Abstract:

This narrative review explores the paradoxical phenomenon observed in a subset of elite physicians who appear to function effectively under chronic sleep deprivation. Drawing from literature in sleep medicine, neuroscience, and critical care, we examine the hypothesis that some individuals possess or develop a physiologic and cognitive resilience that allows sustained performance despite significant reductions in sleep. The methods include a comprehensive review of peer-reviewed articles across multiple databases, utilizing defined inclusion criteria. Results reveal recurring themes of genetic predisposition, adaptive neuroplasticity, and conditioned stress tolerance. We identify specific phenotypic traits, such as preserved executive function and emotional regulation, in particular individuals. However, this functional capacity does not equate to physiologic invulnerability, as long-term sleep loss carries substantial risks. The discussion contextualizes these findings within the framework of medical culture, ethics, and system-level policy implications, while also proposing future directions for research. Functional sleep deprivation in medicine, although rare and possibly adaptive in select individuals, warrants a critical reappraisal to prevent the normalization of a potentially harmful norm.

Keywords: Sleep deprivation, physician performance, chronotype, cognitive resilience, short-sleep phenotype