Surviving the Night Shift

Are you tired? Is every meal breakfast? Is your body out of whack? If so, I bet you're a "night guy." (Note to reader: Night guy is a non-gender-specific term used by people who work nights.)

     If you work nights and you're feeling the strain, you need to know there are steps you can take to make your life bearable without sacrificing your health, sanity and family.

Your Need to Sleep
     Sleep is essential, and, if you work nights, you need to make certain you get enough of it.

     The average person needs eight hours of sleep per 24-hour period, although many believe that six hours is enough to function on. WebMD indicates that people who average only six hours of sleep per day will eventually suffer from the effects of chronic sleep deprivation, including a slow-down in mental processing ability, gastrointestinal problems, vision problems and a weakened immune system.

Attitude Adjustment
     If you work nights, you must live nights, and the rest of your world needs to know this. Many in our profession who work a stretch of nights then try to become "day guys" on their days off often find they are fatigued, grumpy and chronically sick. They don't enjoy their time off as much as they'd like because their body feels out of whack. Then, after a few days of being on a "normal" schedule, they go back to work and feel bad for the first few shifts because their body is trying to readjust to a night schedule.

     This happens because everything we do on a biochemical level is based on circadian cycles. Your internal organs function according to set biological cycles, and disrupting their rhythms can be hard on your body. Flipping your schedule from nights to days over a prolonged period of time can also reduce your life span. The American Heart Association reports that people who flip their sleep schedules can disrupt their cardiac sympathetic and/or parasympathetic autonomic controls.

Friends and Families
     Most "night guys" have friends and family members who do not comprehend the nocturnal lifestyle. You know the routine: They call you at 9 a.m. and act surprised that you're still sleeping. When you explain that you worked all night, they chuckle, apologize half-heartedly and then launch into a topic that must be settled right now.

     There's an easy cure for this: Turn off the ringer on your phone.

     If you absolutely can't turn the ringer off, there's another easy way to handle this problem. On your next night shift, call them back at 3 a.m. and ask: "Hey, how are you? Say, I was just having my lunch break and was thinking about you. I really need to speak to you about..." I promise they will never call when you're sleeping again.

     The same holds true for pagers. There is nothing more aggravating than having a supervisor page you at 9 a.m. to ask where you left a backboard or the PASG air pump. Return the favor by paging the supervisor at 3 a.m. to ask if it's okay to use tile cleaner instead of bleach to clean the floor of your rig. Make sure to use your "nice voice" when you do this.

     A word to managers and supervisors:At least one-third of your staff works nights. Don't ask them to come in for an 8 a.m. meeting on their days off.

     But what about family or work emergencies? The answer is simple. Tell your friends, family and supervisors when you regularly sleep. Give them your pager number and make it clear that it's only for a real emergency. I know people who have two pagers, one of which is their "top secret sleep pager." They give the number to a select few and then shut every other device off. If the sleep pager goes off, they know it's a real emergency.

Eating and Exercise
     As medical professionals, we know the importance of good nutrition. Being sleep- deprived, flipping your circadian cycle and working nights can negatively affect your gastrointestinal tract. Putting junky food into the equation only makes matters worse.

     Exercise is also crucial. The important thing is that you do it consistently and stick to a regular routine. A human body in good physical shape is better suited to handle the stresses of the job and a nocturnal lifestyle. A body that's in decent physical condition is also less prone to becoming sick. Think about all the nasty "bugs" you come into contact with at work. This alone should be enough motivation to exercise. Just don't exercise within two hours of going to bed, because it may hamper your ability to fall asleep.

Stress and Stimulants
     You finish a busy shift that included a senseless fatality. On the way home, someone cuts you off on the highway, nearly sending you into the ditch. As you pull into your driveway, you remember that you forgot to mail an overdue bill. You enter your home, trying to be quiet, but you stumble over some toys in the hallway and the kids wake up and want to see you. Your spouse wakes up and wants to spend some time with you. And the cat wants to be fed—NOW! After all that, you crawl into bed and hope for some decent sleep, because you have to be back at work the very next night.

     Some of the best stress relievers are exercise, recreational activities, solitude and having trusted people in whom you can confide. You need to have a balance in your life between stress and stress relievers.

     One way to immediately reduce the stress that may be wrecking your sleep is to change the nature of your bedroom. If you read, watch TV, eat or spend your recreational time in bed, it's more difficult to make the mental transition that prepares you to sleep. You will wind down faster and fall asleep quicker if you only associate your bed with sleep and sex.

     What about stimulants? Caffeine is probably the most widely used stimulant today. Is it bad? That's up to the individual. Some people can drink coffee by the gallon and not suffer at all, while others can't even risk sniffing the stuff. Be aware that too much caffeine can disrupt your GI tract, cause restlessness, increase your heart rate and make you an ogre. Consuming caffeine a few hours before you go to bed can also rob you of the quality sleep you need.

Sleep Strategies
     We all want and need quality sleep. Here are a few tips on making it a reality:

     Create some noise
     A fan is the best "white noise" producer you can buy. A running fan will drown out about 90% of all the noises that so easily awaken the day sleeper. If you don't have a fan and you are extremely sensitive to noise, ear plugs should do the trick.

     Dim the lights
     If you're going to sleep, it needs to be dark. A good set of room-darkening shades will do the trick. If you're cheap like I am, toss a thick, dark blanket over the curtain rod and secure it with a few clothespins. Another ultra-cheap option is to tape aluminum foil over your windows.

     One thing about light: Being awake during the day and being exposed to sunlight is essential to the mental health of millions. Those who are deprived of it may suffer effects similar to seasonal affective disorder, which, according to WebMD, can include problems concentrating, low energy and fatigue, reduced interest in daily activities, moodiness (depressed, sad or unusually quiet), increased appetite, craving carbohydrates (pasta, bread and sweets), weight gain from overeating carbohydrates, sleeping too much and having a heavy feeling in the arms and legs. If you are struggling with these issues, you may need to reconsider working nights.

     Drinking to sleep
     Generally, having an ounce of liquor, a beer or one glass of wine before you go to bed can help you get to sleep, but not stay asleep. According to WebMD, a small amount of alcohol "raises HDL, or 'good' cholesterol level, lowers blood pressure, inhibits the formation of blood clots (this can be good or bad; it may prevent heart attacks but could increase the risk of bleeding)," and "helps prevent artery damage caused by high LDL, or 'bad cholesterol'." The obvious problems lay in alcohol abuse. EMS professionals may be aware of the problems, but are not immune.

     Sleep aids
     The two most widely used sleep aids seem to be diphenhydramine (Benadryl) and melatonin. Melatonin is the hormone your body naturally produces to induce sleep. According to my physician, melatonin tends to induce REM sleep, and I found that to be true. Taking melatonin shortly before going to bed helped me go to sleep and stay asleep, without the "hangover" feeling you can get from diphenhydramine. If you are considering using these products to help you sleep, consult your doctor first.

Sleep Disorders
     If nothing is working and you're still exhausted, consider the possibility that you have a sleep disorder. The most common types of sleep disorder are: obstructive sleep apnea, central sleep apnea, restless legs syndrome and narcolepsy. If you suspect you suffer from one of these, see your doctor as soon as possible.

Conclusion
     Being a "night guy" isn't for everyone. Working nights can take its toll, but by sticking to a consistent schedule and addressing the problems that interfere with your sleep, you can make your night career an enjoyable one. After all, the "best" calls always occur at night.

James Newberger, NREMT-P, has been a paramedic for 17 years. He currently works for North Memorial Medical Center, a Level 1 trauma center in Minneapolis, MN.