How do you adjust to night shifts?

[take the shot]

Hello, I am a PGY-1 and am scheduled to do a house officer night shift next month. I have no problem getting up early for work but shifting to night shifts for anything but a random cross-cover night seems tough. Just wondering if you guys have any tips or recommendations to make the transition easier. Thanks!

---

Members don't see this ad.

 

[jdh71]

Hello, I am a PGY-1 and am scheduled to do a house officer night shift next month. I have no problem getting up early for work but shifting to night shifts for anything but a random cross-cover night seems tough. Just wondering if you guys have any tips or recommendations to make the transition easier. Thanks!

Sleep during the day, going to bed reasonably soon after you get home (I'd usually eat something and then go to sleep). Get up in the afternoon ~3 hours before your shift. Exercise, get something healthy to eat, make something healthy for midnight "dinner" (food in the hospital at night is CRAP and will make you feel worse). Keep the same schedule. I cannot emphasize enough that you should NOT use your time during the day to do things and run errands. It's a not a day "off". Protect your sleep, health, and sanity by transitioning, and sticking to the schedule. I also found bring a small lamp with an incandescent bulb to be helpful. I'd turn of the the fluorescents in the room I was doing most of my paperwork, and turn the small lamp on. Yellow-orange light is lovely when you're working nights. Good luck.

 

[RosenthalFiber]

Just stay up for like 36 hrs straight the first shift then pass out after. Its no worse than a call day

 

[jerseytrash]

Not everyone is able to adjust right away to nights. Usually though if it's busy overnight it doesn't matter b/c I have no choice but to stay up anyway.

 

[take the shot]

So just to clarify: this night house officer shift is for an entire month. That's why I'm a bit concerned as to the best way to adjust.

 

[jdh71]

So just to clarify: this night house officer shift is for an entire month. That's why I'm a bit concerned as to the best way to adjust.

I told you.

Take it or leave it.

I may or may not know what I'm talking about. Though I've experienced a fair number of rodeos.

(why do I even post here?)

 

[obiwan]

humans were not meant to stay up during the night for extended periods of time.... thats why i would take a swig of some Zquiet when i got home to try to help me sleep but would wake up at around 3-4 feeling like a zombie whenever i was doing night float shifts.

isn't there an acgme rule somewhere that you can only do a certain number of night shifts during a month?

 

[wholeheartedly]

I'm not a doc so that'll probably get me screened out..but yeah I work in allied health field and do straight nights, for the past 4 years.

JDH is on the money. Though I do things just a bit different. I have trouble winding down when I first get home, especially if things have been nuts, and have two mutts that need attention, so I usually stay up for a bit, then sleep until an hour and a half before I need to go in. I feel like sleeping later makes it less likely I'll crash at the end of my shift.

Two tips, I got some great blackout shades and because light slipped in around the edges I used Velcro around the window to seal things better. Maybe not an option if you rent. Gets pitch black, very nice, totally worth the 40 bucks.

Second, watch the caffeine, it's an easy fix, but tends to cause long term issues if you're on a long stretch because its hard to predict when it's going to kick in and how long it's going to last and you might find it causing you more problems than helping. So I steer clear of it and rarely have issues unlike my coworkers who hit up the 5 hour energy or mtn dew and still nod off during their shift or complain they can't sleep when they get home. But everyone is wired differently.

Definitely recommend prioritizing healthy eating, night shift food does generally suck and is the kind that's going to make you want to crash

Also, drink water. Staying hydrated is very helpful too.

 

[jerseytrash]

So just to clarify: this night house officer shift is for an entire month. That's why I'm a bit concerned as to the best way to adjust.

A month? We only have to do it in two week increments (as do most places to my knowledge) - that seems a bit long to work purely nights

 

[jdh71]

A month? We only have to do it in two week increments (as do most places to my knowledge) - that seems a bit long to work purely nights

It's fine. It's not inhumane. You get used to it. Better to do it in one block and have it done.

 

[Bostonredsox]

Sleep during the day, going to bed reasonably soon after you get home (I'd usually eat something and then go to sleep). Get up in the afternoon ~3 hours before your shift. Exercise, get something healthy to eat, make something healthy for midnight "dinner" (food in the hospital at night is CRAP and will make you feel worse). Keep the same schedule. I cannot emphasize enough that you should NOT use your time during the day to do things and run errands. It's a not a day "off". Protect your sleep, health, and sanity by transitioning, and sticking to the schedule. I also found bring a small lamp with an incandescent bulb to be helpful. I'd turn of the the fluorescents in the room I was doing most of my paperwork, and turn the small lamp on. Yellow-orange light is lovely when you're working nights. Good luck.

lol three hours before work and time to exercise and still worrying about being tired, you guys are needy.

I have 5 kids. My night blocks were 630p-8a usually, run home help wife get 3 kids ready for school, drive kids in, get back home around 9-930, help feed/change the two littler ones, let wife take an hour or two nap (who was up most all of the night feeding, changing and rocking kids who are germ machines and always sick), eat something, take a shower, go back in and pick up the younger kid who only goes to half day school, get home and finally go to bed around 1-130p. Wake up around 330 to feed the screaming newborn while wife has gone to pick up the two older kids from school, go back to sleep, wake up at 530 to eat dinner, spend 30 min or so with the kids and then head off to work.

In 6 full months of nights (6 - 4 week rotations of sun-fri nights) over 2 1/2 years I may have gotten >5 hours of sleep 6 times. And Fridays you go to clinic after the night shift.

Long story short, just do it. It's not a big deal. Go to work. Go home and sleep. Get up and do it again. You will do fine. Because you don't have a choice. In general I have found month long night blocks are a million times easier on your body than doing something asinine like q5 call with. 24-30 hour shift every fifth day. I love night blocks. Don't sweat it it's not going to be nearly as big a deal on your body as you think.

If you think about it, getting up at 530 for hospital ward months, working till like 8pm for twelve straight out of every 14 is so many more hours and so much more wear on your mind and body. Night blocks are awesome in comparison

 

[Bostonredsox]

humans were not meant to stay up during the night for extended periods of time.... thats why i would take a swig of some Zquiet when i got home to try to help me sleep but would wake up at around 3-4 feeling like a zombie whenever i was doing night float shifts.

isn't there an acgme rule somewhere that you can only do a certain number of night shifts during a month?

Some of us feel that way on long day shifts.

Not sure about acgme cap but aoa cap is 4 months of nights excluding call. But as I demonstrated above, there are ways to fudge the paperwork to get around the rule.

 

[jdh71]

Nothing needy about it. That's the right way to do it.

If you so choose to reproduce like the species is dying before starting residency, then you obviously get what you deserve and do what you have to.

lol three hours before work and time to exercise and still worrying about being tired, you guys are needy.

I have 5 kids. My night blocks were 630p-8a usually, run home help wife get 3 kids ready for school, drive kids in, get back home around 9-930, help feed/change the two littler ones, let wife take an hour or two nap (who was up most all of the night feeding, changing and rocking kids who are germ machines and always sick), eat something, take a shower, go back in and pick up the younger kid who only goes to half day school, get home and finally go to bed around 1-130p. Wake up around 330 to feed the screaming newborn while wife has gone to pick up the two older kids from school, go back to sleep, wake up at 530 to eat dinner, spend 30 min or so with the kids and then head off to work.

In 6 full months of nights (6 - 4 week rotations of sun-fri nights) over 2 1/2 years I may have gotten >5 hours of sleep 6 times. And Fridays you go to clinic after the night shift.

Long story short, just do it. It's not a big deal. Go to work. Go home and sleep. Get up and do it again. You will do fine. Because you don't have a choice. In general I have found month long night blocks are a million times easier on your body than doing something asinine like q5 call with. 24-30 hour shift every fifth day. I love night blocks. Don't sweat it it's not going to be nearly as big a deal on your body as you think.

If you think about it, getting up at 530 for hospital ward months, working till like 8pm for twelve straight out of every 14 is so many more hours and so much more wear on your mind and body. Night blocks are awesome in comparison

 

[take the shot]

Thanks guys for all your great advice
As with all my other rotations, I imagine it will get easier and less intimidating once things get going

 

[Raryn]

humans were not meant to stay up during the night for extended periods of time.... thats why i would take a swig of some Zquiet when i got home to try to help me sleep but would wake up at around 3-4 feeling like a zombie whenever i was doing night float shifts.

isn't there an acgme rule somewhere that you can only do a certain number of night shifts during a month?

The only ACGME rule that comes to mind offhand is the one forbidding >6 nights in a row.

 

[QuizzicalApe]

I took my day off and used it like a big dumb chump, and completely threw off my sleep cycle. At the time, I would have preferred to have just worked straight through instead of misusing my time off stupidly.

Lesson learned

 

[jdh71]

The only ACGME rule that comes to mind offhand is the one forbidding >6 nights in a row.

6 nights? I'm pretty sure it's 6 weeks of nights in a row.

 

[obiwan]

In general I have found month long night blocks are a million times easier on your body than doing something asinine like q5 call with. 24-30 hour shift every fifth day. I love night blocks.

no way man.

 

[jdh71]

no way man.

They say with enough abuse you begin to love the abuser and find the abuse so much less horrible.

 

[Raryn]

6 nights? I'm pretty sure it's 6 weeks of nights in a row.

Two different rules. You can't have more than 6 nights in a row (i.e. they must give you a night off) and you must not have more than 1 month of nights in a row (i.e. you have to work day stretches in between at some point).

From the actual policies:

VI.G.6. Maximum Frequency of In-House Night Float

Residents must not be scheduled for more than six consecutive
nights of night float.

I.A.2.h).(3)

residents must not be assigned more than two months of
night float during any year of training, or more than four
months of night float over the three years of residency
training. Residents must not be assigned to more than one
month of consecutive night float rotation;

 

[jdh71]

Two different rules. You can't have more than 6 nights in a row (i.e. they must give you a night off) and you must not have more than 1 month of nights in a row (i.e. you have to work day stretches in between at some point).

Seems reasonable. It's been a while since I looked at them and clearly I was conflating the two rules together!

At my shop we all did one month of nights first and second year (and sometimes a second month of nights was done also done - as we had a float system at both the Uni hospital and the VA, but the VA ran with only a single intern at night, whereas the Uni has two interns at night, so sometimes you got "lucky" [some people liked the second month of nights] and only had to do one), though we always had Friday night and Saturday night off, and worked a 24 hour shift on Sundays, those extra nights being covered by residents on the consult services that month. It all kind of worked out. I liked my month of nights because we got so much autonomy, but I don't think I could work nights indefinitely; I start to get cranky.

 

[acceptmeplease]

I take melatonin when I get home, eat something and go to bed. I find melatonin doesn't have the lingering effects of Benadryl. Blackout shades and/or a good sleep mask is necessary.

As said before, do not break the cycle;
On your off night, stay up until at least 3 or 4 am.

Around night 3/5 I don't need the melatonin anymore. I wake up at 5 pm for a 7pm shift.

If I do sleep on my off night, ill wake up early, cook a big meal, and sleep again from 1-5. The meal should last me about 3 nights (I usually grill a ton of chicken).

At work, do not drink caffeine past 3 am or you may have a hard time falling asleep...unless its like the 5th night in a row, then I need caffeine to get the energy to go to bed.

 

[Deferoxamine]

For me, the sleep adjustment is the easy part.
The hard part is getting your GI tract to realize that you'll be regularly eating at different times. Switching back after the extended period of nocturnal (i.e. 2 weeks) also sucks.

 

[Weinberg Angle]

...

 

[CounselortoMD]

I'm not a doc so that'll probably get me screened out..but yeah I work in allied health field and do straight nights, for the past 4 years.

JDH is on the money. Though I do things just a bit different. I have trouble winding down when I first get home, especially if things have been nuts, and have two mutts that need attention, so I usually stay up for a bit, then sleep until an hour and a half before I need to go in. I feel like sleeping later makes it less likely I'll crash at the end of my shift.

Two tips, I got some great blackout shades and because light slipped in around the edges I used Velcro around the window to seal things better. Maybe not an option if you rent. Gets pitch black, very nice, totally worth the 40 bucks.

Second, watch the caffeine, it's an easy fix, but tends to cause long term issues if you're on a long stretch because its hard to predict when it's going to kick in and how long it's going to last and you might find it causing you more problems than helping. So I steer clear of it and rarely have issues unlike my coworkers who hit up the 5 hour energy or mtn dew and still nod off during their shift or complain they can't sleep when they get home. But everyone is wired differently.

Definitely recommend prioritizing healthy eating, night shift food does generally suck and is the kind that's going to make you want to crash

Also, drink water. Staying hydrated is very helpful too.

I worked straight nights for five years. I did exactly what you describe above: treated the early mornings after work as my "evenings". I then went to bed in the early afternoon, and slept until around 9PM when I woke up to get ready for work at 11Pm.