How to deal with constant night float/day shift changes

[Tiburon]

The intern year program I'm at has quite a few times when you're night float for a few days, then days for a few days, then nights again. Anyone have any good tips on how to adjust to this? I've been having problems sleeping during the day before my night float shifts.

Sleeping pills the best option? What sleeping pills do residents commonly use that don't make you groggy and amnesic?

Any other tips would be useful.

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[DocDanny]

Before your night shifts, stay awake as late as possible the night before. Then go to bed at sunrise.

 

[Law2Doc]

The intern year program I'm at has quite a few times when you're night float for a few days, then days for a few days, then nights again. Anyone have any good tips on how to adjust to this? I've been having problems sleeping during the day before my night float shifts.

Sleeping pills the best option? What sleeping pills do residents commonly use that don't make you groggy and amnesic?

Any other tips would be useful.

You don't want to use sleeping pills. You want to do the reverse. The tried and true aporoach is to get jacked up on caffeine during the nights you need to stay up, and simply crash when you need to sleep.

 

[Perrotfish]

The intern year program I'm at has quite a few times when you're night float for a few days, then days for a few days, then nights again. Anyone have any good tips on how to adjust to this? I've been having problems sleeping during the day before my night float shifts.

Sleeping pills the best option? What sleeping pills do residents commonly use that don't make you groggy and amnesic?

Any other tips would be useful.

Good sleep hygeine is helpful. The room you sleep in should ideally be dark. Pitch black dark. And silent. If you can't make that happen use a sleep mask and ear plugs.

 

[gutonc]

The intern year program I'm at has quite a few times when you're night float for a few days, then days for a few days, then nights again. Anyone have any good tips on how to adjust to this? I've been having problems sleeping during the day before my night float shifts.

Sleeping pills the best option? What sleeping pills do residents commonly use that don't make you groggy and amnesic?

Any other tips would be useful.

I wonder if the IOM or ACGME had this scenario in mind when they changed the work hour rules? Now, instead of one exhausted resident per service every morning, we have an entire team of people who haven't gotten a decent night's sleep in 3 years because they're constantly switching back and forth between days and nights.

 

[Law2Doc]

I wonder if the IOM or ACGME had this scenario in mind when they changed the work hour rules? Now, instead of one exhausted resident per service every morning, we have an entire team of people who haven't gotten a decent night's sleep in 3 years because they're constantly switching back and forth between days and nights.

The ACGME is okay with that because they can tell the public, who these rules were apparently meant to address, that no interns have been up for 24 hours when they take care of them. This was never about what was best for residents, it's about window dressing -- what looks best to the laypeople on paper. The 80 hour "cap" helped residents, but this subsequent round of restrictions actually hosed us pretty good. Being tired after a 30 hour shift twice a week, with lots of post call days and a few golden weekends is not nearly as bad as a month of 6 day a week night float for months at a time, and having to switch day to night sleep cycles regularly.

 

[TheLesPaul]

The ACGME is okay with that because they can tell the public, who these rules were apparently meant to address, that no interns have been up for 24 hours when they take care of them. This was never about what was best for residents, it's about window dressing -- what looks best to the laypeople on paper. The 80 hour "cap" helped residents, but this subsequent round of restrictions actually hosed us pretty good. Being tired after a 30 hour shift twice a week, with lots of post call days and a few golden weekends is not nearly as bad as a month of 6 day a week night float for months at a time, and having to switch day to night sleep cycles regularly.

At the same time, having done both (30-hrs as a med student and 16-hrs as an intern now), I feel like I'm much better refreshed on a regular basis even though I don't get a full weekend off. We have night call q5, and our shift is 8p-12; having that 5th day to sleep in every call cycle is almost better than having a full day off every 7 days. But who knows, maybe it will add up towards the end of the year...

 

[Law2Doc]

At the same time, having done both (30-hrs as a med student and 16-hrs as an intern now), I feel like I'm much better refreshed on a regular basis even though I don't get a full weekend off. We have night call q5, and our shift is 8p-12; having that 5th day to sleep in every call cycle is almost better than having a full day off every 7 days. But who knows, maybe it will add up towards the end of the year...

Couldn't disagree more. As someone who also worked under both systems the 30 hour call with post-call days and fewer weekends was much much better for us. But I'm comparing it to the 6 days a week of 13 hour night float shifts for a month at a time that many places do to maximize labor under the new rules.

BTW You really can't compare being a med student to being an intern though, so you really haven't "done both." med students are only on service for short periods of time and never really settle in for the long haul. You are more apt to burn both ends of the candle as a med student as you really don't have any responsibility, and will know you are back on a light rotation in just a few calls. It's really not the same.

 

[Groove]

Options that people use:

1) Stay up progressively later before your night shift and the night before, as late as possible... say 6-7a.m. and then sleep until 1-2p.m. then start... (I do this one...)
2) Go to bed late and get up early the day of your night shift and take a 2-3 hour nap that afternoon and then start your nights. (Never worked for me but people swear by it.)
3) Take a sleeping pill or benadryl, etc.. to "make" yourself sleep a few hours before your night shift, then hopefully you are exhausted when you get in and can sleep.

Either way, the biggest help for me was good sleep hygiene. It made a world of difference in helping me get to sleep and stay asleep once I made sure the room was dark, cool and quiet, blacked out windows, etc..

Some people have an easier time adjusting. It's pretty difficult for me but either way, the first shift sucks when you "flop". I always feel nauseated when I switch.

 

[Perrotfish]

Couldn't disagree more. As someone who also worked under both systems the 30 hour call with post-call days and fewer weekends was much much better for us. But I'm comparing it to the 6 days a week of 13 hour night float shifts for a month at a time that many places do to maximize labor under the new rules.
.

This remains a matter of opinion. I still think for someone with self disciple the night float system is more physiologic than a call system. You CAN sleep at least 6 hours before every shift on a night float system, if you're willing to make enough sacrifices in your personal life (and I will trade a life for adequate sleep, at least for the duration of residency). On a call system you need to destroy your body every 4th night and there's no getting around it. So far I've been hitting the work hour cap and frequently changin to night float as an Intern and I've never come up against the kind of dangerous sleep deprivation that I did with a medical student's call schedule.

BTW You really can't compare being a med student to being an intern though, so
you really haven't "done both." med students are only on service for short
periods of time and never really settle in for the long haul. You are more apt
to burn both ends of the candle as a med student as you really don't have any
responsibility, and will know you are back on a light rotation in just a few
calls. It's really not the same

I'm not sure what you're talking about here, residents change rotations even more often than medical students. As an Intern I'm never on a service for more than a month at a time, and the schedule is mostly designed as 'easy-hard-easy-hard' so I'm always 4 weeks away from a 60 hour/week rotation. As a med student I was on q4 rotations for up to 8 weeks at a time, working to the work hour limit and beyond while also piling on a minimum of 20 hours/week of shelf studying, and I often had multiple hard rotations back to back. Surgery directly to Gyn meant 16 straight weeks of Q4 misery. That's more than 'a few calls', it's nearly 30 in a row. It IS true that you have no real responsibility, but that doesn't mean you get to leave any earlier or that sleep deprivation is any less miserable. It just means you don't even have any real work to distract you as the seconds tick slowly by.

 

[TheLesPaul]

Exactly. While Law2Doc may be right in that med student != resident, you're still *up* for the same amount of hours, and I much much much prefer a regular schedule with sleep every (or almost every) night rather than the work hard/play hard of 30-hrs. personal preference.

 

[Law2Doc]

Exactly. While Law2Doc may be right in that med student != resident, you're still *up* for the same amount of hours, and I much much much prefer a regular schedule with sleep every (or almost every) night rather than the work hard/play hard of 30-hrs. personal preference.

Again being "up" is not the same as being " on". You can go through the motions as a med student but it's never really someone else's life or your career in your hands. As a result it's not nearly as stressful, you aren't working brain cells as hard, and you as a result aren't as tired as you might be if you didn't allow your mind to wander half night. Think back at how tired you were after taking Step 1 as compared to spending the same number of hours at the mall. It's the same thing every night.

 

[Law2Doc]

...

I'm not sure what you're talking about here, residents change rotations even more often than medical students. As an Intern I'm never on a service for more than a month at a time, and the schedule is mostly designed as 'easy-hard-easy-hard' so I'm always 4 weeks away from a 60 hour/week rotation....

for a lot of folks as an intern the easy rotations were 65 hours and the harder rotations flirted with the duty hour caps. I never had a no call rotation intern year. So you settle in differently than as a med student. And unlike the med students, you have to be on your game every day, while med students often coast. That, in and of itself, is enormously less tiring.

 

[gutonc]

I actually did both systems at the same time in residency as my program had a hairy mix of Q3 overnight in the ICU, Q5 overnight on the wards, Q3-ish with night float in the other ICU and the CCU and Q5 with NF on the other wards (two hospitals, a VA and Uni, physically and spiritually connected). All of the systems had their ups and downs and nothing was perfect.

The traditional QX overnight call sucks 1 out of every X nights (X=5 is fine, X=3 blows goats) but you get your post-call day to do stuff normal people do (like laundry and grocery shopping). But the rest of the cycle sis pretty OK. Night float systems are pretty consistently moderately sucky. It's almost never the horror show that you sometimes get on an overnight call system but you rarely (if ever) get a break...it's just 6 solid days of working your butt off 9-14 hours a day.

As far as sleep hygiene goes, an NF system allows you to get more regular (although probably not enough) sleep while the overnight system is more variable, with one day a cycle where you can sleep 12-16 hours at a stretch, assuming you don't have other commitments (like many of us with families do).

To answer the OPs question, "how do I deal with it?" I suck it up and power through. I think it's been at least 6 years since I slept more than 8 hours at a stretch, and I generally function on 6 (even when not on call). It's just life.

 

[QofQuimica]

Options that people use:

1) Stay up progressively later before your night shift and the night before, as late as possible... say 6-7a.m. and then sleep until 1-2p.m. then start... (I do this one...)
2) Go to bed late and get up early the day of your night shift and take a 2-3 hour nap that afternoon and then start your nights. (Never worked for me but people swear by it.)
3) Take a sleeping pill or benadryl, etc.. to "make" yourself sleep a few hours before your night shift, then hopefully you are exhausted when you get in and can sleep.

Either way, the biggest help for me was good sleep hygiene. It made a world of difference in helping me get to sleep and stay asleep once I made sure the room was dark, cool and quiet, blacked out windows, etc..

Some people have an easier time adjusting. It's pretty difficult for me but either way, the first shift sucks when you "flop". I always feel nauseated when I switch.

Me too. It usually takes me about three days until the jetlagged feeling finally goes away. And I do option 1 also. I'm going back on nights next week, and I'll force myself to stay up all night the night before so that I can sleep during the day of my first night shift.