How to switch from night to day

[sonofva]

What's the best way to switch if I work several nights and then go back on days? Thanks!


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[LiamNeesons]

I just go to sleep a couple of hours earlier each night until I'm back to normal.

 

[MedWonk]

I just go to sleep a couple of hours earlier each night until I'm back to normal.

I do this, plus maintain the same wake up time. It sucks at first, but eventually you adjust and become sleepy at the appropriate time.

 

[RustedFox]

If "sleep latency" (time from lay-down to doze-off) is a problem, I've had a lot of success with a half-dose of NyQuil.

I've done a lot of reading on the topic, and I'm also pretty convinced that melatonin has much more therapeutic benefit that 'we' largely realize.

 

[MSmentor018]

i've used melatonin for years with great success. even for a quick nap before flipping into nights. at least for me it doesn't leave that groggy feeling from other sleeping meds

 

[KermitMorgenstein]

I take half a tablet of unisom an hour before bed, right before I get ready to call it a night.


meow

 

[circulus vitios]

Sleep for 4-5 hours and wake up. You will feel like **** but you won't have any trouble falling asleep at your normal bed time.

 

[Birdstrike]

Sonofva, none of that works. Not melatonin, Benadryl, alcohol, other sleep/wakefulness drugs or any other gimmick.

There's absolutely nothing you can do but choose when you want to feel the pain. You can go home after your last night shift, do what your body so sweetly wants to do and crash out and sleep all day. Then you'll be wide awake on your "day off" (air quotes) at 2 am, 3 am, 4 am, and 5 am feeling the pain, only to face the same dilemma the next day.

Or, you can suffer immensely all day after your shift, go running, stay awake and active as possible without having slept all night. Then, half delirious and half glassy-eyed crash asleep at 10 pm not having slept in over 24 hours. This way, you'll have an epic, REM-filled nights rest, like Hans Solo did after being frozen for 1 year during Return of the Jedi. Also, you'll snap your circadian rhythms back in sync as fast as humanly possible.

Pick one of the two.

There is just an unavoidable amount of pain and discomfort that has to be reconciled sometime, somewhere and by someone, with the circadian rhythm back flips. It might affect you and your mood. It might be transferred to a spouse, kids or roommate/significant other. Or your blood pressure and cortisol levels will take the hit.

This is why 40 hours in the ED is 60 doing anything else. This is why, "In EM, when you're off, you're off" is wrong in an epic way. This effect bleeds into your "days off" (air quotes, again) in a way regular-job-people just don't and won't ever understand or appreciate.

Oh...snap! Silly me. There is a solution. How could I forget? It's to work less clinical ER shifts.

I firmly believe that many ED physician-administrators, educators, fellowship attendees, program directors, and other people who reduce their shift load do it primarily for this reason, yet aren't honest about it.


http://www.epmonthly.com/departments/wellness/work-and-life/is-shift-work-killing-you-/

 

[circulus vitios]

Staying up all day is absolutely miserable. Just do what I said.

 

[e30ftw]

if your scheduler hates you, just be scheduled to work a day shift 24hrs after coming off nights. you'll be so deliriously exhausted after your zombie day-shift that you'll go home and be able to sleep that night.

had that schedule 4x in last 3 months, works like a charm!

 

[swamprat]

I sleep like 5-6 hours after the last night shift and wake up pretty tired, push through the day and end up going to bed early that night and then I'm back on days. It sucks but I think its better then staying up all day or crashing and sleeping all day and end up being up all night. Birdstrike def right there is no way to avoid that pain, when I wake up after 5 or 6 hours my body wants to sleep more but I force myself. It basically kills the day I just am a zombie watching tv or doing anything else anyway

 

[RustedFox]

if your scheduler hates you, just be scheduled to work a day shift 24hrs after coming off nights. you'll be so deliriously exhausted after your zombie day-shift that you'll go home and be able to sleep that night.

had that schedule 4x in last 3 months, works like a charm!

Haha... This... the curse that's a blessing of mercy. Hurry up and sleep, because you have to wake up!

The best part is that after ZombieDayShift that ... hey ! the sun is still out, LOLZ! - this is when you get the idea to do truly stupid things like... for example, purchase bongo drums, technology, or (whatever).

 

[Birdstrike]

You Have a Higher Risk of MI and CVA Because of Your Job

"Shift work was associated with myocardial infarction...ischaemic stroke ... Coronary events were also increased."

http://www.bmj.com/content/345/bmj.e4800

 

[Hercules]

I sleep like 5-6 hours after the last night shift and wake up pretty tired, push through the day and end up going to bed early that night and then I'm back on days. It sucks but I think its better then staying up all day or crashing and sleeping all day and end up being up all night. Birdstrike def right there is no way to avoid that pain, when I wake up after 5 or 6 hours my body wants to sleep more but I force myself. It basically kills the day I just am a zombie watching tv or doing anything else anyway

Sleeping 5-6 hours is a full nights sleep for me most nights (married with 4 kids) so I can't sleep that much after my last night shift. After my last night shift I usually sleep 2-3 hrs max then get up and do a really crappy workout and some cardio. Then, just like everyone else said, I trudge through the rest of the day not very functional and take some Benadryl and melatonin about 10 or 11 that night to go to sleep. Bird's right, you have to pay back the pain at some point.

 

[Groove]

Find what works for you and stick with it. Honestly, ambien is probably the single best solution for a sudden "reset". I have a feeling more people in here use it than let on. You shouldn't need it after the second night if you generally don't have problems with sleep. You'll wake up very well rested and sharp. If you take 10mg, make sure you have a good 8hrs, otherwise cut them in half. Only use them for the resets. Benadryl works and I actually used it last week but damn does it make me groggy and feel like my head is stuffed with cotton when I wake up. Melatonin never worked for me. 2-3h "naps" prior to my shift reset does NOT work for me. Going into a busy ED functioning on 10% thrusters is a bad idea. Whatever you do, make sure you feel rested.

Other than that, the best thing I've found is doing everything to maximize your sleep hygiene. Black out curtains, cool temp, making sure everyone in your life respects the fact that you need sleep, etc.. Hit that "do not disturb" button on your iPhone, and whatever else you need to do. I was using a noise maker for a long time but now I keep my ceiling fan on high and it does the same function. Oh, and on the days/nights that you are a bit off and know you'll need to hit the sack earlier, get a good work out or a long run. I always do that and it def helps me sleep.

 

[DoctorMedic]

I agree with most above. Depends on what your needs are on your DOMA "day off my ass" as I like to call them. Usually I either try to stay up all day until like 5-6pm then crash until morning or I'll take a 4hr nap right after the night shift and then go to bed at a more normal time.

 

[Car-rX]

For resetting the body clock, retinal exposure to bright lights at your "new" wake time for 15-30 minutes is supposed to work wonders.
I'm a "night person" who must reluctantly rise for the day job. It's tempting to shuffle around the dim house nursing a cup of coffee unenthusiastically, and the idea of going outside in the sun or turning on all the lights in a room is the last thing I want to do at this hour, but it works.
Researchers at the University of Manchester recently identified the enzyme casein kinase 1epsilon as part of the circadian rhythm mechanism and its responsiveness to light and temperature cues.

 

[alehar]

Nights to days: the morning after the last shift, head to bed and sleep for 3-5 hours, then force yourself to get up and do things the rest of the day. Usually I find you can go to bed pretty easily that night. Add melatonin PRN around bedtime.

Days to nights: stay up as late as possible the night before the night shift, go to bed around 5-7AM, sleep until a few hours before shift.

 

[The White Coat Investor]

Lots of good tips in here. I agree you will feel the pain at some point. Sleep hygiene and drugs (I use diphenhydramine once a month or so) help. One solution I haven't seen mentioned is to avoid the earliest of day shifts, at least directly after a night shift. I suspect most places with some double coverage are like mine. We've got 5 eight hour shifts, 6a, 11a, 2p, 7p, 10p. It is FAR easier to come back from nights and work a 2p shift than a 6a shift. They always say "don't rotate backwards" but it seems to work well for me. If I have the 10p shift on Monday night (go home at 6a on Tuesday) I can go sleep until noon and feel like I got a "full night's sleep", have a productive day until 1 or 2 am, then go to sleep for 8 hours, wake up at 10 am and have another productive day. I miss a lot of sunrises this way, but it does seem to hurt less.

In my group, people tend to only work some of the shifts. They might only work the 6a and 11a. They might work the 6a, 11a, and 2p. They might work only the 2p, and 7p. Others are 7p, and 10p only. One guy works 10ps and 6as. Not sure I get that one but it does give him evenings at home with the kids. I'm still working 6a, 2p, 7p, and 10p, but I'm giving very serious thought to dropping the 6a and/or the 10p as they seem to be the most painful. Far easier to adjust when you're only working 2 or 3 of the various shifts. This is a non-issue for those in my group who never work after midnight. They make a lot less money but it's worth it to them.

Working fewer shifts helps too.

 

[aklark]

Why aren't EM schedules generally made in a block format? i.e. 2-4 or more weeks of nights, followed by a few days off, then switch to days or evenings?

Is this sort of predictability (larger blocks of a single shift) possible to arrange as an attending?

 

[Evisju7]

Find what works for you and stick with it. Honestly, ambien is probably the single best solution for a sudden "reset". I have a feeling more people in here use it than let on. You shouldn't need it after the second night if you generally don't have problems with sleep. You'll wake up very well rested and sharp. If you take 10mg, make sure you have a good 8hrs, otherwise cut them in half. Only use them for the resets. Benadryl works and I actually used it last week but damn does it make me groggy and feel like my head is stuffed with cotton when I wake up. Melatonin never worked for me. 2-3h "naps" prior to my shift reset does NOT work for me. Going into a busy ED functioning on 10% thrusters is a bad idea. Whatever you do, make sure you feel rested..

I can say from my non-doctor experience, ambien works incredibly well. My sleep cycle is constantly being disrupted, but one 8 hour night with Ambien and I'm good to go again. Just MAKE SURE you're in bed when you take it.. away from your cell phone and laptop.. and car keys.

 

[The Buff]

Why aren't EM schedules generally made in a block format? i.e. 2-4 or more weeks of nights, followed by a few days off, then switch to days or evenings?

Is this sort of predictability (larger blocks of a single shift) possible to arrange as an attending?

The problem with large blocks of the same shifts, for you and thus the rest of the group you will force to work the other blocks you are not working, is that it gives you very little personal flexibility. Having a month-long block of nights essentially means you are going to be a hermit for a month. Plus if you have an important event during the day in week 3 it makes it even harder to switch back and forth. Some people, a minority I think, might prefer this schedule and the nocturnists among us seem to pull it off, but for most of us I think it is easier to work 2-3 nights, not do very much during those days, and then force ourselves to come back to the real world. I think it is easier to achieve work-life balance and get the days/times off you need when you are not forced into a preordained block schedule.

 

[scummie]

Very helpful thread!!

 

[JMC2010]

After the last overnight, I do as others above and just sleep about 4 hours and drag my self out of bed and sit on the couch and be unpleasant to talk to most of the day. It's very difficult as my wife is understanding and knows that I will be less pleasant than usual but it still causes some difficulties for us. Anyone have the solution to this problem? Avoidance? Hotel rooms? I feel bad as I recognize that I'm not myself after an overnight but i can't channel the usual energy to be an engaged spouse.

 

[Armadillos]

As a medstudent I started using zaleplon a couple times a month whenever I need to change my sleep schedule or sleep when I shouldn't be sleeping, its pretty amazing for me. Knocks me out for 6-7 hours and I dont feel groggy at all compared to benadryl or something.

So in this situation I would probably sleep like 7 hours after getting off nights, do stuff for the late afternoon/evening and then knock myself out at the time I'm supposed to sleep when on days.

 

[Arcan57]

A lot of the pain is going to depend on how much your circadian rhythm actually changed. If you did 4 straight night shifts sleeping in a completely blackened room with minimal noise problems (something other than white noise), then the pattern of cortisol release has changed. No matter how much sleep you get, until your cortisol peak comes back into daylight hours you're going to feel wiped out during those times. At least personally I've found that no pattern of sleep following a string (3 or >) nights has any significant impact on how long it takes before I don't go through the day feeling like ass.

 

[Day man]

After my last overnight, I nap morning to 1-2p (5ish hours sleep), get up And eat then work out hard, then have a big dinner. I almost always flip back with no issue.

We use the French progressive system so 2 nights doesn't build up too much sleep latency. But I am a huge proponent of working out, especially in residency.

 

[katmandu]

What is the French progressive system?

 

[deleted547339]

What is the French progressive system?

Drink in the morning and only work 30 hours a week?

 

[katmandu]

Drink in the morning and only work 30 hours a week?

Or drink with your patients and everyone is happier with the patient encounter?

 

[Groove]

I just want to update my opinion on melatonin. I'm now about 1.5 wks into a trial of using it and that stuff is amazing. I think the last time I tried it was 10 years ago and maybe it was the 1mg tabs? I've noticed they come in 3mg and 5mg these days and thought I'd give it a shot again after reading this thread. The 5mg is too much but 3mg is perfect. I can't remember sleeping that well in a very long time and seem to wake up really rested and alert. I did some research and it seems to really help reset your clock. So far, it's worked for resets in my case from really late swings back to early morning or vice versa, etc.. but have not tried it yet for 24h turn arounds or short flips. I think the stuff is great though. I don't seem to have that extra day of zombieland where you feel like ass and have a perpetual squint/scowl on your face and family/friends avoid you at all costs. Jury is still out but so far, so good.

 

[RustedFox]

+1 for Melatonin. Big time.

 

[la gringa]

i have been known to think that i may prefer working the next day back (night-off-day) because i sleep SO WELL that i can literally go to bed around 9 or 10am, sleep all day, mope around the house a bit in the evening, then just go back to sleep around normal bed time. i call myself the world's sleep champion - but i have a dark room, live alone, keep my house at 70 year-round, frequently use the blocking function on my phone, and have a white noise app on my phone for when the landscapers are working.

i am a nonabashed fan of both melatonin and ambien. i can practically work on benadryl, does nothing for me but give me side effects. yes, i'm kind of weird.