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  • Taking the danger out of 'doing nights'

    While shiftwork can seriously affect health, performance and safety, there is no escaping the reality that for many doctors it’s a necessary evil.

    However, being tired and stressed isn’t an excuse when it comes to making errors, so managing the effects of shiftwork with our self-care tips is important to keep you alert, healthy and error free.

    Exhaustion no defence

    Doctors doing shiftwork clearly face many challenges. From a medico-legal perspective, errors made by doctors who are tired, stressed and overworked are still errors – exhaustion is not considered a defence for poor decision-making. Therefore, taking steps to manage the effects of shiftwork is crucial to protect yourself against risk.

    A perfect storm

    Circadian rhythms are important as they regulate our body’s physiological and psychological functioning. Researchers believe the interaction of circadian misalignment, sleep–wake disturbance, melatonin suppression, internal desychronisation and sleep restriction contribute to the ill health seen in shift workers.1 These effects cause physiological disequilibrium which, in combination with disturbed socio-temporal and behavior patterns, contribute to ill health, sleep and mood disorders.2 A dose–response relationship also exists in which the risk of adverse effects increases with the duration of night work and the frequency of shift rotations.

    Shiftwork effects

    In the short term, lack of sleep, nighttime sleepiness and impaired alertness have the most dangerous impact on shiftworkers, adversely affecting decision-making, reaction times, attention and information processing. This can cause preventable errors, injuries and accidents, placing doctors at risk of medico-legal complaints and actions.2

    Shiftwork can also have serious long-term effects ranging from oxidative stress and metabolic syndrome to cardiovascular disease, cancer, infertility and poor pregnancy outcomes.3–6 Disturbed circadian systems and exposure to light at night has been linked to an increased risk of some cancers with night work associated with a 50 per cent increase in the relative risk of cancer (especially breast cancer in women).7

    Doctors experience anxiety, depressed mood and reduced motivation as well as cognitive impairment during extended periods of working at night, while depressive symptoms in shiftworkers have been linked to increased absenteeism and errors.8, 9

    Worryingly for doctors, recent research suggests that cognitive function markedly declines among shiftworkers, exposing them to risk of injury, difficulties with problem solving and errors of judgment.

    The good news is that cognitive function can be restored when shiftwork stops, although full function may not return until five years after shiftwork ceases.

    Self-care tips for crazy hours

    It can take time and practice to determine which strategies work the best for you, but the following tips will help you keep the effects of shiftwork in check

    • Try to get shifts that allow enough sleep and recovery time
    • Get at least seven hours sleep in each 24-hour cycle
    • Sleep as soon as possible after your shift ends but eat something nutritious first
    • Use earplugs or white-noise sound machines
    • Make sure the room is well ventilated and dark
    • Schedule exercise before work not after work
    • Eat well – plan and prepare what you will eat and drink on night duty
    • Naps, if sanctioned by your employer, will improve alertness
    • Avoid bright sunlight at the end of a shift when you have to sleep but try to expose yourself to sun at the end of a daytime sleep
    • Melatonin has been shown to improve daytime sleep

    Check out our other tips on managing fatigue and self-care tips for doctors in training.

    Long-term fixes

    • Have your own GP and see them regularly. Read our advice on 'How to be a better patient'. 
    • Have risk factors checked regularly including for mood and anxiety disorders
    • Exercise regularly
    • Eat healthily
    • Know your limits and develop a tailored approach to maximise your alertness and wakefulness at night

    If you are concerned that shift work may be affecting your health seek help early. It is important to know when and where to seek help and there is a range of support services available to doctors needing help.

    The Avant health and wellbeing website offers wealth of information to help you maintain your physical, mental and financial health. For more advice on maintaining your physical and mental health and wellbeing view our Your Health section or to maintain wellness and professional commitment throughout your career, visit our Healthy Knowledge and Career section.

    References

    1. Spallek M, Kessel R, Brinkmann E. Shift work and pathological conditions Journal of Occupational Medical Toxicology 2006; 1: 25. 

    2. Rajaratnam SMW, Howard ME, Grunstein RR. Sleep loss and circadian disruption in shift work: health burden and management. Medical Journal of Australia 2013; 199(8): 11–15. 

    3.Sharifian A, Farahani S, Pasalar P, Gharavi M, Aminian O. Shift work as an oxidative stressor. Journal of Occupational Medical Toxicology 2006; 1: 25. 

    4. Karlsson B, Knutsson A, Lindahl B. Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people. Occupational and Environmental Medicine 2001; 58: 747–752. 

    5. Knutsson A, Hallquist J, Reuterwall C, Theorell T, Akerstedt T. Shiftwork and myocardial infarction: a case-control study. Occupational and Environmental Medicine 1999; 56:46–50. 

    6. Spallek M, Kessel R, Brinkmann E. Shift work and pathological conditions Journal of Occupational Medical Toxicology 2006; 1: 25. 

    7. Kolstad HA. Nightshift work and risk of breast cancer and other cancers: a critical review of the epidemiologic evidence. Scandinavian Journal of Work and Environmental Health 2008; 34:5–22. 

    8. Smith-Coggins R, Rosekind MR, Buccino KR, et al. Rotating shift work schedules: can we enhance physician adaptation to night shifts? Academic Emergency Medicine 1997; 4: 951–961. 

    9. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. British Medical Journal 2008; 336: 488–491. 

    10. Marquié JC, Tucker P, Folkard S, Gentil C, Ansiau D. Chronic effects of shift work on cognition: findings from the VISAT longitudinal study. Occupational and Environmental Medicine, 2014; 0:1–7.