Switching sleep schedules after Night Shift

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RoyBasch

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Hello, I am a staff ER physician recently completed residency. I am finding I have a lot of difficulty switching back to a "days" sleep schedule after doing a night shift(s). I suppose I had a similar problem in residency but I just accepted that I would be tired and busy all the time so I didn't think much of it. Now; however, I find I am missing out on being able to enjoy time off after nights because I am either asleep or tired.

I am interested in getting more disciplined about managing my circadian rhythms and sleep cycles and I was wondering what all you guys do to ease that transition from "nights" back to "days."
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The day after getting off my last night shift in a stretch, I go right to bed as soon as I get home, but I only sleep for an hour or two at most. Then, I make myself stay up until no earlier than an hour or so before my usual "day shift" bed time, and then I sleep hard that night and feel back to normal the next day.

Also, I plan ahead so that I can use that otherwise lost day on activities that don't require me to be 100%. I get chores and errands and things done on that switch over day, so that I don't have to do those things during times when I am more well rested. I don't know if it is possible to avoid paying the piper somewhere along the line, but you can at least make sure that you aren't wasting the best of you on dreck that can be done by the zombie version of you.
 
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I've been thinking of trying Melatonin, I was wondering what other's experiences with it were. Also I think Promethean's advice is good to, I need to be more disciplined about not sleeping very much after my last night.
 
10mg melationin, 25-50mg of diphenhydramine. 1-2 of your fave brew at about 8pm the first night after. Try to sleep 2-4 hours after the shift then suffer until about 8pm lol.
 
OccupyTheED said:
10mg melationin, 25-50mg of diphenhydramine. 1-2 of your fave brew at about 8pm the first night after. Try to sleep 2-4 hours after the shift then suffer until about 8pm lol.
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Yes to all of this. I also set my alarm for 2-2.5 hrs of sleep and get up and exercise (lifting with lower weight than normal and then cardio at a slower pace than my normal training times). The exercise helps make sure I sleep well that night but there are definitely no PRs being set.


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I have tried everything after a night shift. Sleep 2-3 hours and then get up. Sleep a regular schedule then get up and try to go to sleep at a decent time that night. Sleep 5 hours then get up. I have realized that nothing works. I have also realized that if I am switching from nights to days no matter what I do I am useless. My GF had some time to realize this but now gets it. What I now do is if I work a night I usually have either worked a stretch of them or have slowly transitioned to them. My last night I stay in bed as long as possible then I go to work. The next day I stay up all day long. I am mostly useless and watch TV/sit around. My girlfriend realizes this now and we do low key activities. Eventually I crash somewhere around 7 pm and sleep until the morning and my schedule is reset. This works best for me.
 
I should also note that when I tried to sleep just 2-3 hours my alarm would go off for about the next 4 hours q30 min. I just cannot do that as my bed is a bit too comfortable.
 
EMDOC17 said:
I should also note that when I tried to sleep just 2-3 hours my alarm would go off for about the next 4 hours q30 min. I just cannot do that as my bed is a bit too comfortable.
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It is still the same basic recipe of sleep deprivation for the first day after the last night and then sleep properly that night. I think that is the key, whether you nap a little or not at the beginning, what matters is that you are good and tired early that night.

I can actually sleep standing up, so if I don't close my eyes for at least an hour after the end of the shift, I will take a header down the stairs or some other such misadventure. I'm usually so caffeinated by the end of that final night shift that more than an hour or two of sleep is not possible even if I wanted it to be.
 
I read an excellent blog post once on the topic (I *think* it might have been Shadowfax at MovinMeat, but I can't for the life of me find it now, and I've looked several times.)

Basically, it summed up my experience: sleep a few hours, force self to get up and feel groggy and nauseated and awful after 2-4 hours of sleep. Lots of caffeine until feel somewhat normal. A couple hours later, switch to alcohol, don't plan to eat healthy that night, try to go to bed at a decent time. I love melatonin, but only need 5-10 mg. I'm worried I may develop a tolerance, and I really love it. Whether it's the actual melatonin, or the psychological training "now I sleep," it works really well without the groggy anticholinergicy benadryl aftereffects. I also never plan to be remotely productive. This is a DOMA (ie day off, my ass) and it is to be as non-stressful as possible.
 
Wow, my routine is much different than all of yours. I try to take a nap before my night shift ~6-9pm. Then after my nights, I try to sleep for 6-8 hours, wake up ~12-2pm (depending on the length of the nap). Then bed at midnight or 1am, and up ~9am the next day.

I've tried all that melatonin and benadryl stuff, but I don't like it and doubt it's healthy long term.
Also, the method of doing a few hours of sleep then waking up groggy and powering through the day will lead to cumulative lost sleep. I can't see how this is healthy long term.

That said, I don't think there is a magic formula. Working nights is unnatural, but I think the key is making up enough sleep.
 
For those of you using melatonin any recommendations on the specific brand or preparation? I'm always a little dubious of the quality and drug standards of "supplements" that are not Rx.
 
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EMDOC17 said:
I have tried everything after a night shift. Sleep 2-3 hours and then get up. Sleep a regular schedule then get up and try to go to sleep at a decent time that night. Sleep 5 hours then get up. I have realized that nothing works. I have also realized that if I am switching from nights to days no matter what I do I am useless. My GF had some time to realize this but now gets it. What I now do is if I work a night I usually have either worked a stretch of them or have slowly transitioned to them. My last night I stay in bed as long as possible then I go to work. The next day I stay up all day long. I am mostly useless and watch TV/sit around. My girlfriend realizes this now and we do low key activities. Eventually I crash somewhere around 7 pm and sleep until the morning and my schedule is reset. This works best for me.
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You know what works best for me? Not working night shifts. Seriously. Everything else is stop-gap. It costs me quite a bit to pay someone else to do them, but the improvement in my quality of life is huge. You lose at least one productive day a month. How much would you be willing to pay to get that back? Plus, the patient population is different before midnight, and that's worth something too.

I'd like to see more groups have that at least be a possibility. Well-paid nocturnists who either don't mind doing the night thing, work fewer shifts per month to make up for it, or who really need/want the cash are the solution to the night shift issues discussed in this thread.
 
RoyBasch said:
For those of you using melatonin any recommendations on the specific brand or preparation? I'm always a little dubious of the quality and drug standards of "supplements" that are not Rx.
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The key is taking it only when that giant hydrogen ball is not in the sky. There are those on here who disagree with me, but my source is one of the only dual boarded endocrine/sleep med guys anywhere.

10-20mg. Those little 3mg doses are cute, but serve only to sell bottles to those who don't understand the science.
 
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The White Coat Investor said:
You know what works best for me? Not working night shifts. Seriously. Everything else is stop-gap. It costs me quite a bit to pay someone else to do them, but the improvement in my quality of life is huge. You lose at least one productive day a month. How much would you be willing to pay to get that back? Plus, the patient population is different before midnight, and that's worth something too.

I'd like to see more groups have that at least be a possibility. Well-paid nocturnists who either don't mind doing the night thing, work fewer shifts per month to make up for it, or who really need/want the cash are the solution to the night shift issues discussed in this thread.
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THIS. I try to keep nights to a minimum because I know that's best for career longevity for me. I'm actually glad there's an additional $50/hr differential at my shop, so the docs that want the nights can keep that money - and there are plenty who want to, so I'll gladly give them my nights.


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RustedFox said:
The key is taking it only when that giant hydrogen ball is not in the sky. There are those on here who disagree with me, but my source is one of the only dual boarded endocrine/sleep med guys anywhere.
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This.

Melatonin is not a "sleep" hormone. It's a "it is now nighttime" hormone. And no amount of it is going to convince your brain/body that it's nighttime when every other physical cue is telling you that it's daytime.
 
gutonc said:
This.

Melatonin is not a "sleep" hormone. It's a "it is now nighttime" hormone. And no amount of it is going to convince your brain/body that it's nighttime when every other physical cue is telling you that it's daytime.
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Indeed. Don't expect to take 10mg melatonin at 2pm and expect to power nap.
 
RustedFox said:
Indeed. Don't expect to take 10mg melatonin at 2pm and expect to power nap.
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Eh, I'll still take 15-20 mg before I sleep in the daytime. It's probably all psychological, but the combination of sunglasses on the way home from the night shift, bolus of melatonin, very dark and cool room, background noise, ear plugs has greatly improved my daytime sleep and night shift grumpies.
 
bravotwozero said:
THIS. I try to keep nights to a minimum because I know that's best for career longevity for me. I'm actually glad there's an additional $50/hr differential at my shop, so the docs that want the nights can keep that money - and there are plenty who want to, so I'll gladly give them my nights.


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I wish $50/HR motivated my group. The differential would have to be $150-$200/HR before anyone in my group would bite.


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Hercules said:
I wish $50/HR motivated my group. The differential would have to be $150-$200/HR before anyone in my group would bite.


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Wow really? Are you talking about people just working a few shifts a month, or being nocturnists? I was referring to the former


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Just a student, but a night float system would be ideal in my opinion.
 
gutonc said:
You know that you're talking to EM attendings who work set shifts that ensure full 24h coverage of an ED, right?
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Yea so anyways...

Say you have a group of 12 EM attendings. Everyone does one month of nights shifts, presumably as close together as possible.
 
That sounds like a recipe for disaster


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SansaStarkMD said:
Yea so anyways...

Say you have a group of 12 EM attendings. Everyone does one month of nights shifts, presumably as close together as possible.
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a 12 physician group will perhaps be single coverage at night... So then everyone's working 31 straight nights? Or maybe 2 months per year of 15 night shifts? Or 3 months of 10 night shifts?

Sounds awful.
 
On a side note, I queried a prominent internet website last year with the question, How much extra would it take for you to work night shifts? I was surprised at how little it took for people to work nights. Many people wrote that they did it for an extra $1-3 differential per hour. Some people wrote 10-15% was considered standard for most jobs that weren't just menial labor. Granted running an ED at night is a little different than most overnight jobs, but this was nonetheless surprising to me.
 
As a radiologist...I've always wondered how my ED physician colleagues flipped back and forth between overnight and day time shifts. Unfortunately the nature of radiology has necessitated more overnight shifts for myself as well. For those of you out there that have been doing a lot of nocturnal work, how has your health been affected Over the long term. thanks
 
Okay, okay, okay...

12 EM docs.
12 Months in a year.
1 month "night float" per doc.
That means that doc is going to work every single night that month.

Uhh... no.
 
RustedFox said:
Ohhh! Oh! Oh! - I get it now. Each doc is going to quit! That's how you win the game, right ?
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If I got put on a month straight of ED night shifts, I'm pretty sure I'd be looking for a different job before the second Tuesday.
 
WilcoWorld said:
If I got put on a month straight of ED night shifts, I'm pretty sure I'd be looking for a different job before the second Tuesday.
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I interviewed with a SDG that told me that for the first year that most of my shifts would be nights, and that's most of my "buy-in".

They wonder why they're perpetually recruiting.
 
RustedFox said:
I interviewed with a SDG that told me that for the first year that most of my shifts would be nights, and that's most of my "buy-in".

They wonder why they're perpetually recruiting.
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hahaha that's just brazen
 
"...presumably as close together as possible." English is hard.
 
To further clarify an already simple point... typical EP does 15 shifts a month. Have two physicians do 15 nights in a month. Repeat until each physician has done their thirty nights for the year, presumably as close together as possible.
 
Hercules said:
I wish $50/HR motivated my group. The differential would have to be $150-$200/HR before anyone in my group would bite.


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You might be surprised. You don't need everyone to bite. One nocturnist is huge- your night shifts just got cut in half. Two and they go away completely. I figure the differential in my group is something like $75 an hour over the evening shift and $125 an hour over the day shift. Plenty of takers at that price.

Maybe in some groups it works at $50 while in others it takes $200. But the point is the market will solve the problem if you let it.
 
SansaStarkMD said:
To further clarify an already simple point... typical EP does 15 shifts a month. Have two physicians do 15 nights in a month. Repeat until each physician has done their thirty nights for the year, presumably as close together as possible.
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I would still rather either have nocturnists handle the majority of nights or work 4ish nights/month, preferably in one chunk.

Doing 15 month is fine for nocturnists who like it or can tolerate it. That would entirely ruin my month(s) with multiple day/night changes.
 
SansaStarkMD said:
To further clarify an already simple point... typical EP does 15 shifts a month. Have two physicians do 15 nights in a month. Repeat until each physician has done their thirty nights for the year, presumably as close together as possible.
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Your problem here lies not just in your attitude, but in your mathematics. I know, I know.... before you say it; "English is hard", but math might be harder for you.

For your model to work, you need 2 docs to do 15 nightshifts for one month. That's 30 nightshifts per month.
After two months of time, those two docs have satisfied their annual nightshift requirement of thirty nights. Check them off the list.
Every two months, you'll need two fresh docs to do all the nightshifts.
Therefore, you'll need 12 docs in that group to fill the year's worth of nightshifts.
No group has 12 docs in it under this model.
3 shifts/day x 30 days/month = 90 shifts a month.
90 shifts a month/15 shifts per doc = 6 docs.
Where is the work (in terms of number of shifts) for the other 6 docs each month?
They're gone.
 
RustedFox said:
Your problem here lies not just in your attitude, but in your mathematics. I know, I know.... before you say it; "English is hard", but math might be harder for you.

For your model to work, you need 2 docs to do 15 nightshifts for one month. That's 30 nightshifts per month.
After two months of time, those two docs have satisfied their annual nightshift requirement of thirty nights. Check them off the list.
Every two months, you'll need two fresh docs to do all the nightshifts.
Therefore, you'll need 12 docs in that group to fill the year's worth of nightshifts.
No group has 12 docs in it under this model.
3 shifts/day x 30 days/month = 90 shifts a month.
90 shifts a month/15 shifts per doc = 6 docs.
Where is the work (in terms of number of shifts) for the other 6 docs each month?
They're gone.
Click to expand...

The concept remains. Whatever nights you do, do them as close together as possible. English is hard.
 
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