Night shifts are on my mind as I just finished a weekend of them and have them next week too.
Everyone copes with night shifts differently, in their own way that works for them.
In this blog I’m going to discuss some of the strategies I’ve come up with which helps me to get through them as best I can.
To be honest, coping with night shifts does not come naturally to me. I’m not a nocturnal creature and 8-8 ½ hours sleep a night suits me just fine, thank you very much! This said, I am a lot better at managing night shifts than when I started being a doctor.
As something most junior doctors do regularly, it surprised me we get no advice about how we can manage them when we start working. I find this shocking, especially as the WHO now classes night shifts as a probable carcinogen 1. All we got during induction as newbie doctors was being told ‘sometimes all life is, is work, eat, sleep, repeat’.
We are only human. Think of night shifts as jet lag from the UK to Australia without the fun of a holiday! In one of my F2 (second year doctor in the UK) we had a shift finishing at 9pm on the Thursday and started the night shift at 8:30 pm the next day! They are a massive disruption to your circadian rhythm.
I hope this blog helps anyone who struggles with nights or is about to embark upon them for the first time.
Try to get some sleep the afternoon before a night shift.
Some people go to bed really late the night before their night shifts. However, I’m someone who just doesn’t sleep in and this would lead to me losing even more sleep.
What I do is get up naturally (without an alarm) the morning that my night shifts start, go to the gym to burn some energy. I avoid my morning coffee in the hope this will help me sleep in the afternoon.
By 2:30/3pm I’ll put on some blue-light blocking glasses and get ready for a nap. I have some black out curtains I drape over my usual ones to try and help the sleep too.
I often only get 1 ½ hrs sleep but try to stay in bed/doze for 3 hours-ish. If you can get in a full sleep cycle (approximately 90 minutes), actually asleep, this can really help you survive your first night shift and minimise sleep debt.
Wear blue blocking glasses when you get home after your night shift
I find driving home after a night shift can be hard. Driving when sleep deprived has shown to be dangerous and I do all I can to fully concentrate, but I know this is still less than ideal. For this reason I don’t advocate wearing blue light blocking glasses whilst driving home, as I feel this will make you even sleepier on the road.
What I do do is have a quick, warm, shower and then put some blue light blocking glasses on straight away.
Truth be told, if you can avoid them then do! Classic sleep-medication you can get from your GP is addictive and tolerance to them can develop 2. Melatonin isn’t available over the counter in the UK (it is in the USA). Evidence for its use in optimising sleep during night shifts remains inconclusive 3.
My advice is try to alter when you consume caffeine during your night shift (if you drink it) and use sleep aids as a last resort.
I used to find it a real struggle to sleep in the day between night shifts. I now take a dose of nytol as soon as I get in. I find this helps go back to sleep in the day if I do wake up. I tried the half dose first as didn’t want to be sedated at all when I had to wake up again, but I didn’t feel it at all so now take the One a Night form. To be honest, it could be placebo but as it works for me and I only use them on night shifts it’s something that might be worth a try if you do struggle to sleep in the day.
Black out curtains & earplugs
Natural light in the day can really hamper sleep, investing in black out curtains/blinds if you do a lot of night shifts might be worth it. Alternatively, you can buy some cheap black out curtains and just drape them over your usual ones if you want a cheaper option!
If you live in a built up area and are sensitive to sound I also recommend ear plugs. Experiment trying out a few different types and which feel comfortable for you. This can help the neighbour’s dog barking or the postman from waking you up from a slumber.
What and when you eat and drink
I keep a time-restricted feeding lifestyle, on the whole keeping to an 8-hour eating window. Now I have tried this over nights but to be honest, I find it a real challenge and the days you are switching nigh on impossible. I think when your body is going through the stress of night shifts to give it some slack, this is not based on any scientific research I’m aware of, just what I feel when I’m battling through the nights! There is evidence to show keeping a time-restricted eating pattern can have benefits even if not practised every day, so don’t beat yourself up about missing a day or two. This said, I still try to keep to a 12-hour window on the days I’m not switching between day and night time living. I eat a breakfast that will keep me satiated throughout my day time sleep but aim to do this at least 2-3 hours before I will be sleeping. I also take wholesome snacks such as almonds, homemade trail mix, fruit etc if I do get peckish, as your body might crave sugary, processed foods and having these handy helps keep you healthy over the night.
I find eating as soon as I wake up a challenge so tend to take food with me to work and pray I have time to eat it. Eating before you go to work is preferable for some. Generally, eating higher-protein, lower-carbohydrate foods is best. Evidence shows just 1 poor night sleep can disturb metabolism so that glucose tolerance is reduced and appetite is increased via a rise in ghrelin and cortisol and a reduction in leptin 4,5.
I cannot emphasise enough how important it is to keep hydrated through a night shift. Aim to get at least 2 litres in, if not more. You’ll probably be drinking some caffeine, which remember is a diuretic. I find keeping hydrated really helps me feel less nauseous and generally rough during the night.
I have caffeine before and at the start of the night shift, but try to avoid it after midnight, as I would midday in the day time, to prevent caffeine being in my system (the half-life is approximately 6 hours) when trying to go to sleep. I keep hydrated with water and herbal teas after this time.
Try not to have alcohol when you get home in the morning as this disturbs sleep quality.
Say hi / socialise
Now this is something I’ve only started doing recently but I think really helps my mindset on nights. One of the hardest things I find about nights, especially on the weekends, is missing time with my partner. Going a whole weekend being a night nomad is enough to dampen anyone’s spirits, especially if you could be having quality time with them in the day. My favourite in the summer is getting out for a stroll together, this gentle movement and exposure to natural light really helps wake me up. On that note – gentle exercise is great for waking you up, but it can be detrimental if you go overboard. Night shifts are a stress on your body, doing intense exercise which increases cortisol further can tip you over your personal stress threshold and be more harm than good. My favourites are gentle strolls or yoga. Find out what works for you. If you eat before your nights shift why don’t you have dinner with your partner or a friend. This can really help reduce the isolating feeling of nights.
I don’t know about you, but when I am sleep deprived, I am way more emotional than usual. Things I wouldn’t usually brush off and never take personally get me tearing up. This little bit of social interaction and support can really go a long way with this too.
Recently I’ve tried setting my alarm early and squeezing in a little quality time together before I head out for my shift. To me, this is worth the little less sleep but it is all a balancing act.
If you’re working in a team it’s also great to try and socialise with them on your shift. A quick break and checking in on everyone can really make you feel less alone, especially if one of the junior doctors just wondering the wards alone at night.
Only have a nap after finishing nights
I can’t go a full day without sleep after a night shift. But too much sleeps prevents switching back to day time. This is important as sometimes there is limited time to switch back before you have a day shift. For example, this week I finished nights Monday morning and was back and work Wednesday for the day shift. For me I find this a little too quick a turnaround but limiting my sleep on Monday day time really helps. I get home and try to go to sleep as soon as possible and limit myself to 2-2 ½ hours, I aim to get in 2 full sleep cycles. It’s best then if you can expose yourself to some natural light. I then aim to go to sleep my usual time on Monday evening.
These are some of my tips. I hope they help. If you try them out let me know how you get on – you can comment below or on Instagram (@the_lifestylepill) or Twitter (@_lifestylepill).
- Straif, K. et al. Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 8, 1065–1066 (2007).
- BNF: British National Formulary – NICE.
- McKenna, H. & Wilkes, M. Optimising sleep for night shifts. BMJ j5637 (2018). doi:10.1136/bmj.j5637
- Knutson, K. L., Spiegel, K., Penev, P. & Van Cauter, E. The metabolic consequences of sleep deprivation. Sleep Med. Rev. 11, 163–78 (2007).
- Schmid, S. M., Hallschmid, M., Jauch-Chara, K., Born, J. & Schultes, B. A single night of sleep deprivation increases ghrelin levels and feelings of hunger in normal-weight healthy men. J. Sleep Res. 17, 331–334 (2008).