This is the second installment of a two-part audio series about sleep in medical residency. In the first installment, experts discussed the question: Why is quality sleep so tricky for medical residents to achieve and what are the serious ramifications of this problem?
It’s well established that medical residents have strenuous, shifting schedules that make it difficult to get quality sleep. But does it have to be this way? What can health systems, managers, and medical residents themselves do to better their sleep hygiene to avoid burnout, improve their own health and wellbeing to ensure these providers are delivering the best care to their patients?
Our final episode of Boston Medical Center’s HealthCity audio series on sleep health addresses these burning questions and offers tips and tricks for healthier sleep for residents. Experts Naina Limbekar, MD, MPH, a sleep neurologist and Sanford Auerbach, MD, the director of both BMC’s Sleep Disorder Center and sleep medicine fellowship training program, help illuminate the body’s many complex responses to sleep and how exactly shift work impact those responses — particularly in the high stress, potentially traumatic environment of a hospital.
The below audio story, produced and hosted by Madeline Herec Poirier, with sound engineering by Billy Wirasnik, also features excerpts from the audio diaries of BMC’s residents, who disclosed only their first names. The diaries highlight the rigor of all medical residency programs and provide their own lived experience of constantly changing sleep schedules.
One first-year OBGYN resident describes her very first night shift, which happened to be her first ever shift of residency.
“I think the adrenaline just kept me up — just the anxiety and adrenaline, I was up and then I crashed hard when I got home on the couch. I didn’t even make it to the bed I was so exhausted,” she says, describing the “overstimulating” environment of pages, phone calls, questions, noises, teaching moments, and triage. “Maybe it was in the second week…I was just so exhausted. At 3.m. my brain was super foggy, I had to read things three times over, it was really hard to focus.”
The overstimulation and rigor are one thing, but the life-or-death environment in which medical residents work adds another obstacle to healthy sleep. Jeffrey Schneider, MD, chair of the graduate medical education committee at BMC, understands that all too well from his own residency and attending experience.
“It is very, very hard not to bring some of the things we hear or see or do at work home with us,” Schneider says, recalling one particularly traumatizing incident in his career.
The residents share how they help themselves overcome these challenges and find sleep through meditation, cognitive behavioral therapy for insomnia, and BMC programs that allow them to debrief with peers about their feelings and experiences, keeping patient information private.
“For processing all of these things, we have wellness sessions once a month where we as a whole program get dedicated time … that’s separate from our clinical time. And we all go, from intern to chief,” says surgical resident Priyanka. “Just having someone to talk through it with me whether in person or over the phone is pretty helpful.”
