The science around sleep is settled. Adults need seven to nine hours of sleep per night.
For medical students, particularly those working in high-stakes clinical environments in the latter half of medical school, sleep deprivation and extended wakefulness can have big consequences. These include impaired attention, slowed response time and a higher risk of errors, accidents and injuries.
Suboptimal sleep patterns also pose a mental health hazard. Among medical students and resident physicians, chronic sleep deprivation is linked to higher rates of burnout, anxiety and depression, along with decreased motivation for learning.
During clinical clerkships and fourth-year electives, sleep often becomes a variable students can’t control. Research shows, and medical students’ anecdotal experiences reveal, how clinical rotations can strain rest. Here’s a look at the realities on the ground and what medical students are doing to mitigate the impact of sleep deprivations when standardized sleep protections don’t exist.
Sleep deprivation and clerkships
The workload of the opening years of medical school and preparation for Step 1 of the United States Medical Licensing Examination (USMLE) can wreak havoc on sleep. For example, a 2024 survey of medical students found that 75% of respondents reported inadequate sleep during their Step 1 prep. But the transition into clerkships is when sleep becomes most unpredictable for many medical students.
A 2025 study of two New Jersey medical schools’ internal medicine clerkships found that nearly two-thirds of the students slept fewer than seven hours per night. More than half reported sleep-related impairment on their clinical duties or educational activities on at least one or two days a week.
Even more alarming: Of the 222 medical student respondents, 37% reported driving drowsy one to three days per week during the rotation, and 30% reported doing so on four plus occasions in a week.
AMA member Sneha Kapil is a fourth-year medical student in Florida. She compared the most demanding clinical rotations to working two jobs—the actual clinical patient facing-hours were one job and the studying and self-directed learning were another.
The year in which she did her core clerkships “was the hardest year of medical school,” she said. “You are working long clinical hours and also have your OSCEs [Objective Structured Clinical Examinations], your shelf exams, and other assignments, which you have to find time to study for. It’s a challenging time to do everything you need to do and get adequate sleep.”
Protecting medical student sleep
The authors of the study on internal medicine rotations and sleep wrote that “each site ensured one day off every seven days and that weekly hours did not exceed 80 hours, but there was no oversight regarding the number of hours worked on each individual day,” the study says.
Those types of duty-hour limitations are hardly guaranteed, however.
While residency programs have specific standards and policies put in place to prevent sleep deprivation and mandate rest periods. These include limiting work to 80 hours per week, requiring at least 10 hours off between shifts, and mandating rest after long shifts. However, similar national standards to protect medical student sleep do not exist.
Accreditation Council for Graduate Medical Education policy also aims to preserve resident well-being following a 24-hour shift. One such policy calls for a 14-hour break following a 24-hour shift.
Though practices vary widely by medical school and rotation, medical students—like residents—may work a 24-hour shift.
A lack of standardized medical student sleep protections led the AMA to take action. At the 2025 AMA Interim Meeting, the House of Delegates adopted policy to “support the development of national standards to act as the official guideline for medical student work-hour limits, time off after a 24-hour shift, and work-hour guidelines.”
Until such rules are widely adopted in undergraduate medical education, medical students are left to find methods that work for them to maximize rest.
“It is not always possible to get a full seven to eight hours of sleep,” said Kapil, who is serves as section alternate delegate of the AMA Medical Student Section Governing Council for the 2025–2026 term. “However, I would try to use my day off to set myself up for the rest of the week to be as efficient and healthy as possible by doing things like meal prepping.”
“It’s important to have a study cutoff time,” she added. “Giving yourself an hour or two of personal time before bed is important to avoid ruminating on studying or clinical encounters and helped me sleep better.”
