REBEL Core Cast 119.0 – Sleep Hygiene

REBEL EM – Emergency Medicine Blog

REBEL Core Cast 119.0 – Sleep Hygiene

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Employ sleep strategies:

• Anchor sleep: a period of sleep that overlaps each day regardless of your night shift schedule to provide a guidepost for your body clock. Ideally would overlap with when you would normally be asleep if you were not on night shift.
• Split sleep: sleep 3-4 hours immediately after shift then another 3-4 hours immediately before shift

Melatonin timing/dosing:

• Most sleep specialists recommend 1-3 mg 30 minutes before desired onset of sleep
• Align timing to bolster your circadian rhythm, not fight it

Caffeine:

• Limit intake 4-8 hours before bed and no more than 400 mg a day

Diet:

• Choose healthy foods and snacks and consume them in patterns that align with your normal day-night cycle (i.e. eat dinner before your night shift and eat breakfast afterwards)
• Residency/hospital leadership should consider having healthy low-cost/free food options available for residency and staff, particularly on night shifts

Don’t drive sleepy:

• Practice recognizing signs of sleep deprivation (yawning, drifting lanes, falling asleep at signout or at red lights) and do not drive home if present
• Residency/hospital leadership should provide a comfortable place for residents/faculty to sleep and/or provide rideshare options to safely get home when signs of sleep deprivation are recognized

References

Sleep strategies:

1. Minors DS, Waterhouse JM. Does ‘anchor sleep’ entrain circadian rhythms? Evidence from constant routine studies. J Physiol. 1983 Dec;345:451-67. doi: 10.1113/jphysiol.1983.sp014988. PMID: 6663508; PMCID: PMC1193807.
2. Crowley SJ, Lee C, Tseng CY, Fogg LF, Eastman CI. Complete or partial circadian re-entrainment improves performance, alertness, and mood during night-shift work. Sleep. 2004 Sep 15;27(6):1077-87. doi: 10.1093/sleep/27.6.1077. PMID: 15532201.

Melatonin

• Farahmand S, et al. Comparison of exogenous melatonin versus placebo on sleep efficiency in emergency medicine residents working night shifts: A randomized trial. World J Emerg Med. 2018;9(4):282-287. doi: 10.5847/wjem.j.1920-8642.2018.04.008. PMID: 30181797; PMCID: PMC6117540.
• Morgenthaler TI et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007 Nov;30(11):1445-59. doi: 10.1093/sleep/30.11.1445. Erratum in: Sleep. 2008 Jul 1;31(7):table of contents. PMID: 18041479; PMCID: PMC2082098.

Caffeine

1. Walsh JK, Muehlbach MJ, Schweitzer PK. Hypnotics and caffeine as countermeasures for shift work related sleepiness and sleep disturbance. J Sleep Res. 2009;4;80-83.
2. Nehlig A. Interindividual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption. Pharmacol Rev. 2018;70(2):384-411. doi:10.1124/pr.117.014407
3. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.
4. Stephanie Centofanti, Siobhan Banks, Scott Coussens, Darren Gray, Emily Munro, Johnathon Nielsen & Jillian Dorrian (2020) A pilot study investigating the impact of a caffeine-nap on alertness during a simulated night shift, Chronobiology International, 37:9-10, 1469-1473, DOI: 10.1080/07420528.2020.1804922.

Diet

1. Lowden A, Holmbäck U, Åkerstedt T, Forslund J, Lennernäs M, Forslund A [2004]. Performance and sleepiness during a 24 h wake in constant conditions are affected by diet. Biol Psychol 65(3):251–263.
2. Anderson C, Horne JA [2006]. A high sugar content, low caffeine drink does not alleviate sleepiness but may worsen it. Hum Psychopharmacol 21(5):299–303.

Driving Sleepy

1. Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005;352(2):125-34.
2. Green W, Gao X, Li K, et al. The Association of Sleep Hygiene and Drowsiness with Adverse Driving Events in Emergency Medicine Residents. West J Emerg Med. 2020;21(6):219-224. Published 2020 Oct 27. doi:10.5811/westjem.2020.8.47357
3. Steele MT, Ma OJ, Watson WA, Thomas HA Jr, Muelleman RL. The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med. 1999 Oct;6(10):1050-3. doi: 10.1111/j.1553-2712.1999.tb01191.x. PMID: 10530665.

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srrezaie)

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