Going to university is a first taste of independence for most students and it can be difficult to find the right balance between a hectic social life, study and sleep.
But while occasionally missing lectures or submitting work late may not be a huge deal on a lot of courses, the pressure to perform starts on day one at medical school. And this often leads students to sacrifice sleep – and wellbeing – in pursuit of their studies.
Jokes about fighting exhaustion with caffeine and missing out on social events for an evening at their desks are a staple of online forums, and yet, alongside the humour, there’s a real sense that studying to become a doctor quickly sets you apart from fellow undergraduates.
This is certainly true when living in student halls of residence as James, a first-year medical student in Birmingham, discovered. ‘It can be pretty noisy during the night which makes it hard to fall asleep, and because of that, I might be less productive the next day,’ he explains. ‘I like to stay in my room to study but I find it hard to concentrate if there’s noise next door and I’m watching a lecture.’
With so much online teaching during the pandemic, James resorted to noise-cancelling headphones to focus, but he says many other medical students had the same problem. ‘I think the medical school needs to be aware of the particular needs of medical students,’ he adds. ‘For example, it would be good if they can provide dedicated halls or make recommendations for quieter accommodation.’
Safa, a second-year student in the south of England, was fortunate to be allocated accommodation with fellow medics who respect that everyone has an early start, as she points out: ‘When we leave in the morning, the night guard is still on duty in our accommodation, so it’s just a different life to other undergraduates.’
And while university traditionally gives young people the time and space to decide what they want to do, medical school can feel like beginning your professional career. Safa observes: ‘A lot of us started when we were 18 so we’re still figuring things out, but there’s added pressure on us to show the professionalism necessary to be a good doctor.’
This is particularly true when it comes to the General Medical Council (GMC) guidelines, which takes an interest in doctors’ behaviour if their professionalism is called into account.
Many students feel driven to keep up with their peers and to meet their own high standards.
Photo credit: iStock
Coping with burnout
The GMC’s standards for medical education and training requires learners to have access to ‘resources to support their health and wellbeing’. However, medical schools are still highly competitive and demanding, and many students feel driven to keep up with their peers and to meet their own high standards.
And in trying to manage their studies, placements and other obligations, some find themselves exhausted and overwhelmed.
‘It’s almost like: either finish these lectures or get a good night’s sleep,’ notes Safa. ‘Eventually that catches up with you and you realise: I’ve been sleeping five hours a night for the last two months and now I’m tired. And even if we do sleep, it’s not restful because our minds are racing and we wake up thinking: what next?’
Towards the end of her first year, with exams looming, Safa found herself struggling and sought help from her GP. ‘I was feeling pretty burnt out,’ she remembers, ‘I was constantly fatigued and had a real lack of motivation which led me to question if I’d chosen the right degree. While I wouldn’t say I’ve fully recovered now, I am doing OK and I know medicine is definitely right for me.
‘Looking back, I’d just found myself in a position where I felt I couldn’t do it.’
Exhaustion was also a major factor for Amana, a fourth-year student from Manchester who experienced the symptoms of burnout in her third year when she started to spend more and more time at her desk. She explains: ‘Rather than getting a good night’s rest and then reassessing the next day, I started minimising my sleep and my personal time, so I could dedicate that time to revision.
‘I kept saying no to people when they wanted to hang out. All I wanted to do was study because I thought the more I studied, the better my grades would get but actually I noticed my grade percentage started getting lower and I was lacking energy.’
Amana was lucky in that her close family noticed a problem and advised her that making time for other activities, including relaxation and sleep, would have a positive effect. ‘My mum told me to focus on myself more. She said your brain should absorb everything if you’re kind to it, but if you don’t give it what it needs, then one day it’ll just stop functioning.
‘I went into my fourth year with a very different approach. My advice to anyone else in this situation is that it’s good to do your best but if you focus on only one thing, you’re going to crash.’
Meanwhile, there’s been growing recognition of the impact of poor sleep on practising doctors’ mental health and patient safety. The GMC’s latest national training survey reported that three in five trainees said they ‘always’ or ‘often’ feel worn out at the end of the working day. And 44% feel their work is emotionally exhausting to a high/very high degree.
A recent MDU survey found that more than a third of respondents felt sleep deprived on at least a weekly basis and one in four (26%) said tiredness had affected their ability to safely care for patients.
Speaking anonymously to the MDU, one trainee revealed they had prescribed penicillin in error to a patient with an allergy at the end of a long shift in A&E. The patient recovered but the doctor had not forgiven themselves.
‘Due to staff sickness, I was nine hours into what should have been an eight-hour shift, during which time I had not taken a toilet break, eaten or drank… I am always so careful but it was the perfect storm of chronic fatigue, thirst, hunger, bladder discomfort, distraction and an unmanageable workload that contributed to my mistake on that day.’
There’s little sign that sleep deprivation horror stories have dented the popularity of medicine as a career – UCAS applications to study medicine in 2022 went up by 3.5% on the previous year. Nor has it lessened the commitment of the medical students we spoke to, although they recognised the impact of fatigue on their performance and their mental health.
However, there remains a nagging sense that feeling constantly tired is the price you pay for pursuing a medical career, while the crowded undergraduate syllabus doesn’t leave much room for sleep medicine. And without wider recognition of the importance of good quality sleep, there’s a risk that students will fall into unhealthy sleeping patterns at medical school that will cause lasting harm.
Interview by Susan Field.
Nine tips for sleeping soundly
Dr Michael Farquhar is a consultant in paediatric sleep medicine at Evelina London Children's Hospital, part of Guy's and St Thomas' NHS Foundation Trust, and educates healthcare professionals on the importance of sleep.
Here’s Dr Farquhar's advice for ensuring you get a good quality sleep.
- Create a regular sleep routine to figure out how much sleep you need to function. Adults typically need seven to eight hours' sleep each night.
- Keep well hydrated and stick to a regular eating pattern. Junk food and alcohol have been linked to lack of sleep.
- Don't depend on caffeine to get you through the day, as it can affect sleep quality and duration for up to six hours. That said, drinking caffeine before a short breaktime nap can help you wake up feeling refreshed.
- If you can, try to 'bank' sleep if you’re expecting to work late over an extended period and then try to return to your normal sleep routine as soon as possible.
- If you’re returning home late, a light meal is a good idea but don't be distracted by TV or other electronic devices as this can impact your sleep.
- Create the best possible environment for sleep. The ideal is a cool, quiet, dark room and a comfortable bed.
- Make time to relax and unwind as you usually would. Don’t be tempted to let this slide – it should be just as important in your routine as study and work.
- If you wake up during the night, try breathing exercises to help you relax and get back to sleep. If this doesn’t work, try an activity that distracts your mind for a while but avoid picking up electronic devices.
- Get advice if you feel you’re struggling to manage your work-life balance or you’re feeling stressed and unable to sleep. Don’t self-medicate as this could easily make things worse.