On the other hand, numerous studies -- including the link at the top of this page -- conclude that this is the worst way to get anything done.
They can't both be right.
"20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors."
A Wikipedia article focused on medical resident work hours: http://en.wikipedia.org/wiki/Medical_resident_work_hours
And, as other posters have pointed out, this is despite legislation limiting the number of work hours. The fact of the matter is that if you were to actually work to the letter of the law you'd be sneered at, receive poor evaluations, and patients would suffer because there'd be no one around to do the work.
Most programs argue that these hours are necessary to train surgeons since there's not only the usual cognitive side of medicine, but also the technical side of cutting, sewing, etc. That being said, 70% of the hours I put in at the hospital are BS "scut" work which could be automated, streamlined, or passed off to assistants. The actual challenging decision points are few and far between.
Thus, even the 10,000 hour rule--which a lot of programs use to defend their dismal hours--misses the mark completely since, well, the practice isn't focused.
I don't think surgeons are going to be replaced by robots in a significant way for some time, but I would like to see the hands-on part of surgery being performed by techs. A three year, well planned course would be plenty to turn you into a competent operator--as competent as many just-licensed MDs. After all, do you really need 10 years of academic training (four year undergrad, fours of medical school, two years of little operating as a junior resident) to screw bones back together? Why should we expect surgeons to be technically AND intellectually gifted?
We are expecting new duty regulations later this year in response to scientific data on fatigue and the crash of Colgan 3407. Currently the data shows that on a four-day trip we are equivalently drunk with fatigue by the afternoon of day three even with around eight hours of sleep. Most people really need about nine.
Personally, I've never intentionally flown fatigued but I have been surprised by it. By the time I notice I'm fatigued the heading indicator looks like alphanumeric soup and I cannot differentiate 030 from 300 from 330 without the utmost concentration. I tell myself to "THINK, DAMN IT", but that is futile. It is something that cannot be overcome.
Having this experience, there is no way I'd want medical attention from fatigued doctors. Sleep is important for any safety sensitive job. It's always better to error on the side of safety.
Absolute bunk. Doctors are the last people in the world who should "insist they are not affected by sleep deprivation." Their whole job is to make decisions based on medical evidence. It doesn't affect you? Prove it. Show me a study looking for correlations between medical errors and sleep deprivation. Show me a study measuring alertness at the end of an 80-hour work week. Don't give me anecdotes. Give me proof. To do otherwise, as a doctor, is hypocritical.
Here's my anecdote: my wife is a resident, and she comes home from a 30-hour shift so tired, she's nervous about driving and sometimes feels like she has the flu.
Is she just weak? Should other doctors look down on her?
Not without a rock-solid study to prove their point. Instead, doctors seem to have a hazing mentality - "I survived this, so you should have to, too." But it's really a question of medical fact: how do medical work schedules affect patient outcomes? Any doctor who doesn't see that is being dangerously irrational.
A simple test, that worked very well for me, was testing my reading speed (I know it is only a weak indicator for mental acuity, but it is easy and fast to test).
Under perfect conditions (well rested, optimal nutrition, completely silent room, no visual distractions, after mediation and a good cup of green tea) I am able to read about 800 WPM (which is not to bad) of the kind of text I usually need to read with good retention. For me this declines rapidly to less than 200 WPM (which is quite bad for a "knowledge worker") with sleep deprivation and/or a noisy environment, even though I believe I am doing fine.
That being said, even though I would say that doctors are handicapped "mental performance" is handicapped by their working conditions, I fully agree that it is better for patient safety to not hand off a patient to a new doctor say every 8 or 12 hours due to the amount implicit knowledge that a doctor gathers during a >24h time period about his patients that can't be transferred in a handoff.
Software Developers, imagine what a screw up it would be if you'd have to hand off your code every 8h to another developer, who'd have to continue right were you left... add to this not having a version control system, spotty test coverage and highly ambiguous specifications
While this may be true, the process of the handoff could be vastly improved. My wife is a resident, and the quality of info she gets during a patient handoff varies drastically, from detailed notes in a computer, correlated to medical history, to scrawled notes on paper. Sometimes she has to start from square 1.
Maybe the reason handoffs are harmful is because they're done poorly. And maybe they're done poorly because the doctor who's handing off is freaking exhausted.
It's like a guy who's driving home after a 20 hour day that ended with a couple of drinks at the bar, calling home from the car to tell the wife that he's on his way and his driving is perfectly safe. In reality, he is so impaired by the tiredness, the alcohol, and the distraction of the call that he can no longer even understand how far off his game he must be, nor judge the horrific risk he must be taking by driving in that way.
Still, it's rather hard to see a way for a sleep schedule like this to be viable for most people unless it becomes the dominant way that people find their rest (which is hardly likely).
I don't have any personal experience with this though.
(just for kicks, if you worked 10hour days for 7 days a week that is only 70 hour work week... doctors work at least 12 hour days, and usually 16 hour days to get to the full 80 hours!)
Oh and as far as weeding out?
Most 'weeding' out happens first and second year of medical school. In my class alone about 10% of the class failed first year exams, and they were forced to repeat or retake the whole year. (which SUCKS when you just paid $37,000 for a year of school that meant nothing). Then Second year weeding happens again with STEP1 licensing exam:
"Overall pass rates for first time USMLE Step 1 test takers are: 92% for U.S. M.D. medical school graduates, 81% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates" http://en.wikipedia.org/wiki/United_States_Medical_Licensing...
Fail a year or a board exams? You pretty much can only be a psychiatrist or family doctor with little or no hope of every specializing.
My SO is a medical resident. They really are placed in unstable situations (to use a math/physics term). They are required to work 80 hr/week. If they report working more than 80 hr/week they get into trouble for a duty hours violation and yelled at for being "inefficient". If they report less than 80 hr/week they get in trouble for being slackers (a.k.a. "unprofessional", actually that's a catch-all phrase for anything the speaker doesn't like). No serious thought seems to be given to increasing staff levels.
And that's the problem (not your problem but the profession's problem) - the hope is to specialize whereas being a family doctor is the booby prize.
Well I know abut family but why psych?
I know one person who dropped out, but was at married to another resident, so has a safety net. Another resident dropped out due to a medical condition that prevented him from standing for hours a day and landed a job at McKinsey. Another friend dropped out and became a receptionist! Eventually she went into a residency for a lower stress specialty (surgery -> psychiatry).
The only area that learning how to deal with sleep deprivation would be a benefit is surgery and critical care areas (ICUs). But then again, if you could schedule things better and get more doctors in, maybe these doctors don't have to learn how to function on 5 hours of sleep.
I think you're right to the extent that the current medical service system requires doctors to learn to sleep less and less while functioning on an acceptable level (note that I didn't say satisfactory or even exceptional). But I think that's begging the question. Shouldn't we be able to change the current system and allow doctors to focus on building skills/knowledge, not the ability to function without sleep.
tl;dr: sleep deprivation is not a necessary part of being a doctor if we change the system, so saying that doctors must learn how to deal with sleep deprivation is a circular argument.
Frankly, I'm surprised that as many doctors make it through - the working conditions are pretty terrible. Maybe the pay makes up for it, but you only get paid well once you get out of your residency or fellowship.
Better conditions will probably produce better doctors, not subpar doctors.
EDIT: Applied s/two/too
(I'm not specifically picking on Caltech undergrads, BTW. I'm fairly sure this is typical at most schools.)
This may be true, but there are also plenty of students who work from the moment they wake up until the moment they go to bed and still don't have enough time to get all of their assignments done. The problem is that functionally there isn't really any difference between having a 3.5 GPA and a 2.0 GPA, so at some point most people figure out that what they're being asked to do is impossible so they might as well just do their own thing.
Once you're doing real work, turning down work will not make you lazy; it will be an opportunity to say, "Sure, I might be able to assist you with that, but you will have to talk to <important person> and <other important person> about the impact on my work on <important project> and <other important project>."
"Oh... no chance of my project taking priority over those. Shoot, and I really need it done this quarter."
"I think <junior developer> can do the job for you. He might need a little guidance, but if he does, I will be happy to make myself available to answer his questions and point him in the right direction."
"Wonderful, thank you!"
If you postpone things that aren't important to you, but are important to your boss, that's not going to go well. If you postpone things your boss doesn't care about, in order to do a better/quicker job on something the boss considers important, that'll probably make your boss happy.
(Note, I'm using "boss" as short-hand for "your boss, and all the other interested parties, customers, etc. who can affect your boss's opinion of you".)
[Actually watching TV does provide a benefit: it's relaxing. The same is not true for assignments.]
``We are writing this sentence two days before the deadline. Unfortunately that sentence (and this one) are among the ﬁrst that we have written. How could we have delayed so much when we have known about this
deadline for months? (...)''
Certain classes are worse than others and it doesn't usually depend on the content of the course, but the people teaching it. I'd blame the culture of the faculty above the school, although the school likely influences said culture.
The faculty contributed from what I could see, but primarily in indulging procrastination by students. It was quite common for students to hand in the majority of a terms problem sets in the last week, and the professors would accept them even if there was a stated class policy that late assignments would not receive credit. (Of course, I acknowledge that this was particularly onerous to me, because I would be the one who then had to grade a full term worth of assignments in a week.)
I find that I need a pretty consistent 8 hours of sleep a night for normal operation. However, I've found that when I'm doing something challenging (say, a startup or a new project at work, or learning a new programming framework), this spikes upwards fast. I need about 9.5 hours when doing something moderately challenging, and up to 11 hours if it's a problem that requires my absolute full attention.
I remember reading somewhere a hypothesis that sleep exists so that your mind can convert short term working memory into long-term memory. Naturally, you would need more of this if your short-term working memory is more filled up with complicated stuff. But this goes at odds with the cultural practices at Caltech or MIT or med school - if it's true, you should structure the curriculum so that students work very hard during the day, but then have enough time to go home and sleep it off before learning the next day's lesson. I wonder if there's any research on this.
I find I also dream very vividly when working on a hard problem, but this could just be correlation, as REM cycles increase in frequency toward the end of the night, and if the night is extended, there ought to be more of them.
It rings very true to me. I believe that people who have trouble sleeping are often people who didn't learn that much that day, and conversely, people who learn on a given day seem to need more sleep.
I noticed this with my kids. A few months before they started learning to talk, say, at about 13 months, they seemed to need more sleep, even though they weren't exercising any more. This is the period that you can really begin to see them starting to "get it", about a lot of things in their world. Even though they aren't talking yet, they are beginning to understand what you are saying, so they are learning fast.
13 months has to be within a month or so of the median age for starting to walk (in my country at least, I know some start much younger) but you say your kids didn't increase their exercise; presumably then they were already walking at that age?
We have 2 boys that have been treated almost identically, obviously there have been differences and only one of them is a first child. However they have so far had vastly different sleep patterns. The one who sleeps least appears to have developed fastest in linguistic terms. His brother, the slower, was certainly no slouch (and without wishing to boast) is pretty close to top of his class for reading despite being one of the youngest.
I meet quite a lot of different parents & babies/toddlers from different backgrounds and find there are a lot of variations in sleep pattern - I don't have anywhere near enough contact with them to establish correlations with development and sleep pattern though.
My kids could be outliers. I'm sure such studies must have been done?!
tl;dr anecdotes are anecdotal and my experience doesn't bear out your hypothesis
You don't hear the student bragging about how he got enough sleep last night and got all of his work done ahead of time.
I'm an undergrad at Stanford and I think that if you plan ahead well enough it isn't difficult to get enough sleep and get all your work done. It's not only about managing time during the term, but also about managing which classes you take together term-to-term.
There is also something to be said for developing endurance. Eventually you're going to have to do something you don't want to do while incredibly tired.. so pulling all-nighters is a kind of training for that.
Top colleges, military training, and most early stage start-up environments all have either explicit or implicit cultures where part of the values indoctrination is to "achieve under fatigue".
It isn't about what's optimal for long-term productivity or health. It's about gauging mental toughness and weeding out those individuals without an adequate level of committment to that particular community's values.
If the individual can perform adequately under an extreme depravity of conditions, then they can be expected to excel, or at the very least, fall back to an acceptable baseline of trained performance when provided the surfeit of resources available under day-to-day tasking.
</socially undesirable fact of the day>
I sleep much more now. Left to my own devices, I adjust to a roughly 28-hour clock during which I sleep 9-10 hours a cycle.
What we humans fail to see is that running out of hours in a day to study (work et al) should not equal to cutting back on sleep. Cutting back on sleep is a quick & dirty approach but has its negatives which the article pointed out. If only we could see our consequences of these actions using some monitoring tool/data I'm certain many folks would be in a better position to balance/optimize their study and sleep patterns.
So, both the article and these schools can be right ;-)
Why the upvotes? is it because everyone is tired?
In the past I've experimented with quantities of sleep, polyphasic sleep, measuring sleep quality, light / sound in the room, sleep supplements, etc, etc. Why? because sleep takes up 25-30% of my life. Its a no brainer activity for me to try to hack and optimize. Further, given sleep is such a big part of all of our lives, I'm surprised more people on this site do not have a similar mindset about experimenting and tweaking their sleep patterns.
Show me some articles with new research, personal experiments, or useful tips that can allow me to hack my sleep - these kind of interpretations are much more useful to digest.
And no, I'm not tired.
So the article is useful for me, hence the upvote. I do agree about 3) though.
If your account is less than a year old, please don't submit comments saying that HN is turning into Reddit. (It's a common semi-noob illusion.)
I don't think being defensive of quality is a bad thing though. It's often unnecessary, but I'd say that's better than being under-cautious.
Most realities are harsh to accept; but that doesn't change anything. Don't you see that some non-sense posts are making at the top here? And that is happening more too often?
I don't deny that today HN has the best of Internet and Techie crowd; but it is also a fact that there is also some junk. So let's accept it.
And yea guys, thanks for the down rating; much appreciated.
However, in normal running mode, 6 hrs (as long as I'm getting exercise) feels normal to me and it's what I sleep even without an alarm unless I'm recovering from severe sleep deprivation (I don't drink coffee and generally just drink tea when I really need to stay awake...). What are other people's experiences? Somehow the dark room scenario in the article seems unrealistic. I do agree that for creative work that more sleep (in my case 6 hr/night) seems necessary--but if I find myself sleeping longer (like say 9 hrs), then I just end up feeling more tired...
I'm probably making more errors than I would normally but they're mainly minor. By about 8:00 pm I get pretty fatigued and I may nap for 10 minutes at this time, to recharge for the evening.
The work I am doing is challenging but for the moment doesn't require a lot of creativity, so the tradeoff between the sheer amount of work I can get done versus the decrease in errors is worth it to me at the moment.
I do exercise pretty consistently however (approx. 4 times/week for 30 to 45 minutes) and I find this invaluable in terms of keeping me less stressed and more productive.
The broken link there is meant to point to (http://www.sleepfoundation.org/article/how-sleep-works/how-m...) and I can't spot where it mentions this study.
In any case, you put me in a room with no clock or windows (and presumably no serious stimuli as it's likely to influence the results) and I can bet you I'll sleep twice as much - out of pure boredom.
The "executives" who sleep < 7 hours need to fine a hour more. If I was a board member, I'd insist my C-level team sleep 8 hours!
Fortunately, our two bar prep professors were not only licensed attorneys, but also Ph.D.s in neuropsychology. Part of our rigorous training therefore was not simply learning the law, but actually learning how to learn -- in particular, how to store and recall so much data on demand -- and above all, how to manage our time. (It turns out the human brain is actually quite good at writing and storing data, but really bad at what can be best described as "random access memory" operations: recalling random data at will, instantly.)
A great deal of emphasis was placed on structuring extremely precise "living schedules," for example, what to study when, for how long, when to eat, what meals, and above all, how and when to sleep. And how to force ourselves to sleep when we couldn't.
Long story short, forcing ourselves onto regular sleeping patterns was both immediately necessary and yet proved to be one of the hardest disciplines to learn: to force yourself to stop studying at a given hour (typically 10PM) even in the midst of learning something, and allow time to drive home, have a snack, rest, unwind, and then fall asleep by 11PM, to then awaken at 7 and be back at the library at 8... every single day, for 2 months... that was truly an act of willpower. Especially for me, as I've always been the personality type where, once I start doing or learning something, I can't stop until it's totally finished or mastered. Forcing myself to stop studying without having yet completed the particular matter was excruciatingly difficult.
The same thing proved true for the three-day bar exam itself of course: had to sleep between 9 and 10PM and awaken by 6AM, with virtually no studying at all in between days. At this point, you just had to trust your brain to marinate on all that it had absorbed in the 2 months leading up to those fateful three days.
Looking back on it now, it was due largely to my discipline with sleeping habits that I was able to pass the bar on my first try.
I would ascribe your success to proper nutrition, proper mnemonics, adequate sleep, and lots of studying.
Getting enough sleep (and not too much) is important but what is the advantage of keeping it within those tight boundaries? The natural human sleep cycle is often running on non-24 hour cycles and the science I've seen indicates that if you CAN work on these cycles it enhances memory, cognition and creativity.
I don't understand why you give so much credit to your rigid sleep schedule, especially because all the science I've seen indicates that what is important is getting adequate sleep and then studying properly, not sleeping at particular times.
Obviously I didn't mean to exclude the value of the actual studying, I'm just saying that studying -- without proper sleep and sleeping schedule -- would have lead to physical and mental and fatigue. And the nature of the bar exam material makes it virtually impossible to adequately perform on a sleep-starved mind.
"How to store and recall so much data on demand" sounds interesting too.
I'm currently testing it. The last two days I went to bed at a time which the tool suggested; getting up wasn't much of an issue, and I felt some improvements, but it's definitely too early to say that it works for me.
Sleep doesn't work in neat 90 minute cycles. They're really longer in the early part of the night, and get faster and more biased towards REM in the later part of the night. The details are very individual and also vary night to night, so you can't predict with any accuracy at the start of the night what stage you'll be in at 7:00:00AM the next morning.
(Anecdote: A friend of mine used to swear by a theory, mostly as a joke, that the recipe for good night's sleep was sleeping an odd number of hours. One day he came all happy and said, "Thank God 15 is an odd number!")
Is that really all that's happening here?
I've read articles about high functioning executives that barely sleep at all and seen studies about less sleep improving lifespan along with all the standard sleep is so important articles. I think its safe to say the jury is still out on this subject and keep hoping it doesn't continue to over saturate the news/science pipeline for much longer. Until there is a definitive answer you'll continue hearing me say "sleep is overrated".
Athletic activity causes actual physical microdamage that takes rest time, nutrition, and hormones to repair. The elevated secretion of human growth hormone during REM sleep is a significant reason why athletes perform better on more sleep.
No such analogue exists for the human brain. Mental activities, at worst, deplete neurotransmitter levels. I have seen no evidence to suggest that massive dosages of sleep do a better job of restoring these levels than minimally adequate amounts.
The systems of the body are not neatly partitioned into modules.
I will absolutely concede that there is a threshold where sleep deprivation will negatively impact my (or anyone's) ability to perform, its just a question of what that threshold actually is.
The surveys I can find associate "normal" amounts of sleep with better lifespan, and both abnormally high and abnormally low levels of sleep (<5 or 6 and >9 or 10 hours, depending on the study) with various negative outcomes. E.g. this meta-analysis pools prospective studies looking at heart attack and stroke rates: http://eurheartj.oxfordjournals.org/content/early/2011/02/03...
Sleeping less than your own individual sleep need probably does not improve life span. The participants in the studies you're referring to who slept vastly more than others were those with sleeping disorders, some with extremely bad sleep apnea. They felt the need to sleep more because the quality of their sleep was so poor. But of course, having a lot of poor-quality sleep is not equivalent to having fewer hours of good-quality sleep.
The contribution I would like to make to this discussion is that each person's sleep need is individual.
Normally, I get 5 hours per night and I rarely experience low levels of functioning or excessive fatigue.
And as other have pointed out, the methodology of the cited experiment in the article is highly suspect. Any normal human being, locked in a room with no stimuli, is likely to sleep as much as possible to pass the time.
That's probably not what's happening with you if you naturally sleep 5 hours per night without an alarm though. If you are using an alarm, you should try sleeping as long as your body feels like for two weeks. Don't block sunlight from your windows, let the sun make sure you wake up if your body thinks you've slept enough. If your body thinks you are still not rested, it will keep you asleep even in sunlight.
Heck, breathing is more important than all those things. Go without it for 4 minutes and you're dead. However, many people recommend controlling and slowing your breathing as a way to relax. Is that breathing deprivation?
The OP defeats a straw man. He argues against complete deprivation of sleep, yet his conclusion is based on sleep that isn't limited at all. Proving that something can't be done without entirely is far removed from proving that we can't cut back a bit.
He might be right, but for an article intended to be persuasive, he does a bad job of supporting his thesis.
2) Go to bed earlier
3) Start winding down at least 45 minutes before
4) Write down what's on your mind
Does anyone here have any other sleep hacks to share?
1) Wake up at the same time every morning.
2) Eat light in the evening, but have a small, low carb/sugar snack before bed.
3) Eat breakfast every day.
4) Drink caffeine before short (less than 25 minute) naps.
5) Ensure your bedroom is as dark as possible at night, and as light as possible when you wake up.
6) Sleep in the cold.
7) Stay away from bright light sources before bed (TVs, computers, bright house lights).
Worked for me the last couple of days.
Over the last 12 years, when I have worked with many people with a wide range of sleep problems, I have discovered that the problem is not in fact that we do not get enough sleep. I think that with the expectations we put on ourselves these days it is almost impossible to get enough sleep. I found that sleep (and food and the other methods we use) is simply not powerful enough to recharge our batteries properly.
Probably 50 years ago it was enough to eat 3 meals a day, sleep 8 hours a night, have weekends and a few weeks holidays every year and so on. My grandfather used to work in the City of London (financial district) and they went to the office in the morning, had a long, sociable lunch and didn't do much else for the rest of the day. Look at bankers and other financial people today and there is simply no comparison. So I believe it will become more and more essential for people to find ways of recharging their energy that are much more powerful than sleep, holidays etc. That's why we are seeing an increase in the number of people meditating, doing yoga and lots of other practices that build energy levels as well as rest.
A lot of us can function on much fewer hours of sleep regularly and don't believe it adversely affects our performance (It does affect mine though). Does anyone think there may be some selection going on here?
What I mean is, perhaps it's true that HN's distribution is more skewed toward the side of people who need less sleep (and hence has more productive hours in the day) and are willing to sleep less in order to get things done. Maybe we don't really represent the general population.
Just a warning in case anyone takes our testimonials too seriously.
Some research shows that mood is impacted more drastically than function. Since burnout and perseverance are such key topics (and emotionally dependent ones), maybe heroic sleep deprivation is an under-recognized threat to entrepreneurial success.
Avoiding thinking about things when you go to bed is something I am struggling quite a bit with. I will sure try out to write down my thoughts.
Any other advice to avoid your mind thinking too much when it should be winding down?
Contrary to some advice, I fall asleep pretty well with the TV on or something. If there is nothing stimulating at all, I just toss and turn and think about what else I'd rather be doing. I need a "light distraction" to put myself on idle, or I will start to actively invent my own.
There have been numerous studies showing a correlation between a healthy diet and sleep requirements. People who eat healthy have more energy and feel less tired throughout the day. In the same regard people with an unhealthy diet tend to feel more tired and nap more often and for longer periods of time.
Eating foods with a low glycemic index throughout the day will keep you grounded, preventing sugar highs and lows, and overall make you feel less tired.
My personal opinion based on my lifestyle is that my nutrition decisions directly affect my sleep requirements. I think it is most important to begin the day with a healthy breakfast upon waking up. This meal should include plenty of fiber, protein, and omega-3 fats.
If you're still unconvinced: http://www.gwern.net/Melatonin.html
Ngoc Thai: The Man Who Doesn’t Sleep
Exceptional book that really transformed my college experience.
Seriously? I bought the guy's argument up until that point.
i guess atleast 8 hours sleep is needed as my doctor said me.
you can also watch this video to help you more
Everything is equally important for life to survive, breathing, drinking water, food, sleep, exercise. How does it matter if breathing is more important that exercise? It is common sense; you obviously breath more than you do exercise.