terns were randomly prompted during on-call and post-call days (but not between midnight and 7 a.m.) to report their fatigue at that moment, using the seven-point Stanford Sleepiness Scale. One point indicates 'feeling active and vital, alert, wide awake,' and seven points indicates 'almost in reverie, sleep onset soon, losing struggle to remain awake.'

Interns on the nap schedule increased their average sleep time by 41 minutes, from 144 minutes a night up to 185 minutes. Interns on the nap schedule who forwarded their pagers to the 'night-float' resident increased their sleep times even more, from 142 up to 210 minutes. Sleep efficiency – the ration between time in bed and time asleep – also improved for those on the nap schedule, from 73 percent, considered abnormal, up to 80 percent.

When prompted, interns on the nap schedule reported far less fatigue. They logged an overall sleepiness rating of 1.74 compared to 2.26 for those on the standard schedule. (Lower is better.) They had lower scores while on call, 1.59 versus 2.06, and much lower scores the day after being on call, 2.23 versus 3.16.

'A rating of one or even two is consistent with peak performance,' said Arora, but people may start to get 'sluggish,' she said, at three. Anything above three is 'clinically relevant.'

The researchers found, however, that despite mounting fatigue and the allure of protected sleep time, interns were reluctant to rely on the night-float residents, forwarding their pagers only 22 percent of available opportunities. When interviewed, interns emphasized the importance of caring for their own patients and concerns about losing important information whenever responsibility is transferred back and forth with another physician.

Although interns did not mind sacrificing sleep for their own patients, they did not feel the same allegiance when they had to 'cross-cover' patients whom they did not know to help other physicians.
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