Before you started studying / working in medicine, how many hours of sleep did you get a night (on average)? What happened to your sleep during med school, residency, and beyond? Sleep, and the lack thereof, is so tied up in our working hours and such a tradition in medicine, that we almost take the lack of it for granted. Sure, things seem to be improving, but, we will argue, the current system which ignores the fundamental right to rest is bad for patients and doctors.In this piece, we will also explore the detrimental effects of sleep deprivation in medicine and shed light on the urgency of prioritizing adequate sleep for physicians.
How many hours is OK?
How many hours of work a week is acceptable? How many hours can a human being work in a highly cognitive job before their error rate increases? How long can a person be awake and still make safe life-or-death decisions? What is the effect of too little sleep on physician mental health?
In the fast-paced and demanding world of medicine, sleep deprivation has become an all-too-common companion for healthcare professionals. As we navigate through long shifts, unpredictable schedules, and the weight of patient care responsibilities, our own well-being often takes a backseat. However, the consequences of sleep deprivation on our physical and mental health, as well as on patient safety, cannot be overlooked.
Yet we seem to accept this constant state of deficiency as the norm. As a 2017 Atlantic article stated so succinctly, “Neither truck drivers nor bankers would put up with a system like the one that influences medical residents’ schedules.”
What is sleep deprivation in medicine?
Sleep deprivation is a condition characterized by insufficient or inadequate sleep, resulting in a cumulative deficit of sleep over time. It occurs when an individual consistently fails to obtain the recommended amount of sleep required for optimal functioning and restoration of the body and mind. In the context of physician and resident working hours in the United States, sleep deprivation has been a significant concern due to demanding schedules and long shifts.
I have shared in our anonymous peer-support group meetings about driving home after 30 hours awake. I ran a red light. I am lucky no-one was killed. I got pulled over. The cop, very kindly and luckily for me, saw the state I was in and offered to escort me home!
As Dr Jillian Rigert has written about in our blog, “sleep deprivation was a main factor that led to my mental health decline”. Further, Jillian felt “embarrassed that I was exhausted from sleep deprivation. I was embarrassed for craving the basic needs of a normal functioning human… sleep.”
How many hours of work a week is acceptable? How many hours can a human being work in a highly cognitive job before their error rate increases? How long can a person be awake and still make safe life-or-death decisions? What is the effect of too little sleep on physician mental health?”
The rules around sleep
In the United States, the working hours of physicians and residents have been a subject of scrutiny and reform due to the potential impact of sleep deprivation on patient safety and the well-being of healthcare professionals. Historically, extended work hours were common, with medical residents often working excessively long shifts and experiencing reduced sleep opportunities. This practice raised concerns about the increased risk of fatigue-related errors and compromised patient care.
The same Atlantic article states that residents in America are expected to spend up to 80 hours a week in the hospital and endure single shifts that routinely last up to 28 hours—with such workdays required about four times a month, on average. This is typically work more than twice as many hours annually as their peers in other white-collar professions, such as attorneys in corporate law firms.
The rules governing medical resident hours in the United States are primarily set by the Accreditation Council for Graduate Medical Education (ACGME). These are often referred to as “Duty Hour” or “Clinical Experience and Education” requirements. As of 2026, the core framework remains centered on the “80-hour rule,” though there is built-in flexibility for certain specialties and levels of training.
Residents must not work more than 80 hours per week, averaged over a four-week period. This includes all in-house clinical and educational activities, clinical work done from home (like charting), and “moonlighting” (extra shifts for pay).
Scheduled clinical assignments must not exceed 24 consecutive hours – but residents may stay up to 4 additional hours to ensure a safe transition of care (hand-offs) or for brief educational activities. They cannot take on new patients during this extension.
Residents must have at least one day (24 consecutive hours) free of all clinical and educational duties every seven days, averaged over four weeks.
Residents should ideally have 10 hours (and must have at least 8 hours) off between scheduled shift.
After a 24-hour in-house shift, residents must have at least 14 hours free of duty.
In-House Call: This cannot occur more frequently than every third night, averaged over four weeks.
- At-Home Call (Pager Call): This does not have a “every third night” limit, but the time spent in the hospital must count toward the 80-hour weekly limit. Additionally, the “one day off in seven” rule still applies.
The rules around sleep
In the UK and Europe, resident (specialty registrar) hours are regulated by the European Working Time Directive. This law requires the working week to be an average of 48 hours, with further rights relating to break periods and holiday allowance, such as:
- 11 hours rest a day
- a day off each week
- a rest break if the working day is longer than six hours
- 5.6 weeks paid leave each year.
So despite a 32-hour difference in average weekly hours worked, there is no evidence that UK/EU physicians are inferiorly trained to their US counterparts. Whether this translates into better patient care or physician mental health in these countries is not known.
But intuitively, getting adequate rest has to be a priority for our physicians in training.
Compared to my internship and residency experience where I routinely worked 80-100 hours a week, the above seems like luxury. Yet we hear from US and UK/EU doctors about management pressure to under report working hours; and pressure from senior doctors to “be a team player”.
It seems that legal protection is an important first step, but culture shift is as crucial.
The impact of sleep deprivation
Sleep deprivation affects numerous aspects of our lives, including cognitive function, emotional well-being, and overall performance. Studies have consistently shown that prolonged wakefulness impairs attention, memory, decision-making abilities, and reaction times. These cognitive deficits can have grave consequences in medical practice, where split-second decisions and accurate recall of critical information are paramount.
Moreover, the emotional toll of sleep deprivation should not be underestimated.
Chronically sleep-deprived humans are more susceptible to mood disturbances, increased stress levels, and higher rates of burnout. As healthcare professionals, we already face immense stress due to the nature of our work. Sleep deprivation exacerbates these challenges and places us at an even greater risk of mental health issues.
Sleep-deprived doctors make mistakes
Patient safety is another area profoundly impacted by sleep deprivation in medicine. Fatigue-related errors can have devastating consequences, jeopardizing both patient outcomes and our professional integrity. Studies have linked sleep deprivation among healthcare workers to an increased risk of medical errors, medication mistakes, and adverse events.
The impact of these errors can be catastrophic for patients and contribute to the distress experienced by healthcare professionals involved
What can be done? A wake up call
Recognizing the significance of addressing sleep deprivation, healthcare institutions and professional organizations are taking steps to prioritize sleep health among medical professionals. Policies and guidelines are being developed to limit the duration of continuous work hours, ensure sufficient rest breaks, and establish mechanisms for reporting fatigue-related concerns. These efforts are commendable, as they acknowledge the urgent need to address the systemic factors contributing to sleep deprivation.
However, tackling sleep deprivation in medicine requires a multifaceted approach. Personal responsibility is a crucial aspect of this equation. We must prioritize self-care and make deliberate choices to prioritize sleep within our own lives. Establishing healthy sleep habits, creating conducive sleep environments, and practicing good sleep hygiene are essential steps we can take to protect our well-being. Recognizing that sleep is not a luxury but a fundamental pillar of our ability to deliver safe and effective patient care is key.
Supportive organizational cultures and leadership play a vital role in addressing sleep deprivation. Institutions must create an environment that encourages open dialogue about sleep health, reduces stigma surrounding fatigue, and supports individuals in seeking help when needed. Furthermore, integrating fatigue management programs and providing access to resources such as nap rooms or sleep education can be instrumental in mitigating the adverse effects of sleep deprivation.
Ultimately, Residents need legal protections based on science and backed up by institutional protections and culture shift.
Together we are stronger
We must also remember that we are part of a collective effort to promote patient safety and improve healthcare outcomes. By fostering a culture of collaboration and looking out for our colleagues, we can create a support network that recognizes and addresses the challenges of sleep deprivation in medicine. Peer support programs, mentorship opportunities, and shared experiences can be invaluable resources for managing the demands of our profession and navigating the sleep-deprived landscape together.
Conclusions
Sleep deprivation in medicine is ubiquitous and somehow accepted as normal when it is not. It poses a significant threat to our well-being and the safety of our patients. The cognitive, emotional, and professional consequences are undeniable. By prioritizing sleep, supporting each other, and advocating for systemic changes, we can mitigate the impact of sleep deprivation and work towards a healthier, safer, and more sustainable healthcare system.
Let us wake up to the importance of sleep in our medical lives and empower ourselves to provide the best care possible—both for our patients and for ourselves.
