getting used to the Circadian rythym?

[soxman]

I've heard that EM Physicians work various shifts in hospitals and that their sleep-wake cycle getting messed up is one of the main drawbacks to EM. One was telling me how his day off was messed up because he was sleeping the whole time.
Do EM docs get used to this? Any tips to combat this "hangover"?

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[southerndoc]

Do EM docs get used to this? Any tips to combat this "hangover"?

When working an overnight, sleep in shifts. 8a-11a, then 3p-6p if you're working a 7p-7a shift.

Most attendings don't work that many nights, at least the ones I know. I know of one group that only works 4 nights/month because they have so many attendings!

 

[GeneralVeers]

I've heard that EM Physicians work various shifts in hospitals and that their sleep-wake cycle getting messed up is one of the main drawbacks to EM. One was telling me how his day off was messed up because he was sleeping the whole time.
Do EM docs get used to this? Any tips to combat this "hangover"?

Nights are not as much of an issue once you get out of residency. Most private hospitals have double attending coverage during the day, and go to single coverage during the night shift (which on average is not as busy). That means only about 1/6 of all shifts are night shifts (given three 9 hour shifts in a day).

 

[Apollyon]

I know of one group that only works 4 nights/month because they have so many attendings!

No **** - we do 3 nights/month (unless you want more).

 

[totalbodypain]

I find gin works just fine.

 

[8744]

Drink beer, bitch about the United States, cross border for health care, repeat.

Oh, hold on. I thought you said Canadian rythm.

Sorry. Please disregard this post.

 

[bartleby]

After doing an overnight, I go home, have a light snack and hit the sack as early as possible. Dark room, eye shades and earplugs (preferably the foam kind)or some sort of white noise machine if you can't tolerate the plugs. If I'm doing a string of nights, I tend to need more sleep than usual... 7-8hrs. If I don't sleep in a single block of time, I don't feel rested. When I do my last night, I keep the same post-night bedtime routine but only sleep 4-5 hours, so I look & feel alive until an early bedtime (10-11) that evening.

I sometimes take ambien to go to sleep the evening after coming off a night, but I do not take meds to sleep between nights.

Some people who have trouble sleeping during nights get over-caffeinated during the latter part of the night. A cup of coffee is fine in the first couple hours of your shifts, but one of my co-residents used to wonder why he slept so crappy during the day after his nights, but meanwhile he's busy throwing coffee down at 5-6am.

You want to do everything you can to tell you body, "it's night-time... time for beddy-bye" when you walk out at the end of a night shift.

 

[southerndoc]

Some people who have trouble sleeping during nights get over-caffeinated during the latter part of the night. A cup of coffee is fine in the first couple hours of your shifts, but one of my co-residents used to wonder why he slept so crappy during the day after his nights, but meanwhile he's busy throwing coffee down at 5-6am.

This is why I do not participate in the 4-5am coffee run during an overnight shift.

 

[The White Coat Investor]

I worked 6 nights a month as an intern, 5 as a junior, and 4-5 as a senior. At my current gig I work 6 a night, but am able to sleep 1-4 hours most shifts. Yea, its a weird gig, I know. That's the military for you.

I find sleeping as long as possible with the A/C pumping, the fan on high (white noise), and the room way dark works for me. After the last of a string of nights I sleep 2-3 hours, then force myself to get up and go back to bed by 11 or 12 at night. Usually I'm okay going back to the day life after that. I try not to schedule anything in my life while I'm working nights works for me, then I can just veg out when I'm not working.

 

[ERMudPhud]

I've wrestled with this problem for a while and this is what I've come up with. As some of you know I've spent the last 5 years doing research while covering night shifts at a local hospital. I used to do either friday and saturday night twice a month or wed, thurs, fri, saturday once a month. I used to have a hell of a time on sunday. I would try like hell to stay up all day so I could enjoy the day and fall asleep that night since lab meeting and the start of a normal work week was just around the corner monday morning. If I slept for just a few hours sunday morning I was impossible to wake up and felt like **** the rest of the day. If I tried to say up I would invariably crash by midafternoon for a nap which would make it impossible to sleep that night. I tried taking the nap anyway and then taking benadryl or ambien to fall asleep that night but that always left me feeling real hungover on monday. Then I read that modafanil had been approved for shift work sleep disorder. I had a talk with my PCP. Now I put all my nights in a row and after the last night I take 200mg right at the end of my shift. I stay awake all day sunday and I'm able to enjoy the day with my kids. I usually hit a low period around early afternoon and either take a real short snooze or just push through it and feel normal the rest of the evening. Then I crash and sleep like I'm dead around 10pm. I've noticed it makes me a little more manic than my normal self so I would never work while on it. I am also a bit more irritable but I think much less irritable than I was when I was just trying to stay awake. I'm leaving the research gig now for full time clinical but I still plan on putting all my nights in a row and doing the same thing.

 

[dlung]

No **** - we do 3 nights/month (unless you want more).

A senior was discussing this with one of our attendings recently, and the attending told him that when he interviews for jobs that he should expect that his group/hospital to give him no more than 50 night shifts/year unless he wanted to take more.

 

[DogFaceMedic]

When working an overnight, sleep in shifts. 8a-11a, then 3p-6p if you're working a 7p-7a shift.

Most attendings don't work that many nights, at least the ones I know. I know of one group that only works 4 nights/month because they have so many attendings!

I have not tried this. Are you dragging between 11a and 3p or can you get some work done, exercise, or whatever; then, can you easily get back to sleep at 3p?

And PandaBear is it the circadian rythm or the canadian rythm that cures people of socialized medicine?

 

[leviathan]

I've heard that EM Physicians work various shifts in hospitals and that their sleep-wake cycle getting messed up is one of the main drawbacks to EM. One was telling me how his day off was messed up because he was sleeping the whole time.
Do EM docs get used to this? Any tips to combat this "hangover"?

I just came off night shifts at my job, and it's 6am (PST), and I still can't sleep. Usually, when I start day shifts, the first day I'm running on about 1 hour of sleep. The next night I am right back into a regular schedule when I fall asleep around 11pm and get up at 5am. If you're getting off a night shift, just shut the blinds tight, put on some earplugs, and I find I can sleep a straight 8 hours uninterrupted.

 

[dchristismi]

Staying away from the 5am coffee run is key. It always smells soooo good, and the nurses send a tech out to Dunkin Donuts for *real* coffee... I try to limit caffeine anyway, but especially when I know I'll need to sleep in the near future. If I'm on a string of nights, I just plan to crash when I get home (7:30-8:30-ish) and sleep until I wake up around 3-4. Working 12s, there's really not much time for life whether it's days or nights, so I just plan to work, sleep, eat, maybe take the dogs for a run, and not much else. That way, if I do get anything productive done, it's an unexpected bonus.

Day to night switches are easy - stay up as late as possible the night before going to nights. I shoot for 3am, but don't always make it. Discovery Channel, History Channel and TLC help. Or occasionally I'll plan to do midnight cleaning or Wal-Mart runs.

On night to day switches, I go directly to bed, sleep until about 1, force myself to get up (dogs wanting to go for runs NOW seems to help... cold noses!), and plan to just chill for the rest of the day. I'm usually ok for bed by 10-11, but if I think I'll have trouble, I'll take Ambien. I'm a bit grumpy and sleep deprived, but it's not as bad as being post-call, IMHO.

 

[12R34Y]

Staying away from the 5am coffee run is key. It always smells soooo good, and the nurses send a tech out to Dunkin Donuts for *real* coffee... I try to limit caffeine anyway, but especially when I know I'll need to sleep in the near future. If I'm on a string of nights, I just plan to crash when I get home (7:30-8:30-ish) and sleep until I wake up around 3-4. Working 12s, there's really not much time for life whether it's days or nights, so I just plan to work, sleep, eat, maybe take the dogs for a run, and not much else. That way, if I do get anything productive done, it's an unexpected bonus.

Day to night switches are easy - stay up as late as possible the night before going to nights. I shoot for 3am, but don't always make it. Discovery Channel, History Channel and TLC help. Or occasionally I'll plan to do midnight cleaning or Wal-Mart runs.

On night to day switches, I go directly to bed, sleep until about 1, force myself to get up (dogs wanting to go for runs NOW seems to help... cold noses!), and plan to just chill for the rest of the day. I'm usually ok for bed by 10-11, but if I think I'll have trouble, I'll take Ambien. I'm a bit grumpy and sleep deprived, but it's not as bad as being post-call, IMHO.

This is PRECISELY why I chose a residency program with 8 hour shifts!!!! plenty of time for life. 12's equal NO LIFE outside of work.

later

 

[GeneralVeers]

This is PRECISELY why I chose a residency program with 8 hour shifts!!!! plenty of time for life. 12's equal NO LIFE outside of work.

later

Not necessarily. We do a 2-on, 2-off schedule. On the days off, there is time to do anything one wants. If I was working 8 hour shifts I'd probably just go home, eat and sleep anyway.

 

[southerndoc]

Staying away from the 5am coffee run is key. It always smells soooo good, and the nurses send a tech out to Dunkin Donuts for *real* coffee...

We have a 5 am Dunkin Donuts coffee run every single morning in the ED. Initially I got on the list, but it didn't take long to figure out why I was wide awake at 9:30-10 am lying in bed unable to sleep.

 

[southerndoc]

I have not tried this. Are you dragging between 11a and 3p or can you get some work done, exercise, or whatever; then, can you easily get back to sleep at 3p?

I usually get work done. Exercise, do laundry, whatever. I don't do anything that requires a lot of mental stimulation... so no studying for sure.

It works best now that I'm working senior shifts. The 11p-8a shift is awesome. Go home, sleep from 9a-noonish/1p, get up for a few hours, go back to sleep at 5p and sleep till 9:30 or 10. That's how to best maximize the circadian rhythm. (One of our attendings has studies that support this.)

When you work 12 hr shifts, it's harder to sleep with this schedule.