This sounds like a bit of a nonsensical statement. Is there any way to optimise night shifts? Are they not just inherently torturous?
Well, in some ways, yes. It is pretty much unanimously regarded as one of the most onerous parts of clinical life as a senior house officer (SHO) in any specialty. A disrupted sleep pattern, incessant workload, relentless stress levels during a time when the body desperately requires the antithesis. It’s just unnatural. Bottom line.
Yet, I do believe there is a way to make night shifts better. Or at least I have discovered my own way to make them better. I have a routine that I have tweaked over time to optimise how well I cope with night shifts. As I’m sure is overwhelmingly evident from my previous journal entries, my natural state is to immensely dislike night shifts. For a while, I approached them with a vengeful, unremitting loathing. I would sense them looming ahead and anticipate them with anguish. But that just left me in a state of greater misery. So I conceded that I ought to make an internal enquiry as to what I could do to improve my “nightlife”.
1. Meditation. This helps me to set the correct tone for the day/night ahead.
When I awake, I like to meditate for 10-15 minutes. Meditation, for me, is a way to inject calm, clarity, and focus into my mind. Until I have meditated and set the tone for the day/night, I do not check my phone for any messages, emails, or social media notifications. Usually, I keep my phone on airplane mode right up until the point that I need to use the internet again for my meditation app. The idea behind this is that I want to keep my mind as fresh as possible. I strongly believe the mind is, for want of a better expression, the most “naive” and “absorbant” first thing in the morning (or evening, during night shifts). It’s like freshly dried plaster on a wall. No paint, no dust. Just clean, fresh plaster.
If I look at my phone and start soaking up all of the messages and newsflashes, my mind immediately begins to kickstart into stress mode. Suddenly, my ability to control and set the tone for the day has been removed from my own hands. Additionally, whatever I read tends to stick around in my mind for the day. For example, that work-related email or the long-delayed personal administrative task that requires completion. It’s an explosion of information, like a spark that sets the cognitive pistons in motion, generating uncontrolled mayhem in the mind before the day has even commenced. So much so that it’s incredibly challenging to reset and return to ground zero.
Meditation first thing helps me relinquish a sense of peace and control over my mind. It also helps me to touch base with how I’m feeling and any anxieties which may precipitate throughout the day.
2. Yoga. This helps to iron out the aches and pains in my body.
So, for fear of sounding incredibly geriatric, I utilise yoga to help ease the aches and pains which I tend to suffer with during nights. Perhaps it’s the change in sleep pattern, the stress during a time when my body is used to rest, or simply the hospital chairs. Usually, it’s lower back pain, but sometimes it can be lower limb joints or shoulders.
Yoga for lower back pain is amazing to help ease these aches and pains. I usually just search for and follow a tutorial on YouTube. Making time for this is such a key rehabilitative measure to be able to segue straight back into physical activity without injury following nights. Additionally, it’s relaxing and goes well with meditation, so doing yoga prior to meditation offers a nice sequence.
3. Comfort.
I like to take things in that provide me with comfort. It’s not too complicated. Just things like plenty of food, warm layers in case there is time to rest in the office, a couple of treats. Not eating during night shifts is just bananas to me. The amount of physiological stress on the body means that an absence of calories will simply result in low energy and a catabolic state. I tend to take in ample food so as to not risk the severe hunger pangs at 4am after I’ve gulped down the sum total of my food for the night. I like to make the whole experience as comfortable as possible and so I ensure to have foods that are healthy but satiating. Having said that, my diet is nowhere near holier than thou. I just feel munching on decent vitamin sources is pretty key.
Additionally, I tend to avoid piling up all the calories before bed. I struggle to sleep at the best of times and indigestion only serves to make the whole thing worse.
4. Sleep hygiene and decaffeination.
I know. This is one of my favourite points to persistently bang on about. But my logic is this: if my sleeping pattern is already disrupted, what use would exogenous induction of even more stress in my body be when the body is under enough physiological stress at night? My own anecdotal research suggests that caffeine only makes me more stressed and irritable and is not conducive to the achievement of an adequate, clean, good quality sleep.
I prefer to smoothly and naturally land the plane in the morning when hitting the home straight. Limiting sunlight exposure and creating a bedtime atmosphere at home are essential steps. One thing I’m useless at is the avoidance of screens. If I was to optimise one more element then it would be that I read before bedtime instead of watching a TV programme. Equally, escapism helps to take the mind away from the hospital hubbub. I’ve not really solved my dilemma. Ah, well.
5. Organise something to look forward to.
I’ve never really been good at organising something to look forward to after a run of night shifts. But when I have, it’s made a huge difference. If the nights are particularly awful, I just contemplate the upcoming “fun thing” that I have planned and tell myself the shift will be over soon. And after the nights are done, I then have something to reconnect me to the outside world again.
I wanted to share these improvements that I have made, almost as a way to document my current thoughts and feelings about this aspect of my clinical work. I have an inherent habit of tweaking and optimising my own routines and behavioural processes to try to adapt to new situations and make things more efficient or manageable. Sort of like a continuous personal development system.
In the end, however, everyone is different. The night shift routine has to be something that works for the individual, it’s far from a one-size-fits-all. I would love to hear about different people’s systems. Is there anything that works well for you?
Vasudev Zaver 
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