The Art of Sleeping: Setting the Stage for Sleep During Your Residency

Home / Campus / ( Published on 2015-06-30 )

By Rachel D. Steinberg, Psy.D.
Faculty and Staff Assistance Program

Sleep is an essential component to our health and psychological well-being, yet insomnia and other sleep related difficulties are common. For example, National Sleep Foundation surveys found that 40 million Americans suffer from sleep disorders and that most sleep difficulties are undiagnosed and untreated. In addition to its importance for metabolic, cardiovascular, and immune system health, sleep is the time when we consolidate new information and store it in memory. The importance of sleep is particularly important during your residency because of its roles in your personal well-being, ability to provide patient care, and learning. In fact, sleep deprivation contributes to medical and diagnostic errors, accidents (i.e. needle stick injuries, car accidents), decreased work performance, and difficulty in thinking and mood.

Maintaining healthy sleep habits can be difficult especially during residency where hours and rotations are changing frequently. Furthermore, many of you are struggling to find a work life balance and are likely feeling overworked and exhausted. These feelings can lead to stress which can impact the quality and amount of your sleep. While setting a regular bedtime and wake time are ideal there are many other useful techniques and tips that can be used during your residency. Sleep techniques generally fall into three categories: stimulus control, general sleep hygiene, and stress reduction and relaxation skills.

Stimulus control

  • Use your bed for the 3 S’s (sleep, sex, sickness). Other than these three, avoid activities in your bed and bedroom, such as work, phone or text communications, using the computer, watching TV, and reading. The goal is to create connections in the brain that associate your bed with rest (or sex), but not work.
  • Go to bed only when you feel drowsy. Be aware of your internal cues such as heavy eyelids or reading the same passage over and over again, not to external cues such as the clock or when your roommate or partner goes to bed.
  • Develop a pre-sleep routine. This might mean turning down the lights, drinking a cup of herbal tea, taking a soothing bath, or reading a relaxing book. This helps signal the brain that the time of sleeping is approaching.
  • Develop a sleep routine. When going to bed, immediately turn out the lights and allow for sleep to occur naturally. If you are not asleep within 20-30 minutes, get out of bed, leave the bedroom, and do something quiet and relaxing such as reading a book or listening to calming music. Repeat this last step as often as necessary until you fall asleep. Remember, it is best to avoid watching TV or using the internet when you are trying to fall asleep because the bright screen lights stimulate the brain and keeps you awake.
  • Develop a wakeup routine. Establish regular waking hours (if possible). Open the drapes as soon as you wake up, or if possible, get out into the sun. If it is cloudy or foggy, or you must wake up in the middle of the night, turn on some lights. Your body’s circadian rhythms are regulated by light.

Sleep Hygiene

  • Avoid caffeine (particularly in the two hours before bed), nicotine (its stimulant effect can last hours and nicotine withdrawal at night can cause you to wake), alcohol (great for getting to sleep but horrible for quality of sleep), and large or heavy meals before bedtime.
  • Set the stage for sleep. Arrange a cool, dark, quiet bedroom.
  • If you nap, nap smart. Limit napping to 45 minutes (if possible) and avoid napping later than 4:00 pm (if you have the day shift). 
  • Exercise. Studies find a relationship between insomnia and sedentary lifestyle. Be careful, however, intense exercise two hours before sleep should be avoided. 
  • Diet and sleep. Maintain a healthy balanced diet and adjust your eating routine around your sleep cycle. Aim to eat a substantial breakfast, moderate lunch, and light dinner 

Stress Reduction and Relaxation Skills:

  • Mindful Breathing: 

Periodically, take a few deep breaths during the day and to let some tension out. Breathe in for 2-3 seconds and out for 5-6 seconds. Try to notice any tension in your body and breathe out, letting it go. 

  • Progressive Muscle Relaxation:

This involves tightening and releasing of specific muscles groups from head to toe. The emphasis is on noticing the differences between tense feelings and relaxed feelings. 

  • The Body Scan: 

Similar to progressive muscle relaxation in its focus on the body head to toe, the body scan works by guiding our attention to each part of the body sequentially. 

  • Visualization and Guided Imagery Techniques:

These techniques involve the creation of a detailed mental image of a peaceful setting or environment (e.g. walking along the beach, sitting in the woods, etc.). The goal is to associate the senses of the peaceful images, such that the imagery alone induces relaxation.

Links for audio/video resources for guided mediations:

Many of you are under extraordinary levels of stress and the demands of residency training can be overwhelming. Physicians are often held in an exalted position in our society which can lead to an internalized expectation that physicians’ don’t have problems. Extraordinary internal resources are necessary to have accomplished the academic success required for residency training, but that doesn’t mean you can’t have problems. If life starts to feel like it’s too much, reach out to someone. We at the Faculty and Staff Assistance Program can provide you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues. Please contact FSAP at 415/476-8279 or visit the website.