Surviving & Thriving on Night Shift
By Christina Hornack, DO
PGY-3 Adena Emergency Medicine Resident
ACOEP-RSO Immediate Past President
AOA TIPS Fellow 2020-2021
Whether you are a full-time nocturnist or just doing your share, night shift is a reality most of us face. This article represents the collected wisdom of those brave warriors who willingly face the dark side as their permanent shift. Learn to not just survive, but thrive, and maybe even enjoy yourself.
Why
Why anyone would choose full-time night shift work is often a mystery to those who can’t conceive of a more terrible fate. But there are many benefits to being a full time nocturnist – chief amongst them is that your schedule is regular and always the same. You know you will be able to make a 6:00 p.m. meeting no matter what day it is because your shift doesn’t start until 9:00 p.m. Further, doctors willing to work primarily nights are a premium to any group and enjoy not only a more tailored schedule but often get a differential in any hourly pay structure. Lastly, the environment will often be more relaxed, the team more cohesive, and the interruptions from the senior brass, thankfully, few.
Sleeping
The primary issue with working nights is getting restorative sleep. It can be difficult to get sleep during the time when the rest of the world is awake, mowing their lawns, and ringing your doorbell to sell magazines. While sleep is usually a very personalized thing, most people find that cold, dark, quiet rooms are the best environment to facilitate those much-needed Z’s. Getting them can require a combination of:
• Blackout curtains to block daylight
• Removable insulation panels that can be slid into the windows as needed
• A ceiling fan or window air conditioner to drop the temperature a few degrees
• A sound machine to block out more distant sounds by taking advantage of physics
You may also benefit from some adjuncts to environmental control, including a comfortable sleep mask that utilizes an elastic strap instead of Velcro, which can pull long hair, get caught on things and making loud noises when it opens. In addition, many people swear by ear plugs, of which there are many varieties available including foam, silicone, and fancy high end electronic “sleep buds.” Some are lucky enough to be heavy sleepers that don’t require any additional help blocking out the world.
The final ingredient in good sleep is turning off your brain. While some people can instantly fall asleep wherever and whenever, most of us are not as fortunate. Many of us require help in the form of chemicals. Bilayer melatonin with a quick dissolve layer and another layer engineered to dissolve more slowly in your small intestine is a game changer for many of us. Others prefer Unisom, Ambien, or Benadryl to help fall asleep.
Another issue that may arise is staying asleep long enough to be fully restored. Many of us can fall asleep relatively easy after a long night shift, but our brains and our bodies will quickly revolt and wake us up after only a few hours. How do you fall back asleep and not be in a fog when you finally wake up? One of our members suggests taking children’s dissolving Benadryl tablets. The 12.5mg dose is just enough to help you get those last few hours without causing any lingering side effects. And it’s available in grape flavor!
Maintaining Wellness
Now that we’ve covered why we want to do this and how to get great sleep, we need to identify ways to keep yourself well. While wellness looks different for everyone, there are a few key factors that long-term nocturnists insist on across the board. Some type of regular exercise was an almost universal suggestion, whether it’s just a few minutes of yoga after a long shift, or an hour-long sweat session after a lighter shift. The endorphins help you sleep, and most centenarians agree that the key to maintaining health is maintaining movement.
Another key factor is determining your limit of shifts in a row. If you find that on the sixth night shift you keep losing track of which abdominal pain is in Room 5 and which consultants you’ve spoken to, you may want to reduce limit your run of shifts to one fewer. For people having to switch back and forth, limiting the number of runs in a month can be helpful but comes at the cost of having more days in a row. You need to know your own personal limit so you can be the most effective, and therefore the most well as possible.
On the matter of changing from night shift to day shift, the most successful nocturnists maintain mostly the same schedule whether they are working or off. This allows your body to adjust to whatever your schedule is, and gives you that all-important cortisol spike right when your body knows you’re about to wake up.
People who only work a few night shifts a month will inevitably have to shift back and forth. Many people suggest taking a short two to four hour nap on the morning of your last night shift in order to start moving your schedule back to normal. No one suggested just trying to stay up the whole day after your last night shift. Remember those 24s in residency? No one wants to repeat those if they can avoid it!
Regardless of your reasons for needing or wanting to do night shifts, with a few adjustments to your home environment, your approach to sleep, and your commitment to regular exercise, it can be possible to not only survive but thrive on the dark side.
Special thanks to Jennifer Himmel Salch, DO, Jacqueline M Dziedzic, DO, and the entire Women in Emergency Medicine Committee of ACOEP for their collaboration on this article.