How to maximise sleep on night shifts

One of our toughest working requirements is night shifts. The ‘hero’ attitude to putting patient care above personal needs is, many times, what keeps the NHS going. But what are the implications of this self-sacrifice? And is it really in the best interest of the patients under our care? Despite increasing evidence for the effect of sleep deprivation on our ability to deliver safe care, doctors often don’t receive much, if any, information and education on the importance of sleep management. Here, we’ll go through some important facts about sleep, and tips for how to optimise your waking and sleeping hours.

Preparing for night shifts: You can 'Bank’ sleep in the 24 hours before a shift (long lie-in or nap), and encourage this by doing some exercise in the morning. Stay well fed and well hydrated to avoid waking from hunger or thirst.

During the night shift: Avoid high calorie/fat/carbohydrate foods (shift workers have an increased risk of CVS disease and diabetes, so try to maintain ‘normal’ eating patterns, and eat healthy food. Maximise exposure to light to keep you more alert. Have short (15-20 minute) naps when able – it improves levels of alertness and responsiveness, and the short duration avoids dipping into ‘deep’ sleep, which is more difficult to wake from.

After a night shift: Avoid driving if you haven’t had enough sleep. Your safety is paramount. If you want to look like a real rock star, wear sunglasses to minimise light exposure (only if safe to do so if you’re driving). Have a meal at 30 minutes before bed to avoid waking later from hunger. When you wake up, have bright light exposure for 20 minutes from waking.

Recovery from night shifts: Take a short morning nap of 1-2 hours (ideally before midday) after your last night, then go to bed at normal time. Enjoy a little lie in the next morning, and you’ll likely to need 2 normal nights to re-establish your normal sleeping pattern.

Be aware of the effects of sleep deprivation: You're more likely to make mistakes and avoidable errors (risk to patient safety), slower to process information (especially novel situations), and have impaired alertness (vigilance/reaction time). Crucially, you’re more likely to make decisions that involve higher degrees of risk. If you’re feeling drowsy and you’re not needed for an urgent situation, it may be in your patient's interest for you to delay attending a call and take a short nap before making further clinical decisions.

Use caffeine carefully: Have your coffee right before you nap – caffeine takes 15-20 minutes to take effect, so it will kick in just as you’re getting back to work. Caffeine has an effect on alertness for up to 6 hours after ingestion, so try to have your cuppa at in the first half of your shift

Electronics keep you up: Light (especially blue light) has a direct effect on body clock – it suppresses natural melatonin secretion. Either set a technology curfew before bed (ideally 30-60 minutes), or use the ‘night’ mode available on some devices (reduces blue light).