Narcolepsy is a neurological disorder typified by excessive daytime sleepiness. The symptoms of the disorder can be disabling, and for years treatment relied on amphetamines and related stimulants to help patients stay awake. For nearly 2 decades now, modafinil (Provigil) has been available to treat the symptoms of narcolepsy; modafinil has been the preferred wake-promoting drug due to its mechanism of action and safety profile that is distinct from traditional stimulants. It was long believed that modafinil could produce the benefits of the stimulants without the dangerous and unwanted side effects. However, a new study conducted by the National Institutes of Health (NIH), reported in the Journal of the American Medical Association, has shown that it might not be as different from traditional stimulants as once believed. Read more →

Residency training in the United States has historically been a period of abusive hours and intense training. Until recently, there was no limit to the number of hours per week a resident could work. In fact, that has something to do with why they’re called “residents” in the first place: they practically lived in the hospitals in which they worked.

Then came the Libby Zion case, in which a young woman died while under the care of overtired residents. Suddenly America realized that it probably wasn’t a good idea to have inexperienced doctors taking care of really sick people on less than three hours of sleep per night. Read more →

I’ve been thinking about sleeping a lot lately. Not in the sense of curling up under the blankets for hours on end, but in the sense of thinking about the topic of sleeping. As the program director of an internal medicine residency program, one of my jobs is to make sure that my residents are rested enough to provide appropriate patient care. I was under the impression that they were. But recently, the Institute of Medicine (IOM) came to the conclusion that many residents are still sleep-deprived, posing a threat to the safety of patients under their care across the United States. Based on this conclusion, the IOM made the bold recommendation that after 16 hours of continuous work, residents must be allowed an uninterrupted five hour block of time for sleep, preferably between the hours of 10pm and 8am. Read more →

On December 2nd, the Institute of Medicine (IOM) released a report suggesting that resident physicians have further limits on work hours than those enacted in 2003 by the Accreditation Council for Graduate Medical Education (ACGME). While the number of hours per week would remain at the ACGME maximum of 80, the IOM recommends on 30-hour shifts that a “protected sleep period” of 5 hours occurs between 10pm-8am. These measures are aimed at reducing physician fatigue and the number of resultant medical mistakes. Read more →

The Lancet recently published clinical trial data from a Harvard study which compares the experimental new drug tasimelteon to placebo in treating jet lag. The medication works by binding to the same receptor as melatonin, and activating it as a direct agonist.

Melatonin is a neurotransmitter produced by the brain that is believed to play a pivotal role in the regulation of our “biological clock” or circadian rhythm. Melatonin levels fluctuate in the bloodstream throughout the day, and surge during the nighttime hours when it is dark outside and our bodies are inclined to sleep. The trouble with melatonin is that it falls under the FDA category of supplements and nutraceuticals, and is therefore largely unregulated in terms of potency, manufacturing process, and quality of ingredients. Studies are hard to conduct and successfully repeat for this reason as well. Read more →

These days, sleep is often seen as an expendable resource. With so much work to do and limited time to accomplish tasks, going to sleep later and waking up earlier seems so natural. For some people, lack of sleep was used to prove toughness and stamina. It was common for physician trainees to boast (in some cases complain) about getting little sleep. However, studies showing suboptimal patient care when residents are sleep-deprived have resulted in shorter working hours and mandatory time off after a number of hours at work. Read more →