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Circadian rhythm? What circadian rhythm?

SoCuteMD

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    I need some help from you folks. For the last 3 years of EM residency, I've had no difficulty sleeping whenever I had a chance. Now my schedule's a little lighter so I'm less sleep-deprived, and after I've been on evenings I just can't seem to fall asleep at night! That means that every Wednesday conference AM is PAINFUL! I do all the "right" things: 1 caffeinated drink daily, get up early to tire myself out, no TV in my bedroom, no napping when I get home from a day shift. Yet, here I am, at 2:20 AM and I am WIDE awake! Seriously - I just threw in a load of laundry and folded some clothes.

    What are your tricks for getting back on a day schedule after you've been on evenings? (I've mastered the overnights switch back to days)
     

    southerndoc

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      I use benadryl (usually the Unasom diphenhydramine quick tabs), 25-50 mg to help sleep. Sometimes I've found the caffeine helps me sleep (weird, I know), but usually I stay away from it 6 hours before bedtime. I've almost mastered the ability to fall asleep by learning to concentrate on nothing but blackness, and whenever an idea or something pops into my head, I redirect my thoughts to basically concentrate on nothing. I know it really seems weird reading this, but with practice you can get it. I can fall asleep pretty much everytime within 5 minutes of hitting the pillow. The benadryl is mainly to help me stay asleep as I often times will wake up when I'm really tired (paradoxical effect?) after a string of night shifts.
       
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      leviathan

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        I'm the exact same way. I'll be exhausted in the late afternoon/early evening and I try to avoid napping. Then of course I get a second wind when it's time to sleep. Then I regret not napping earlier so I could have at least got some rest.

        Anyway, 5-10mg of melatonin about 2 hours before bed often seems to help, but I try to avoid being reliant on medications to fall asleep. Benadryl makes me feel terrible the next morning.
         

        edgesofsanity

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          As above. Also - lower your bedroom's temperature (shut heating ducts in winter, open A/C up in summer), blackout curtains/blindfold as needed. But the most important one I think gets overlooked is regular cardio exercise.
           

          VienneseWaltz

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            Ambien, if your PMD will prescribe it. Now that I'm out and only working a handful of overnights a month, I don't need it (one or two overnights in a row is not enough to reset my clock), but it was awesome in residency.
             

            la gringa

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              Ambien, if your PMD will prescribe it. Now that I'm out and only working a handful of overnights a month, I don't need it (one or two overnights in a row is not enough to reset my clock), but it was awesome in residency.

              +1 for Ambien... there are horror stories out there, but I have had no problems.
               

              dotcb

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                I think sleep is definitely a case where the little things add up to success. My favorites are:

                Dark room - light blocking curtains
                Temperature - keep it cool, I use an oscillating fan which keeps it cool and gives good white noise
                Exercise - daily
                Anchor sleep - I always nap before night shifts. Try to do something active & tire myself out.
                Avoid naps to keep self tired when need to sleep. May also get myself up a bit earlier sometimes so I'll be tired to sleep in the evening (when transitioning back to days).

                I usually sleep 1-3 hours before a night shift, and 5-6 hours after.

                The only med I've tried is melatonin, which hasn't been all that effective. I still get insomnia every now and again, but doing well at these things keeps it to a minimum.
                 

                dchristismi

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                  I find that regular exercise does help, but when I'm stressed, I don't sleep nearly as well. (Hello Medical Director position and scheduling stress! I haven't slept solidly in a week!)

                  I like melatonin, do use ambien occasionally (usually only 5 mg), benadryl only if I have to shift forward and sleep in, and all of the above sleep hygiene stuff. Oh, and wine. Definitely wine.


                  Actually, the thing that's worked best was to mostly work afternoon and evening shifts. I have enough partners that want the mornings, that it's a lot easier on my system. I sort of feel like I've lost some of the circadian flexibility I used to have by jumping all over, but my sanity appreciates it. I just despise early morning meetings. I move them to noon when I can!
                   

                  DrMom

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                    I'm one of my group's noctournists. I have 2 layers of blackout curtains and a dark film on my windows. My walls are painted a dark color. I use a ceiling fan and custom made earplugs.

                    I can't help much with the transition from evening shifts, but for nights I make sure I come in well rested. Usually not an afternoon nap for me but staying up until about 3am the night before and sleeping until late morning. After coming off of my last night shift I will sleep 2-4 hours starting in mid morning and then get up. I still have trouble staying asleep that night so I usually take a lunesta to help keep me asleep all night.
                     

                    VienneseWaltz

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                      -1 for ambien..took it once, hallucinated heavy all night in the CICU s/p open heart surgery. Bad times.

                      Definitely would avoid Ambien with other drugs on board. Also, never ever take Ambien CR (12.5 mg) the night before work or a situation requiring you to have a clear sensorium, even if you are getting 8+ hours of sleep. I learned this the hard way.
                       

                      WilcoWorld

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                        My 4-point wellness program (roughly in order of importance):

                        Refusal to work an untenable schedule (which means compromising on things like day off requests).
                        Exercise.
                        Meditation (another word for what SD and Dr. McN described above).
                        Wine.
                         
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