A good night’s sleep requires both quality and quantity. A recent study evaluating medical student sleep habits suggests physicians in training are lacking in the former.
The National Sleep Foundation recommends adults get seven to nine hours of sleep per night. A 2016 study of 800-plus medical students across 49 institutions indicated that medical students are generally logging enough sleep time. A majority of the students who participated in the study, however, reported indicators of poor-quality sleep, such as sleep disturbances, snoring or shortness of breath.
Erin Ayala, PhD, a core faculty at Saint Mary's University of Minnesota, co-wrote the study and has done extensive research on medical student stress, well-being and self-care. She said that poor sleep can have far-reaching effects on medical students.
“Med students who don’t get enough good-quality sleep might find it difficult to focus on the complex information that they are learning for sustained amounts of time during their lectures, especially when it’s all didactic” during the first two years of medical school, Ayala said.
Ayala offered these tips to medical students hoping to improve the quality of their sleep.
In order to evaluate how well you are sleeping, you need a baseline. Tracking your sleep provides that baseline.
“There’s a lot of value in tracking sleep patterns,” Ayala said. “Technology makes it really easy to do that now, especially with some of the smart health devices such as the Fitbit.”
As with monitoring food intake or exercise, sleep can uncover patterns that require change.
“We may think that we’re doing well, until we look closer at our behavior,” she said.
Those devices can estimate the quality of sleep and track when a user is actually falling asleep and waking up.
Ayala’s research indicated that first- and third-year medical students reported the poorest quality of sleep. That fact may be indicative of the new roles and responsibilities those students are encountering—the outset of medical school and the beginning of clinical training.
Students cannot control their workload and have limited control over their schedules. When possible, however, a consistent pre-sleep routine can help improve quality.
“When possible, go to bed at the same time every night and wake up at the same time every morning,” Ayala said. “If needed, [students] can set an alarm on their phone telling them when to wind down.”
This means limiting screen time to give your eyes a break, and finding a calming activity—it could be leisure reading, writing in a journal or prayer.
For those with trouble sleeping, Ayala recommends meditation, which can be facilitated by a number of apps, including Calm and Headspace
“Med students are often running, running, running throughout the day, and can be really revved up as a result,” she said. “When thinking about the two different nervous systems, the parasympathetic and the sympathetic, the sympathetic can be in overdrive because a student is really energized and activated, stressed. The deep breathing or the meditation helps balance that out by activating the parasympathetic nervous system, which allows the body to relax at the end of the night.”
The brain is associative. To foster an environment that allows for the right sleep-time state of mind, a bed should be associated with sleep, not studying.
“Some students will take this to another level and move their study space and desk into another room, so depending on their living situation, that could be an option,” Ayala said.
When you are in the bedroom, research indicates that keeping the temperature on the cooler side can help with sounder sleep.
Ayala cited caffeine and alcohol as the two substances medical students must limit to sleep soundly. Caffeine, a substance many medical students turn to when fatigued, blocks the adenine receptors in the brain, making it difficult to fall asleep. Alcohol disrupts the natural sleep cycle and limits rapid-eye-movement sleep.
In the end, Ayala believes, adjusting habits to improve the quality of sleep can have a big payoff.
“Research shows that sleep plays a really important role in learning and memory,” she said. “Even for students who are able to sit through lecture and get that information and access it, a full night’s sleep at the end of the night will help them consolidate, synthesize and make sense of that information.”