Fatigue refers to mental or physical exhaustion that stops a person from being able to function normally. It is more than just feeling tired. Fatigue is caused by prolonged periods of physical and/or mental exertion without adequate time for rest and recovery.

The ACGME, and other accrediting bodies, have implemented requirements mandating programs to educate faculty and residents to recognize signs of fatigue and sleep deprivation.

The Signs

• Repeated yawning and nodding off during conferences
• Loss of ability to do something quickly
• Increased tolerance for risk
• Passivity
• Inattention to details
• Decreased cognitive functions
• Irritability
• Motor vehicle accidents / near misses
• Increased errors
• Impact on sleep process itself
• “Microsleep” The few seconds of sleep you don’t recognize occurred
• Sleep inertia (the confusion and dysfunction that occurs upon awakening from deep sleep)

What Can I Do?

• Develop healthy sleep habits
• Protect sleep times on your days off
• Nap 20-30mins every 12 hours
• Recognize you will be more prone to accidents
• Avoid or be judicious regarding medications
• Pay particular attention with “hand-offs”
• For sleep inertia: Anticipate it - get out of bed, stand up, and turn on the lights
• Review the app resources provided below

• Aim for 7-8 hrs nightly of sleep, especially after a busy rotation
• Keep to a routine when possible. Going to bed and rising about the same time helps.
• Limit stimulants such as caffeine and bright lights before going to bed
• Optimize sleep environment: Make the bedroom comfortable with appropriate mattress, pillow, cooler temperature, sound, and lighting level.
• Protect sleep time: Turn off the phone. Ask your family/ friends to help you. Try not to incur a sleep debt from non-work activities
• Get adequate exercise but avoid it directly before sleep. See resources under Gyms & Fitness Centers.
• Eat right. Avoid going to bed hungry; however, eating a large meal within 3 hours of sleep may keep you awake.
• Get light exposure when awake
• Develop relaxation rituals before sleep such as reading, meditation, or listening to music. After an intense day, decompress to help you sleep
• Get sufficient catch up sleep the days following your time "on call" and particularly your 24-hour period per week off. Avoid over-doing it to "make up" everything you haven't been able to accomplish. Make rest a priority.
• Get help. If you suspect a sleep disorder, seek appropriate medical attention and get it treated. Contact a Residency Advisory Committee member.