Sleep and Studying Medicine - nap partners?

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I am a very lucky person. Extremely lucky in fact.

No, I didn’t wake up this morning to find myself already a consultant. I didn’t receive any declarations of love from the likes of Michelle Pfeiffer. I didn’t even win at bingo last Saturday (it was a one-time thing, I promise).

I’m extremely lucky for a very simple reason, and the wonderful thing about it is that if your priorities are anything like mine, then you’re an extremely lucky person too. Because one of the most fantastic and wonderful events in our lives happens every single day. Sometimes even twice in fact, especially in my case.

Now I could draw this out and tease you a bit about what on earth I’m talking about, but you’ve obviously read the title of this article, so you know where I’m heading. Yes, my fellow fortunate human being, I’m referring to sleep.

Sleep.
What a wonderful word.
Sleep. One syllable. No problems with pronunciation. No silent letters. Just a hissing sound and a popping sound sandwiching a lovely double ‘e’ which you can stretch as much as you want to. Sssleeeeeee-pah! Marvellous. But within this little word lies more or less one third of our lifetime. And what a great one third it is.

Ever since Adam first woke up, people have been going back to sleep on a regular basis. When we were newborns we used to do it practically all the time, waking up only for that other daily blessing: food. Then we entered the realm of school, and our sweet dreams started to be stopped abruptly at around six each morning. Our cries of despair were whisked aside, just as we were then whisked into a red van and sent off to get our education. One could argue that we never actually got used to this 6 a.m. alarm-bell, but by the time we had finished our secondary school it was slightly childish to complain about it, and after all it made summer seem all the better. Then our social lives started to kick in, and we found that there was loads to do during the late hours, whether we were out trying to acquire a taste for beer, or whether we stayed up watching television or chatting online. But since the 6 a.m. curse had yet to be broken, we were suddenly faced with drastically reduced sleeping hours. Some might argue that that’s why we were so moody and irritable, but word has it there’s some hormonal involvement too.

Fast-forward seven years and here I am in fifth year medicine. A nine-month climb towards the most important and mind-bogglingly scary exams of our lives. All our medicine, surgery, obstetrics, gynaecology, paediatrics and pharmacology, as well as hints of our anatomy, physiology and pathology, needing to be ingrained and organized into succinct topics that can be recalled on request as we sit by some bedside holding a patient’s hand and realizing that it’s not them who needs reassurance.

Now fifth year medicine is quite an ironic situation. As the big red circle around the month of June looms on the horizon, we realize that we need to stay awake for longer in order to study why, amongst other things, sleep is so important for us. We learn about the various stresses that the human body is subject to during its lifetime, and how all work and no play makes Jack a cardiology patient. We study all about the immune system (well, it’s on my schedule) and how it can start going haywire unless we get enough rest. But as we study these topics, we often realize that the house is eerily quiet, and that the sun’s rays are already creeping somewhere over Russia and heading in our direction. That’s right, it’s three at night.

Yours truly isn’t much of a nocturnal study type, and at the moment post-midnight studying is a rarity. But I’m writing this in February, and I can feel it in my guts that it’s only a matter of time.

Ah yes, my guts.

There they go again, rumbling away as I type. One of the various organs that isn’t too fond of fifth year. Because as we cut back on the sleep, and trudge home wearily from our morning grillings on the wards, it starts to show. Now I wouldn’t like to generalize in any way, but I think it’s safe to say that the prevalence of irritable bowels, anxiety, gastritis, pimples, headaches, irritability, and overall somnolence has risen rather steadily since the carefree days of summer. And we must not forget the number one complaint: the expanding waistline - because much as we disregard sleep, we find ourselves with less time to kick a ball around or bang one against a wall with a racquet. And just like the sleep reduction, it shows.

Now it’s hard to draw a clear-cut line as to how much sleep we really need. The fabled eight hours sound pretty straightforward, but going to sleep at ten isn’t very good for your social ratings at sixth form, and ever since we seem to have got used to sleeping late, especially since the dear old web came along. Thankfully, we Maltese seem to have hints of Mexico in our genes, so we can all turn to the great problem solver that is the nap.

Ah! The nap. Another very brief but very exquisite word. Especially nowadays.

It seems like the answer to all our prayers. Thanks to the nap we can cut down on our nighttime sleep as much as we wish, and then make up for it in the afternoon. The idea sounds even better when it appears that we don’t need to work out the length of our nap by simple arithmetic. The idea of ‘power-naps’ has been around for quite some time, and is based on the fact that even a short fifteen minute snooze can be enough for you to rest and keep going for longer. In fact, power-nap advocates usually say that they shouldn’t exceed thirty minutes, because by then you start drifting into deep (REM) sleep, which takes longer to wake up from. Apparently, Napoleon and Churchill were amongst those who got by on very little sleeping hours, boosted by numerous short naps, and although they never went through fifth year, they had other worries that were nearly as bad. So on paper, a series of fifteen minute slumbers should keep the average fifth year studying and fully alert till the wee hours. On paper.

God knows I’ve tried loads of nap techniques during the past months. As you may have gathered, I’m particularly fond of my bed. Give me a quilt, a pillow, and a cold, thundery night outside, and I’m a happy guy. But give me fifth year, and I’m slightly less happy. We wake up at the unearthly hour of half-six (no major complaints so far), and drive through mind-numbing traffic to St. Luke’s before tackling a good seven hours of lectures, ward-rounds, tutorials, clinical meetings and clerking, with the occasional sandwich-break. Most of those seven hours are spent standing up, whilst slowly realizing how much you have yet to learn about the topic at hand. The occasional telling off by the tutor helps drive this home. So at the end of it all, we rush home full of good intentions and plans about how to learn topic X once and for all. So far so good.

However, having slept around five to six hours the night before, when we do finally sit down at our desk at home and open our lovely textbook, we realize that studying is not what our body has on the menu. At this point, I often decide that in the long run a power-nap would help me study more. The problem is, however, that my fifteen-minute naps usually last from around four till around seven. And when I wake up and stare at my not-so-trustworthy alarm clock in horror, I vow that I will nap no more. Resistance, however, is of course futile.

The following day, after having had a good night’s sleep and feeling all pumped up and ready to face a nap-less afternoon, I sit at my desk. Knowing my luck the topic of the day will probably be haematology or some other haven of joy. As I start to scan the pages and jot down notes, my lunchtime pasta starts to get broken down within, and blood rushes to my abdominal regions. The seven hours spent standing on the wards start to catch up with my legs, and the mental strain of the morning’s toils starts to make my head throb. Over and above, my natural clock starts to reminisce about the previous day, when around this time I was huddled up under my quilt. Zapping downstairs for a coffee doesn’t even have a placebo effect any more; as I admit to myself that it will be quite a while before the caffeine kicks in. So finally, in what at the time seems like a decent compromise, I decide to remain at my desk and simply rest my head for a few minutes. I solemnly swear that at the time it seems like a reasonable idea, but as you can imagine, I awake a good two hours later, my Kumar glistening with what my atonic mouth failed to hold back.

By the weekend I am usually immensely frustrated as I look back on yet another not-so-great-in-the-study-department week, and declare to whoever’s listening that I will organise my sleep-life once and for all. But the truth is I enjoy sleeping, as I’m sure most of you do. We’ve been driven to the point where we sometimes see it a necessary nuisance that must be respected, or else the day’s work and play won’t be enjoyed to the full. But sleeping is fun! One of the most insanely magnificent feelings in the world is when I wake up on a cold morning, and as I grudgingly pull on a sock, I realise that my alarm was set to the wrong time, and that I can in fact sleep another hour. Climbing back under the warm quilt on a morning like this is enough to move a grown man to tears. I sometimes do this on purpose in fact, but it loses some of the effect.

My main worry, however, is whether this is a temporary state. I guess I can handle a tough nine months, and then be able to look back on my ‘harrowing fifth year’ with a nostalgic smile like some WWII veteran. But will this ever stop? Will my working life be even worse? Will I yearn for my days of leave if only for the fact that they offer more than five hours of sleep at a stretch? Am I ready for this?

I’d better stop asking these fatalistic questions because I get all scared and woozy in the head. And it’s not as if I don’t have anything to worry about at this point in time. After all, I doubt I’m capable of answering these questions right now.
For now, I’ll just sleep on it.




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