Can't Sleep? Afraid to Sleep? Read This.

Question:

Sometimes I can't sleep, and other times I'm afraid to sleep because of the amount of work that I have to do. How do I fit in quality sleep during medical school?

Response from Graham Walker, MD Resident, Emergency Medicine, St. Luke's-Roosevelt Hospital Center, New York, NY

Sleeping well -- or at least enough -- is a challenge for medical students and even for physicians long after they've finished a grueling residency. If it's not the long hours, it's a late call in the middle of the night or the tossing and turning while you worry about a patient you saw on the previous day. At the same time, not sleeping well sets you up for a rotten next day filled with brain fog and the mistitration of caffeine. One of the most frustrating things is knowing that you need to sleep but feeling wide awake. What are we to do?

Ask any sleep specialist and they'll tell you that it all begins with good "sleep hygiene." That term refers to the behavioral and environmental factors that precede sleep and that may interfere with sleep. To improve your sleep hygiene:

• Avoid stimulants and depressants starting 6 hours before your bedtime (some would even say after noon). The goal is to prime your body to be appropriately tired at just the right time.
• Don't take naps. As great as they feel, they're going to mess up your sleep cycle.
• Don't study or do anything else in bed besides sleep. This helps train your body so that your bed is the place where you sleep, and getting in bed means "time to get sleepy."
• Dark, quiet, and cool conditions are most conducive to falling and staying asleep.

You can find more recommendations at the University of Maryland's Sleep Disorders Center Website.

So that's how to fall asleep, but how can you fit it into the demanding lifestyle of a medical student?

Like everything, it's all about balance. When you hear people talking about having a balanced life (social life, academic life, work life, family life), they never mention their sleep lives. You get 24 hours in a day to do with as you please, but sleep affects your ability and motivation to do what you want in other parts of the day. Sure, you can be the all-star in rotations and studying and still have a social life, but if you're sleeping 1 hour a night you will fall asleep in lectures, overdose on coffee, and feel cranky all day long. Making sleep a priority is vital to performing well in life. (Think of it this way: If you're getting a good night's sleep, you'll be energized the next day and less sluggish. You could potentially get more done because you're efficient.)

When it's late and I'm studying, I try to recognize my own limitations and the law of diminishing returns: You can only cram so much into your head in one evening. The later it gets, the less able you are to concentrate, analyze, and store the information that you so desperately want. Do you ever find yourself staring at a page trying to read but finding your mind constantly wandering? Alert! Alert! It's tired! Sleep helps you consolidate and lock in facts that you've been learning all day. If you don't sleep, what's the point of all that studying?

That said, even the most dedicated people have times when they simply have to cram. Try this method next time: Study until you start to recognize those diminishing returns, and then throw down a bookmark and go to sleep. Set your alarm for a couple of hours earlier than when you'd normally get up. You'll be surprised how much easier it is to study at 4:00 AM with some sleep under your belt than it is to wade through information at the end of a long day. (And, you can do some night prayers too.)

Finding the right way to sleep -- and knowing what your own body needs -- is absolutely critical to your success as a physician. Experiment with different approaches, and once you find what works for you, commit to it. You will be happier, healthier, and better able to cram that last bit of knowledge into your head to do your best in medical school, residency, and your career.

Du'a 

And for Muslim, here's the du'a that you can read if you can't sleep.

اللَّهُمَّ غَارَتِ النُّجُومُ ، وَهَدَأَتِ الْعُيُونُ ، وَأَنْتَ حَيٌّ قَيُّومٌ

يَا حَيُّ ، يَا قَيُّومُ ، أَنِمْ عَيْنَيَّ وَأَهْدِئْ لَيْلِي

“Ya Allah, sudah terbenam bintang-bintang sudah terkatup banyak mata sedangkan Engkau hidup dan jaga, tidak tidur. Wahai Yang Tegak, Yang Hidup dan Yang Jaga, tenteramkanlah mataku”.

This article has been written by afore-mentioned doctor and has been edited a bit by me.