Improving your Sleeping Habits
Whilst the days of doing a long run of night shifts might be over for many doctors, working at night is still an essential part of providing a 24-hour service to patients. With the pressure on rotas and increased workload, many doctors are running on empty – especially those who are on-call. When you are working at night, it can have a detrimental effect on your sleeping habits and getting back into a routine can be tricky.
We are going to look at some tips to help you get back into a healthy sleep routine following night shifts, and some ideas to help you stay as refreshed as possible when working through the night.
You may think that some of the suggestions in this guide are obvious. However, everyone needs to be reminded sometimes that you need to look after yourself properly in order to give the best possible help to others. It is very easy to put yourself at the bottom of the list, but you need to make sure that you are healthy and alert so you can minimise the risk to yourself and your patients.
The aim of this article is to provide simple advice that you can follow to ensure that you are as healthy as possible when both working and recovering from working through the night.
Working through the night is something that is expected for many people who work in the NHS, and most do so relatively successfully. However, our bodies are controlled by an internal daily body clock. When you work during the night, your body is constantly fighting against its natural rhythm to sleep when it is dark. Instead, you are trying to be alert when you are programmed to wind down and feel sleepy.
Fatigue is well known for reducing your performance, and we are not just talking about feeling a little tired when you are working. There is no feeling like it, and the best way to describe it is pure exhaustion. If you are not getting the proper rest in between or when you are on your shift, you are expected to make serious decisions when sleep deprived. When you are tired you are not able to judge your own performance correctly so may not even realise you are making mistakes.
The combination of fatigue and a body clock that has not adapted well to preparing for the night shift can make for an uncomfortable shift and an increase in errors. The first thing that you need to do is start preparing for working through the night well in advance.
1. The first step is to manage your normal sleep when you are at home. Make sure that your bedroom is a suitable and relaxing place to sleep, and avoid using devices such as phones, computers, and TVs when you are in bed. If you find that you cannot get to sleep within the first 30 minutes do not lie there feeling stressed as this will make falling asleep even harder. Get up and go into another room to distract yourself and then try again.
2. The next obvious step is to ensure that you get enough sleep before your nightshift. If you do not, you will find that any sleep that you miss will start to catch up with you as the night goes on.
3. Try to get an afternoon nap before your shift, and not just before you are due to work. Your body will sense that you are due to begin your shift and will (hopefully) start to make you feel more alert and ready for the night. If you try to sleep right up until your shift starts, you will find your body will try to fight the sleep and you will find that your catch-up nap will be unsuccessful.
Preparing yourself for a night shift well in advance both mentally and physically can have a positive impact on your night and reduce the chances of making mistakes when working on call.
Once you are on your shift, staying awake and alert will depend on how much work you have. Your alertness levels will be lower than normal, and it is important that you stay vigilant. Working whilst your performance is at a safe level should be your main priority.
Eat well – it is important that you eat as well as you possibly can when working through the night. It is all too easy to fill up on fried fast food, and while that may seem like a good idea at 3am, it won’t be doing anything to help your energy levels. Keep a bag of fruit and nuts to hand when working on the night shift as these foods release energy slowly and will keep your levels topped up throughout the night.
Stay hydrated – You may think that sticking to coffee all night will increase your energy levels, and it will for a while! But the caffeine will also interrupt your sleeping schedule when you have finished working which you want to try and avoid. You need to ensure that you have a water bottle with you, or you know where the water fountains are, as mild dehydration will increase your fatigue levels.
Naps – developing a nap routine when working at night is imperative. You need to make sure that you don’t nap for longer than 45 minutes, as you will end up having to wake up in the deep sleep period. Set an alarm on your phone when you first put your head down. If you manage to get a power nap, your alertness levels will increase significantly. If you don’t, you will still have had a break from the intensity on the shift, which will also help to keep you alert and vigilant.
While these all seem like obvious tips, they are overlooked by many doctors as they simply do not put their own wellbeing first. It is very easy to slip into the habit of thinking you are indispensable when you are working on a night shift, and while it is important to be available when required, you need to make sure that you are alert and performing well to keep your patients safe.
Once the nightshift finishes, you would expect to react as you would if you finished a normal working day. In theory, your body clock should start to help you wind down and get the much-needed rest that you deserve. However, you will find that no matter how tired you feel your body will take cues from the daylight and society that daytime is when you need to be awake and active. You will probably find that your sleep is often fragmented and very brief, no matter how tired you actually are.
How you recover from a nightshift will depend entirely on whether it is your last night shift. If you are working more consecutive nights, then you need to keep your sleep levels topped up. Firstly, you need to decide if you are alert enough to drive, especially if you have a long commute. Exhaustion is well-documented to kill many drivers, and if you have had a long night shift then you will have slowed reflexes and poor judgement. It may be worth getting some sleep at the hospital first or using public transport to get home.
Ensure that your bedroom is suitable for sleeping in the daytime by being quiet and dark, and let others know that you have been working through the night so you don’t get woken up unexpectedly. If you wake up earlier than expected, try to relax, and get back to sleep or distract yourself until you feel sleepy again. Make sure that you are fed and hydrated to keep your alertness levels high and ready for your next shift.
If it is your final nightshift, then you may think that following all the above steps is the right way to recover. However, you will end up shifting your body clock permanently, which is not good for when you must start back on day shifts. The best way to recover is to follow these steps:
Exercise – this may be the last thing that you are thinking of after a long nightshift, but no matter how tired you are you need to release stress. It could be a light workout at a gym or a walk in the park and you need to make sure that you work up a bit of a sweat. Don’t push yourself too hard, 20 minutes will be enough!
Treat yourself – once you are home, treat yourself to a nice shower or hot bath. Make a healthy meal and avoid junk food as eating foods high in carbohydrates will give you an energy rush that could affect your sleep.
Take a nap – it is not recommended to sleep for 8 hours throughout the day following your final night shift. 3-4 hours should be enough to top your sleep levels up, anything more and you will end up being away for most of the night again.
Make plans – make plans with your partner or friends for the afternoon. It will mean that you don’t oversleep, and it will still tire you out ready for the night’s sleep. After being on nights, you will be socially deprived so it is important that you plan something that you enjoy.
Get to bed early – it is natural to want to stay out when you have made plans, but don’t forget that your friends will probably not have had a 10–12-hour night shift the previous evening. Make sure that you limit your time and aim to get into bed between 8-10pm to get your sleep levels properly topped up.
The risks associated with sleep deprivation when you are a doctor are serious, so it is important that you manage your sleeping habits when you are working night shifts. Don’t forget that every person is different, so while these tips and combinations may work wonders for one person, you may find other ways to get your sleep routine back to normal. Try a few different things, and eventually you will find the combination that works for you.
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