Now that I’ve started surgical residency, sleep deprivation is an issue I’m intimately familiar with. Let’s talk about the science of sleep deprivation and how to best handle it.

I’ll start off by saying I do not recommend you deprive yourself of sleep, and if you have difficulty maintaining or getting enough sleep then you should seek professional help.

There’s a strange culture surrounding sleep. We wear our sleep deprivation as a badge of honor reflecting our productivity and commitment to what we do. But this is an unhealthy way to go about it. There’s nothing to be proud of with sleep deprivation. In fact, I would argue that it often is due to poor time management and inefficiencies throughout your day.

That being said, there are a few instances where sleep deprivation is nearly impossible to avoid, such as during residency, certain rotations in medical school, or other demanding professions outside of medicine. However, there’s always a way to increase your efficiency and thereby increase the amount of time available to sleep. I have also gone over how to maximize your hours of sleep in the following blog post.

Sleep Smarter – Sleeping Science, How to Be Better at it, & Feel More Refreshed

Six hours of high quality sleep goes a lot further than six hours of low quality sleep.

Why Sleep Deprivation is Bad

So what’s the big deal with sleep deprivation anyway? We know that chronic sleep deprivation is not good for us, but how come?

Sleep deprivation leads to impaired memory, compromised problem-solving abilities, impaired fine motor skills, and an increased risk of getting in a car crash if you’re behind the wheel without getting enough Z’s.

In a study on Sleep Deprivation and Alcohol Intoxication, researchers found that performance on various cognitive and spatial reasoning tasks was impaired by sleep deprivation. More specifically, 17-19 hours without sleep corresponded to performance equivalent to a BAC of 0.05%. After longer periods without sleep, performance was equivalent to a BAC of 0.1%, above the legal limit.

Sleep deprivation has also been associated with increased levels of amyloid beta, a protein associated with Alzheimer’s disease. More prolonged sleep deprivation also increases the protein tau, another protein linked to brain damage in Alzheimer’s and other diseases.

A recent study in the Journal of Neuroscience suggests that sleep deprivation alters the activity of astrocytes and microglia in the brain, support cells for neurons, such that the brain is more susceptible to damage. Clickbait titles read that sleep deprivation causes your brain to eat itself. While that isn’t quite true, these supporting cells are critical to healthy brain function.

Ok, so you don’t care about the long term effects of sleep deprivation. As I’ve said many times on the channel, all nighters are going to cause more harm than good, so don’t do them. This also ties in with the next point on sleep inertia. Sleep inertia is a period of mild cognitive impairment and motor dysfunction that occurs when someone wakes from non-REM sleep, usually in the middle of the night or when sleeping after a period of sleep deprivation. It can last between 10 and 120 minutes, and can leave you more prone to poorer judgments. This is one reason sleep deprivation in resident physicians working in the hospital is so worrisome.

Navigating Sleep Deprivation

Alright, what can you actually do about it? The first and most obvious thing is, of course, to get more sleep. If you think that’s not possible, I encourage you to critically look at your day and see if you can be more efficient, thereby opening up more time for sleep. After that, I suggest check out my blog posts on How To Wake Up Early and Grow To Like It and Sleep Smarter – Sleeping Science, How to Be Better at it, & Feel More Refreshed.

Let’s go back to sleep inertia. You can mitigate the effects of sleep inertia with light exposure, physical activity, frequent napping, and good nutrition and hydration.

If you know that you will have irregular shifts, such as overnight call, plan accordingly. I personally recommend sleeping a few hours before and a few hours after your shift. So let’s say you have a shift from 10PM to 8AM. Sleeping 4 hours before and 4 hours after would not be a bad approach. If you don’t have time for a few hours of sleep, let’s say you’re on night  call after a full day, then try to take a power nap. A power nap of 15 to 30 minutes has been shown to improve an individual’s alertness. Again, avoid longer naps because of sleep inertia, which will impair your performance.

Eating properly is crucial, as you burn additional calories when working intensely. Dehydration and reduced glucose levels can impair decision making. It generally takes two full nights to recover from one night of sleep impairment.

Among resident physicians, such as myself, working in the hospital, the most common countermeasure is caffeine. Use caffeine wisely though. Like any other substance, you can develop a tolerance and/or become dependent on it. I personally save caffeine for my sleep deprivation emergency situations, where I am having trouble staying awake, such as last week when I was on overnight call. I use a French Press with freshly Ground Coffee and throw it in a Zojuroshi Thermos. It’s an excellent system, and even straight black the coffee tastes amazing. I have also resorted to Caffeine Tablets as backup if I don’t have coffee on hand.

I’ll be going over caffeine science and how to use it effectively in an upcoming post.

Lastly, please don’t drive while sleep deprived – it is very dangerous and like we learned earlier, can impair you to the same level as driving drunk. It’s better to pay for an uber than to risk your life – many hospitals even offer this as a service.