You have just finished an overnight shift and are driving home after you stayed in the emergency department an extra hour to complete your charts. It was a difficult shift, with one STEMI, a bad child-abuse case, a trauma resuscitation that did not go well, and an overabundance of abdominal complaints necessitating multiple rectal exams—you are 100 percent exhausted. You came to a stop in a line of cars at the red light and must have drifted off to sleep for a few seconds because you now have an angry driver from the car ahead of you at your window screaming, “You hit my car! Have you been drinking?” Your overnight shift is turning into a morning-after nightmare!

As emergency physicians, we are shift workers and have to develop strategies to accommodate the disruptions that occur with shift work. How do we prevent such episodes as the one above from occurring?

Assess Your Sleep Situation

To start, let’s look at your current situation. Answer the following three questions by choosing the answer with which you identify most.

1. In anticipation of an overnight shift, my plan of attack for sleep is:
   1. What plan? I can sleep whenever and wherever. I can sleep until 6 pm if I want!
   2. I try to take a nap before the overnight shift, but it never works.
   3. I try to sleep until at least 3 pm the day after an overnight, but I find myself awake at noon and exhausted but unable to fall back asleep.
   4. What plan? I have two kids and administrative duties. An overnight is just a missed night of sleep.
2. On a typical overnight shift, I find myself:
   1. Ready for anything!
   2. Inserting a caffeine IV while taking shots of espresso.
   3. Fading around 4 am and desperately pacing to stay awake.
   4. Wondering how comfortable the stretchers are for napping.
3. Working overnight shifts is:
   1. The best thing about EM.
   2. A necessary evil.
   3. An impossible task.
   4. Easier when you are younger.

If most of your answers are A’s, you are lucky and kind of a freak of nature. Are you interested in joining our practice? We always can use more “night people.”

If you answered mostly B’s, C’s, and D’s, read on for some strategies you can use.

Combating Sleep Disorder

Shift work sleep disorder (SWSD) is common in people who work nontraditional hours. It is defined as difficulty sleeping and excessive sleepiness due to a noncircadian-based schedule. Some people with the disorder have an increase in accidents or work-related errors and increased irritability. While most of us do not have true SWSD, we probably all can identify with some aspects of the disorder.

Anecdotally, a 32-year-old physician commented that her husband has diagnosed her with “decision fatigue” after she arrives home from a night shift, citing that she has difficulty making small decisions such as what to eat or drink.

Multiple studies have shown that night shifts are hard on the body in many ways. Studies suggest that people who work nights are at an increased risk of developing breast cancer, metabolic syndrome, and type 2 diabetes.¹ One study has determined that short-term memory is most affected by both overnight and day shifts.² Anecdotally, a 32-year-old physician commented that her husband has diagnosed her with “decision fatigue” after she arrives home from a night shift, citing that she has difficulty making small decisions such as what to eat or drink.