The first year of physician residency training is to mental endurance what the Ironman triathlon is to physical endurance. You constantly feel as if you are overwhelmed, futility is evident in the majority of your tasks, and there is always someone ahead of you in the race that is better at what you do than you are. At the end you feel a marginal sense of satisfaction and accomplishment, similar to taking a few jabs from Anderson Silva before being knocked-out in the second round. The more significant residual sensation is fatigue. Being a glorified medical secretary for 80 to 100 hours a week is surprisingly draining. The death, patients’ personality disorders, and frequent pages from nursing staff can adversely affect sleep hygiene. Is a blood pressure of 52/19 bad? You do not know, and my interest is diminished at 3 a.m.

But this is an office-focused column, right? Here I am describing the casualties and collateral disutility of my 100-hour work week, when your 40-hour week sitting at your cubicle is equally demanding. I have the excitement and intimidation of life and death to keep me jacked-up and focused. All you have is an office crush and a 3 p.m. fax to keep you going.

Face the hard fact: You get bored at work, which is why you feel like you have been roofied at 2 p.m. on a daily basis. You attempt to catalyze a resurgence of energy with stimulants, music, and a flirty conversation with the new Mormon intern. But your inappropriate romantic advances end quickly when you realize you have a better chance of scoring a lay-up against LeBron James than scoring with a disciple of Joseph Smith.

This week we will review some of the common contributors to work-place fatigue, with a few hints on how to conquer the daily drag.

The physiology of mental fatigue

Sleep medicine and studies analyzing the physiology of fatigue are relatively new disciplines. According to research in a leading sleep medicine journal, Sleep and Biological Rhythms, the behavior of the human sleep-wake cycle has two contributing pathways: one for the circadian pacemaker driving melatonin rhythm (the suprachiasmatic nucleus pathway) and the other for the sleep–wake rhythm. This basically means that there are multiple neural pathways contributing to fatigue, with other factors such as neurotransmitter levels (serotonin and dopamine), serum electrolyte levels, and even serum amino acid levels contributing to the mix.

Common contributors to mental fatigue

1. Poor sleep hygiene
Although there is still no consensus among researchers about the “ideal” amount of sleep, there are certain golden rules of sleep hygiene. Good sleep hygiene includes maintaining a regular sleep schedule (going to bed and arising at the same time each day), avoiding excessive daytime napping (more than 30-45 minutes), no stimulants before bedtime, avoiding strenuous exercise immediately before sleep, and only using the bed for “sleep and sex”.

2. Depression
Mental health disorders like depression and general anxiety disorder produce insomnia and subsequent daytime drowsiness.

3. Substance abuse
Alcohol redistributes the amount of time spent in the individual sleep stages. The disproportionate amount of non-REM sleep in the first half of the sleep cycle has been documented in numerous studies. Stimulants such as caffeine, cocaine, and methamphetamine act as central nervous system excitatory agents and interfere with sleep.

4. Hypoglycemia
If you do not eat, then your serum glucose levels will drop. Without carbohydrates as a simple energy source, the body turns to lipids and proteins for catabolic energy.

5. Deconditioning
There is a lot of scientific evidence that supports the claim that physical and mental lethargy are strongly correlated. If you exercise, eat well, and maintain a healthy lifestyle, then your energy level will greatly improve.

Beating that “2:30 feeling”

1. Improved sleep hygiene
Create your own “ideal sleep space”, with the noise level, lighting conditions, and comfort that you desire. Never use the bed as a place of work or conflict, and attempt to adhere to a strict sleep schedule.

2. Improved diet
Eating smaller, more frequent meals during the day will provide a more stable serum glucose concentration. This will help you to avoid the highs and lows of heavy sugar intake and the accompanying hypoglycemia due to the insulin bolus released by your pancreas.

3. Exercise
A mixture of cardiovascular and strength training exercises provides the body with the energy (cardio) and the metabolic drive (strength training) to maintain a high energy level throughout the day.

4. Substance assistance
Caffeine is a methylxanthine that acts both as a central nervous system stimulant and as a vasoactive agent that can alleviate physical fatigue. Use the drug in moderation and with caution. Tolerance quickly builds-up to this wonder compound, and it can worsen osteoporosis by interfering with calcium absorption. The drug also acts as a diuretic, which means you’ll be in and out of the bathroom in proportion to your consumption.

5. Napping
Short naps (30-45 minutes) can help rejuvenate the brain, but excessive daytime napping has the opposite effect. Cocaine is a hell of a drug, and if it was not for the strokes, coronary vasospasm, psychosis, and heart failure, then I would suggest the upper to everyone. Instead, I suggest you enjoy an occasional cup of coffee and work on better sleep hygiene. Cubicle naps may seem safe, but all it takes if a single episode of sleep-flatus and you’ll never be viewed the same way again. Nobody wants to be labeled the “Sleep-farter” in the office. Nobody.

So there you have it – how to beat that 2:30 feeling. No 5 Hour Energy required.