying shifts, I scheduled sleep on my calendar to make sure I was as rested as possible even if it was not consecutive hours. Whenever I was transitioning from overnights (end at 7a) to days or evenings, I would sleep from 8a to 1p and then sleep again at an early night hour (like 9p). This allowed me to get some things done in between and then when I woke up the next day I was ready for a day or evening shift.

Now that I am exclusively overnight worker, I have black out blinds, a very comfortable bed with 1000 count sheets, and the warmest most cozy down comforter. Of course these are specific to Minnesota climate issues if for some reason I am having a real problem falling asleep, we have a room in our house with very soft recliners that has no windows. I don't use any medications for sleep or wake assistance…sometimes I'll eat too much which does help me sleep but I don't do it for that purpose.

Regarding the 7-8 hour target…this is a guideline shared by Mayo Clinic, the National Sleep Foundation, and others for adults.

 

[Dharma]

Cool. Thanks for sharing your experiences!

I'm hesitant to buy into broad sweeping generic advice on a personal level but I can see it's purpose on a public health level. The average individual is not self-tracking, monitoring sleep, and making modifications (diet, exercise, supplements, etc) to improve results and maximize efficiency. For those who do however, could be a very different story.

 

[evilbooyaa]

Cool. Thanks for sharing your experiences!

I'm hesitant to buy into broad sweeping generic advice on a personal level but I can see it's purpose on a public health level. The average individual is not self-tracking, monitoring sleep, and making modifications (diet, exercise, supplements, etc) to improve results and maximize efficiency. For those who do however, could be a very different story.

If you can run efficiently on 4 hours of power sleep (or whatever you want to call it), go for it.

I don't care what steps I'm taking, 4 hours of sleep day in and day out would not work for me.

I think if OP can average at least 6 hours every 24 hours (with naps if necessary) he'll be OK.

There were days on my surgery rotation that I literally came home from work at 7pm and literally fell asleep without studying/dinner etc. There are just some days it happens. Better to show up without fully researching a topic (would check it out on my phone on the walk to the hospital) than to not show up at all.

 

[epsilonprodigy]

Thanks for all the great advice! To clarify, as Venko said, this is only a problem when I'm running on significant sleep debt. I am usually up by 6 am or a bit before anyway, but that's assuming I've been sleeping 6-8 hours/night. It's the combination of adjusting to waking up at 3 am (which is what I'll have to do during surgery) and chronic sleep deprivation. I think the SleepBot things would cause me to bash the damn thing to death, promptly return to sleep and not remember a shred of it ;-) I actually just invested in one of those Phillips sleep lamps that's supposed to wake you up gradually with light, and finish off with an alarm for added assurance. We'll see how it goes...

The other reason I want to get on top of this is that I pretty much require at least a short morning workout in order to function. Even a 10-minute run makes a huge difference. If I don't squeeze this in, I'm a lot less productive and just not very nice

 

[calvnandhobbs68]

Thanks for all the great advice! To clarify, as Venko said, this is only a problem when I'm running on significant sleep debt. I am usually up by 6 am or a bit before anyway, but that's assuming I've been sleeping 6-8 hours/night. It's the combination of adjusting to waking up at 3 am (which is what I'll have to do during surgery) and chronic sleep deprivation. I think the SleepBot things would cause me to bash the damn thing to death, promptly return to sleep and not remember a shred of it ;-) I actually just invested in one of those Phillips sleep lamps that's supposed to wake you up gradually with light, and finish off with an alarm for added assurance. We'll see how it goes...

The other reason I want to get on top of this is that I pretty much require at least a short morning workout in order to function. Even a 10-minute run makes a huge difference. If I don't squeeze this in, I'm a lot less productive and just not very nice

Getting up at 3 sounds terrible even for surgery. I don't think many people in my class woke up before 4:30 on the worst surgery days.

 

[wholeheartedly]

These all look like fun experiments, errr options.

http://www.hellawella.com/7-alarm-clocks-that-will-definitely-get-you-out-of-bed/14211

 

[evilbooyaa]

Getting up at 3 sounds terrible even for surgery. I don't think many people in my class woke up before 4:30 on the worst surgery days.

Depends on how many patients you have and how early the OR opens. On vascular surgery sometimes the attendings would want to round at 5:30AM (prior to the 6AM surgery start time). That meant pre-rounding on the whole list started at 5:00AM. Which meant for me, as the noob MS3 who had 3 patients, I had to be there by 4:30. Luckily, I lived within walking distance to the hospital, but the other MS3 with me lived about a 20 minute drive away.

 

[scarletgirl777]

Hi, my name is Epsilonprodigy, and I am an MS-2 with a sleep addiction.

Okay, that's a misnomer. I'm actually a naturally early riser, but I've found that, especially as I get older, I will assuredly sleep right through any alarm/ruckus/natural disaster if I am sufficiently sleep deprived. This is particularly true if I have to be up before 6 am. Obviously, I'm going to have to find a way to correct this before my surgery and OB rotations, when we'll have to arrive at 4:30 or 4:45 am (and I live 40 minutes away) and on some days, won't leave until after 7 pm.

Now, I know that being late pretty much spells the end for us short-coated folks. I'm not complaining about the need to get up early: once I'm up, I'm up and will get moving accordingly. The problem is being in control enough to actually get myself in a vertical position and stay that way. Putting my alarm across the room and setting multiple alarms has NOT worked. It seems (although I never remember doing it) that I somehow manage to get myself across the room to turn it off, and hop right back into bedBefore you ask if I've ever held a job, or how I get to class, etc.... the answer is that I generally don't exist in a sleep-deprived state for long. This is merely a problem I've noticed when I'm ridiculously sleep-deprived.

Has anyone had success with those wake-up lights, wristbands or any other new-agey products?

Move closer to the hospital--whatever it costs is worth it. It would be a tragedy if you crashed on the way home from an overnight shift, plus, bc of travel you are losing 1h20m of sleep, more if it's the winter and even more if it's the winter and you can't park in a garage

 

[Leonid]

Move closer to the hospital--whatever it costs is worth it. It would be a tragedy if you crashed on the way home from an overnight shift, plus, bc of travel you are losing 1h20m of sleep, more if it's the winter and even more if it's the winter and you can't park in a garage

My surgery rotation is over 50 miles away and it's still very much winter here (there were a couple of fatal accidents in the snow this morning). I'll have to wake up at 3:30ish am to leave by 4:30 to get there by 6 am. I drove 45 miles in the snowiest January in history to another rotation. Schools don't care. I got hotel rooms on the really bad days because safety and sleep were more important to me then more student loans.

 

[colbgw02]

Sleep in a room that gets plenty of sunlight and don't close your shade/blinds entirely to allow at least some light in.

This is fabulous advice provided that you live above the Arctic Circle. Even then, it's only useful for half the year.