Putting More Sleep in your Sleep Wake Cycle

I've never had a newborn, but I imagine the fatigue is chronically similar to coming home from my first night shift after being on days for many weeks.  I feel as if I'm floating, on another planet, and without that fourth cup of coffee, probably not safe to drive home.  Actually, there's evidence to suggest that being post-call on a heavy rotation may be equivalent to being drunk, except probably less fun :-) (read the study published in JAMA here.)

Sleep wake cycle disturbances is one of the most distressing parts of residency and many other careers that require frequent shifts in working hours.   Not only is insufficient sleep tied to increased fatigue and increased risk for medical errors (putting the patient at harm)  prolonged sleep disturbance is dangerous for the healthcare worker, with a notably increased risk for metabolic syndrome, obesity, and other chronic diseases (source.)

So clearly, optimizing your sleep while working a job that demands frequent changes in scheduling is ESSENTIAL for your own health and the safety/quality of care for patients.  But this is obviously more easily said than done.  I get asked really frequently how I manage to adjust to an every changing work schedule.  Particularly medical students and new interns are very nervous about these demands because they've never had to experience it before.  Let me share with you- I was TERRIFIED of this aspect of medical training because I had convinced myself that my body was incapable of functioning at night. As a disclaimer, I'm the girl who goes out on a Friday "night" but is still somehow promptly in bed before midnight.  All nighters as teenager? LOL no.  Mornings are my natural habitat, and being up past 10pm is just not my jam.  I knew if I was going to succeed in feeling at least neutral with the constant schedule shifts, I had to quickly come up with an adjustment plan that worked for me; after a few years experience can you believe I actually *prefer* the workflow of nights?? Yeah, me neither.  All these methods are based on my experience working a night float system rather than 24 hour calls. This means that I only work nights when I have a 1-2 week blocks of them, so I'm never having a middle of my week interrupted by a single overnight call.  This has both it's advantages and disadvantages, but keep that in mind while reading below :-)


Pre-night shift prep: it's all about mindset.  You know it's going to be a challenge. You know you'll feel a little anti-social and disconnected from the regular world for this period of time.  Planning ahead on your non-negotiables during this time can really help.  If you're someone who, for example, must call their mom every day, figure out a time when you can squeeze this in given your new schedule.  Go in prepared with all the food and hydration you need on a normal day.  Just because it's night time does NOT mean you need to eat all nighter food.  Nourish your body and you'll thank yourself later. And as I will mention incessantly here, make your sleep the ultimate priority.  Things have a way of falling into place when we are well rested. 

#1: The first night


It's pretty miserable.  Accepting this as fact will help you charge through so we can get to recovery time.  Unless you've somehow managed to get in a solid nap during that first day, you're going to be up for roughly 24 hours and your level of functioning will suffer.  You will not feel great, but just remind yourself that it gets better (because really, it does!)  Set an early routine for your eating schedule. Our bodies get used to being fed at a certain time;  I recommend eating before going into your night shift, then eating "lunch" around 11pm/12am.  

Add a disclaimer when you're speaking to those you're working with overnight or coworkers you need to share details with in the morning (for example, during sign out time/giving report.)  Let others know you're not fully adjusted and if they would be kind to double check your work to provide an extra security blanket in preventing mistakes.  Most importantly, if you're driving home, truly check in with yourself in regards to your safety behind the wheel.  As alluded to above, this level of fatigue can be equivalent to drinking alcohol! Your safety MUST come first.  

#2: The first morning

Regardless of how much caffeine you needed to stay up all night, drink a little bit in the morning if you're a regular consumer of it.  This will prevent you from waking up in the middle of the day due to a withdrawal headache (seriously this happens and it's kind of the worst!) I promise you, you'll be so run down from having just pulled an allnighter, it's unlikely to prevent you from falling asleep.  The best success I have with quickly adjusting is to eat a small meal ("dinner"), brush my teeth, shower, and immediately get cozy in bed.  When I would try to find leisure down time, it prevented me from just listening to my body and passing out, and made adjusting a bit more difficult.

Which reminds me- your sleep hygiene has to be immaculate.  Create your bedroom to be an oasis for peace and tranquility.  Black out curtains have singlehandedly saved my sanity with the constant shift in my schedule! Seriously, don't waste your time without them, they are not optional.  Additionally, minimize sound and completely avoid electronics.  Use an old-school alarm and keep your phone in another room (you don't need to hear the vibration buzz from some email you probably don't need to read).  A TV should not exist in your room.  Keep your bedroom a neutral temperature and suck it up on turning on the heat/AC as needed to keep your comfort level pristine.  Sleep is the most critical aspect of wellness, and it's worth going above and beyond to maximize it.  

#3 After the first sleep

Hopefully you were able to sleep through most of the day and wake up with a few hours to spare before having to head back into work.  Use this time to create your own personal rejuvenating routine. For me that obviously includes exercise; if I can sweat (even if it's just for 20 minutes) I'll have a little pep in my step for that night. It also includes reminding my husband I'm alive and do exist.  We will go for what feels like 2 weeks straight without spending quality time together when I'm on nights, so it's important to sit for a cup of coffee (while he's not drinking coffee because, you know, it's 6pm.) Whatever it is you need to do on a daily basis to feel whole, yeah, do that before heading into work. 

#4 The Second Night

Hopefully you'll be pleasantly surprised at how well you feel tonight, and you stay up with far less anxious fatigue.  You're a little more efficient and you actually feel like you exist on Earth.  You're getting used to the strangeness of nights, and the feeling that you're not particularly sure what day of the week it is; "is it tomorrow? is it today? why does it actually feel like lunch when its 12:30am? Weird." 

The important part of night #2 is after coming home. Because you're not as exhausted to the core, it's easy to waste time watching netflix and getting absorbed by the internet hole and before you know it, it's 11am and you've yet to fall asleep.  STICK WITH THE PLAN.  Come home, eat, shower, get cozy in bed.  You'll thank yourself for the pattern.

#5 That first time back to daylight


Honestly, switching BACK to days is sometimes the most painful part.  You've gotten comfy in your routine and you worked hard to get there! So why must the pain come back so quickly?  Before you know it, you're back to the grind of daylight hours and you start to recognize why nights are kind of nice. Less bustle, more peace (for the most part.. if you're in healthcare then, you know. #sundowning.) You are overwhelmed with the energy of everyone else as you rejoin the rest of society and the sun.  What has worked for me is, after coming home from that last night shift, keep your day sleep short.  Max out at ~5 hours so that you're actually tired that evening and you have a better chance of adjusting for the following day.  Wake up after an extended nap and have plans to do something entertaining but low key (a long walk, late brunch, etc.)  Prepare to settle back in at home by ~8pm and allow yourself to fall asleep whenever you feel like it.  Inevitably you'll have trouble falling asleep or staying asleep during that first night, but you'll just need a little patience. Our bodies are really good at working with us once we are overwhelmingly sleepy.  You may suffer on that first day back in society when you have to actually function, but eventually you'll start to get rest and feel normal.

The key in all of this is prioritizing sleep and practicing optimal sleep hygiene. You can have the best intentions in the world to be well rested, but if you aren't setting yourself up for success you'll never feel your best.  Your health and the safety of others should be important to you-- treat it as such!  

On the topic of sleep aids, I really recommend trying to avoid them.  Prescription sleep aids are addictive with a myriad of side effects, as are over the counter options like benadryl.  The only one I may recommend you use is melatonin as it is non-addictive with minimal adverse affects. As always-- check with YOUR doctor first!  And really, sleep hygiene trumps all.

If you have any questions or added tips for minimizing sleep-wake disorder, please comment below. And as always, thank you SO much for reading. It's an honor to share your time in this space <3


Shanny DO