Friday, 6 August 2010

Tips for working nights

One of the things slowing down my posting rate, even post-IBCLC exam, is my schedule working nights doing lactation support. I thought it would be so easy going in! After all, I'm a doula and have now lost count of the number of nights I've powered through on a PowerBar and some adrenaline (I don't even do caffeine). Then I'd go home, sleep it off, and be fine. How different could this be?

Color me naive. It is so different to work nights regularly than it is to jump in for a night or two, power through, and then go straight back to your normal schedule. At the end of the first two weeks of nights, I was on the cliff's edge and totally unable to figure out why. Two things helped me realize why this was so hard:
1) To shift from sleeping, say, 11pm-8 am and then start sleeping 8 am-4 pm, then switch back 3 days later, is like having a 9-hour time zone jump twice a week. Hello, jet lag!
2) Apparently, your brain makes melatonin during the day and serotonin at night. When your sleep schedule gets screwed around with and you don't get any "day", you don't get any serotonin. Hello, inexplicable depression!

I was basically a wreck - miserable for no reason, other than of course the reason that I was tired all the time and felt like I could never get enough sleep.

Now, however, things have improved greatly and I attribute this in large part to my new plan for handling nights. I found Rural Doctor's post on working nights very helpful - she has instructions from sleep to eating - but I've made some modifications.

First, I tried to do her method of splitting up sleep - getting up fairly early in the morning and then going back to bed and sleeping in the afternoon. I may try it again, but 1) that means the entire day is shot for me - and this is unfortunately not my only job, so that can make schedules challenging and 2) my body has yet to agree that, for example, 5 + 4 = 9 when it comes to sleep. I can sleep 5 hours, then break, then sleep 4 hours, and feel equally crappy both times I wake up and for many hours afterward. I have to get long consecutive sleep stretches. This has been the #1 most important change from the first 2 weeks, where I was still trying to convince my body to do simple addition.

Also, I don't do caffeine so that part is skipped. I tried it one night when I was really sleep-deprived with a big ol' cup of highly caffeinated tea before work. I still can't definitively pin this on the caffeine, given that I was also so sleep-deprived, but I got a horrific headache at work. Like, when I bent over patient beds to help with latch and positioning, my head would feel like it was going to throb apart when I stood up. One of the lovely nurses dug into her personal stash of ibuprofen for me (and I vowed never to be without it at work again), I was capable of bending over to assist with feedings again, and decided no more caffeine.

So my schedule, with modifications from the original, is more or less this:

Night before first night shift:
  • Stay up as late as possible, generally about 3 am.

Day of first night shift:
  • Sleep till 11 am or so. Then have afternoon/evening available for getting other work done (my shift begins at 11 pm, unlike most shifts which start at 7 pm).
  • Pack lunch, put together outfit (I don't own many scrubs and tend to go the business casual route the way most of the other LCs at this hospital do.)

For each night shift:
  • Packing a lunch: helpful, although the cafeteria at night has a couple reasonably healthy, although not-super-appetizing options (I can't think of much less appetizing than hospital cafeteria packaged sushi at 3 am). But there's not always time to run down there, so it's good to have the food nearby.
  • Snacks!: Helpful for staying awake. I also use them to health it up if I caved and brought a frozen entree. So last night I had a frozen burrito but brought cherries and carrot sticks to go with it. (I also rarely go into the nurses' lounge, where lurk the donuts...)
  • Hydration: I have learned to skip, for reasons related to sleep. How to put this delicately? Wait, I'm a doula, I don't do delicacy: if I drink all night, it makes it hard to stay asleep during the day because I get up to pee too often and then it's hard to get back to sleep. I try to drink water before or at the beginning of my shift, and then really limit it. I'll chug all I want if it's my last night shift in a set, but the other nights I value sleep over thirst-quenching.
  • Get out as soon as you can: One of the best tips I got from the Rural Doctoring post was not to hang around and chit-chat with the oncoming shift. It really does feel like being rescued from Gilligan's Island, or having fresh troops arrive at a beleaguered battlefield. Especially being the only lactation person on overnight, I want to recount complicated cases, tell them something crazy a nurse said, ask about the schedule, chitchat about the weather, etc. etc. Instead I push myself to mention anyone who I think needs more explanation than easily fits on the follow-up list I'm leaving, and then wish them a good day and head out. Again: sleep takes priority.
  • Mid-shift slump: I tend to have a slump around 4 am, especially the first night in a set. Those moments of tiredness can feel a little desperate - that "oh my god, if I don't sleep RIGHT NOW I am going to cry" - but it's happened enough times now that I remind myself that it will pass and I'll feel better within an hour. By the time shift change happens, I could probably stay up the rest of the day (not recommended).
  • Keeping it dark: I keep forgetting to bring sunglasses with me to wear home at the end of the shift to keep my body thinking it's night. Knock on wood, I've had no trouble falling asleep even without this (fortunately it's a short drive home). However, keeping my room dark has made a HUGE difference in the quality of my sleep. I got Eclipse 0% curtains at Target, and while they don't actually let in 0% of the light, those + a sleep mask make a big difference. I also use two fans (ceiling and box) to stay cool and for white noise. Heaven! (I add the Rural Doc's recommendation of a cat who is a good napper.)

After the last day shift:
  • Short nap in the morning, no more than 3 hours. Stay up till a normal bedtime and then go to bed and sleep as much as needed.

The other thing that has been helpful with all this is just time and getting my body used to it. The first time I tried to pull an all-nighter to write a paper, I couldn't function past 3 am. College (and my last-minute paper-writing habits) beat this weakness out of me quickly and while I always rued my procrastination and felt fairly nauseous the next day, I could do an all-nighter when needed. This proved invaluable when I started working as a doula. I spent the first couple weeks of this job feeling queasy and crappy almost constantly, whether I'd worked the night before or not. And then...it just got better. My body figured it out.

So my recommendation to any of you who are dealing with transitioning to a new sleep schedule, or trying to figure out how to do long doula calls and still remain upright, is to give yourself time and patience. I had some panicky moments where I thought I was going to feel like this forever/as long as I had this job (which at that point didn't seem like it could possibly be very long). It passed, and now I feel reasonably functional even on my more sleep-deprived days.

Of course, it messes with posting...I promise I'm working on those, albeit slowly...