Jerry Seinfeld has a stand-up routine where he talks about how he’s really two people: “night guy” and “morning guy.”
Night guy stays up as late as he wants, and never worries about what happens to morning guy, who only gets a couple hours of sleep and is miserable when the alarm goes off. Morning guy hates night guy, because night guy always sabotages him, and there’s really nothing morning guy can do about it.
But he does have one trick up his sleeve: he can miss work, get “day guy” fired, and make it so that that night guy is broke and can’t stay out late anymore.
I mention the bit because at its core it’s about something all of us have dealt with: the effects of sleep deprivation. And all kidding aside, the cascading effects of not getting enough sleep or getting poor quality sleep can be a real problem, especially if you’re doing something that requires attention or is intellectually demanding. For med students in particular, it’s important to get enough quality sleep when your head hits the pillow, or your academic performance and emotional well-being can suffer.
If you’re having trouble sleeping, this article will review some tips for getting some great zzz’s. We’ll even talk about the best frenemy of sleep-deprived people the world over: coffee. Is it really helping you? Same goes for that Monster (drink) under the bed at night. Is it interfering with your rest, and would you be better off without it? It may be something to consider. We’ll talk about it later.
To get things started, let’s begin with a little information about what happens when you drift off to sleep, and some of the amazing things happening in your brain when you enter the Land of Nod.
How Sleep Affects Your Brain
1. Memory Consolidation
When you’re in class during the day, all the things you’re learning about medicine are initially formed in the hippocampus (and some other brain structures). Later, when you go to sleep, that information (i.e., semantic memory) gets transferred from the hippocampus to the cortex for long-term storage. This seems to take place during slow-wave sleep, when the hippocampus transfers newly learned information to the neocortex by reviewing or reactivating it.
The effects of this transfer are twofold: one, it moves information from the hippocampus to its permanent residence in the cortex, and two, it “frees up space” in the hippocampus so that new memories can be formed the next day.
So basically, if you don’t get a good night’s sleep, it’s kind of a double whammy: long-term storage is inhibited, and the hippocampus will have a reduced capacity (by as much as 40%) to form new memories the next day.
2. Emotion and Mental Health
Of course, sleep isn’t just important for cognition. Poor sleep quality is associated with increased stress, anxiety, and depression in medical students. The causation can work in both directions: at times, sleep problems can trigger emotional health issues, and at other times, emotional health issues trigger sleep problems. And either can exacerbate the other, leaving you stuck in a tough cycle that makes it hard to focus on your studies.
Med Students and Sleep: A Complicated Relationship
Given how important sleep is for learning and emotional health, it’s unfortunate that medical students report high levels of sleep disturbance. They’re more likely to suffer from insomnia, and even when they manage to get the recommended seven to nine hours of sleep, they often have poor quality sleep. This is particularly true during exam weeks, when students are often unable to sleep due to anxiety and the need to study.
To make matters worse, medical schools usually say very little about the importance of sleep and proper sleep hygiene. It figures the one thing they don’t teach you is maybe the most important thing of all!
If your school hasn’t shared any tips with you when it comes to sleep hygiene, we’re going to pick up where they left off.
Let’s talk about some things you can do to improve your sleep. We’ll start by highlighting something so diabolical, so seductive, so insidious that it warrants discussion in its own right.
That’s right, we’re looking at you coffee.
(I’m sorry, but we have to go there!)
Coffee and Med Students: A Love Affair? An Addiction? Or Both?
Coffee may well be the world’s most popular drink. And caffeine is that superstar drug everyone loves. Even Harvard and Johns Hopkins have touted its many benefits. Some people even think caffeine (due to coffee houses springing up in Paris and London) may have sparked the Age of Enlightenment, though these things are hard to prove.
There may be some benefits to caffeine use, but in the end, it’s a drug. And it can really play games with you. I can’t tell you how many times I’ve had the following conversation with myself after quitting coffee:
“Wow, that was a great night’s sleep. I haven’t felt this good in a long time.”
“Why did I even drink coffee? What is so great about coffee? I hate coffee. Who needs coffee?”
“You know what would be good right now? A cup of coffee!”
Then I tell myself, “What’s the big deal? One cup won’t kill me.”
And that’s true. One cup won’t. But then I start drinking it every day, in increasingly larger amounts. Next thing I know it’s 4 a.m., I can’t sleep, and I just Googled “Is Taylor Swift still dating Travis Kelce?”
For me, in the end, it’s just not worth it.
But maybe you can handle it. Many medical students love coffee and energy drinks like Red Bull. But if you’re drinking them and having trouble sleeping, just consider cutting back on them, or even quitting them altogether.
Alright, so let’s stop attacking the most popular thing in the world and get into some other tips for getting a good night’s sleep!
Here are some things you can do to get a good night’s rest (besides quitting coffee).
11 Things Medical Students Can Do to Get a Better Night’s Sleep
1. Seek treatment for depression and/or anxiety.
If you think you might have depression or anxiety, you’re not the only one. A disproportionate number of medical students report symptoms of these mental health issues. They can easily disrupt your sleep, which only creates more stress, making it even harder to sleep, and so on.
Seeking treatment for depression and/or anxiety can definitely alleviate your symptoms and improve sleep quality. See if your school has counseling and psychological services (CAPS) or student health services. If not, see if you can get a referral from a peer or faculty member. Another option is to call the Physician Support Line, which has psychiatrists available to speak with doctors and medical students in need of assistance. It’s free, confidential, you don’t need an appointment, and you don’t have to be in a crisis to use it.
2. Use tried-and-true sleep hygiene techniques.
Sleep specialists recommend the following to get a better night’s sleep:
- Go to bed at the same time each night and get up at the same time each morning. (This can be tough if you haven’t slept, but try and stick it out.)
- Don’t eat (or don’t eat a lot) 2-3 hours before bedtime.
- Avoid exposure to bright light a couple of hours before bed.
- Avoid drinking alcohol 2-3 hours before bed.
- Relax in the evening (if possible).
- Get some sunshine in the morning or the early afternoon. Vitamin D levels have been linked to sleep variability.
- Avoid caffeine in the afternoon or evening. (Or even altogether? I promise I won’t bring it up again.)
- Reduce your exposure to electronics (computer screens and cell phones) 1-2 hours before bedtime.
This article lists a number of behavioral interventions you can use to improve sleep. Scroll down to the appendix for an excellent list of sleep behavioral guidelines.
3. Spend less time in bed.
Wait, what? Spend less time in bed? Yes! Some people who don’t get enough rest because they can’t fall asleep try to solve the problem by going to bed earlier. The idea is if they just go to bed sooner, they’ll still get enough rest, even if they have trouble falling asleep.
The problem is they usually just end up spending more time in bed struggling to fall asleep, which leaves them frustrated and upset. Then via classical conditioning, they associate the bed with stress and anxiety, rather than sleep.
The solution to this is to limit the amount of time you spend in bed, not increase it. This means you’ll spend less time tossing and turning. Additionally, staying awake longer will increase your body’s natural sleep drive, which builds up over time.
The bottom line is, if you want to get more sleep, spend less time in bed!
4. Don’t associate your bed with studying & stress.
Picking up on the previous point about the role classical conditioning can play in sleep problems, reserve the bed for sleeping. You don’t want to start associating the bed with things like studying, watching Netflix, or scrolling on your phone. That will just make it harder to fall asleep when you get in bed.
5. Think differently!
Cognitive psychologists have a fancy term for changing the way you think called “cognitive restructuring.” This is what it sounds like. Instead of filling your head with anxiety-laden thoughts about sleep, try substituting thoughts that are a bit more realistic.
For example, instead of thinking “I’ll never be able to sleep tonight” say “I’ve been here before and I’ve always gotten to sleep eventually.”
Which is true, right?
Or instead of saying “This is awful. If I don’t sleep, tomorrow will be a disaster” think “Even if it takes me a while to fall asleep, I’ll be alright tomorrow.”
And you almost certainly will be. Odds are, nobody is even going to notice you didn’t get enough sleep. If you’ve been putting in the work day in and day out, tomorrow won’t be the disaster you’re imagining it could be.
Even if you do run into trouble the next day because you’re tired, it’s not going to change the course of your career. If you have a bad exam or something like that, those things happen. But you want to get it under control for next time, so maybe reach out to student health services for help.
6. Don’t get upset if you wake up in the middle of the night.
If you manage to fall asleep but wake up in a couple of hours, don’t freak out. There may be nothing wrong with you! Some people think that for most of human history, it was normal for humans to wake up in the middle of the night for a couple of hours.
There’s a lot of historical evidence (though it’s been challenged) that until the Industrial Revolution, humans had a biphasic sleep cycle, in which they fell asleep shortly after dusk, woke up in the middle of the night for a couple of hours, and went back to sleep. So if you wake up in the middle of the night (or early), don’t assume something is wrong with you. You may be entirely normal, just living in crazy times!
7. Try not to procrastinate.
If there are things you’ve been putting off, be they financial, professional, or personal, try getting them done. For reasons probably related to the cumulative effects of stress, people who procrastinate are more likely to have trouble sleeping at night.
Also, when you’re ready to go to bed, don’t delay it. This is called bedtime procrastination, and it’s been linked to sleep problems, especially when people stay up looking at their smartphones instead of going to sleep.
8. Avoid napping late in the day.
If you’re getting up at six or seven in the morning, try not to nap past three or four in the afternoon. These times aren’t set in stone, but as a rule, napping later in the day can make it harder to fall asleep at night. If you’re having trouble getting to sleep, consider napping earlier in the day or eliminating the nap altogether. Easier said than done, to be sure.
9. Cut back on alcohol, or quit it altogether.
First I went after coffee, now I’m going after alcohol? I know, but I’d be remiss if I didn’t mention that even low and moderate amounts of alcohol can disrupt sleep. If you’re having trouble sleeping and you think drinking may have something to do with it, try to reduce or eliminate the booze and see what happens.
If you struggle with excessive alcohol use (which is more common among medical students), again reach out to your program to see what resources are available or call the Physician Support Line.
10. Try some relaxation techniques.
For centuries, deep breathing exercises have helped people get a good night’s sleep. Among the most tried and true breathing exercises is diaphragmatic breathing, in which you breathe by expanding your stomach and keeping your chest still. The effects of this are pretty remarkable. You almost have to relax when you breathe this way. Putting on classical music (think soft piano pieces by Chopin, Mozart, etc.) before bed also seems to work for many people.
11. If none of this works, reach out to someone.
If you try this stuff out and nothing seems to be working, be sure to reach out to either student health services or a trusted provider. Sleep specialists can help you! Maybe medication is the way to go, or they can share some other tricks of the trade to get you the zzz’s you need.
Final Thoughts
If you’re having trouble sleeping, don’t worry—many other medical students are having the same problem. That said, it’s something you want to get fixed, or your mental health and performance in school can start to suffer. Use these tips, and there’s a great chance your sleep will begin to improve. If it doesn’t, be sure to reach out to student health services or another trusted source. They can help you get the rest you need!
For more (free!) health tips for med students, check out these other posts:
