Another Late Night

In the days following my last post I have worked successive night shifts. I even voluntarily switched into someone's night shift to keep my string together. Today is my first day off so I went to a party with my sister, a party that ended long ago, bringing me to my topic sentence. I can't sleep. As a result of last week's schedule only a raging party would have made me feel normal. Because I am a doctor I even have a label for my problem: shiftwork sleep disorder.

Definitely, there are downsides to my personal life that never occurred to me until this week. For example, being awake when everyone is asleep (though it does give me a chance to catch up on email and do some writing). And, being asleep when everyone is awake--I've seen less friends this week working 60 hours than working 90 hours in internal medicine. Also, there is the switch between nights and days that feels like a flight from New Delhi to San Francisco International Airport. That is a trip I wouldn't make on a weekly basis no matter how much I love my grandparents.

More importantly, shiftwork syndrome could potentially affect patient health if I don't manage it well. At least I'm in the right place to seek help. Our former residency director Rebecca Smith-Coggins has done several studies on the sleep habits of Emergency Physicians. In one such study she showed decreased performance during night shifts. After all, the accidents at Bhopal, Chernobyl, and Three-Mile Island all happened between 12am and 4am.

I could write a daily blog on the negative biologic cascade that may have led to these disasters but a good treatise already exists. In short, it comes down to not cooperating with our circadian rhythms which are programmed to operate on a more regular 23-26 hour cycle. Not only is our level of arousal associated with a regular pattern but so are gastric secretions, hormonal levels, sexual arousal, social behavior, anxiety, and metabolism. Circumventing the forces of nature is always a tricky endeavor. For this reason I try not to compound the problem by relying on pharmaceuticals as sleep aids.

One idea that rings true to me is the planned nap proposed by Dr. Smith-Coggins. Despite the fact that she showed an improvement in performance when this was implemented in her study, it just always seemed like a good idea at every job I've ever had. Other strategies include good sleep hygiene. That is, keep the bedroom for sleeping not work, follow regular habits around bedtime, reduce stress, and seek social support.

Don't get me wrong; I'm not trying to lament my life--I love emergency medicine. But sleep disturbances seem to be exponentially expanding from the invention of the light bulb to our rapidly expanding global economy. It is a health issue worth taking seriously.

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