Resident physicians know that overnight shifts are inherently exhausting. Research shows that it’s the transition from day shifts to nights that truly drains performance.
When residents don’t prepare their sleep schedules in advance, they are more likely to hit cognitive levels comparable to a 0.05% blood-alcohol concentration, says a study published in the Journal of Clinical Sleep Medicine.
While those figures may sound discouraging, a deep dive into the study data and insight from a physician who spent years working with residents on overnight shifts sheds light on strategies that maximize performance. Here are some key tips.
Sleep bank—if you can
The study of 23 internal medicine residents in the same program measured resident sleep through self-reported sleep logs. Residents documented their sleep and work hours starting three days before their first night shift and continuing through the next eight days.
Data indicated that sleep banking—getting nine or more hours of sleep for several nights before starting a night shift rotation—was the most effective tactic to transition to night shifts. The study found that resident physicians who were able to sleep bank had the highest performance effectiveness (PE) of 88.6%—a measure of cognitive function during night shifts, with 100% representing optimal performance.
The study’s authors pointed out, that those residents who were able to sleep nine hours or longer may have been in a sleep-deprived state prior to the study period.
Jodi Abbott, MD, is the AMA’s medical director of education center curriculum and outreach. Having spent decades working with residents, including a stint as an ob-gyn residency program director, she found that sleep banking is not necessarily practical for everyone’s schedule or physical makeup.
“Not everybody can sleep bank,” she said. “Everybody has an individual sort of personal chronometer. Some people can't sleep nine hours. Some people could easily sleep 14. But if you simply aren’t able to sleep bank, don’t feel bad about it. We do have other strategies to help night performance.”
Dr. Abbott was the subject matter expert on a new micro-lesson, “Sleep Deprivation: Fatigue Mitigation Strategies,” that aims to help residents learn more about effective sleep hygiene to improve resident well-being and quality care.
The micro-lesson is part of the AMA GME Competency Education Program, which delivers education to help institutions more easily meet Accreditation Council for Graduate Medical Education (ACGME) common program requirements. Current program subscribers have access to award-winning online education designed for residents on the go. It’s easy to use and saves time with simple tracking and reporting tools for administrators. Learn more.
Dive deeper:
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Power up with a nap
It’s also schedule-dependent, but napping during shifts has major value. The researchers behind the Journal of Clinical Sleep Medicine study, which was published last year, found that residents who were able to log at least one hour of sleep during their shifts had a noticeable boost in performance (83.4% PE).
That finding rings true for Dr. Abbott.
“For some people, working in a setting like an emergency room, it’s continuously busy overnight,” she said. “But in other places, there may be downtime, and taking the opportunity to power nap—having both a place to lie down and the chance to rest—really helps.”
The study’s authors also had a caveat about caffeine use in their own data, writing that "it is important to note that the Performance Effectiveness is predicted in this model, and it is possible that actual performance on cognitive testing may improve after consuming caffeine."
Take care with caffeine
The Journal of Clinical Sleep Medicine study found no significant performance differences between residents who used caffeine and those who did not. For residents who feel that caffeine has a positive impact on their performance, Dr. Abbott offered that it is important to time administration correctly.
“Even for people who are responsive to caffeine, if you use it near the end of a shift it can interfere with sleep later,” Dr. Abbott said. “It’s a potent tool, but it has to be used carefully."
Dive deeper:
- How programs can address the five top resident physician stressors
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- 3 trends in resident physician burnout that demand action
Keep it consistent
Many aspects of sleep during overnight shifts are out of a resident’s control. Your sleep schedule away from the hospital, however, is in your own control.
Residents who managed eight or nine hours of sleep a night during the first week of their night shift showed up sharp (86.8% PE), while those clocking less than six hours were often less effective (78.6% PE).
The Journal of Clinical Sleep Medicine study suggests that residents who stick to a nocturnal rhythm, even on days off, find it easier to resume night shifts. Maintaining that schedule, the study’s author’s point out, may come at the expense of other necessary activities like social time and time for activities related to well-being.
"If you try to stay up all day on weekends and then go back to work at night—whether that’s on a Sunday or Monday night—it can be really challenging,” Dr. Abbott said. “It’s tempting to switch your schedule every weekend, but it’s better for your health if you don’t. Try to at least sleep in late and stay up late, even if you’re not fully nocturnal.”
