To identify sleep strategies of Internal Medicine residents transitioning to night shift and report their effect on performance.

Residents logged hours of sleep and work starting three days prior to the first night shift and continuing through the next eight days. Cohorts were defined by sleep logs and compared separately by transition strategy, total hours of sleep, amount of sleep occurring at work, weekend sleep schedule, and residency training year (PGY). Data from logs were entered into the Fatigue Avoidance Scheduling Tool to measure predicted Performance Effectiveness (PE) during each night shift.

Twenty-three residents were evaluated. The Sleep Banking transition strategy (n = 2) had higher PE (mean = 88.6%) than all other sleep strategies combined (n = 21, mean = 80.9%) [p=0.016]. Additionally, residents who slept an average of 8-9 hours daily during their week of night shifts had a higher mean PE compared to those who slept <6 hours (86.8% vs. 78.6%) [p=0.014].

Residents who engaged in Sleep Banking prior to the first night shift had higher PE and spent less time above a 0.05% blood alcohol concentration (BAC) equivalent compared to all other strategies. Similarly, PE and time spent above a 0.05% BAC equivalent improved with increased average hours slept per day during the week of night shifts. Optimizing performance on night shift through the adoption of efficacious sleep strategies is imperative to mitigate patient safety issues that may result from poor alertness and cognitive abilities.