Crawling Into The Hole

OK, I'm starting my second run of night shifts at Macy's, this time SEVEN in a row so I'm hoping my day-to-night transition method is going to hold up:

Day before/day of the first night shift:

• Day before:  long afternoon nap, stay up until midnight.
• Day of:  Get up at 6:30am, NO COFFEE, no big projects or significant physical exertion. 
• Day of:  Back to bed at 11am, with the help of a light sleeping aid, a white noise machine, a blackout mask, and the company of a cat who is a good napper.  
• Day of:  Sleep until 4:30 or 5:00pm. COFFEE AT LAST!!  Light exercise regimen. Prepare a balanced "breakfast" of high-quality carbs and protein.
• Day of:  Pack a light lunch and several high-quality snacks. Night shift begins at 7:00pm.

For each night shift:

• Pace yourself at night. Work hard but remember to take lunch break at 1:00am or so.
• Pack a lunch: the only food available at night at most hospitals is crap, so you want to bring some quality food with you. Right now I'm enjoying a large salad containing a hard-boiled egg and some whole-grain pasta or brown rice. As winter approaches I'm probably going to hot entrees but we'll see.
• Carry snacks: otherwise you'll end up eating potato chips and leftover donuts all night long. I like fresh blueberries or another piece of fruit, a handful of pistachio nuts, maybe some peanut butter and graham crackers.
• Caffeinate appropriately: I drink lovely coffee from 5:00pm until midnight of a night shift, then no more. If you drink coffee until 7:00am, it is going to be awfully difficult to go to sleep again at 10:00am.
• Hydrate: To avoid the horrible, pinched, slightly hung-over feeling night shifts can often produce, I drink plenty of water at night--about two liters, usually lightly flavored with Crystal Light or Propel powder at twice the recommended dilution. I know these drink mixes are nothing but chemicals and damnation, but the sports medicine docs I know cite studies which demonstrate that providing flavored water encourages athletes to drink adequate fluids during competition. (Yes, being a nocturnalist is an endurance event.)
• DON'T NAP!  If you nap at night, you interrupt the illusion that you're awake during the "day." This doesn't mean you can't take a sanity break, especially between the "siesta" hours of 2:00-4:00am. I usually put my feet up on a chair and close my eyes to listen to some music. However, I do NOT lie down in the call room or permit myself to fall deeply asleep. I've found that napping during night shift makes it harder to sleep during the day, which in turn makes me want to nap at night, etc. etc. 
• Don't take forever over sign-out: When I'm tired, I start blithering. Furthermore, after working by myself all night, the arrival of the daytime hospitalists feels like being rescued from Gilligan's Island, so I often find myself kibbutzing--but this is a mistake. Sign out in fifteen minutes and go HOME.
• Maintain the illusion of night: Before I leave the hospital, I put on dark sunglasses to minimize the amont of daylight my eyes--and therefore my brain--receive on my way home. I keep these shades on until I"m ready to go to bed at 10:00am. This helps induce therapeutic sleep during the day.

After the last night shift:

• Return home, give thanks for the end of the ordeal.
• Go to bed as soon as you can--8:30 or 9:00am works for me.
• Get up again in the early afternoon--not later than 1:30pm.
• Caffeinate lightly until the late afternoon.
• Stay awake until a normal early bedtime (9:30 or 10:00pm), then go to bed like a normal person.
• Be prepared to feel worse the following day, because the day after the day after making a night-to-day transition is the hardest physically. Keep to a standard day schedule but don't take on any detailed projects, such as doing your taxes or putting up curtains.

This method has worked well for me in the past, when I was a Night Float resident, although I've never done 7-8 nights in a row, which is what I'm planning to do as a nocturnalist in the upcoming months. 

Comments

[Eric]

So, uh, what about modafinil?

It's how I handle phase shifting. (100 mg within 30 minutes of the desired "wake up" time). I haven't had jet lag since, and I really feel like I'm "crispier" cognitively than if I tried to support the wakefulness with caffeine.

[family doc]

I think it actually gets much easier the more nights you do because your body shifts into the new schedule. It's the 2nd and 3rd nights of the sequence which are the hardest but then it's kind of nice. Good luck!

[Sharon]

Sounds like a really well-planned out routine! I'm bookmarking this for possible use in several years. Just starting my second year in medical school, but if I need this in the future I will be so glad I have it. Thanks!

[georgia nocturnist]

The reason for being a nocturnist is so that you can do things that you want to do in the daytime, i.e. run, read, write, raise kids. If you require such elaborate shift training, you really ought to stick with a 9 to 5 gig. I did night for three years. Sleep isn't really all it is made out to be.

[doctorjen]

Are you SURE you don't want to move to the Midwest and do traditional family practice with a group of lovely family docs? Some nights required for attending your own clients' births, but only work 1 weekend in 4!

[Sarah]

I'm an ER doctor and it never ceases to amaze me how our types become experts at using sleep, food, and caffeine to make our bodies do unnatural things (study for eight hours a day for months on end in medical school, then call nights, then overnight shifts, etc.). You are clearly a sleep schedule altering ninja, as so many of us must be.