How do you handle working night shifts?

Please note that there is no medical advice offered in this article. The topic discussed is only for discussion purposes.

One recurrent issue that healthcare workers frequently face is the unpredictable hours that we have to work. The same goes for any occupation that has long shifts and nocturnal hours—this includes nurses and truck drivers too. How does one adapt to an odd schedule, and what impact does that have on your health?

You need your beauty rest if you job requires keeping people alive!

Since the majority of Smart Money MD readers are in the healthcare profession, I am curious to see what everyone does.

Doctors who take call face this their entire careers. You get called at 1am for an emergency, and your entire evening and following day (or week) is shot.  Working harder in this manner doesn’t even necessarily translate to increased pay.  Doctors who work shifts face similar issues when they’re assigned an overnight shift. This includes Emergency Room physicians, Radiologists, Anesthesiologists, Hospitalists (Apologies if I missed your specialty!). Sometimes these evening shifts alternate between day and overnight shifts. For instance, a Hospitalist may have five straight overnight shifts followed by a week of days. Or even one overnight shift interspersed between day shifts.  These odd hours take a toll on your health, and becomes even more burdensome as we age.

How do people manage to adjust to these hours for an entire career? I get jet lagged for weeks after travel across the world, and I only make these trips once every couple of years.

Pharmacologic assistance.

Caffeine is a common strategy that almost everyone I know has consumed in the course of life. This commonly comes in the form of coffee, tea, energy drinks, and even mints! A cup of coffee helps me power through a rough day of clinic after no sleep from an evening of call previously.

Melatonin. I’ve seen melatonin tablets in the nutritional supplements section of most grocery stores and pharmacy aisles.  I know doctors who use them to help them sleep during the day after a night shift.  The idea is that these tablets supplement your body’s production of melatonin, which in turn triggers the sleep-wake cycle. The mechanism of action isn’t quite known exactly, but it seems to have some effect on fighting jet-lag and altered sleep patterns. I don’t believe that there is any proven statistical benefit of melatonin supplements but there are clearly people out there who claim it works for them.

Antihistamines / sleep agent. I know people who just take non-specific H1 blocker for sleeping. Some people take prescription medications to help. Long term use of this type of medication is not condoned by any medical professional, but in a pinch, it can help you get by.

Lifestyle modification.

I tend to modify my activities and allow time to readjust my clock.  Fortunately I do not work the evenings often, so I don’t have to deal with the changes as frequently as other specialists.  I usually try to adjust my sleep schedule according to my work schedule. For the first two nights I often am groggy as have not adapted yet. I probably go through at least one sleepless night before I am able to catch up.

I try to stay hydrated. This means additional bottles of water at work, and additional trips to the bathroom! I don’t recall reading any scientific evidence on hydration to combat altered sleep cycles, but mild hydrotherapy shouldn’t hurt if you’ve got working kidneys. 😉

I try to exercise to jumpstart my body. This includes mild stretches, runs, or calisthenics. No marathons. Exercise does help me sleep better when my schedule gets flopped. I usually don’t do anything extremely strenuous, as I am probably fatigued anyway from work or the lack of sleep.

I try to avoid other mentally taxing activities outside of work.  You only have so much brainpower.  I need that brainpower for work. If my altered sleep schedule is only a temporary change, I try to minimize critical decisions (like buying a house, semi-dangerous lawn work). Just go to work, come home, exercise, eat and sleep. Simple.

Those of you evening shift workers, what tips do you have?

(Photo courtesy of Flickr)

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  • PICU MD

    I think there’s a difference between “awake all night” night shift work (i.e. ED MD or night nurse) vs. being “on call” at night and intermittent waking. The former you can change your life to be nocturnal if you only work nights. The latter where you’re awake some times and sleeping in the other is more difficult to deal with.

    • Smart Money MD

      True. Even in some “night float” Hospitalist situations, I’ve seen that the overnight docs can sometimes get in a few hours of sleep (the really lucky ones). Some of these guys I’ve seen just stay up the entire day too taking the kids to school and running errands.