June 1, 2013

Surviving the terrible night-shifts

Too tired to eat Night shifts are dreadful. Even days before starting a week of night-shifts I feel my stomach beginning to turn upside and down. Hungering for sleep in the early morning hours, I'm almost in a dreamstate, careless as a sociopath, trying to stay alert while making important decisions that my patients’ life depends on. The last hours of the night-shift is one of my most terrible moments. There's only one way out of it - to stay awake and finish my work. And hope for the best.

Having done about 10 years of night-shifts in the ED I have tried many different tactics to make these a little easier. It seems there are indeed some things that work better than others and I wish someone had taught me these in my first years. Therefore I’d like to share my experiences with you.

The day before

Do lots of sports! Jog, bicycle, gym... 40-60 minutes of physical activity gives me the same amount of energy as a day-sleep. Also, being in good physical condition makes the difference of being a zombie in the ED or just a tired doc.

Avoid sleeping for longer time. I’ve tried all variants - long sleeps in the middle of the day and just before starting the shift. I’ve found out any nap longer than 30mins makes me tired already in the first hours of the shift. It’s like these utterly rare days when I manage to get ‘restoration sleep’ and sleep for 10 hours or longer... I feel energy-less and drowsy all day long when that happens. It is if my mind cannot wake up although my body has.

For this reason I’ve changed my tactics - more physical activity and less daytime sleeping. Crucial for this to work is to have had 8 hours of sleep after ending the last cycle.

Deep relaxation techniques. I’m habitually impatient and find it hard to do deep-relaxation as much as I’d like to do. But when it works I’ve found even as little as 20 minutes of deep relaxation to be equal to 1-2 hours of sleep and I feel much more energetic than if I’d slept. It is if some magical reset button is pressed and I’m not only physically more energetic but also mentally, especially when I manage to meditate also.

Enjoy a good podcast. Some podcasts from ED colleagues have made me so excited that I can’t wait to start my shift. A great example would be some the great ultrasound videos available which make me eager to try some amazing and new technique I've learned for new diagnostic approaches.
I'm not saying I start every night shift with goose-hairs... but a good podcast really helps me getting mentally prepared and reminds me I'm not the only one getting ready to stay awake a whole night. The worst night-shifts are those after being away from work for a longer time and suddenly thrown into the cage again. That’s when a good podcast while out jogging helps a whole lot.

In the lion-cage

Save the coffee for the last hours! Coffee is great but only when it’s timing is right. Too much coffee is as bad as no coffee. Thus I try to save it until the final hours, when I really need that energy boost to get it to the finish-line. But I also want to fall asleep when back home and even get a good, restoring sleep. That means no more coffee for the last 2-3 hours.
In an ideal night shift I would drink tea only. I’ve managed that maybe some 2-3 times and it felt good indeed. I hope you have more luck with that than I've had!

No heavy meals. Everyone feels tired after eating big and doing it in the middle of the night-shift is something I avoid - it’s like tying an anchor to my brain. I try to eat so that I feel just about full in the beginning of the shift, when my energy is at maximum, and then eat light meals in the night. I’d love to tell you I eat fruits and drink lots of water but the truth is I’m a candy junkie and I regularly break personal records in the early morning hours of a night shift. I try to stick to chocolate though - it makes my stomach less bloated and goes well with the coffee!

Move and stretch. This doesn’t have to be said, only reminded of! Taking 3 minutes to do a few arm bends, deep knee bends or just standing up on toes - these boost your circulation a little, enough to move the tired proteins away from your brain for a while. Even stretching helps.

Do power naps. When it’s as if I have zero energy left, I put all aside and do a power nap. I simply close my eyes and try to forget everything. Even as little as 5 minutes while sitting in front of the computer helps me to regain some energy to survive one more hour. Longer than that and my body enters sleep mode. A power nap is max 5-10 minutes.

If my caffeine level is too high a power nap is not an option. In that case sitting down and listening to one or two favorite songs with ear-buds can help a little. Music helps my mind draft away to other dimensions. It's all about coming up to the surface and inhale just a little fresh air. To get away from the night-shift just a little bit!
When the world is sleeping... Talk with the patients. I have a few extraordinary memories of conversations with patients in the middle of the night. After all, the night does have it's charm - the little things happening while the world is sleeping somehow have magic in them. There is something in the air that makes talking intimately easier. Patients smiling through their tears or telling about an amazing life-changing event gives me more energy than any power nap. I just have to remember to relax and listen. And so often these extra few minutes have revealed essential clues for the diagnosis and patients are much more tolerant to the tired ED doctor.


All in all - the more physical activity I can do the day or days before, the better my physical condition and the less sleeping-the-hours-before I do, the better I survive the terrors of a night-shift.

I’d love to have your night-shift tips - please share below!