Hi Dr. Cranquis! I know you get a lot of these, but I just want to say thank you for creating this awesome blog. :D I'm a pre-med student, graduating in a little more than a year with a degree in biology, and I've been questioning myself if I really wanted to be a physician or a researcher. I've been weighing a lot of things, like the workload and whether or not I'll be able to maintain healthy relationships during med school and during my practice as a doctor...and so your tips have been really helpful (even if I live on the other side of the globe haha). Your stories are amusing as well. All these and some other things helped me decide that yes, I do want to be a doctor...so, thank you so much.:)
By the way, quick question - how did you manage to stay up during those long nights studying or as an intern in a hospital? Like I said, I'm just in pre-med, and I'm already depending on energy drinks to keep me awake on some days. I know it's not advisable, considering it's going to be much much harder during med. :|
Glad to encourage/amuse/pseudo-mentor you, Sleepless in Sri Lanka (or wherever you live)! :)
Oh man, those energy drinks have got to go. You’re just burning up your kidneys, raising your blood pressure, stressing out your heart, providing a poor liquid substitute for water — not worth it! With practice, your brain can learn to function quite well while on low sleep, without the “beating a dead horse” effect of caffeine and other stimulants washing into it. You’ll go through a fatigue-filled withdrawal at first when you quit using them, but I believe it’s worth it, for the pro-health benefits long term!
Yes, med school is tiring, and intern year is — well, I don’t like to think about how tired I constantly felt for those 12 months (the rest of residency was tiring too, but a little less overall). But (and I say this with a small note of pride), I never used an energy drink or caffeine to keep me awake through med school and residency. Instead, I relied on a few habits/things:
- Power-naps: Your body’s “sleep cycle” can provide brain-recharging rest without that zombie-fied sensation, if you only nap for 20-25 minutes at a time (that’s starting from the moment you lay down). During the first 20ish minutes when your brain receives the “ok, time to go to sleep” signals, your brain waves change enough to start relaxing your blood pressure and slowing your heart rate, providing physical relaxation even if you don’t fall totally asleep by the time your alarm goes off. If you nap past 20-25 minutes, chances are that your sleep cycle will have dipped too close to the neurochemical state of REM sleep, and so you’ll have a much harder time waking up your brain when the alarm goes off at 30 to 60 minutes. So, when I was on call during residency, if I knew that chances were good I would be disturbed with an admission or a patient issue within the next 2 hours, I’d just take a power-nap and then stay up for an hour before napping again, to avoid getting that “brain fog” feeling.
- Hydration: Keeping the body well-saturated with water through a long call night helped to stave off some of the hunger pangs (which eventually lead to unhealthy “midnight snacks” from the cafeteria or vending machine, typically high-fat or high-sugar items, which then lead to FOOD COMA). Plus, the sensation of a full bladder really helped keep me focused on getting that ER admission or medication dosing adjustment taken care of ASAP!
- Proper night-time eating: Yes, I would eat a snack when I got a chance on call nights, but I’d try to keep it something simple and easy on the tummy (fresh fruits and veggies, dried nuts and fruits, etc.) — again, with the goal of not inducing post-prandial sleepiness.
- Pre-Sleeping and Post-Sleeping: Now in this area, everyone is a bit different. You have to figure out what “pre/post-call-sleeping” pattern works best to help prepare and repair your body/brain around a call night. In my case, I functioned best on-call (and afterwards) if I (1) went to bed an hour earlier the night BEFORE my call-night, (2) took a power-nap during my lunch-time on the day of my call-night, and (3) didn’t try to get any serious sleep DURING my call-night until at least midnight. Then after finishing call the following morning, I would go home and sleep for 2-3 hours, trying to get up by 2pm at the latest, so that I could still feel tired enough to sleep well that night (this was one main reason why I would avoid energy/caffeine drinks during my call night — otherwise I would be too wired to get in that mid-day nap after call was over). You’ll need to experiment a bit to find what helps you out.
Like any skill, staying functional on little sleep improves with practice. (It’s not a skill I wanted to stay “awesome” at all my life, and that’s why I got a shift-work job after residency was done). While I was “in the trenches,” my body/brain learned to cope with 3-5 hours of accumulated sleep within 30 hours. It didn’t feel good, but I didn’t kill anybody either. :)
You’ll notice all of this discussion has focused on “staying up late during residency” — what about “staying up late to study in med school”? Well, I didn’t do that, and I don’t recommend it. Yes, the “all-nighter” is a hallowed tradition among med students, considered a “preparatory training” for the call nights of residency — but again, I feel this habit just burns up your physical and mental stores and ages your body prematurely with a low “benefit margin” scholastically. If I was in a real time-crunch during med school (before exam weeks, especially), I would rather go to bed by 11pm or midnight and then get up at 4am to keep on studying before my first exam at 8am, rather than staying up until 3 or 4am and then trying to sleep for a few hours before the test. It’s all about circadian rhythms here: our bodies want to sleep when it gets dark, and if you “push” past the first few hours of night into the early morning, and THEN try to sleep, your body doesn’t slip into REM sleep as easily, the sleep is not as restful, and your brain is more fuzzy-wuzzy come test time.
But hey, that’s just what worked for me. Hope some of this advice can help you too! And on that note I’m going to bed — it’s late. :)