The art of napping, or how to get power from your nap

Apr 30, 2018

It’s 3am in the morning; you are covering too many wards. Nurses are paging you for a patient with high fever from 3C while you are busy formulating good questions for a phone consult with the consultant who told you “not to ring me unless you have a good reason to get me coming in”. You are too busy to take a break although your adrenaline level is keeping you high anyway. When you can finally come off duty after a gruelling night shift and handover at 7:30 am, you don’t realize how exhausted you are until you almost doze off at the traffic lights driving home.

Delivering optimal patient care requires absolute attentiveness, emotional readiness, technical and clinical skills. This can hardly be achieved when you are sleep deprived and exhausted – body and mind. The deleterious effects of long working hours are well-documented and include impairment of mood, memory, physical dexterity and cognitive function [1-3]. Even worse, a recent study found that sleep deprivation adversely affects the recognition of subtle facial cues of the emotions that are most relevant to highly evolved prosocial interactions including empathy [4].

Yes... yes... you say we know all that; but what can we DO about it?? Well, we have searched the literature for helpful stuff and have come up with some ideas about napping that may be of practical help.

Official endorsement of napping

In recognition of the gruelling hours traditionally worked by junior doctors, and the negative effects this has on not only the young doctor but on patient safety, the US Accreditation Council for Graduate Medical Education published new guidelines in 2010. In these guidelines “strategic napping” during long shifts was strongly encouraged! At the time it was considered pretty amazing that the organisation that sets the standards for training programs for young doctors in the U.S. has endorsed napping, albeit carefully qualified as being of the strategic kind [5]. Nevertheless, this move reflects an increasing awareness that napping can actually be good for you.

How can napping help?

Napping is undoubtedly beneficial to your health, performance and overall wellbeing [6-11]. The trick seems to be in the timing of the nap; here ‘less is more’ as the saying goes.

People often think that the longer the nap, the more benefits can be gained from it. This is not so. The secret of taking a high quality nap is in preventing yourself from entering or waking up during deep or slow wave sleep as this is likely to induce sleep inertia. Shorter naps (10-20 minutes) mostly consist of stage 1 or 2 (light) sleeps, while deep (slow wave) sleep sets in after 30 to 45 minutes under normal conditions. Thus, taking a longer than 30-minute nap can result in sleep inertia, a transient period of feeling drowsy and groggy with impaired alertness, labile mood and cognitive function [11, 12].

So, to put power in your nap, keep it short.

As with everything in life, we need to keep in mind that ‘we are all individuals’; so the perfect nap timing and context may differ from person to person. There is nothing like finding out your best power nap parameters by trial and error!

…and let's stick with the term ‘power nap’ as the often used moniker ‘cat nap’ is clearly a misnomer. Cats basically sleep all the time, up to 20 hours a day. We hope to maximise the benefits from the minimal sleep, napping like a cat would bring in more harm than good to a human.

Napping puts you in good company!

A lot of famous people and high-achievers were fierce proponents of the power nap.

  • Albert Einstein was an accomplished micro-napper
  • Winston Churchill believed that napping helped him get twice as much done each day. He insisted on an afternoon nap to clear his mind for wartime victory
  • Napoleon had powernaps... even on the battlefield... on his horse!!
  • Margaret Thatcher did not like being disturbed during her snoozes around 3pm
  • The inventor Thomas Edison had secret power napping cots in his home, laboratories and libraries for whenever the need to revitalise arose
  • Leonardo Da Vinci was famous for taking a 15 minutes nap every 4 hours.

Some tricks to get the most out of your nap


Taking a relatively “uncomfortable” nap

Instead of lying flat on a cosy bed supported by a memory foam filled mattress, try napping in an armchair. The “slumber with a key” method is also an interesting way to prevent entering deep sleep as the artist Salvador Dali wrote in 50 secrets of Magic Craftsmanship [13]. This method involves placing a plate upside down on the floor and hanging a key in between fingers, so the key would clang the plate when one has fallen asleep deeply.

The timing of the nap

Afternoon naps have been shown to produce the best immediate effects and better performance outcomes. During night shifts, the best time to take a nap is when the highest level of sleepiness (or greatest sleep debt) is felt – mostly around 2 to 6 am. It was found that a 10-minute nap right before the end of a night shift led to sleep inertia, and it did not improve performance [11].

Have a nappuccino – the stimulant or caffeine nap

Have a cup of coffee before napping as it takes effect towards the end of the nap (a.k.a. controlled recovery period), however, beware of your caffeine intake as it should be no more than 400 mg daily. British researchers Horne and Reyner [14] found that caffeine and a 15 minute nap significantly improved cognitive performance, subjective sleepiness, and EEG activity indicating drowsiness compared to just napping. Nappuccinos that included “non-sleep dozing” (i.e. if you cannot actually fall asleep properly) also were effective.

Future directions: Nap pods in hospital and assigned ‘strategic’ naptime – why not?

More and more institutions around the world have recognised the benefits of napping and have built nap rooms for their employees/students. Such nap zones incorporate chairs with recliner options, cots or giant beanbags. In Brazil, there is a Power Nap Center accommodating twenty soundproofed cabins with “nappers-friendly” designs, including blue lighting and relaxing music. Some universities and teaching hospital also have “sleeping pods” equipped with white noise machines and disposable pillowcases to boost students’ productivity [15,16]. Positive feedback with reduced sleepiness was reported from a pilot study that had implemented formal breaks for nursing staff [17], though there were some barriers in gaining approval from the nursing manager…!

In the meantime….some tips for getting power naps in the hospital

  • Find a space with low lighting and noises levels
  • Set your phone on silent
  • Set an alarm for 10 to 20 minutes
  • Have a cup of coffee before the nap so it can maximally empower you
  • Remember even “non-sleep dozing” is effective

May the power of a well-timed snooze be with you!

Avant and onthewards partnership

Avant has partnered with onthewards, a free open access medical education website, run by junior doctors, and dedicated to delivering practical, high quality online resources for medical students and junior doctors.

What started as podcasts for junior doctors at Royal Prince Alfred Hospital has grown into a website that improves the availability of online resources for early career doctors. Avant and onthewards have committed to working closely together to develop risk management content tailored for junior doctors.

This article was originally published by onthewards. Avant sponsors onthewards as part of our strategic partnerships program.

References

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2. Davydov L et al. Investigation of correlation between house-staff work hours and prescribing errors. Am J Health Syst Pharm. 2004. June; 61(11):1130-4. Full article available from: http://www.ajhp.org/content/61/11/1130?sso-checked=true

3. Mansukhani MP et al. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: a systematic review of the literature. Postgrad Med. 2012. July; 124(4):241-9. DOI: 10.3810/pgm.2012.07.2583. Abstract available from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22913912

4. Killgore WDS et al. Sleep deprivation impairs recognition of specific emotions. Neurobiology of Sleep and Circadian Rhythms. 2017. January; 3(Supplement C):10-6. DOI: 10.1016/j.nbscr.2017.01.001. Full article available from: http://neurosciencenews.com/sleep-deprivation-facial-expression-6283/

5. Accreditation Council for Graduate Medical Education. 2010 ACGME Residency Common Program Requirements 2010. Available from: https://www.ama-assn.org/sites/default/files/media-browser/public/rfs/dutyhours_0.pdf

6. Stickgold R. Sleep-dependent memory consolidation. Nature. 2005. October; 437(7063):1272-8. DOI: 10.1038/nature04286. Abstract available from Nature: https://www.nature.com/articles/nature04286

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8. Cvejic E, Huang S, Vollmer-Conna U. Can you snooze your way to an ‘A’? Exploring the complex relationship between sleep, autonomic activity, wellbeing and performance in medical students. Aust N Z J Psychiatry. 2018. Jan; 52(1):39-46. DOI: 10.1177/0004867417716543. Abstract available from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28649873

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11. Hilditch CJ et al. Sleep inertia associated with a 10-min nap before the commute home following a night shift: A laboratory simulation study. Accid Anal Prev. 2017. February; 99(Pt B):411-5. DOI: 10.1016/j.aap.2015.11.010. Abstract available from: http://europepmc.org/abstract/med/26589387

12. Tassi P, Muzet A. Sleep inertia. Sleep Med Rev. 2000. August;4(4):341-53. DOI: 10.1053/smrv.2000.0098. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/12531174

13. Dali S. 50 Secrets of Magic Craftsmanship. New York: The Dial Press; 1948.

14. Horne JA, Reyner LA. Counteracting driver sleepiness: effects of napping, caffeine, and placebo. Psychophysiology. 1996. May; 33(3):306-9. Abstract available from PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8936399

15. Zak AJ. Sleeping on the Job: The Rise of Nap Pods. Sleep Review. 2014; July. Full article available from: http://www.sleepreviewmag.com/2014/07/companies-invest-nap-pods/

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