DTD 175 audio
===
[00:00:00] This is the Drive Time Debrief, episode 175.
Hey guys. Welcome back to the podcast. I'm Amanda. Laura. I'm Kendra. And today is gonna be a good one because we are gonna talk about shift for sleep workers. What? Whoa, what? It's, wait, you said shift for sleep workers. Oh, sorry. Sleep for shift workers. Reporting. Sounds like something I would [00:01:00] like to do.
Sleep for people that work second and third shifts. How about that? Because it wrecks us sometimes. Mm-hmm. As somebody who formerly worked all nights. Mm-hmm. I think that was probably the closest I came to a mental breakdown of all time. Mm-hmm. But Kendra is our sleep aficionado and she's gonna give us a little intro here.
Yeah, I too was wrecked by my sleep and a lot of things I didn't figure out were a result of this till we started getting into this wellness 911. When we developed our course, I was diving deep and I was going down some pretty good rabbit holes, but what I was finding was, man, this is good to know and be aware of because
sometimes we ask ourselves, am I going crazy? You're not going crazy. Sleep is so important. And I underestimated the importance of not only quantity, but quality. And today we're really gonna hit on like when we sleep and why [00:02:00] shift work sleep is so disordered that there's actually a diagnosis.
It's called shift work sleep disorder. And we all qualify for this, but don't be alarmed. We don't have to rush out and get the diagnosis and treatment. Like we're gonna hit on it and it's okay. But shift work sleep disorder is basically where your circadian rhythm sleep is disordered.
So it affects people not just working night shift, but working like second, third, and all night shift. Or if you work a job that you have to be there at like three, four or 5:00 AM, so that is your time. Our brains are set on a circadian rhythm. It's biphasic, and we should be sleeping according to sun.
And so when the sun is out, our brains are like, it's awake time, and when it gets dark, we're supposed to be asleep. And so that's not always the case. And so we're gonna talk about, you know, how to hack this. That is what is [00:03:00] referred to as chrono disruption. So it is actually sleeping not aligned with your normal, natural pathophysiology, circadian rhythm.
So when we have to do that, we are gonna need to do some stuff and we'll get into that. Alarmingly shift work sleep disorder affects 40% of shift workers. So like this affects half of people. Of course we're sensitive to it because we're healthcare professionals, but we're talking like factory workers, tradesmen that have a second and third shift.
So some of the symptoms of shift work sleep disorder are trouble falling asleep after shift. So shout out if anyone's ever gone to bed and been like, my body is so tired, but I'm like
wide awake. I can't even go to sleep. Like, ah, this is killing me. Right. Waking up too soon. So we have trouble staying asleep. Brain fog, difficulty concentrating. Mood swings, irritability, headaches, low [00:04:00] energy, like this all goes without saying.
And all of us have experienced this at one time or another, but also struggling with work and our daily activities when we're in the recovery. So we'll talk about that too, because the recovery time is just as important. So if you're not a consistent third shifter or nocturnist, there are some things to do to recover after you're off your string of nights.
So let's talk about identifying bad sleep habits. There's something called good sleep hygiene and poor sleep hygiene, and I will just say I suspected some things were affecting my sleep, but denial runs strong in this one. But some things that you might suspect affect your sleep negatively would be having a cup of coffee right before you go to sleep. That's what I was doing on the night shift. I'd drink coffee all night long, hit the hay and then, you know, I thought I was sleeping okay, but there's a really good chance that's before there was such a thing as wearables.
But eating right [00:05:00] before bed might be something that kind of jacks up your sleep. That's something surprising to me that I've noticed. Alcohol, let's just call it what it is. There is a great chance it is unconscious but does not equal repair, like restorative sleep. Those are two separate things. Yes. What you're shooting for is restorative sleep where you're flushing your brain system out and your immune system is firing up and you're healing and growing and all of these sorts of things.
Mm-hmm. Not the same as just purely being unconscious. And yeah. And we learned that the metabolite of alcohol is actually a stimulant. Yeah, exactly. It will actually, it's an upper. And so once you metabolize through that half-life of that depressant mm-hmm. It's good time go juice turns on. Yeah. Well, and that's the worry with a lot of, you know, sleep assistant medications that people take.
Is that, are you truly getting restorative sleep or are you just unconscious? So, mm-hmm. Just something. Yeah. Yeah. Irregular schedules. Now this is something you might not be able to have control of when you are scheduled for work, but some [00:06:00] of us are real loosey goosey with our bedtimes and wake times when we could have more control over it.
Mm. So, mm-hmm. Ideally you would have more regular sleep times when that's available to you. And then something that you might not be aware of is having some control over your sleep environment. So we can talk about that a little bit here in the next section. So yeah, if you're noticing a lot of frequent awakenings, sleep inefficiency where you're not going to sleep well when you go lay down in bed or super groggy when you wake up in the morning, all of those could be something to pay attention to.
Real quick one of the things that really was eye-opening to me was when we work at night or during these unconventional hours, your body, part of the circadian rhythm relies on a hormone called melatonin. We talk about taking the melatonin supplement, but there is physiologic melatonin that is automatically programmed with the circadian rhythm. So you are having to [00:07:00] overcome your body's physiologic response. The program is inherited in us and so there are ways we'll talk about to sort of hack this, but just know that there's nothing you can do about physiology 'cause your body's preparing for sleep.
There's a sunset and a sunrise for a reason, and it's not just to shed light on the subject. Our brain has all that incoming input and it is responding to that. And so that is why we will talk about this, but exposure to artificial light or just being in bright light the whole shift and then literally when you leave the hospital putting shades on, a hat on like whatever you can to say, okay, it's getting dark and I'm preparing for sleep.
We'll talk about this. But that is one of the things that we have to hack and that can further exacerbate the problem if we're not creating a good sleep environment. Yeah. So there are some evidence-based strategies that you can use for shift workers. The first one would be shift schedule optimization, which you know, in [00:08:00] Laura, my residency, they were huge on doing your last night shift and bouncing back then very next day and having the very early morning shift.
I think the theory would be to like just get it over with and get back on regular schedule. But I think that they have discovered in the literature that forward rotating shifts is probably a better idea, and having at least 48 hours off after a night shift is probably a better idea. Limit consecutive nights if you're able to.
There are some people who will do all nights and then they just kind of shift their whole life into the night. I mean, that's something too, I don't know. I tried to do that and two thumbs down on that from my opinion, zero out of five stars would not recommend. It just doesn't, especially being a mom with kids, like trying to even do that thing is like whatever.
Yeah. God bless the nocturnists out there. I mean, honestly, like I am sending you all the love in the world. I tried and I could not do it. So consider that there is more literature now [00:09:00] about what works better for if you are a shift worker with rotating shifts.
Number two, consider your light management. Bright lights during the night shift, and then blackout and blue blocking eyewear on your way into the car, you know, and immediately when you get home, try to go straight to bed. Like blackout shades could be something that helps a lot. And then that's also why you don't want to, if you're gearing down, trying to get ready for bed, please don't pop your phone open without blue blocking glasses if you really do need to get your rest, because that is just wiping out your own natural melatonin when you blast some blue light straight to your pineal gland there.
Yeah. Plan napping and caffeine timing. Just be aware that caffeine has a half-life of like nine hours. And so please, at least six hours before bedtime, cut out the caffeine. And there are some people that really benefit from taking a short nap before a night shift. I would be so cranked out. Like, I couldn't ever make that work.
But if you [00:10:00] can, that would be super, super helpful. Yeah, I know some of our partners do that and be strategic about it though, because like usually it's a 30 minute or less. If you require a little bit more than that, then make sure it's like an hour and a half, that full 90 minutes so you can possibly get a full REM cycle.
So I've read several things about how strategic napping is the key. So if you can go and just do a power nap 30 minutes or less, great, that's actually ideal. But if that just makes you more groggy and you're not sure where you are when you wake up, like maybe take that plan for a full 90 minutes at least, and go from there.
Yeah, at least try it. All right, so sleep hygiene. Let's talk about it.
You want a cool [room], they're talking like 67 degrees. If you can handle it, I will say I have cranked it down sometimes so cold that my face skin was waking me up. It was too cold. Okay. That might be too cold for most people. Yes, for most people, 67-ish. But like if your face is waking you up because it's too cold, then maybe that's too much.
Yeah. And just know [00:11:00] that physiologically, your body prepares for sleep by dropping one degree. So physiologically, your body, I mean, it's just like the whole thing about heart rate slows, blood pressure slows, body temp drops one degree. So keep that in mind. Yeah. My favorite is to take like a scalding hot bath and then I'm cooling off after the next hour or two before bed, but.
Darkness matters more than you think. That ambient lighting from your alarm clock blasting straight to your noggin is not what you want. And blue is worse than red. So if you do have to have a nightlight kind of go with like an orangey red instead of blue, white. I've noticed recently that the little Roomba in my room, like that's something I probably need to hide behind something, so I'm not getting that ambient light. Maybe watch your security system. If your security system lights up, you can turn it to blackout. But as dark and cool and quiet as you possibly can get. Consider if having a TV on [00:12:00] really is that helpful, or if it's like distracting you. I sleep far better when it's quiet actually, because my husband snores.
I need a white noise machine. They talk about that a lot. That's something I found too. Yeah. Creating ambient noise is not a bad thing. So whether it's a fan, we have one of those like fan thingies in our room that sounds basically like one of those circulating fans. And we can put it on all these settings, but
it roars at that low speed, but there are those white noise, brown noise, they have all kinds of things now, but find the one that actually works for you. But it does matter because, you know, any sound at all waking you up, that's just, that's not the recipe for success. Yeah. You can also find different color sound channels on YouTube.
Like, there's brown, there's pink. Mm-hmm. I had no idea there were all these different noises. But anyway. Anyway, if you have an Alexa you just turn on ambient sounds and I love brown noise. I like it. It's a little deeper than white noise. I like the low rumble. And then mm-hmm. Also my second favorite [00:13:00] is airplane.
It's like a low rumble. Anyway, okay. Yeah. So when you are off, try to keep a regular routine. There's a different set point for bedtime and wake time. So even if you go to bed at three in the morning, if you've got a set wake time, that might be why you're waking up. So anyway, if you're off, there is importance to trying to establish a regular bedtime and a regular wake time. Avoid heavy meals. Now that I have, you know, a little whoop thing on my wrist, it wakes me up a whole lot more than I ever noticed, ever before. Screens, if you absolutely must use a screen, try to have it on the nighttime settings so it's just not quite as bright blasting into your eyeballs.
Yeah, try those things. Another part of sleep hygiene is if you are laying there in bed for longer than, I don't know, 30 minutes or so consider getting up out of bed so you don't train yourself that bed is a place to struggle sleeping, but you don't go [00:14:00] reward yourself with flipping on the lights and doing all kinds of stuff.
Your brain is trying to get a little dopamine. Don't reward it. So you do nothing until you get sleepy again and you go right back to bed. But train your brain that bed is where you sleep and you know the other thing, but nothing else.
Okay, so cognitive behavioral therapy. I think the I is for insomnia, right? Correct. CBT-I correct. There are apps for this that are beautiful. Mm-hmm. Mm-hmm. Just Google yeah. Calm app has a whole program you can go through, but you can set it on different settings.
Mm-hmm. Yeah. But there's literally an app called CBT-I. That's all that it does. And it's beautiful. And I think it was set up from the military. I can't remember who set up that app, but anyway that's great. And then pharmacological support. Talk with your sleep specialist about this, but sometimes they do consider melatonin for daytime sleep and there are other meds that you can take for shift work sleep disorder that you can check into.
Yes, I would add if you're feeling exhausted all the time and you never wake up feeling [00:15:00] rested, go see a sleep specialist, like I have a sleep disorder and noticed that a couple of times a year, I'd wake up feeling rested and I was like, huh, I wonder if it's always supposed to be like this. Go get that checked out because if you're already dealing with sleep issues with the shift work and you have sleep apnea or something else on top of that, like you just need all the help and support you can get. So, highly recommend a sleep study if you're feeling super tired all the time.
So we've talked about all the different things that can affect our sleep and one thing I don't think we touched as much on was how important it is, but I will just add if you look at these stories of physician suicide, and you all know that we are at a very much increased risk of suicide as physicians compared to the general population. In every case that I have heard
there has been extreme sleep deprivation involved, so it definitely messes [00:16:00] with your cognitive processes to not have adequate sleep. Also, I read something recently that every time we get less than six hours of sleep, apparently our telomeres shorten. I don't have the reference right here, but I believe it.
Mm-hmm. And we want good, healthy, fluffy telomeres so that we don't have negative effects from aging and DNA issues. So it's important. Telomeres are the key for longevity. And so if we're shortening our telomeres, we're shortening our lives. We're shaving years off our lives. That's what we're doing. Well, additionally, sleep deprivation is as [impairing as] driving with sleep deprivation is as much impairment as being legally drunk. So that's another thing like. And don't underestimate too, sleep deprivation isn't like I've gone a week.
There was a study, if you've ever, we've talked about Dr. Peter Attia's book Outlive, but in his book, he was [00:17:00] talking about some of the studies that were done in the military and some of these deployments where the soldiers would have long flights across the world and then they would have to immediately go to their assignment.
And so they would check inflammatory markers, vital signs, other things. And even after 24 hours, so this is sleep deprived, meaning no sleep after 24 hours, there was statistically significant increase in the inflammatory markers, in the atherosclerotic indices, in the amount of impairment on the cognitive.
They had 'em take tests before and after, so it was considerable, even just after 24 hours. And if you're not awake 24 hours, which sometimes we do 'cause some people I know, our partners would stay awake like at the end of a shift, get home that morning, and then just try to power through. Like you can't make good decisions.
And also, you know, you shouldn't really be handling operating heavy machinery, including driving or making, you know, life altering decisions. But the point of what I'm saying [00:18:00] is don't underestimate the effect that even short sleep, what Laura said, six hours or less. Six hours or less per night, or whenever you're sleeping, is considered short sleep.
And that has the same impact as going, you know, 24 hours or more without any sleep. So just know that after one night of short sleep, you can experience the same thing. So this is why it's super important, y'all. And also if you've read, there's quite a few studies out in the last year or two on the effects of short sleep on the brain or on the... They're almost there. They haven't quite shown a causality, but there's definitely correlational data that shows increased risk of early onset dementias and all cause dementias, not just Alzheimer's, but we're talking all dementias, early onset. They are just about there with actually figuring out that short sleep is a causation and not just correlation.
So we're warding off that [00:19:00] dementia people. Come on now. That's right. I gotta get that glymphatic system going and washing out all that trash outta your brain so it doesn't turn into plaque.
Okay. So what are some small changes that we can each make to improve our sleep? Sounds like Amanda could cover up the red dot on her Roomba. One other thing that I love is my sleep cooling mat thing. Oh yeah. I can't remember. Chili Sleep is where I got it from. I think that thing is great. So is there something like that that you can add to make your sleep better? Get some bamboo sheets or get a weighted blanket. I swear by that thing, it helps me so much.
So is there something that you can do? Move your bedtime half an hour earlier so you get, you know, stop watching TV in bed. Stop using your phone in bed. Just choose one thing that you can do that doesn't feel like really hard [00:20:00] to do, that doesn't feel like deprivation to your brain. And mm-hmm. And then add to that.
And over time, you're gonna have better sleep and better mental and physical wellbeing. Sleep is, oh, if you needed another reason, sleep will help you lose weight. Short sleep makes your ghrelin go higher, so you definitely will have a more reasonable appetite if you're getting enough sleep. So do all that, look at the way your sleep hygiene is, and if you think about it as like physical hygiene, it's like, ooh, I really do need to brush my teeth every day. So I really also need to stop scrolling on my phone in bed. What are the small things that we can each do to move in the right direction a little bit? And if we haven't touched on one of your biggest sleep challenges, send us an email. We'd love to hear kind of what
what is it that is keeping you awake or making it so that you don't feel rested? And email us [00:21:00] at [email protected] and we just value you each so much and want to, to take care of yourself. Oftentimes, sleep is the first thing that goes when we've got too much going on and it really needs to be one of our very top priorities, so just invite you to start taking care of yourself in that way.
And I will say too, maybe something we haven't touched on is really communicating with your household. So if you live by yourself, great. You don't have to, but maybe get your dogs or something on your sleep cycle, I don't know. But definitely if you cohabitate with a significant other, partner or children,
communicate with them. I used to do this, probably I didn't protect it as much as I should have, but it was more or less like a warning. I'm getting ready to go on a string of nights, I will be unavailable and if you do try to approach me, it might not be safe. So I used to set that warning, but I probably could have done a little [00:22:00] bit better on setting boundaries.
Like, hey guys, I'm getting ready to do my string of nights. This is when I plan to sleep. This is, you know, just communicating with them so that you can feel supported. I know as moms there was a lot of times when I would not schedule the sitter or not have my nanny pick them up from school that day thinking, well, I already missed them in the morning 'cause I'd get home after they'd leave. I really do wanna pick 'em up, but I really wasn't ready to wake up by two or two thirty whenever I'd have to leave the house to get them. Probably not a safe driver. So I think back like, thank you Lord for watching over me, but just think about that like it is. We always encourage, you know, trying to figure out or getting clear on your values and how you wanna show up.
And regardless of being present as a mom or a parent or wife or whatever you're doing, what do you need to show up as that best version? And it may be that the nanny picks them up from school too, and you can, you know, meet 'em at home later or whatever it is. Pick 'em up from [00:23:00] practice, but just honor yourself and what you need and don't, and you know, if you need permission here, permission granted to tell your loved ones what you need during that time and you need special care and this is what you're gonna do.
And don't ever feel bad about communicating that. And then also seek support. We have done a community together. I recommend seeking out like Facebook or Insta, whatever these groups. There's always a lot of good resources out there so that you feel supported in whatever you need. And also if you just need ideas, I mean, Laura and Amanda, we've all mentioned ideas today of how we can hack this.
But you know, seek out your physician if you feel like you really need pharmacotherapeutics or even just getting a sleep study or just anything. But do not feel bad about this. This is one of those things that you can do for yourself that does actually create or help you to show up as your best self, mentally, emotionally, physically, and we love the longevity, so it adds years to your life.
[00:24:00] So, thank you for being with us. We're excited to announce our next webinar coming up. We'd love to have you join us. Five Steps to Freedom From Burnout. So scroll down in the show notes and click the link to get registered and we would be happy to see you there. So until next time, you are whole.
You are a gift to medicine and the work you do matters.
