The Graveyard Shift and Sleep Deprivation

[RogueDadMD]

http://www.roguedadmd.com/2017/05/the-graveyard-shift/

The danger of working night shifts...

[SValleyMD]

Definitely a huge issue..

Another huge issue IMO is in the non shift work specialties where the concept of call often equates to even more sleep deprivation issues that's usually never recognized or fairly reimbursed by admin.

[RogueDadMD]

SValleyMD wrote:

Another huge issue IMO is in the non shift work specialties where the concept of call often equates to even more sleep deprivation issues that’s usually never recognized or fairly reimbursed by admin.

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Absolutely.  "Home call" while being awake all night with phone calls and then being expected to function normally during the entire day is it's own underappreciated problem.

[squirrel]

Having worked solely night shift for over 3 years, I think you are missing the big point.  5-6 hours of sleep per 24 hours for even a couple days is not a good way to function, be it working day or nights.  I get 7-8 hours sleep on days I work and on days I don't.  When I try to trim this for more than I day, I start to get moody.  Decreased sleep for a period of time with definitely effect cognitive functioning.

[RogueDadMD]

squirrel wrote:

Having worked solely night shift for over 3 years, I think you are missing the big point.  5-6 hours of sleep per 24 hours for even a couple days is not a good way to function, be it working day or nights.  I get 7-8 hours sleep on days I work and on days I don’t.  When I try to trim this for more than I day, I start to get moody.  Decreased sleep for a period of time with definitely effect cognitive functioning.

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I'm not actually sure who you that quote is directed at, because at least part of your point actually is the point I'm making.  People rail against call because of the lack of sleep, but working night shifts messes up the body.  There is no guarantee of getting 7-8 hours of sleep after a night shift.  I know many people who work nights, and I know very few who are able to sleep that much after each night shift.

I have no idea what your setup or schedule is when you say you work night shifts -- that means completely different things depending on your work and setup and family, etc.

Getting 7-8 hours of sleep is great. Occasionally I get that much after a night shift.  It's also extremely difficult to do after every night shift when you have little kids.  That's also why I also try to get a nap in right before the shift starts (a nap during the shift is great but extremely rare).

When I was a resident I got to sleep as much as I needed after a call OR after a night shift.  That just isn't feasible now.

[Hatton]

I read your post rogue about the unmatched shoes.  Really good stuff.  My personal sleep deprivation story is when I was an intern of 2 weeks at Vanderbilt. I was doing a rotation in the Nicu sticking premies all night and figuring out fluids.  I went home after 0 sleep and totaled my car on the interstate. I was back at Vanderbilt hospital being evaluated by a 2 week surgery intern.  He later became a friend. I ended up meeting plastic surgery who sewed up my forehead that had hit the steering wheel.  I met several general surgery residents who did a peritoneal lavage on me.. Thank god it was negative. I was back at work in 48 hours with steri-strips on forehead and a black eye.  I ended up getting a great evaluation for the rotation I guess because I showed back up.  Hard way to meet new people in a new city.

[squirrel]

Rogue,

Just saying the short sleep is the issue that is all.  I think I misconstrued thinking the post associating night shift and the sleep deprivation.  In reality, I agree with you, it is usually all the other external issues or schedule that leads to it.  That is true I think whether it is day or night.  For me, night shift actually works better schedule wise.  Im and ER doc, so being a night shifter actually stabilizes my schedule as it is similar from one day to the next. The other option is all different times of shifts.  We joke, it now is like I have a 9-5 job, I just go to my office (bed) and sleep great with either a mask or black out curtains and white noise.  I see my kids in the morning, have breakfast, take them to school, and see them after school.  I usually work 10p-6a or 11p-7a.  Do have some 12 hour shifts here and there 7p-7a (those usually are bad just cause of the longer time and less hours to commit to sleep/family/etc).

I do agree with you about the "call" a lot of the consultants have to do taking calls and sometimes coming in for a full OR or clinic day after a night of that.  I am sure many consultants may think otherwise, but myself, as well as other of my colleagues do genuinely feel bad when we have to call you in the middle of the night for either an admit or to come in for an emergent case.  I usually start all my calls wth "sorry for the time of call..."

[hightower]

I disagree that its just the short amount of sleep that is the problem with night shift work.  I'm not an expert on sleep/wake cycles or anything like that but there is definitely a natural rhythm that our bodies adhere to and when you suddenly shift that rhythm to something new and then try to go back again, it causes havoc on our systems.  Our bodies have a natural cycle of responding to daylight and darkness, all life does.  It really messes us up to suddenly stay up all night and try to sleep during the day for a few days at a time.  Perhaps being a "night only" doc helps you maintain a normal rhythm and that's why it works for you?  For me it doesn't work though.
For the last 6 months I've been working part time nights as a hospitalist and I can tell you from experience that it's causing problems.  Initially I was doing multiple nights in a row, but that was too painful so I asked to do only 1 night per week and that's what I've been doing for awhile.  I know how I feel when I'm just a little tired from perhaps staying up a little too late and only getting 5-6 hours of "normal sleep."  But, I feel completely different and a lot worse after a night shift when I'm only able to get 5-6 hours sleep during the day.  If I try to sleep more than that I generally can not.  And if I do, I end up not being able to sleep at all the next night and my whole cycle gets super screwy.  I have been working 1 night a week (sunday) for the last 5 months and it generally takes me until Wednesday to feel "normal" again.

I'm thankfully not going to be doing any more nights starting in a June because I have learned that I simply can't keep punishing my body like this.  I've enjoyed the extra income and freedom that my part time nocturnist schedule has given me, but I can't keep putting my health at risk and that's why I'm going back to days only.

[RogueDadMD]

I agree with both of the last two -- it's both inability to get enough sleep after a night shift and poor quality of sleep. It's just bad for you.

Those are some of the main points I'll bring up in my future post. Plus a few other thoughts on call that I'll save for my blog.

[HLM]

I think another piece of this puzzle is not just sleep deprivation or night shift working but going against your natural circadian tendencies.

I've mentioned this before in response to a post a while back about night shift work.

I don't know that anyone is a true vampire that wakes in the nighttime and then is asleep throughout the entire day. But since I was a child, my natural tendencies when I didn't have a schedule to adhere to would be to fall asleep between 3-4 am and sleep until noon. So although my night shift work requires me to still be outside of my natural tendencies, I believe that night shift work fits better with my sleep cycle than when I had to be getting up at 5 or 6 am for day shifts.

I've worked as a nocturnist for the past 5 years and my sleep is generally better than when I worked days. I agree that it is hard for me to get 7-8 hours of sleep during the day after a night shift. But I seem to be able to make up for it with a two 10 hour sleep sessions when I'm off service and and at home and can fall asleep at 2 instead of 3 and sleep until noon. I had so many drives home from my day shifts where I feared falling asleep at the wheel coming home at night because I was starting off with such poor sleep since it is very difficult for me to fall asleep and get a normal amount of sleep before coming in for a day shift. I found myself falling asleep at 1 or 2 and then having to get up 4 or 5 hours later and being exhausted. Or falling asleep at 8 after getting home from work but waking up a few hours later and not getting much more sleep for the night because I was so off of my natural sleep schedule. It's been the rare night shift that ends where I feel that exhausted and when I do, I sleep at the hospital before driving home.

So, I guess my only point is that I think it really is a different strokes for different folks issue to some degree in that some people are better geared to be up late at night.

That said, I agree that having young kids makes night shifts brutal. And I also would agree that I don't think most humans do have a funky circadian rhythm like I do. I think for most people, staying up and being sharp in the middle of the night is a struggle. So I think it is a big issue in medicine and other 24 hour a day jobs.

I'm interested to see what Rogue Dad has to say on the issue in his future blog post and if he has any solutions to what can be done for covering nights when most people are clearly not functioning at their best at that time of day.

[RogueDadMD]

I'm not sure I'll be solving the problem.

I'll provide my two cents, but I don't know if my thoughts will be worth even that much.