Too many hours, too little sleep

Taking Care on a 12-Hour Shift

When duty calls for an extended shift, play it safe by following these tips:

Ration your coffee. Caffeine should be on a PRN basis, especially if you work the night shift. By caffeinating yourself judiciously, says Rogers, you’ll be getting maximum effect when you need it most—those times when you’re dragging at work. And you should close the coffee bar at least four hours before you go to sleep.

Prioritize your duties. When possible, restrict the cognitive heavy lifting to those hours when you’re wide-awake—the first few hours on shift. If the action slows down just as you’re slowing down, don’t let yourself fall asleep (unless, of course, you’re allowed to nap during breaks). Get up, have a snack, stay where it’s brightly lit.

Take your breaks. A recent University of Pennsylvania study shows that nurses often work through lunch. Anecdotal evidence suggests they are reluctant to take breaks because it would impose on colleagues who’d have to cover, says Rogers. Other studies have shown that working 12 hours without a break, even when you’ve gotten adequate sleep, can affect your cognitive skills.

Curtail consecutive shifts. Limit the number of consecutive days of an extended shift to two or three at the most, suggests Rogers.

Leave on time. To combat sleep deprivation, Rogers and other experts advise limiting work to 12 hours per 24-hour period. If the culture at your hospital or unit makes that impossible, then work to change the culture.

The Side Effects of Insufficient Sleep

10 That Can Affect Your Health

Lack of sleep can put you at higher risk for:

• hypertension
• stroke
• cardiovascular disease
• diabetes
• obesity
• muscular skeletal injuries
• needle sticks
• depression
• increased pain
• auto accidents

10 That Can Also Affect Patient Care

The Joint Commission outlined these as patient-safety factors:

• inability to stay focused
• reduced motivation
• compromised problem solving
• confusion
• irritability
• memory lapses
• impaired communication
• impaired information processing and judgment
• diminished reaction time
• indifference and loss of empathy

Plan for a Good Night’s Sleep

Here are 10 simple steps to help you get more ZZZs:

1. Sync up with your circadian clock. Daylight is key to regulating sleep patterns. Expose yourself to natural light each morning.
2. Get some exercise. In one study, people who said they worked out vigorously also reported they slept better. Another study of 155,000 adults indicated that any exercise is good for your sleep. Those who reported walking, gardening, golfing or doing any exercise within the previous month were one third less likely to report problems sleeping, and half as likely to report daytime sleepiness. Research indicates that exercise might also help relieve sleep apnea.
3. Make sleep a priority. The wash, those bills, this week’s Homeland—none are more important than your sleep. Period.
4. Lights out. Since light cues the body to stay awake, make your bedroom as dark as possible. (Blackout shades or an eye mask, anyone?) Sleep experts also recommend banishing the television, tablet, computer, phone and anything with LED lighting from the room. In fact, your bedroom should be reserved for two activities—sleep and sex.
5. Keep it cool. Your bedroom should be cool but comfortable, dark and quiet.
6. Go for comfort. Indulge with luxurious linens, cozy PJs, a comfy mattress (if it’s sagging in the middle, it’s time for a new one) and pillows that offer support.
7. Establish a ritual. Just as children settle down to sleep with a bedtime story, adult bodies also respond to cues. To condition your body to become sleepy, establish a relaxing nighttime routine, one that starts 30 to 60 minutes before you head to bed. It doesn’t matter what it is—as long as it’s not stimulating. An hour before bedtime, shut down the computer, turn on the soothing music, take a warm bath, sit in candlelight, have sex, do whatever it is that will help you relax. Avoid bright light and stress-inducing thoughts.
8. Set a bedtime. And a wake time. Your body likes consistency.
9. Lay off the stimulants. For at least four hours before bedtime, institute a prohibition on caffeine (even if you can fall asleep after a double espresso, caffeine can affect melatonin production and the quality of your sleep).  Also, while alcohol may make you fall asleep, it has a stimulant affect after your blood alcohol level drops, so it can disrupt your sleep.
10. Surrender to sleep. That means letting go, not worrying about anything. Attitude counts. If you go to bed believing you’ll fall asleep, you’ll have a better chance of quickly nodding off.

“Nurses who work more than 12½ hours at a stretch are three times more likely to make a patient care error.”

Under the Influence

You wouldn’t think of going to work tipsy, would you? Well, from a neurobehavioral standpoint, being awake for 17 consecutive hours is like having a blood alcohol level of 0.05—the legal limit for driving in many countries. Awake for 24 hours? That’s similar to someone with a blood alcohol level of 0.10 (grounds for arrest for a DUI in the United States.). Drowsy driving is second only to drunk driving as a cause of car accidents in the U.S. “Unfortunately we don’t have a breathalyzer for sleepiness,” says Ann E. Rogers, the Edith F. Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing.

Did you know? The National Highway Traffic Safety Administration estimates that 1,550 fatalities and 40,000 nonfatal injuries per year are caused by drivers who’ve had too little sleep.

What About the Night Shift?

The human body was built to be awake during the day and asleep at night. You pay a price when you try to fool Mother Nature with a counterclockwise approach to your circadian rhythms. A slew of studies indicate that working the night shift is hazardous to our health. Besides the side effects that are part and parcel of short-changing sleep, shift workers also may be at higher risk for some kinds of cancer. All the more reason to be vigilant about sleep.

Not Just Nurses

The Centers for Disease Control and Prevention has labeled insufficient sleep a public health epidemic. An estimated 50 to 70 million Americans have chronic sleep difficulties, and nearly 30 percent of adults get less than six hours of sleep a night, according to surveys.