This is fascinating, as so many people can't sleep well. I imagine that the economy is causing many people to worry instead of sleeping now. ( More doctors need to take their own advice on healthy habits! ) Sleep is when the cells repair and the psyche repairs in the form of dreams. The immune system is enhanced by proper sleep. This will be the next trend like eating locally grown food or taking vitamin D pills!

How about 30 to 36 hour shifts every third or second day during our residency in the 70s ? That was the time when one understood the sweetness of a good night's sleep. No wonder that many doctors now choose specialties which give them enough time for good sleep. As in medicine, other professions also should look into the matter about how the working time and of the employees will provide them with enough time to sleep.

I live in New York, which is oddly known as the city that never sleeps. I wish that I could live in the country. Wake up with the sun and the rooster, and go to sleep with the darkness and quiet. Here, in the big city, It's never totally dark, and certainly never totally quiet. Getting mad at my upstairs neighbor is just additional fuel for the fire of awakeness. I desperately need to sleep. Yet, all around me, all the time, someone is awake. It's usually me. Wondering how to sleep. Farmers never have this problem. Maybe that's the solution. Go live on a farm.

Sleep depraved is an old friend that I had the good fortune to say good-bye to in 2005 when I retired from the USPS . My tour (shift) was from 6:00pm to 2:a30am with 2hrs of overtime thrown in for a 10hr. tour. Working nights is an art form at best You need to adjust your sleep routine so you can make it to the end of your tour and still have some energy to take care of personal bussiness. I no longer hang with the Vampire crowd.

When I was fifteen my wise old family doctor told me that going to combat as an infantryman would solve my sleep problems. He was right. I have walked deep into cold swamps, asleep while marching to war.
Yet strangely, I needed much less sleep to function when behind lines than I normally do. I am one of those nine hours per night sleep (or closed eyed rest) people, yet in combat I slightly arose from sleep every two to three minutes to listen carefully for the sounds of the night, the rhythmns and silences that meant trouble. Every ten to fifteen minutes I raised my head and searched the horizon for a minute to search for changes in the shadows and shapes--and thereby lived.
And I was happy and healthy. As a medic and sniper I suppose I had almost the perfect world between moments of tragedy. I was lived in the now, listening, smelling, feeling the ground, smelling our meat eating scents and their fish eating scents, using my peripheral vision most of the time, which seemed to help me rest and recover, yet darting around seeing with that direct, fight or flight, looking thru the leaves to see behind them, that deep, 3-D vision, seeing all the colors, the 300 shades of green, the yellows and tans and gray and blues.
I worked comrades who were even more reliable, even those who did not much like me, than my family and my peacetime friends--and I have always been blessed with both of the later. But we had made our pact to be reliable and do what needed to be done. And so sleep was more relaxed, if so alert
And so sleep was restorative and was easily drifted into and out of, softly and lightly.
That old doctor also gave me good advice. "Do not worry about getting to sleep, about being awake. Just practice relaxing or praying, but with your eyes closed. Worrying or struggling will tire you, but resting will rest you almost as well as sleeping.” And he was right.
What amazes me about so many doctors is how late at night they come into you room in the ER. Mostly asleep until a step before the doorway, they snap to, sharp and alert until they walk out, and then instantly almost sleep walking, sit down to that computer, and lord, you better check what they wrote: b sometimes it becomes the right elbow instead of the left or a different muscle from the one they told you, the muscle in the forearm that is almost a mirror image of the correct one they told you.
And while I suspect that can be dangerous, working thru the long nights, the doctors probably keep alive and relatively healthy a lot of people who would not be cared for them if their days were much shorter. Pickins County, Al I hear is down to two fulltime doctors.

Here is thanks to the doctors who work late at night and early in the morning.

There's a lot of talk of the benefits of sleep but what if you sleep too much or what is too much? I sometimes sleep 12 hours and probably sleep an average of 10 hours a day. I am on 2 antidepressants which is why I don't sleep more. I feel like I am not getting any work done.

Thoughtful commentary from a conscientious doc. But what does it really mean to be "sleepy", biologically speaking? Which parts of the brain and which proteins sense the need to sleep? What is being sensed? And what changes in your brain to make you feel refreshed the next morning? These questions are not even asked in medical school. Why not? They are fundamental to our understanding of the body and the mind. Their answers will likely reveal underlying properties of consciousness itself. And they will undoubtedly allow us to improve performance and quality of life, both of which suffer following poor sleep.

i work in a doctor's office that take care of patients with sleep disorder. Modern technology is the major culprit.If only we could turn off our computers @ bedtime people will sleep better and we will be able to function in our daily lives.In the meantime, ambien ,lunesta, and other medications will be prescribed to get the sleep we need.

Poor sleep habits lead to poor sleep quality and cause a negative health inertia all their own.
Ironically, we basically destroy the sleep quality of our hospitalized patients with fluorescent lighting, hallway noise, and over-frequent vital sign checking. See my post on the inertia of ill health here:

http://glasshospital.com...

-Dr. John

Doctors as experts on sleep? Much like drug addicts giving advice about drug abuse or the obese running
diet clinics.When you pick your expert you pick your solution. Just what we need,more drugs from that always helpful pharmaceutical industry.

I come from a family of night owls, try as we might we struggle to make ourselves go to bed before 2, when I visit my parents house it gets worse, and here I sit at 5 AM awake and going to bed soon. I started dating a Resident doctor recently and I was shocked to hear about his 24 hour shifts. The 80 hour limit of work per week is not enough- they need to cut these 24 hour shifts in half.

I'm sure that the last half of the last comment would make the author cry.

It is outrageous that doctors in training are required to work ridiculously long hours, putting patients at risk in the process. There are laws that govern how many hours long-haul truckers can work without sleep. Why don't we have the same for doctors? We are trying to reform health-care and bring down costs. What is the cost of all the mistakes that sleep-deprived doctors make in terms of poor outcomes, longer hospital stays and lawsuits? I don't want a doctor who can stay awake for 36 hours straight. I want to live longer than that. Give me a doctor who by law can't work more than 12 hours a day or 60 hours a week except in a rare emergency situation. The current system is barbaric. The first rule of medicine is "Do no harm." Maybe the first rule should be, "Take care of yourself, and get your rest."

40 years ago, the residents stayed up all night, and the senior doctors were awakened only for emergencies. Now that residents' duty hours are strictly limited, do you know who picks up the slack? It's the guys who didn't get any sleep 40 years ago.

My husband, at 64, now stays up all night doing basic patient care, while the residents go home at 4:30. (I could never function without sleep and chose a specialty with no night duties.)

I remember being so tired that I had to be reminded to swallow each bite of supper. That wasn't good for patient care, but protecting residents from ALL night duty just shifts the burden to senior staff, who have no protection from all-nighters.

My husband is finishing up residency- part of which was in surgery- and I saw the effects of doing 30-36 hour shifts every third night. I also have brother-in-law who is a pilot, and there are mandatory rest periods. I fail to understand how doctors who also have the lives of patients in their hands are not required to have adequate rest periods. We would never let a pilot pull 30 hour shift flying around the world.

Thanks for a fascinating article! My father, a family physician, once told me a story of when he was in residency, doing the whole 36 hour shift thing. He was examining an elderly woman who was hard of hearing in the ER at 3 or so in the morning. To better help her hear what he was saying, he the mistake of sitting down at a chair next to her. Next thing he knew, it was 7AM, and he and the woman had been sleeping together blissfully for the past few hours!

After completing a year of medical internship in 1983 where I and most were on call every 3rd night for the most part of the year, the medical director in his parting comments said,"I know we were hard on you but you all have learned how to operate under duress and se things through and are the stronger and better for it". Some grain of truth , but my sleep patterns were destroyed for years.

Dr Shives ignorse some simple realities. The operative specialties require practise to make perfect. The limitation in number of procedures eventuated by the limitation in working hours has made less trained and less competent graduates of residence programs. Is that a risk we in the community are willing to take? Dan Frazier would not like to be operated on by a doctor fresh from residency who had perdormed two of the procedure contemplated. It is a difficult point to reconcile.

I have read that serious body-builders who do heavy training twice a day often sleep twelve hours a day. Would more exercise improve sleeping ?

Fifty two years ago I married a medical student (ah, the glamor of the doctor) who soon became an intern and then a three year resident. And I never got to know him. Always distant and driven, it seems to me now that he should have been a businessman like his father. Fortunately, he ended up in medical administration. How well I remember the silent, sometimes irritable man who dragged himself home after working straight through every other night as an intern and the same every third night as a resident. He missed the toddlerhood of his two children; maybe that's the reason he was always relatively uninterested in them. Sad.

I began working on an ambulance when I was just 15 years old. From there I moved to working in Hospital ERs and then Hospital TSICU in patient care areas. From the age of 20 on I was also a mother and by the time I was 29 I had progressed to a divorced single mother of 3. While I was working on the ambulance I became use to having my sleep interrupted nearly nightly and to taking little cat naps in odd places. By the time I was 44 I was accustomed to living off of 4-5 hour sleep night and a cat nap of 15 minutes on my lunch break. When I was off I was too busy to change. During those years I was diagnosed as depressed. I had 5 car accidents, one of which I was severely injured. I changed professions at 44 but my sleep habits didn't. I retired at 48 and still my sleep habits didn't change. Then I remarried and if I got out of bed my movement would awaken my husband so I stayed in bed and discovered I would fall back to sleep in a reasonable amount of time. Over the years I have become more able to sustain sleep for a prolonged period; sometimes up to as long as 7 hours! I am no longer 'depressed' or fatigued all the time. I still take my little cat naps but they now last up to half an hour. I have also discovered for me, that my irritable bowel syndrome has disappeared as I have gotten more sleep as have my tension headaches.

I would suggest that any person who has been diagnosed as depressed and is taking medications for depression look at their sleep patterns. If you are sleeping less than 8 hours in a 24 hour cycle then make an appointment with your primary care physician and ask for a referral for a consultation to a Sleep Specialist. Make sure you let all your physician and psychologist know you are going to the Sleep Specialist also.

I'm so tired.......

Please, don't mention Ambien and Lunesta as antidotes to a sleepless night. While they may work for some people, they were hell for myself and my wife. Ambien = headaches, grumpiness, feeling out of sorts. Lunesta = everything you eat tasting like some sour metal. And I should add that for us the pills never worked to the point where we each had eight hours of truly restful sleep. Their commercial are totally nonsense, and completely false.

Yes, I've known people who have sworn by each of these panacea but if they go against the printed recommendations on the bottle of pills and use them for longer than short periods of time, as all of them will, then they're messing with psychoactive chemicals that become less effective over time and cause increasing side effects.

Although I won't go into the awful details of what it's like to take a sleep study (the glue-y globs stuck all over your head and upper body for electrodes, lying on your back and not being able to move all night, etc. etc.), take it from me and one of my doctors that it's a great way for a clinic to sell sleep apnea machines, which seems to be the whole purpose of the exercise beyond creating misery.

Sleep medicine seems to me to be an oxymoron; I have yet to find a doctor with a cure-all (acupuncture? massage? light suppression? not eating before bed? eating before bed? on and on...) and even just yesterday when I happened to mention to my eye doctor that I was up at 4 in the morning, he said 'oh, you should have called me', because he was up then too, trying to get back to sleep for hours.

I think the sanest and most useful advice I've heard in years about sleeplessness is from Ramon Reiser (above comment): "Do not worry about getting to sleep, about being awake. Just practice relaxing or praying, but with your eyes closed. Worrying or struggling will tire you, but resting will rest you almost as well as sleeping.” This is the same advise my grandmother gave my mother when she was stressed about exams in high school, and it's probably smarter than taking Ambien or some other psychoactive drug, sleep studies and all the rest.

I know someone who does 3 hours a night, has done for years, she claims. @paramendra

I developed a routine of slapping myself in the face on the 45 minute drive home after a night on call (really, ONCALL, all one word in capitol letters). Then I'd crawl into the house and lie on the family room floor while my 2 and 4 year old sons climbed on my back and 'played' with mommy.

Am I a better doctor for it? Doubtful.

http://mamasoncall.com