Making the Most of Working the Night Shift

The drawbacks of sleep deprivation among medical providers are well-reported. So, what can clinicians do to counteract the negative effects of working after dark?

For residents and some other physicians, working a night shift can be a reality in an emergency department, intensive care unit or elsewhere. Doing your best work in the darkest hours requires foresight. But planning ahead can help your patients benefit from your sharpest medical expertise. It will also ease your interactions with colleagues so you can be effective and efficient. Finally, getting enough rest will help you maintain your own well-being and keep a clear mind — all of which is crucial when caring for patients and minimizing medical errors.

As of the 2011 standards established by the American Council of Graduate Medical Education maintain, residents working or “duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting, with a minimum of one day free of duty every week.”

First-year residents can work 16 hours at a time, while second-years can work up to 24 hours a shift. “Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00 p.m. and 8:00 a.m., is strongly suggested,” the standards read. It’s possible to work up to another eight hours a week based on “sound educational rationale,” too.

The health drawbacks of sleep deprivation in the medical world are well-reported: In its April 26, 2016, issue, the Journal of the American Medical Association published a study that found registered nurses who regularly worked a night shift for more than five or 10 years were linked to “a statistically significant but small absolute increase of coronary heart disease risk”1 than those who worked day shifts.

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In a March, 2016 report from Intensive Care Medicine, researchers found that “the cognitive abilities of intensivists [those working in the intensive care unit] were significantly altered following a night shift in the ICU, regardless of either the amount of professional experience or the duration of sleep during the shift.2

Similarly, a 2015 article in the Portuguese medical journal Acta Medica Portuguesa following a group of 18 doctors found that “acute sleep deprivation resulting from nocturnal work in the medical professions is associated with a reduction in attention and concentration and delayed response to stimuli. This may compromise patient care as well as the physician’s health and quality of life.”3

Other health issues related to sleep deprivation include an impaired immune system and blood sugar imbalances, according to the American Sleep Association (ASA).

What can you do to counteract the negative aspects of working night shifts?

Know Yourself

“New hospital rules aim to protect staff from the consequences of excessive daytime sleepiness,” said Neil Kline, DO, an internist and sleep disorder physician based in Pennsylvania and a representative of the American Sleep Association . “However, no one knows your limitations like you do. It is important to recognize those limitations so that you don’t hurt yourself or someone else.”

Sleep deprivation happens when you don’t get enough sleep for your body to be healthy, and it can be identified by feeling very sleepy during the day, having accidents or other blunders caused by inattention, crankiness, hunger, and/or weight gain or loss, according to the ASA.

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Every person’s needs for sleep differs to feel rested, and “there is no magic pill or medication that can fix insufficient total sleep,” Kline said. “Ideally, it is best to maintain a regular sleep-wake schedule. Of course, the ideal schedule would allow [for] sleep at night and work during the day, but when tasked with a night shift, ensure adequate time before and after the shift.”

Tips for Better Daytime Sleep

Writing for WebMD in “Sleep and the Night Shift ,” author Katherine Kam lists nine tips to help night shift workers get adequate sleep when they are away from the workplace. They include:

• Working overnights several days in a row contributes to sleep loss. If possible, taking days off between night shifts help decrease sleep deprivation.

• Erratic schedules that include both day and night shifts are tough on sleep. It’s easier to adjust to a schedule that rotates from day shift to evening to night, rather than the reverse order, Kam writes.

• Live close to the workplace; you’ll be able to sleep more and commute less.

• While working, look for bright light, particularly sources that mimic daylight. It helps to keep your mind awake while on the job.

• Just as you would in a day job, drink caffeinated beverages earlier in your shift to wake up. Doing so later may affect how quickly you get to sleep after you go home.

• On your commute home, use “dark, wraparound sunglasses and a hat to shield yourself from sunlight,” Kam writes. Avoid errands at this hour, too.

• Try to fall asleep and wake up at the same time each day.

• Put your phone on silent while you are sleeping.

• Avoid sunlight — by using blackout blinds and/or curtains — while you try to fall asleep after your night shift.

Cheryl Alkon is a freelance health care writer based in Massachusetts. This article was originally published by the American Association for Physician Leadership in October 2016.

REFERENCES

1. Celine Vetter, et al., “Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease,” JAMA, 2016,315(16):1726-1734).

2. Maltese, F., et al. “Night Shift decreases cognitive performance of ICU physicians,” Intensive Care Medicine, 2016, Mar, 42(3);393-400.

3. Sanches, I., et al.“Effects of Acute Sleep Deprivation Resulting from Night Shift Word on Young Doctors,” Acta Med Port, 2015 Jul-Aug;28(4):457-62.