Sunday, July 26, 2009

Running for the Schedule- and Sleep-Challenged

Elle, a new Emergency Medicine resident, recently asked me the following:

Please, can you tell me any advice to continue running during residency?

First, you have NO IDEA how much running helps when you’re a resident. It’s probably more beneficial for a resident, mile per mile, than almost anyone else. So you really have to. What you’ll have to give up on is rigid consistency. Get three runs in per week no matter what and no matter when. When you get home – whenever that is – just get those shoes on and get out there.

For example, when do you run? After work or before? How does it affect you at work if you ran before a shift?

I run after. Nothing chills me out after a hard day better than a run; it’s a beautiful thing. Before work, I don’t yet have any built up frustrations/worries/anger/etc., so a run feels a lot less useful. And: I am unbelievably stiff when I wake up, so running feels less good physically. A lot of people are morning runners, though, and they tell me that it gets them ready for the day. I think it’s something you just have to figure out on your own. If you can switch up, you’re lucky. When I had the odd night shift, I would run in the afternoon, and it felt fine.

When is sleep more important (because I'm sure my sleep-deprived mind will always think sleep is more important)?

Hmmmm. Well, I came up before duty-hour regulations, and I never could sleep well at the hospital, and I need a LOT of sleep, so I guess I’m qualified to say this: running always trumps sleep.

Should I adjust pace or length of run for sleep deprivation?


If I don't go at all, say during a rough 4 week rotation, at what percentage of my original distance/time should I be running once I get back to it?

Maggot, you are NEVER going to not run at all. That is NOT allowed. I ran even when I was on an ICU rotation, sleeping at the hospital every third night, having work weeks that regularly ran over 100 hours.

Ahem. Anyway. If there is something terrible that prevents you from running – bad chest colds do it for me – how quickly you bounce back will depend on your “base” – how long you’ve been running. If it’s years, you only need maybe one or two easy runs (i.e., even slower than usual) before you’re back to normal. If you’re a newbie, it might take you a week or two.

Can you comment on running after a night shift? If I wake up and run in the middle of the day, is that better than other times to run?

That depends. If you’re up one night and then back to day shifts, take a nap, then get up and run, then go to bed at a near-normal time. If you’re completely switching to night shifts, you’ll probably have to figure out whether you can completely reverse your days and nights and run accordingly, or if you have to fit running in at odd times, which is what I did.

Anyone have any other advice for the schedule- and/or sleep-challenged runner?


Romance said...

I am utterly sleep deprived- adopted two withdrawing, born to an addict babies back to back staring the end of 2006 while running a thriving business.

In our kids- especially the youngest- withdrawal meant not much sleeping and despite all our efforts she is totally nocturnal post withdrawal. Ok you get the picture- working mom a 15 month old and almost three year old. I work six or seven days week. I know- I have ridiculous life. Three hours of sleep at a time is a serious treat...

Running saves my brain and ability to still write up FQHC and county health proposals and adeptly interrupt epi data.... without running- I would be a puddle of nominal brain activity...

I run when I can- six days week no matter what- I get in about 30-40 miles a week - because it is saving my sleep deprived self. I look at my calendar a week in advance and schedule in my run times- so its whenever- early morning, evening, lunchtime -- I would love a regular 'run time' - but my schedule doesn't permit it right now.

I doubt I will run this much once I get to sleep on a regular basis-

I swear running helps me deal with my sleep deprivation. Coffee and miles.

I carry gear in my car- some days it kills me to start a run because I am so tired- but then as I finish up- I am grateful- I always feel better.

sarah (SHU) said...

i am a running resident! on a q4 schedule right now but still getting in 5-6 workouts/week :) i prefer early mornings, but i agree with dr. mama that you can ALWAYS fit it in if you are organized about it -- with the caveat that i have no idea if i'd be able to do it if i had kids, too.

Blue said...

for anyone interested in running, i just read the new book Born To Run by Christopher McDougal. It is an excellent read, and will inspire anyone who is a seasoned runner, new runner, wannabe runner, or feels guilty cause they hate running. including all your maggots. ♥

Charlie's Bird said...

I am such a maggotty maggot. Just discovered your blog, I am an OBGYN in South Africa and am trying to take some inspiration from your running tips, thanks. Tonight, we start again!

Jul said...

Multiple methods of getting a run in is awesome. I can run around the neighborhood's cul-de-sacs, at the abandoned airfield down the street (tres awesome - sometimes teenage deer will follow me around) OR at the 24-hour gym one town over. Multiple methods = harder to come up with convincing excuses for shirking ("It's too late/rainy/far away/boring/etc!").

(... says the person who missed her run yesterday because she was getting a big honking tattoo and then eating tacos. SHAME.)

Anonymous said...


Anonymous said...

This isn't a question about sleep deprivation, and in fact is more about exercise in general, but I started running because of you so I am blaming you. =)

Here's the question: Lately, exercise seems to make my menstrual cycle go wonky. It first happened a couple months ago, when I started exercising every other day for a couple weeks; I had just finished a period, and then a few days later it started again (about 6 more days of light bleeding). I stopped exercising soon after that for various reasons.

Now I've had an opportunity to start running again, and it's been about a week and a half; I just finished menstruating about 4 days ago, and this morning woke up and was bleeding again.

Is this something I should see my doctor about? I don't know if weight has anything to do with it, but I am borderline underweight.

KMK said...

I ran more as a resident than I do as a doc. I'm an after work runner, for the reasons you mention, but found running before night shifts more manageable than after when all I wanted to do was sleep.

E. said...

"Maggot, you are NEVER going to not run at all." That is inspirational. And scary. And hot.

OMDG said...

Wait, running trumps sleep deprivation ALWAYS???? Not sure I agree 100% on that one.... surely there must be some limit.

True enough though. Life is just better with an exercised body.

DoctorMama said...

Anonymous Bleeding Maggot -- be more specific about "borderline underweight."

Anonymous said...

"Anonymous Bleeding Maggot" (eww!) says:

I have a BMI of anywhere from about 17.5 to 18.5, depending on the day and how tall the doctor thinks I am. I don't think I am underweight because a) I am built this way; b) my weight is fairly stable and c) I don't "do" anything to manipulate my weight. It is what it is and I don't worry about it. (Except when my body starts doing unexpected things.)

DoctorMama said...

ABM -- although BMIs are an exceedingly rough predictor of anything, you do fall in the range of being likely to ovulate less on account of your thinness. (And I'm not picking on you. I've had others wonder whether I've had an eating disorder, and it's quite insulting.) Then a sudden burst of strenuous exercise could interrupt the tenuous hold you have on ovulation to begin with. But: skinny exercises seem to be more fertile than skinny nonexercisers, though lots of confounding could be going on there. What I wouldn't do is start and stop and start and stop with the running, nor would I overdo it at all. Be consistent and let your body catch up with its new circumstances. You should also know that cycles get wonky all the time for a lot of reasons. As for seeing a physician, yes if it's messing with your rhythm method or if you're having infertility; if it's just a pain, you can wait a while and see where it goes.

Anonymous said...

Hey, in case there are any moms out there with new babies who don't sleep or let their mamas sleep, lemme tell ya, there is a limit to the combo of sleep deprivation + running. I found it. I tried to go jogging at an incredibly slow pace around three months pp (my son still had colic then) and nearly passed out on the road. I just wanted to lay still and not move until the swirlies went away.

By the way, a friend of mine who is an anesthesiologist, said that all of his MD learnin' and trainin' was a cakewalk compared with his colicky baby in terms of sleep deprivation. He said his kid trumped residency.

Jennifer said...

Advice for schedule- and sleep challenged runners: Just run.

I have small children, my own business, and never get enough sleep. I also have a wonky schedule. The only way to start was to JUST GO. No matter what time, as soon as there was someone to watch the baby and I had a break in my work day. No client on the phone? Babysitter with child? I had to get myself out the door immediately.

Eventually, this turned into a schedule, but you have to stop with the excuses and go as soon as a window of opportunity presents itself.

As for the sleepiness, when I am really, really tired, I start out more slowly than I usually do. Sometimes once I get going I can bring up the pace to my usual speed, sometimes not, but I always feel better when I get home, no matter how much sleep I got (or didn't get) the night (or nights) before.