AGING WELL IN EMERGENCY MEDICINE INTEREST GROUP
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Mitigating the Risks and Burdens of Night and Rotating Shiftwork in Emergency Medicine: Part II Vik Wall, MD FAAEM
n Part I of this two-part series, adverse effects of circadian disruption were described and partially explained. This second installment regarding circadian disruption explores strategies to minimize impacts of circadian disruption. While no pill, as yet, exists to mitigate the risks of night shift work, a “stay tuned” strategy seems wise, because research into small molecules that reset the zeitgebers in the body is being actively pursued. Results of this research may help shift workers. Meanwhile, social adjustments and lifestyle adjustments will be likely to mitigate some of the risks. While currently there are no double blinded controlled studies available, I will present some educated guesses regarding helpful factors.
[M]imicking east to west travel by working day shifts, then evening shifts, then overnight shifts, in a succession, followed by some time off to become ready for the next set of day shifts, will be easier for most people.”
First, to maintain sleep hygiene is paramount. If it is possible to obtain even two hours of “anchor sleep” (a time when you are asleep every day) as you navigate the circadian disruptions that night shifts cause, that should be done. A sleeping environment that is light tight and soundproof, possibly complimented by a white noise generator or a fan set on low speed (which can also provide white noise), with a regulated cool temperature and no or a minimum of disturbances is mandatory. If you can construct such a place in your home, do it. If not, one can at least wear comfortable eye shields and ear plugs. Is there an ideal shift rotation pattern? A pattern that works for everyone has not yet been proven. Even different members of a group may benefit
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from different rotation patterns. However, it appears that the old “seven days on, seven days off”, followed by seven days working the opposite shift, is a pattern to be avoided, as it takes much longer than seven days for the body to adjust and performance to return to peak, even though one may feel rested after a few days. Nurses and doctors on “straight nights” nonetheless continue to have persistent hormonal rhythm disruptions more than a decade into this lifestyle. My guess is that the limit on successive night shifts for those who rotate should be two. Further, many people who travel internationally across various time zones find it easier to travel from east to west, than to travel from west to east. This might be because humans isolated by daylight cues, such as by living in a cave or living in a shelter without daylight while riding out a storm for several days, will naturally gravitate to an approximately 25-to25.5-hour circadian rhythm. Other research shows that most humans’ natural circadian rhythms center on 25 to 25.5 hours, with a range of 23 to 26+ hours. It seems reasonable to assume that mimicking east to west travel by working day shifts, then evening shifts, then overnight shifts, in a succession, followed by some time off to become ready for the next set of day shifts, will be easier for most people. To work night shifts, then evening shifts, then day shifts seems unwise, because such a schedule works directly against the body’s circadian tendencies. Try to figure out your natural rhythm to help you choose your best rotation. I believe groups should compensate the night shift worker for the health risks they undertake by paying at least 10% and probably 20% more for >>