How do you deal when you're tired all the time?
June 19, 2017 11:44 AM   Subscribe

I'm a medical student doing my required clinical rotations. Like all of my classmates, I'm absolutely exhausted at the end of the afternoon. But somehow, I need to pull it together to study in the evenings. People who have had to work through situations like this, how do you do it? How do you make your brain work when you're tired all the time?

I'm getting 7 hours of sleep most nights, and I take a nap immediately upon arriving home mid afternoon (I'm about to nap right now). I'm also eating reasonably well and exercising regularly.
posted by ocherdraco to Health & Fitness (25 answers total) 11 users marked this as a favorite
I have found green tea a nice remedy for being tired at work. It has a lower caffeine content than coffee so you don't have that big crash later and you can sip it all day and it doesn't tear your guts up like coffee can.
posted by zzazazz at 11:48 AM on June 19 [3 favorites]

How long is that nap? Too short and it won't refresh you. Too long and you move past refreshed and end up even more tired.

For me, the best amount is 20-25 minutes and not a hair longer. I set my alarm. When the alarm goes off I feel super tired, not refreshed at all...but then within the next five to ten minutes of being awake my energy really returns.
posted by BlahLaLa at 11:57 AM on June 19 [5 favorites]

The science on caffeine naps is noncommittal at best, but they've worked for me in the past when I was working in the Middle East but had to work U.S. hours as well.
posted by Etrigan at 12:07 PM on June 19 [2 favorites]

Any chance you can do your studying in the early morning before you go on rotations?
posted by joan_holloway at 12:11 PM on June 19 [8 favorites]

What are you eating, and how much?

I recently went on a Keto diet (which involves cutting almost all carbs). What was illuminating was how the type of food, not necessarily the amount of food, has an effect on my energy level. For me, there were two patterns that I stopped that had an effect: 1) eating when I'm hungry (vs. eating on a schedule), 2) eating carb or sugar-heavy meals (pasta, sandwiches) all at once during lunchtime, which creates a food-coma like effect and make me sluggish.

Now, all bodies are different, and what works for me may not work for you. But I do suggest trying out different meal patterns - proteins & salads at lunch, and intermittent snacking on nuts during the day, for about a week, and seeing if that has a difference on your energy level.
posted by suedehead at 12:15 PM on June 19 [5 favorites]

Up your water. How's your nutrition? I am chronically exhausted but have more energy when I eat low carb (25g or less per day.)
posted by DarlingBri at 12:24 PM on June 19 [1 favorite]

"Eating reasonably well" means different things to different people. Any refined sugar (as in candy, cookies, soda) makes me very tired later in the day (one cookie in the morning would still be considered eating reasonably well by most people, but it has a big effect on me). Before I started avoiding sugar, I always felt like I was going to drop from exhaustion in the afternoon. I eat lots of complex carbs (brown rice, steel-cut oatmeal), and that doesn't make me tired at all.

Your schedule really taxes your body, so you might need to be more strict than most people in order to function well.
posted by FencingGal at 12:27 PM on June 19

I also came to say that I have TONS more energy and clear-headedness when I restrict carbs heavily (25-30g/day). I get no brain fog and I have a lot of energy until it's time to sleep and then I sleep incredibly soundly.
posted by quince at 12:34 PM on June 19 [1 favorite]

Are you a person who needs more than 7 hours of sleep? I am. Figuring that out about myself was a breakthrough that had the biggest impact on surviving a crazy schedule. I realized I needed to make 8+ hours of sleep a priority, which meant not being ashamed about a 9pm bedtime. That solved the root problem: being tired all the time.
posted by craven_morhead at 12:35 PM on June 19 [3 favorites]

Fixing the tired all the time will help in the long run. You. An look into the nutrition advice above, but I would also get your blood work checked. Vitamin D deficiency, iron deficiency or low thyroid could all make you sleepy.

My other suggestion is so take a short walk, like just a couple of blocks, before sitting down to study. Sometimes getting tour blood flowing can really help, but IME you don't need to do so much that you get sweaty, just want to raise your pulse.

Also, while you are busy are there things in your routine that you can stop? Sometimes when I have a lot of juggling to do to get everything done it makes me feel tired. This is totally a situation where I would eat my big meal of the day at the hospital cafe and do minimal cooking and subsequently wash less dishes at home.
posted by MadMadam at 12:39 PM on June 19 [1 favorite]

I am also a clerkship student now (hi). I do the bulk of my studying that requires mental energy on the weekend (or days off, depending on your call schedule). During the week I do daily Anki reviews on my phone, usually starting on the bus in the morning and then throughout the day at odd moments, and UWorld questions on my phone during any spare odd moments beyond that. If I don't manage to get to my Anki reviews during the day I'll generally do them on my tablet while I use the elliptical.

But yeah, I do not have energy in the evening to do much besides personal hygiene and feeding myself. I have to be awake at the hospital so I try to make sure none of my time there is wasted.
posted by telegraph at 12:53 PM on June 19

For me, the difference between 7 hours sleep and 8 hours sleep is the difference between "I can make it through another day" and "GOOD MORNING WORLD!" A nap ends up being more about damage control than making up the difference. In other words, 8 hours sleep is better than 7 hours + a 1 hour nap, for me.

Can you experiment with getting more sleep at night? You are clearly a very busy person, but it seems like an extra hour a day isn't impossible to carve out of your schedule.
posted by Cranialtorque at 2:06 PM on June 19

As someone who's very close to a medical student: Yeah, the "study before rotation" thing is not likely to work. Rotations typically start very early and end pretty late.

First thing, there's no fault with your biology. It's normal to feel tired when you're running on one of the most strict schedules in academia. Things like extra protein and lower but more consistent doses of caffeine can help,certainly. But part of this is just that med students are treated like workhorses and expected to be chipper about it too.

Give some food/sleep changes a try but if you are constantly tired, don't wait till a crisis point to ask for some accommodations(your school's counsellors should be able to tell you what can be done. I know several med students who have limits for on-call time,for example). There's nothing wrong with you for being tired, so don't expect yourself to be able to give it 100% all the time.
posted by InkDrinker at 4:29 PM on June 19 [2 favorites]

I find it helpful to plan ahead as much as possible so your week runs on autopilot. If you have Sunday off (say) and you can plot out what you want to study on which days the coming week, and grocery shop for a menu you predetermine, and pin it up on the wall, so that you don't have to devote any energy to thinking about what to eat and what to study, it's just already there and you can turn your energy to the task instead of thinking about the task.
posted by Eyebrows McGee at 5:16 PM on June 19 [1 favorite]

Drink a cup of coffee or green tea immediately before your nap and then it will kick it by the time you wake up, giving you the benefits of both the nap and the caffeine.
posted by Jacqueline at 6:02 PM on June 19 [1 favorite]

A few months back when I realised I really had to start pulling late night work sessions again despite my 30-something body not being as able to do so as my teenage self was, I gave up coffee.

It sounds counter-productive, but what it actually means is I gave up non-emergency coffee. I switched to decaf for my morning brew, and I don't drink caffeinated beverages except, at most, every second or third day, when I need that extra kick to stay up and work another couple of hours at night. It is so much more effective when used sparingly like this. If I have a week where I have to work late multiple nights in a row, it's tough, because I can't use the caffeine every time or it loses its effectiveness again, but if it's just a couple of late nights in a week, it works well.
posted by lollusc at 7:07 PM on June 19

I have found that meditation leaves me much less groggy than a nap, and I feel very refreshed and renewed afterward.
posted by Vermillion at 5:51 AM on June 20 [1 favorite]

On clerkship rotations, everything that goes on during the day is "studying," as long as you treat it as such. I did very little dedicated studying when I got home in the evening. Do the dedicated studying for the exams when you're not deathly tired - on the weekend if you have one.
I would take notes on what I was learning throughout the day, as things happened. Keep your eyes and ears open for how medicine is actually practiced - you'll remember better what the treatment for CHF is when you're linking it in your head to a patient that you actually saw. When people are talking about something you don't understand, look it up right away. Carry your resources with you - do those Anki decks or UWorld questions whenever you have a free moment. Read Pestanas, and whichever books you like, on the job, when it is appropriate. This will vary greatly for each rotation, of course. Attendings and residents often understand that you have to study for tests too.
If you have a second during the day and you're working with other residents or students stop and say, "I want to understand how you decide to operate on cholecystitis" and go through it step by step with your colleagues. Or just say, "I can never remember all the causes of pancreatitis" and your fellow students will likely be happy to review them because they need to remember it themselves.

If you feel like you absolutely must study in the evenings, give yourself a break first, where you don't think about medicine at all, then try to tackle it.

Actual advice on functioning while tired: Personally, I cut out caffeine entirely because the crash would leave me nonfunctional. I would also fantasize about how powerful my sheer will was when I needed to dig deep for energy (whether or not this was true, who even knows). The reality is that anxiety and adrenaline push you forward, though it's a terrible long term solution. You can think about how people's lives depend on you understanding medicine. However, your mental health is vital to succeeding so don't push yourself too far and allow yourself breaks when you need them!!!

Another strategy: if you aren't trying to go into a competitive specialty, don't kill yourself over getting good grades and just aim to pass. This is entirely valid.

If you just started rotations, have a little hope, I felt like I got better at functioning while tired with practice.
posted by bobobox at 6:05 AM on June 20

I'm going to give you some advice as a chronically ill person, who's tired all the time regardless of how busy I am (not to belittle your tiredness, just to say I have a lot of experience with being constantly tired!), and as someone for whom caffeine doesn't work.

First, give yourself some down time. You can't work all the time. You need some time for yourself. I'm sure you've heard this before, and I did too, but it took me a long time to realize that it really did increase my productivity--I used to think "I don't have time to finish all of my work, so if I take time to take care of myself, I'll have even LESS time to finish my work" when actually, if you take time to take care of yourself, you'll find you can get the work done in less time. Personally, I find doing something in the realm of creativity helps me--not necessarily being creative myself, but at least being adjacent to it. So, reading, listening to music, etc. I also crochet and knit and sometimes draw, but I find drawing seems to take more energy than any of the above. Find something that works for you that is relaxing but still stimulating. Try doing that for an hour or so after you get home, before you do any work.

Second, make sure to stay hydrated. Even if you think you are hydrated, try drinking a glass of water before doing any work. I find this can really clear my head and give me a little bit of energy.

Third, plan your study time. Every night, set up your schedule for the next day and mark out when you're going to study. I find having that commitment allows me to keep going for longer, and I don't get stalled as much before starting. If you get it into your head that once you get home, your day is done, your body will act like that. If you think of studying as a commitment and extension of your "workday," then you may find your brain stays "on" instead of shutting down as soon as you get home.

Fourth, set goals. When you have assignments and papers, it's easy to see yourself making progress because you complete things. When you're studying, you don't really get those moments of "I finished it!" to motivate you. If you have a lot of vocabulary, break those into chunks and attack them one at a time. If you have to study from a textbook, break it down into chapters or sets of chapters. If it's more nebulous, try organizing similar concepts into little "bundles" of stuff you need to learn. Write them down in a list, and check things off as you feel you've mastered them. That can help give you focus, and a sense of accomplishment that will keep you going.
posted by brook horse at 9:13 AM on June 20 [2 favorites]

Nthing the above suggestions:
- Caffeine
- Cutting out the nap and getting more than 7 hours of sleep at night (sleep hygiene)
- Very low carb diet. I did a Whole30 diet and the most impressive effect I noticed was that in the third week, I stopped feeling tired in the late afternoon. I ALWAYS feel tired in the late afternoon no matter how much sleep I get, how hard I'm working or not working, etc so this was quite incredible to me. It was almost worth staying on a Whole30 diet for... but the diet made me a complete jerk to be around so I had to sacrifice all-day energy for having a viable long term marriage.
posted by treehorn+bunny at 9:04 PM on June 20

I should note that during the Whole30 I almost completely quit caffeine because I didn't enjoy 'bulletproof' coffee (no dairy, no sweetener), making the all-day energy that much more impressive.
posted by treehorn+bunny at 9:05 PM on June 20

I haven't been tired today! I got up extra early, went for a short run, and did my studying before I had to get to the hospital.

All of your ideas have been very helpful.
posted by ocherdraco at 3:44 PM on June 21

I also switched to decaf coffee in the mornings--that is probably a significant contributor to the fact that I haven't been exhausted for the past two days.

Caffeine withdrawal headaches suuuuuuuuuuck, y'all. But they suck less than being perpetually exhausted.
posted by ocherdraco at 6:13 PM on June 22

Bee tee dubs, the non-tiredness lasted for exactly three days. Still trying to figure out what's going on.
posted by ocherdraco at 7:42 PM on July 9

I finished med school a few years ago, but I remember rotations. There would be some days that I would come home and pass out on the floor, in my scrubs, no shower, no teeth brushing, no dinner.

My advice is:
1) Let it happen sometimes. Sometimes, you just can't fight off the sleepiness. Don't feel guilty those days.

2) Eat lots of fruits and veggies and minimal processed/cafeteria food. This has done wonders for my wakefulness. It's hard to be on top of this as a med student, but it's important. Consider weekend meal prepping. Carry healthy snacks in your white coat pockets.

3) Don't go straight home after work. Go to a coffee shop or the school library. I'm much more likely to fall asleep at home.

4) Exercise - which it sounds like you're already on top of.

5) Set smaller goals. Like, you're gonna get through just 20 UWorld questions before bed, or 2 chapters of Case Files or something. If you need to study, better to accomplish something at least.

Hope this helps! Rotations are physically but also psychologically demanding - all the people-pleasing, long hours, confusion about what's expected of you. You'll get through it. Good luck!
posted by aquamvidam at 5:11 AM on September 14 [1 favorite]

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