Sleep & Fatigue

June 24, 2021

Holly Stewart, MS, Director of GME Wellness

How to Recognize Sleep Deprivation and Fatigue

Sleep deprivation and fatigue interfere with concentration, cognition, fine motor tasks, decision making, and emotional stability. It can impact your ability to safely care for patients and can compromise your own safety and wellbeing – particularly when it comes to driving while drowsy and your mental and emotional health.

The Office of GME and your individual programs recognize that adequate sleep and restoration are needed for optimal performance. We strongly emphasize the honest and accurate reporting of duty hours so that programs can help prevent fatigue and burnout.

Causes of Sleep Deprivation and Fatigue

• Less than six hours of sleep per night
• Work overload and/or shift work
• Jet lag
• Illness
• Depression, anxiety, and stress
• Medication side effects
• New baby, puppy, or disruption in home environment (inability to complete full sleep cycles)
• Sleep apnea, snoring (self or others), and other sleep disorders

Signs of Sleep Deprivation and Fatigue

• Difficulty keeping eyes open
• Nodding off and/or yawning repeatedly
• Slowed cognitive processes and reaction times
• Emotional changes including irritability, anger, or tearfulness
• Difficulty managing emotions

Signs while driving:
All of the above, plus
• Trouble focusing on the road
• Drifting lanes and/or missing exits
• Unable to remember driving the past few miles
• Closing eyes at traffic lights

What to Do When You’re Drowsy and Need to Work or Drive

Talk to your attending/supervising faculty member. Your faculty were once trainees themselves and have likely experienced significant fatigue at some point in their careers. Have an honest conversation with them about your concerns, particularly if you believe your ability to safely care for patients is compromised.

Strategic napping in call rooms. Darken the room as much as possible and limit your use of electronic devices (to the degree that patient care is not compromised). Set an alarm for your desired wake-up time. While needs will vary by individual, nap lengths should generally be kept to under 30 minutes (before going into deep sleep) or at about 90 minutes (average length of a sleep cycle). Thoughtful timing of naps may help you avoid sleep inertia and grogginess by awakening during light stages of sleep. If possible, try not to nap too close to a planned extended sleep period.

Drink a caffeinated beverage. Strategic use of caffeine involves ingestion at times that will promote alertness and performance during periods of vulnerability. A significant alertness boost can be obtained from 200 mg of caffeine (two eight oz. cups of coffee) with positive effects at doses as low as 100 mg. Caffeine reaches peak concentrations in the bloodstream 30-60 minutes after consumption. While it has its benefits, too much caffeine can induce sleeplessness, irritability, and anxiety. You should not rely on caffeine as a substitute for sleep!

When post-call, take a 20-minute nap before leaving for home. Wear dark or amber-tinted sunglasses when outside or driving. You may also want to strategically time caffeine consumption in the last half of your shift so that it enables you to safely drive without impacting your extended sleep period once you arrive at home.

Find an alternative to driving. Call a friend or family member to pick you up, or take a taxi or rideshare service (Uber, etc.). NGMC GME will reimburse a one-way ride home from the hospital(s) or clinic.
If already driving and you notice signs of sleepiness, pull over at a safe spot and take a short nap or contact a friend to pick you up.

Practicing Healthy Sleep Habits

It goes without saying that resident and fellow work hours can be long and unpredictable, and it can be challenging to prioritize your sleep when there are so many demands on your time. However, whenever possible, the following strategies are recommended to support healthy sleep habits.

Develop a bedtime routine. When possible, go to bed and get up at the same time each day. Find a pre-sleep routine that helps you to relax and prepare your body and brain for sleep, such as reading, stretching, or meditation.

Aim for at least seven hours of protected sleep time. Most adults have a genetically hardwired sleep requirement for optimal functioning that ranges from seven to nine hours. When sleep requirements are not met, a sleep debt ensues that must be paid off.

Create a sleep-friendly environment. Keep your bedroom cool and dark. If needed, use earplugs, a fan or white noise machine, and an eye mask or blackout curtains to reduce light and noise. Talk with the people you live with about the ways they can help to protect your sleep and avoid sleep disruptions.

Limit certain activities before bedtime. Stop using electronics – including your mobile phone, computers, or TV – at least an hour before lights out. Avoid intense exercise and consuming alcohol at least 2 hours before bedtime, and never use alcohol as a sleep aid.

Approaching a Sleep-Deprived Colleague

The sleepier you are, the less accurate your perception of your degree of impairment. Studies have shown that sleepy people underestimate their level of sleepiness and overestimate their alertness. At NGMC, we aim to create a culture of safety and interdependence in which residents and faculty can raise concerns about sleep deprivation and fatigue without fear of judgment or retaliation.

When approaching an impaired colleague, be honest with the affected person about your concerns. Let them know what you have observed and that you care about their wellbeing and their ability to safely care for patients. You can suggest the appropriate fatigue mitigation strategies outlined on the previous page.

If needed, inform the supervising faculty, Chief, Program Director, or Director of Resident Wellness about your concerns. If the issue is chronic, suggest that they contact their primary care provider and/or make an appointment with the Resident Assistance Program or Director of GME Wellness for further support.

NGMC GME Resources and Contacts

Taxi & Rideshare Reimbursement
NGMC GME will reimburse a one-way trip home and up to a 20% tip for any resident or fellow experiencing fatigue. Submit a receipt of the transaction to your Program Coordinator or to Holly Stewart, Director of GME Wellness.

Resident Assistance Program
Residents and fellows have free and unlimited access to counseling and other mental health services through the Resident Assistance Program, a part of the NGHS Employee Assistance Program. Sessions can be used to explore causes and strategies for managing fatigue and burnout.

For additional information or support with sleep and fatigue management, contact
Holly Stewart, MS
Director of GME Wellness

Mac Hafele, PhD
Neuropsychologist, Resident Assistance Program

American Academy of Sleep Medicine’s SAFER Presentation: Sleep and Fatigue Education in Residency
Centers for Disease Control and Prevention
Peel, J. Resident Sleep and Fatigue presentation, UT Health San Antonio;