sleep, circadian rhythms, and medical training daniel j. buysse, m.d. professor of psychiatry e-1127...
Post on 16-Dec-2015
214 Views
Preview:
TRANSCRIPT
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical trainingtraining
Daniel J. Buysse, M.D.Daniel J. Buysse, M.D.
Professor of PsychiatryProfessor of Psychiatry
E-1127 WPICE-1127 WPIC
(412) 246-6413(412) 246-6413
buyssedj@upmc.edubuyssedj@upmc.edu
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical training: Objectivestraining: Objectives
To briefly review circadian rhythms in humansTo briefly review circadian rhythms in humans To briefly review sleep and sleep deprivation To briefly review sleep and sleep deprivation
effects in humanseffects in humans To discuss the impact of sleep and fatigue on To discuss the impact of sleep and fatigue on
medical traineesmedical trainees To review management strategies for sleep To review management strategies for sleep
lossloss
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical training: Objectivestraining: Objectives
To briefly review circadian rhythms in humansTo briefly review circadian rhythms in humans To briefly review sleep and sleep deprivation To briefly review sleep and sleep deprivation
effects in humanseffects in humans To discuss the impact of sleep and fatigue on To discuss the impact of sleep and fatigue on
medical traineesmedical trainees To review management strategies for sleep To review management strategies for sleep
lossloss
What are circadian rhythms?What are circadian rhythms?
Approximately 24-hour rhythms in Approximately 24-hour rhythms in physiological, psychological, performance physiological, psychological, performance measures… including sleep and wakefulnessmeasures… including sleep and wakefulness
Endogenous: Property of the organism, not Endogenous: Property of the organism, not the environmentthe environment– Pacemaker is suprachiasmatic nucleus (SCN) Pacemaker is suprachiasmatic nucleus (SCN)
of the hypothalamusof the hypothalamus
– Regulation by rhythmic expression of gene Regulation by rhythmic expression of gene transcription productstranscription products
Influenced by Influenced by entrainmententrainment and and masking masking effectseffects of the environment of the environment
How are doctors and their patients How are doctors and their patients alike?alike?
They both have circadian rhythmsThey both have circadian rhythms They both need sleepThey both need sleep The both suffer from the effect of sleep lossThe both suffer from the effect of sleep loss
Examples of Examples of humanhumancircadian circadian rhythmsrhythmsCzeisler and Khalsa, 2000Czeisler and Khalsa, 2000
Core body temperature
Urine volume
Thyroid StimulatingHormone
Growth Hormone
Prolactin
Parathyroid Hormone
Motor activity
Cortisol
Time
Circadian rhythms in performanceDijk and Edgar, 1999
Single-occupant motor vehicle crashesSingle-occupant motor vehicle crashesPack et al., SLEEP, 1995Pack et al., SLEEP, 1995
Circadian Rhythms
Suprachiasmatic Nuclei (SCN)
Light
Output Rhythms
Physiology Behavior
Entrainment by light in a human subject Moore-Ede, 1982
Time of Day (hours)
Scheduled rest-activity
Unscheduled “free-running”
Scheduled light-dark schedule
Unscheduled “free-running”
Scheduled light-dark schedule
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical training: Objectivestraining: Objectives
To briefly review circadian rhythms in humansTo briefly review circadian rhythms in humans To briefly review sleep and sleep deprivation To briefly review sleep and sleep deprivation
effects in humanseffects in humans To discuss the impact of sleep and fatigue on To discuss the impact of sleep and fatigue on
medical traineesmedical trainees To review management strategies for sleep To review management strategies for sleep
lossloss
Sleep and wakefulnessSleep and wakefulness
Three fundamental behavioral/neurological Three fundamental behavioral/neurological states of healthy mammalsstates of healthy mammals– WakefulnessWakefulness
– Non-rapid eye movement (NREM) sleepNon-rapid eye movement (NREM) sleep
– Rapid eye movement (REM) sleepRapid eye movement (REM) sleep Endogenous neural controlEndogenous neural control
– Widely distributed sleep/wake centersWidely distributed sleep/wake centers
– Linked to circadian systemLinked to circadian system Influenced by numerous exogenous factors… Influenced by numerous exogenous factors…
including voluntary behavior including voluntary behavior
Sleep in healthy young womanSleep in healthy young woman
Homeostatic and circadian regulation of human sleep Borbely et al., 2001
Time of Day
Sleep propensity
Sleep propensity
High
High
Low
Low
What is sleep good for?What is sleep good for?
Cognitive functionCognitive function LearningLearning Mood regulationMood regulation Metabolic functionMetabolic function
Sleep and learning in a visual taskSleep and learning in a visual taskStickgold, Stickgold, ScienceScience, 2001, 2001
Retesting after wakefulnessor sleep
Retesting over one week
Sleep after learning
Sleep deprivation after learning
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical training: Objectivestraining: Objectives
To briefly review circadian rhythms in humansTo briefly review circadian rhythms in humans To briefly review sleep and sleep deprivation To briefly review sleep and sleep deprivation
effects in humanseffects in humans To discuss the impact of sleep and fatigue on To discuss the impact of sleep and fatigue on
medical traineesmedical trainees To review management strategies for sleep To review management strategies for sleep
lossloss
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Mustafa and Strohl, unpublished data. Papp, 2002
Sleepiness in Residents: Epworth Sleepiness in Residents: Epworth Sleepiness ScaleSleepiness Scale
American Academy of Sleep Medicine
0
5
10
15
20
Mean 5.90 2.20 11.70 14.70 17.50
Normal Insomnia Sleep Apnea Residents Narcolepsy
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Sleepiness in Residency is Under-Sleepiness in Residency is Under-recognized: Why?recognized: Why?
Physicians know relatively little about sleepPhysicians know relatively little about sleep needs and sleep physiology. needs and sleep physiology.
There is no “drug test” for sleepiness.There is no “drug test” for sleepiness.
Most programs do not recognize and address Most programs do not recognize and address the problem of resident sleepiness. the problem of resident sleepiness.
The culture of medicine says:The culture of medicine says:
– “ “Sleep is “optional” (and you’re a wimp if Sleep is “optional” (and you’re a wimp if you need it)” you need it)”
– “ “Less sleep = more dedicated doc”Less sleep = more dedicated doc”
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Conceptual Framework (in Conceptual Framework (in Residency)Residency)
PrimarySleep Disorders(sleep apnea, etc)
Fragmented Sleep(pager, phone calls)
Circadian Rhythm Disruption(night float, rotating shifts)
Insufficient Sleep(on call sleep loss/inadequate
recovery sleep)
EXCESSIVE DAYTIME SLEEPINESS
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Sleep Needed vs. Sleep ObtainedSleep Needed vs. Sleep Obtained
Myth:Myth: “ “I’m one of those people who only need 5 I’m one of those people who only need 5 hours of sleep, so none of this applies to hours of sleep, so none of this applies to me.”me.” Fact:Fact: Individuals may vary somewhat in their Individuals may vary somewhat in their
tolerance to the effects of sleep loss, but are not tolerance to the effects of sleep loss, but are not able to accurately judge this themselves. able to accurately judge this themselves.
Fact:Fact: Human beings need approximately 8 hours of Human beings need approximately 8 hours of sleep to perform at an optimal level. sleep to perform at an optimal level.
Fact:Fact: Getting less than 8 hours of sleep starts to Getting less than 8 hours of sleep starts to create a “sleep debt” which must be paid off. create a “sleep debt” which must be paid off.
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Sleep Fragmentation Affects Sleep Sleep Fragmentation Affects Sleep QualityQuality
= Paged
NORMAL SLEEP
ON CALL SLEEP
MORNING ROUNDS
American Academy of Sleep Medicine
Homeostatic and circadian regulation Homeostatic and circadian regulation of human sleep of human sleep Borbely et al., 2001Borbely et al., 2001
Time of Day
American Academy of Sleep MedicineAmerican Academy of Sleep Medicine
Time of Day
Sleep propensity
Sleep propensity
High
High
Low
Low
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Sleep Disorders: Are you at risk?Sleep Disorders: Are you at risk?
Physicians can have sleep disorders too!Physicians can have sleep disorders too!– Obstructive sleep apnea: Snoring, obesity, Obstructive sleep apnea: Snoring, obesity,
sleepinesssleepiness– Restless legs syndrome: Urge to move legs Restless legs syndrome: Urge to move legs
associated with dysesthesiasassociated with dysesthesias– Periodic limb movement disorder: Repeated leg Periodic limb movement disorder: Repeated leg
jerks with arousals jerks with arousals – Learned or “conditioned” insomnia: Unable to Learned or “conditioned” insomnia: Unable to
sleep despite adequate opportunitysleep despite adequate opportunity– Medication-induced insomniaMedication-induced insomnia
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Adaptation to Sleep LossAdaptation to Sleep Loss
Myth: “I’ve learned not to need as much sleep during my residency.”
Fact: Sleep needs are genetically determined and cannot be changed.
Fact: Human beings do not “adapt” to getting less sleep than they need.
Fact: Although performance of tasks may improve somewhat with effort, optimal performance and consistency of performance do not!
American Academy of Sleep Medicine
Sleepiness and sleep deprivationSleepiness and sleep deprivationBelenky, Belenky, J. Sleep ResearchJ. Sleep Research, 2003, 2003
Performance and sleep deprivationPerformance and sleep deprivationBelenky, Belenky, J. Sleep ResearchJ. Sleep Research, 2003, 2003
American Academy of Sleep Medicine
Learning
DrivingSafety
Health&
Well-BeingFamily
Relationships
Patient CareProfessionalism
MoodAnd
Performance
Workplace
Sleep DeprivedSleep DeprivedResidentResident
Learning
DrivingSafety
Health&
Well-BeingFamily
Relationships
Patient CareProfessionalism
MoodAnd
Performance
Workplace
Sleep DeprivedSleep DeprivedResidentResident
© American Academy of Sleep Medicine
Consequences of Chronic Sleep Consequences of Chronic Sleep DeprivationDeprivation
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Surgery:Surgery: 20% more errors and 20% more errors and 14% more time required to 14% more time required to perform simulated laparoscopy perform simulated laparoscopy post-call (two studies) post-call (two studies) Taffinder et al, Taffinder et al, 1998; Grantcharov et al, 20011998; Grantcharov et al, 2001
Internal Medicine:Internal Medicine: efficiency and efficiency and accuracy of ECG interpretation accuracy of ECG interpretation impaired in sleep-deprived interns impaired in sleep-deprived interns Lingenfelser et al, 1994Lingenfelser et al, 1994
Pediatrics:Pediatrics: time required to place time required to place an intra-arterial line increased an intra-arterial line increased significantly in sleep-deprived significantly in sleep-deprived Storer et al, 1989Storer et al, 1989
Across SpecialtiesAcross Specialties
American Academy of Sleep Medicine
Effects of sleep deprivation on mood in Effects of sleep deprivation on mood in medical residentsmedical residents Baldwin and Daugherty, Baldwin and Daugherty, SleepSleep, , 20042004
2
3
4
5
6
7
<4 4 to 5 5 to 6 6 to 7 >7
Average Hours of Sleep per Night
Res
iden
ts' R
atin
gs
Moodier & more shorttempered
Impaired my capacityto care for patients
Work hours too long
More conflict withprofessional staff
Misjudgements inpatient care
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Impact on Medical ErrorsImpact on Medical Errors
Surveys:Surveys: more than 60 % of anesthesiologists more than 60 % of anesthesiologists report making fatigue-related errors. report making fatigue-related errors. Gravenstein 1990Gravenstein 1990
Case Reviews:Case Reviews:– 3% of anesthesia incidents 3% of anesthesia incidents Morris 2000Morris 2000
– 5% “preventable incidents”5% “preventable incidents”– 10% drug errors 10% drug errors Williamson 1993 Williamson 1993
– Post-op surgical complication rates 45%, higher if Post-op surgical complication rates 45%, higher if resident was post-call resident was post-call Haynes et al 1995Haynes et al 1995
American Academy of Sleep Medicine
“Fatigue related”
Risk of motor vehicle accidents after Risk of motor vehicle accidents after extended and nonextended shiftsextended and nonextended shiftsBarger, Barger, NEJMNEJM 2005; 52:125-34 2005; 52:125-34
Work shiftWork shift
≥≥24 hours24 hoursWork shiftWork shift
<24 hours<24 hours
Odds RatioOdds Ratio
CrashesCrashes 5858 7373 2.3 (1.6-3.3)2.3 (1.6-3.3)
Near-missesNear-misses 1,9711,971 1,1561,156 5.9 (5.4-6.3)5.9 (5.4-6.3)
CommutesCommutes 54,12154,121 180,289180,289
Risk of motor vehicle accidents after Risk of motor vehicle accidents after extended and nonextended shiftsextended and nonextended shiftsBarger, Barger, NEJMNEJM 2005; 52:125-34 2005; 52:125-34
Number of extended shifts per month
0 1 - 4 ≥5
Rat
e of
pos
itiv
e re
spon
se
Nod off driving OR=2.39 (2.31-2.46)Nod off in traffic OR 3.69 (3.60-3.77)
Sleep, circadian rhythms, and medical Sleep, circadian rhythms, and medical training: Objectivestraining: Objectives
To briefly review circadian rhythms in humansTo briefly review circadian rhythms in humans To briefly review sleep and sleep deprivation To briefly review sleep and sleep deprivation
effects in humanseffects in humans To discuss the impact of sleep and fatigue on To discuss the impact of sleep and fatigue on
medical traineesmedical trainees To review management strategies for sleep To review management strategies for sleep
lossloss
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Estimating SleepinessEstimating Sleepiness
Myth:Myth: “I can tell how tired I am and I know when “I can tell how tired I am and I know when I’m not functioning up to par.”I’m not functioning up to par.” Fact:Fact: Studies show that sleepy people Studies show that sleepy people underestimate underestimate their level of sleepiness their level of sleepiness and and overestimateoverestimate their alertness. their alertness. Fact:Fact: The sleepier you are, the The sleepier you are, the less accurateless accurate
your perception of degree of impairment. your perception of degree of impairment. Fact:Fact: You can fall asleep briefly (“microsleeps”) You can fall asleep briefly (“microsleeps”)
without knowing it! without knowing it!
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Anesthesia resident studyAnesthesia resident study
Residents did not perceive themselves to be asleep Residents did not perceive themselves to be asleep almost half of the time they had actually fallen asleep.almost half of the time they had actually fallen asleep.
Residents were wrong 76% of the time when they Residents were wrong 76% of the time when they reported having stayed awake. reported having stayed awake. Howard et al 2002Howard et al 2002
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Recognize the warning signs of sleepinessRecognize the warning signs of sleepiness
Falling asleep in conferences or on roundsFalling asleep in conferences or on rounds Feeling restless and irritable with staff, Feeling restless and irritable with staff,
colleagues, family, and friends colleagues, family, and friends Having to check your work repeatedly Having to check your work repeatedly Having difficulty focusing on the care of your Having difficulty focusing on the care of your
patientspatients Feeling like you really just don’t careFeeling like you really just don’t care
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Myth:Myth: “I’d rather just “power “I’d rather just “power through” when I’m tired; through” when I’m tired; besides, even when I can besides, even when I can nap, it just makes me feel nap, it just makes me feel worse.” worse.”
Fact:Fact: Some sleep is always better Some sleep is always better than no sleep. than no sleep.
Fact:Fact: At At what timewhat time and for and for how how long long you sleep are key to you sleep are key to getting the most out of getting the most out of napping. napping.
Alertness Management StrategiesAlertness Management Strategies
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
NappingNapping
Rationale:Rationale: Naps temporarily improve alertnessNaps temporarily improve alertness TypesTypes
– Preventative (pre-call)Preventative (pre-call)– Operational (on the job)Operational (on the job)
LengthLength– Short napsShort naps: No longer than 30 minutes to avoid : No longer than 30 minutes to avoid
the grogginess (“sleep inertia”) that occurs with the grogginess (“sleep inertia”) that occurs with awakening from deep sleepawakening from deep sleep
– Long napsLong naps: 2 hours (range 30 to 180 minutes): 2 hours (range 30 to 180 minutes)
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
NappingNapping
TimingTiming– If possible, take advantage of circadian “windows If possible, take advantage of circadian “windows
of opportunity” (2-5 am and 2-5 pm) of opportunity” (2-5 am and 2-5 pm) – But if not, nap whenever you can!But if not, nap whenever you can!
ConsCons– Sleep inertiaSleep inertia– Allow adequate recovery time (15-30 minutes)Allow adequate recovery time (15-30 minutes)
Bottom line:Bottom line: Naps take the edge off but Naps take the edge off but do not do not replacereplace adequate night sleep adequate night sleep
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Get adequate (7 to 9 hours) sleep Get adequate (7 to 9 hours) sleep beforebefore anticipated sleep lossanticipated sleep loss
Avoid Avoid starting outstarting out with a sleep deficit with a sleep deficit
Healthy sleep habitsHealthy sleep habits
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Recovery from Sleep LossRecovery from Sleep Loss
Myth:Myth: “All I need is my usual 5 to 6 hours the“All I need is my usual 5 to 6 hours the night after call and I’m fine.” night after call and I’m fine.”
Fact:Fact: Recovery from on-call sleep loss Recovery from on-call sleep loss generally takes 2 nights of extended generally takes 2 nights of extended sleep to restore baseline alertness. sleep to restore baseline alertness.
Fact:Fact: Recovery sleep generally has a higher Recovery sleep generally has a higher percentage of deep sleep, which is percentage of deep sleep, which is needed to counteract the effects of sleep needed to counteract the effects of sleep loss. loss.
American Academy of Sleep Medicine
Objective sleepiness: Baseline, post-call, Objective sleepiness: Baseline, post-call, and extended recovery and extended recovery Howard, 2002Howard, 2002
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Time to fall asleep
on MSLT (min)
American Academy of Sleep Medicine
0
5
10
15
20
1000 1200 1400 1600 1800
Time of Day
Post-call Baseline Extended
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Healthy sleep habitsHealthy sleep habits
Go to bed and get up at about the same time
every day Develop a pre-sleep routine to wind down Create a comfortable environment for sleep Get regular exercise if possible Protect your sleep time
Enlist your family and friendsMinimize interruptions
American Academy of Sleep Medicine
Effect of traditional and limited work Effect of traditional and limited work schedules on sleep and attention in schedules on sleep and attention in internsinterns Lockley, Lockley, NEJMNEJM 2004; 351:1829-37 2004; 351:1829-37Work hours/ week Sleep hours/ week
p<.001 p<.001
Hou
rs
Traditional schedule
Attentional failures/ hour 11pm - 7am
p=.02
Failu
res
/ ho
ur
Limited hours schedule
Effect of traditional and limited work Effect of traditional and limited work schedules on medical errors in internsschedules on medical errors in internsLandrigan, Landrigan, NEJMNEJM 2004; 351:1838-48 2004; 351:1838-48
Serious Medication medical errors errors p<.001 p<.03
Num
ber
Traditional schedule
Procedural Diagnostic errors errors p=.34 p<.001
Num
ber
Limited hours schedule
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Recognize signs of drowsiness while Recognize signs of drowsiness while drivingdriving Trouble focusing on the road Difficulty keeping your eyes open Nodding Yawning repeatedly Drifting from your lane, missing signs or exits Not remembering driving the last few miles Closing your eyes at stoplights
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Drive smart; Drive safeDrive smart; Drive safe
It takes only a 4 second lapse in attention to have a It takes only a 4 second lapse in attention to have a drowsy driving crashdrowsy driving crash
AVOID driving if drowsy AVOID driving if drowsy If you are really sleepy, get a ride home, take a taxi, If you are really sleepy, get a ride home, take a taxi,
or use public transportationor use public transportation Take a 20 minute nap and/or drink a cup of coffee Take a 20 minute nap and/or drink a cup of coffee
before going home post-callbefore going home post-call Stop driving if you notice the warning signs of Stop driving if you notice the warning signs of
sleepinesssleepiness Pull off the road at a safe place, take a short napPull off the road at a safe place, take a short nap
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Drowsy driving: What does not workDrowsy driving: What does not work
Turning up the radioTurning up the radio Opening the car windowOpening the car window Chewing gumChewing gum Blowing cold air (water) on your faceBlowing cold air (water) on your face Slapping (pinching) yourself hardSlapping (pinching) yourself hard Promising yourself a reward for staying awakePromising yourself a reward for staying awake
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
DrugsDrugs Melatonin:Melatonin: Few data in residents Few data in residents Hypnotics:Hypnotics: May be helpful in May be helpful in specificspecific situations situations
– Persistent insomniaPersistent insomnia
– Scheduled night shift/ day sleep with no daytime Scheduled night shift/ day sleep with no daytime responsibilityresponsibility
– Short-acting agents (zolpidem, triazolam, zaleplon, Short-acting agents (zolpidem, triazolam, zaleplon, eszopiclone) generally preferredeszopiclone) generally preferred
– Ensure adequate time for sleepEnsure adequate time for sleep AVOIDAVOID alcohol to help you fall asleep alcohol to help you fall asleep
– Alcohol induces sleep onset…Alcohol induces sleep onset…
– ……but disrupts sleep later onbut disrupts sleep later on AVOIDAVOID regular use of stimulants (methylphenidate, regular use of stimulants (methylphenidate,
dextroamphetamine, modafinil) to stay awakedextroamphetamine, modafinil) to stay awake
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
CaffeineCaffeine
StrategicStrategic consumption is key consumption is key Effects within 15 – 30 minutes; half-life 3 to 7 hoursEffects within 15 – 30 minutes; half-life 3 to 7 hours Use for temporary relief of sleepinessUse for temporary relief of sleepiness Cons: Cons:
– disrupts subsequent sleep (more arousals)disrupts subsequent sleep (more arousals)– tolerance may develop tolerance may develop
– diuretic effectsdiuretic effects
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Adapting to night shiftAdapting to night shift
Myth:Myth: “I get used to night shifts right away; no“I get used to night shifts right away; no problem.” problem.”
Fact:Fact: It takes about one day to adjust to each one It takes about one day to adjust to each one hour of time zone change. hour of time zone change.
Fact:Fact: Adjustment often includes physical and Adjustment often includes physical and mental symptoms (think mental symptoms (think jet lag). jet lag).
Fact:Fact: Studies of chronic, well-adapted, full-time Studies of chronic, well-adapted, full-time night shift workers show night shift workers show no adaptationno adaptation of of physiological phase markers.physiological phase markers.
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
How to survive night floatHow to survive night float
Protect your sleepProtect your sleep Ensure optimal sleep environmentEnsure optimal sleep environment Nap before workNap before work Consider “splitting” sleep into two 4 hour periods.Consider “splitting” sleep into two 4 hour periods. Have as much exposure to bright light as possible Have as much exposure to bright light as possible
when you need to be alertwhen you need to be alert Avoid light exposure in the morning after night shift Avoid light exposure in the morning after night shift
(dark glasses driving home from work?)(dark glasses driving home from work?)
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Alertness strategiesAlertness strategies
There is no “magic bullet” There is no “magic bullet” Know your own vulnerability to sleep lossKnow your own vulnerability to sleep loss Learn what works for you from a range of Learn what works for you from a range of
strategiesstrategies There needs to be a shared responsibility There needs to be a shared responsibility
for fatigue management and a “culture for fatigue management and a “culture of support” in the training programof support” in the training program
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
In summary…In summary…
Fatigue/sleepiness is an impairment like alcohol or Fatigue/sleepiness is an impairment like alcohol or drugs.drugs.
Drowsiness, sleepiness, and fatigue cannot be Drowsiness, sleepiness, and fatigue cannot be eliminated in residency, but can be managed.eliminated in residency, but can be managed.
Help combat sleepiness in residencyHelp combat sleepiness in residency– Recognition of sleepinessRecognition of sleepiness– Use of alertness management strategiesUse of alertness management strategies
When sleepiness interferes with your performance When sleepiness interferes with your performance or health, talk to your supervisors and program or health, talk to your supervisors and program directordirector
American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
““Patients have a right to expect a healthy, alert, Patients have a right to expect a healthy, alert, responsible, and responsive physician.”responsible, and responsive physician.”
January 1994 statement by American College of Surgeons January 1994 statement by American College of Surgeons
Re-approved and re-issued June 2002Re-approved and re-issued June 2002
American Academy of Sleep Medicine
top related