Arora et al1 report that, even after following duty-hour regulation of the Accreditation Council for Graduate Medical Education (ACGME), residents continue to be sleep deprived. Still, hospitals entrust care of patients to these residents.
We agree that the Sleep, Alertness, and Fatigue Education in Residency (SAFER) program is a first step in the right direction in helping residents to reduce their sleep debt. In addition to attaining the minimum hours of sleep, we also need to focus on residents' altered circadian rhythm. This disruption results from multiple factors including an intermittent overnight call schedule and an inconsistent bedtime, which can give rise to a chronic sleep phase delay syndrome. This sleep disorder in itself leads to chronic sleep deprivation and daytime somnolence.
Yegneswaran B, Elshinawy A. Would Helping Residents Have a Regular Circadian Rhythm Improve Their Sleep Deprivation?. Arch Intern Med. 2008;168(4):435. doi:10.1001/archinternmed.2007.117