Episode 3 - Restful, RN
May 23, 2023
About This Episode
Rest: The elusive but ever important need for our health. We learn about sleep hygiene, early birds and night owls and why you shouldn’t hit snooze from Sabra Abbott, MD, PhD, a sleep medicine physician at Northwestern Medicine.
Episode Guests
Sabra M. Abbott, MD, PhD
Dr. Abbot earned her PhD and MD from the University of Illinois, Urbana-Champaign, then trained as a resident at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and as a sleep medicine fellow at Northwestern Medicine. One of her research and clinical interests is the management of circadian rhythm sleep-wake disorders. She serves as director of the Northwestern Medicine Center of Circadian and Sleep Medicine at Northwestern Memorial Hospital.
Rest: The elusive but ever important need for our health. We learn about sleep hygiene, early birds and night owls and why you shouldn’t hit snooze from Sabra Abbott, MD, PhD, a sleep medicine physician at Northwestern Medicine.
Episode Guests
Sabra M. Abbott, MD, PhD
Dr. Abbot earned her PhD and MD from the University of Illinois, Urbana-Champaign, then trained as a resident at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and as a sleep medicine fellow at Northwestern Medicine. One of her research and clinical interests is the management of circadian rhythm sleep-wake disorders. She serves as director of the Northwestern Medicine Center of Circadian and Sleep Medicine at Northwestern Memorial Hospital.
transcript
Saklak [00:00:00] I am Alyssa Saklak.
Masnari [00:00:06]And I'm Laurin Masnari.
Saklak [00:00:08] On Better, RN, we get real about nursing.
Masnari [00:00:11] The good and the gritty.
Saklak [00:00:12] We talk to real healthcare experts.
Masnari [00:00:15] With the goal of becoming better.
Saklak [00:00:17]For our patients, our colleagues.
Masnari [00:00:18] Our family, our friends.
Saklak [00:00:20] Our partners and ourselves. Hey, Lauren.
Masnari [00:00:26] Hey.
Saklak [00:00:27] How'd you sleep last night?
Masnari [00:00:28] Could have been better.
Saklak [00:00:29] Did you hit your snooze?
Masnari [00:00:30] I hit the snooze today.
Saklak I woke up before my alarm.
Masnari [00:00:33] Classic. This is it. This is our personalities. I'm a snoozer.
Saklak [00:00:36] I'm surprised.
Masnari [00:00:37] And you're up.
Saklak [00:00:38] I feel like you're always on time though, so you can't be hitting it that --
Masnari [00:00:41] I can, I can still snooze and be on time. I think it just set my alarm too early because I like to snooze. It's a mental thing. I don't know if that's good for me. I think we'll find out today.
Saklak [00:00:51] You know who would be really good at talking about this with?
Masnari [00:00:54] Tell me.
Saklak [00:00:54] So today, we have Dr. Sabra Abbott, a Northwestern Medicine sleep medicine physician who specializes in shift work sleep disorders.
Masnari [00:01:04] I can't wait for this conversation because, as a manager and talking to new nurses, the thing that is heavy on their minds when I'm transitioning them to night shift is: How am I going to have a social life? How am I going to survive on my days off? What does this look like? Is my health going to be impacted? And so, I know that Dr. Abbott specializes in shift work and circadian rhythms, and I'm really interested to hear her perspective about how we can support these nurses through this tough transition that we're asking them to flip their lives and their schedules.
Saklak [00:01:34] Absolutely. I mean, for that time that I was on night shift, I was just a sleep and nap queen and I don't even know if that was like the right or healthy way to be managing the sleep schedule. We always hear tips and tricks, and there's some nurses who I feel like are just built for night shift. And I'm curious, I have several questions. Are people more built for night shift or day shift?
Masnari [00:01:54] Are you a morning person or a night owl?
Saklak [00:01:56] I wake up before the sun.
Masnari [00:01:58] So, morning person.
Saklak [00:01:59] Such a morning person that they kicked me off night shifts. They said, you are too sunshine-y. And they sent me to the computer in the corner.
Masnari [00:02:05] You're still sunshine-y.
Saklak [00:02:06] What are you?
Masnari [00:02:07] It's hard because I think it depends on the day. I think in the morning, mentally I'm awake, but in the evenings is when I like, I like to work out at night before I go to bed, and I like to night shower, like all of those things. So physically, I think I'm more active at night, but mentally I'm sharpest in the morning. So, I wonder if that means anything.
Saklak [00:02:25] Well, I say it's about time we introduce Dr. Abbott to get down to the bottom of some of these questions we have.
Masnari [00:02:32] Let's do it.
Abbott: [00:02:37] My name is Sabra Abbott. I'm a neurologist at Northwestern. I've been here about 10 years now. I primarily practice in the Sleep Medicine Clinic. I am the program director for our sleep medicine fellowship, and then I do a little bit of general neurology on the inpatient side as well.
Masnari [00:02:52] So, you have a lot of free time.
Abbott [00:02:55] Tons of free time, and I spend it all sleeping.
Masnari [00:02:57] I love it. Tell us what it means to get good rest.
Abbott [00:03:00] So, I think that might be one of our first areas that we can start getting into some myths. I think oftentimes, because of commercials for sleep aids, there's this perception that you should just get into bed, fall asleep right away, and not be aware of what's going on until the next morning when the sun rises and you look perfect. It is normal to take a few minutes to fall asleep. You know, 10 to 20 minutes to fall asleep is normal. It's normal to wake up a couple times during the night, but you really should be able to get back to sleep fairly quickly. And if we're talking about good, healthy rest, ideally you should be getting up without an alarm clock. But we know that in our current society, that's not always the easiest thing to do. And oftentimes, we are dependent on the alarm to get up to make sure we're at work on time.
Saklak [00:03:42] That makes me feel better ‘cause I wake up before my alarm and feel like I have a natural alarm clock. So, does that mean I have a good rhythm going?
Abbott [00:03:51] You probably do. And so, the best way to get good sleep is to keep the same schedule night after night, which as healthcare workers is really challenging. But we do have internal clocks, and the fact that you're waking up a little bit before your alarm probably means that you're on a good schedule and that your body is sort of anticipating the time that you should be waking up.
Masnari [00:04:10] Dr. Abbott, you specialize in circadian rhythm and shift work, correct?
Abbott [00:04:16] Among the other things I left out of my introduction, I am also the director of our circadian medicine clinic, and so my primary focus for the outpatient side is looking at circadian biology, treating shift workers and other circadian disorders.
Masnari [00:04:29] So why do you think that it's so much harder for shift workers to get adequate rest as compared to people who, like Alyssa said, work a regular nine-to-five?
Abbott [00:04:38] So, there are probably two factors to that. So one is that most people who are shift workers don't work the same shift every single night, or if they work nights, they still have family and friends who work days and so on their days off, they don't want to be following that same schedule. The reason it's so hard to sleep as a shift worker is that we have an internal clock that tells us what time of day it is. It's ideally designed so that when the sun comes up, we're prepared to do all of those daytime activities. Things like eating, being awake, being alert, and then when the sun goes down, we are prepared to do those nighttime activities, so be more likely to rest, less likely to eat. All of those things that should happen at night. When you're working shift work, you're flipping that whole schedule around and so you're trying to be alert at night when your body wants to be asleep. You're trying to sleep during the day when your body wants to be alert, and it's very hard to reverse those patterns because the sun still rises in sets and provides that daytime signal for you.
Masnari [00:05:38] We were talking about shift work, and you were talking about how when it's let out, your body wants to be awake and active, but our night shifters are sleeping during that time. I feel like in my meetings with my new nurses we talk about how they don't know when to eat or what to eat at what time, when they're done with their shift.
And at 7 am they want dinner, but it's breakfast time. What's the right thing to do in that situation? Is there a right thing to do?
Abbott [00:06:01] That's a really good question, and I think it's an area that there's a lot of really active research going on right now. We think that because of the fact that you still get that daily sunlight, your body probably doesn't flip and adapt to that night shift schedule. And so, because of that, all of your metabolic processes still are more active during the daytime. And so, there is at least one school of thought that we should do is still focus most of your meals during that daytime. And so, one way that you could approach this is eat a large meal. When you get home from night shift, sleep during the day, eat a large meal before you go on night shift and just have a snack in the middle of that overnight shift. So, you're still kind of shifting most of your food during the daytime. We think that that might be better for a couple of reasons. So one is that it may help avoid some of that dreaded weight gain that typically comes along with night working night shifts. But also, there's a little bit of data out there that it might actually make you more alert during the night shift. You — if you aren't having that kind of big food coma that happens in the middle of your shift, and so that's kind of how I advise my patients to structure it. There's still a lot of active research still ongoing, so I think in a couple years we'll have even more precise guidance for that.
Saklak [00:07:14] When I worked night shift and I wanted to be social the next day, or even, you know, if I worked two days in a row and then was off, one my go-to was to take a nap for a couple hours and then be social. And I think everyone kind of has a different practice around, you know, when you're trying to flip back to daytime schedule, is there any supportive research that can kind of help guide nurses into what would be best? I think some people, it almost feels like they're built for a night shift, and can do it for years. So, I'm curious, that napping piece, is there any evidence behind that of what works best?
Abbott [00:07:51] There are a couple of things to take out of your question there. So, in terms of how you adapt from going to a night shift to then being able to socialize, see your friends and family. People who aren't working night shifts, one of the recommendations is what we call a compromised phase. So, it's a fancy way of saying that when you're working night shifts, you're usually trying to sleep during the day, and then you usually have a couple days off. You may go back to night shift or you may not. But then the question is, what do you do with your sleep during that time? A lot of people try to completely flip backwards so that they're going back to sleeping at night and being awake during the day, and that's really hard for your body to do. You can imagine it's sort of like having the worst possible jet lag. You flew halfway around the world, and you're trying to shift your schedule to that. So instead, what we recommend is kind of finding somewhere in between. So as an example, if you are normally sleeping from like 8 am to 5 pm on your days off. Then you move that a little bit earlier. So maybe you sleep from, you know, like 3 am to noon. And the way you make that transition, like you said, that first day between doing nights to either being off or doing days, it does make sense to take a little bit of a nap. By that I mean, somewhere around four hours or so, just so you kind of get rid of that, what we call homeostatic drive, that makes you want to fall asleep so you can be up and then you can go to bed a little bit earlier the following night, to get at one of your other questions. That idea that some people are more built for night shifts than others. So, every single one of us falls somewhere on the spectrum between being a night owl and being an early bird.
It's part of your biology. It's not something that you're going to change. It's kind of like being short or being tall. It's who you are. People who are night owls obviously tend to do a little bit better with the second and third shift types of schedules. People who are early birds do not do well at all with the overnight shifts, but they do a lot better with the early morning shifts. And so, part of it, we all kind of have to go through some degree of shift work as we're going through our training, but recognizing who you are and trying to find the shift that fits best with your, what we call chronotype, is also going to benefit you in the long term.
Masnari [00:10:03] So, being a night owl, or being an early bird it's part of your makeup, like it's part of your DNA. It's part of like, it's built into you.
Abbott [00:10:10] Yes. So, there are lots of studies that have actually found people who are on the extreme ends of these. So, there are families full of early birds, there are families full of night owls. Basically, if you want to get into the biology of this, we have an internal clock that's basically in every single one of our cells.
It's this combination of genes that go through a process of transcription and translation, and essentially, they go through that whole cycle in about 24 hours. And if you have mutations that make you go through that cycle in shorter than 24 hours, you tend to be more early and more on that early bird end of the spectrum.
And if your particular genetic makeup makes you go through that cycle in a little bit longer than 24 hours, you tend to be more of a night owl. Most of us fall somewhere in the middle, but it's all part of your DNA.
Masnari [00:11:00] I think about our nurses or our team members that we work with who are also parents, but are also doing shift work, are responsible for someone else, a family member, a child, a parent, someone. And I think about how challenging that must be for them because not only are they doing shift work, but they're also responsible for caring someone when they should be trying to recover themselves.
Abbott [00:11:21] I think some people will choose the night shift because they're trying to split care responsibilities and trying to have somebody home during the daytime, not realizing that it is challenging to burn the candle at both ends, and sleep should not be something we consider optional in order to be able to take care of those responsibilities. And so, I think it's an important thing to recognize that you do need to prioritize some time for sleep and time for everything else.
Masnari [00:11:48] As a manager of an inpatient unit, what advice do you have for people who are trying to support other people who are in a position like that? How can I be the most, most supportive to my team members who are in this type of situation.
Abbott [00:11:58] That is a challenging question because I think the thing that I do not have and you do not have is the ability to add more hours to the day. And so, it is trying to find a way to balance work responsibilities, home responsibilities and your own personal health. And that's something that I spend a lot of time coaching my patients and walking through what their different responsibilities are and trying to figure out how we can find some happy medium where nothing gets neglected.
Saklak [00:12:26] The thing that popped into my head as we were talking about this, is all the other little hacks that we do. So, like melatonin, blackout curtains. You know, sleep sounds, I swear night, shift nurses can have a whole slew of things that they share with one another. Is there anything that stands out more in your research and experience that helps people to get better sleep?
Abbott [00:12:50] So, I think my number one thing would be the blackout curtains. It is a lot harder to sleep if you're getting light into your bedroom. I think my number two is a sign on your bedroom door that says “I am sleeping.” A lot of my patients, again, because they're home, the family members think, oh, well, I'm just going to go, you know, ask a quick question. I'm going to just do this one thing. You never do that in the middle of the night, but we forget because it's daytime and everybody else is awake. You may go in or the dog might come in, or the kids might come in and disrupt your sleep. So do not disturb sign is really helpful. And then I think either a good pair of earplugs or a white noise machine also can be really helpful because there's just a lot more noise during the daytime. It's harder to sleep through that. Those would be my top three.
Masnari [00:13:33] Are noise machines like habit forming? So, if I, I use a noise machine at night and then when I go on vacation, I feel like I can't sleep as well. Is that because I don't bring my noise machine with me or because I'm in a different environment? Is there anything to be said for the consistency of the physical environment and the temperature of the room that you're sleeping in?
Abbott [00:13:48] So, I don't think that they're habit forming per se, but you should talk to a bunch of sleep researchers when they ever go to a conference away. And all the little things that we have done to the hotel room is kind of insane. So, we're going around covering up alarm clocks, we're covering up lights, we are turning on the fan a 100% of the time, so you're not getting noise from the elevator. Once you figure out the routine that works for you, you definitely want to try to mimic that in any sleeping environment that you're in, because you just sort of get used to being able to sleep in that appropriate environment.
Masnari [00:14:20] What are your thoughts on the snooze alarm? How bad is that for me in the morning?
Abbott [00:14:24] Horrible idea. The idea is that you were sleeping, you disrupted that sleep, and then you are trying to go back to sleep and if you set the alarm starting at 6, but you didn't need to get up until 6:30. Just set it for 6:30 and get up instead of having half an hour of very interrupted, disrupted sleep at the very end of your night.
Masnari [00:14:44] It makes sense, but it's just so much better. Just five more minutes feels like I can take on the day, but it's not true. Mm-hmm. I just need to get up.
Abbott [00:14:51] You just need to get up.
Masnari [00:14:52] What about if I wake — like Alyssa wakes up a few minutes before her alarm. What if I wake up an hour before my alarm? Do I just get up or should I try to get that last hour?
Abbott [00:15:01] That's a tricky question. There's a delicate balance there. You don't want to spend a lot of time in bed if you're not sleeping because that can precipitate some degree of insomnia because your brain starts thinking, well, bed's a place where I lay awake and I plan my day and I think about everything that happened to me. Now within reason, we know that you're going to wake up during the night. So, if you're laying there and you're just going to try to fall back to sleep, and you're back to sleep in five to 10 minutes, great. If you find that you're laying there and you're just sitting there thinking about stuff, and 20 minutes have gone by and you know you're not going to fall back asleep before that alarm goes off, just get up.
Saklak [00:15:36] After a long 12-hour shift, whether it's days or night shift, it could be a very physical and mentally exciting day. A lot going on. And it can be really hard to unwind after a 12-hour day, but you're so exhausted. Is there a phenomenon that, that is kind of why that's happening, and what is your best advice for that event occurring? I, you know, I hear a lot of nurses talk about their mind as racing of the shift that happened or a code or, whatever events had happened that day. and it's almost like you can't fall asleep even though you're exhausted.
Abbott [00:16:10] Yeah, I think it's that, that kind of overtired feeling. And I just came off of two weeks of doing inpatient. I know where you're coming from. I certainly wasn't doing the hard 12 hours on a physical intense activity. But a lot of stuff happens on the inpatient side. A lot of, emotionally taxing things happen when we're caring for sick people, and I think we have to acknowledge that that's not just going to go away when you walk out the door. And so, taking some time to relax and decompress and think through what happened during the day. Don't think that you can just jump right from work and jump into bed and be fine, because you're going to sit there and you're going to think about stuff. You're going to process things. And so, there are two components of this. So, one is just giving yourself a little bit of time to relax and unwind before you go home and jump into bed. And you're going to find just the activity that works best for you, whether it's a little bit of stretching, some meditation, reading, something that's unrelated to work. Stay away from screen time because that's going to give you extra light exposure, is going to wake you up a little more. There's also a lot of just emotionally taxing things that can happen if you're either on social media or looking at the news.
And so, trying to get something that's going to put you more in that sleep state is going to be helpful. But then there's another component of this, which is in the behavioral sleep medicine side of things, we call this scheduled worry. But this idea of all of that stuff that you're sitting there trying to process when you're laying in bed at night, because it's the first time that things have been quiet. You're not getting pulled in a million directions. Move that out of the bedroom because you don't want bed to be the place where you process what happened during the day. That is going to lead to more difficulty sleeping. So set aside time at some point during the day outside of the bedroom, where you kind of think through and actually deal with all of the stuff that happened during your day, rather than using the bed for that.
Saklak [00:17:59] That is so helpful, and I will now schedule my worry at a different time and keep it out of the bed. Dr. Abbott, thank you so much for your insight and wisdom. This was so much fun, and I, I hope we answered a lot of the questions. I mean, the list can go on from nurses, so, might even have to do a part two down the line, but thank you so much.
Abbott [00:18:20] You're very welcome and I also, I am always happy to see people in clinic if you want to have an individual one-on-one discussion of how to manage and deal with your shift work. We are always happy to see you in clinic.
Masnari [00:18:30] Amazing. Thank you so much, Dr. Abbott. Thanks for tuning in.
Saklak [00:18:39] Better, RN is brought to you by The Woman's Board of Northwestern Memorial Hospital.
Masnari [00:00:06]And I'm Laurin Masnari.
Saklak [00:00:08] On Better, RN, we get real about nursing.
Masnari [00:00:11] The good and the gritty.
Saklak [00:00:12] We talk to real healthcare experts.
Masnari [00:00:15] With the goal of becoming better.
Saklak [00:00:17]For our patients, our colleagues.
Masnari [00:00:18] Our family, our friends.
Saklak [00:00:20] Our partners and ourselves. Hey, Lauren.
Masnari [00:00:26] Hey.
Saklak [00:00:27] How'd you sleep last night?
Masnari [00:00:28] Could have been better.
Saklak [00:00:29] Did you hit your snooze?
Masnari [00:00:30] I hit the snooze today.
Saklak I woke up before my alarm.
Masnari [00:00:33] Classic. This is it. This is our personalities. I'm a snoozer.
Saklak [00:00:36] I'm surprised.
Masnari [00:00:37] And you're up.
Saklak [00:00:38] I feel like you're always on time though, so you can't be hitting it that --
Masnari [00:00:41] I can, I can still snooze and be on time. I think it just set my alarm too early because I like to snooze. It's a mental thing. I don't know if that's good for me. I think we'll find out today.
Saklak [00:00:51] You know who would be really good at talking about this with?
Masnari [00:00:54] Tell me.
Saklak [00:00:54] So today, we have Dr. Sabra Abbott, a Northwestern Medicine sleep medicine physician who specializes in shift work sleep disorders.
Masnari [00:01:04] I can't wait for this conversation because, as a manager and talking to new nurses, the thing that is heavy on their minds when I'm transitioning them to night shift is: How am I going to have a social life? How am I going to survive on my days off? What does this look like? Is my health going to be impacted? And so, I know that Dr. Abbott specializes in shift work and circadian rhythms, and I'm really interested to hear her perspective about how we can support these nurses through this tough transition that we're asking them to flip their lives and their schedules.
Saklak [00:01:34] Absolutely. I mean, for that time that I was on night shift, I was just a sleep and nap queen and I don't even know if that was like the right or healthy way to be managing the sleep schedule. We always hear tips and tricks, and there's some nurses who I feel like are just built for night shift. And I'm curious, I have several questions. Are people more built for night shift or day shift?
Masnari [00:01:54] Are you a morning person or a night owl?
Saklak [00:01:56] I wake up before the sun.
Masnari [00:01:58] So, morning person.
Saklak [00:01:59] Such a morning person that they kicked me off night shifts. They said, you are too sunshine-y. And they sent me to the computer in the corner.
Masnari [00:02:05] You're still sunshine-y.
Saklak [00:02:06] What are you?
Masnari [00:02:07] It's hard because I think it depends on the day. I think in the morning, mentally I'm awake, but in the evenings is when I like, I like to work out at night before I go to bed, and I like to night shower, like all of those things. So physically, I think I'm more active at night, but mentally I'm sharpest in the morning. So, I wonder if that means anything.
Saklak [00:02:25] Well, I say it's about time we introduce Dr. Abbott to get down to the bottom of some of these questions we have.
Masnari [00:02:32] Let's do it.
Abbott: [00:02:37] My name is Sabra Abbott. I'm a neurologist at Northwestern. I've been here about 10 years now. I primarily practice in the Sleep Medicine Clinic. I am the program director for our sleep medicine fellowship, and then I do a little bit of general neurology on the inpatient side as well.
Masnari [00:02:52] So, you have a lot of free time.
Abbott [00:02:55] Tons of free time, and I spend it all sleeping.
Masnari [00:02:57] I love it. Tell us what it means to get good rest.
Abbott [00:03:00] So, I think that might be one of our first areas that we can start getting into some myths. I think oftentimes, because of commercials for sleep aids, there's this perception that you should just get into bed, fall asleep right away, and not be aware of what's going on until the next morning when the sun rises and you look perfect. It is normal to take a few minutes to fall asleep. You know, 10 to 20 minutes to fall asleep is normal. It's normal to wake up a couple times during the night, but you really should be able to get back to sleep fairly quickly. And if we're talking about good, healthy rest, ideally you should be getting up without an alarm clock. But we know that in our current society, that's not always the easiest thing to do. And oftentimes, we are dependent on the alarm to get up to make sure we're at work on time.
Saklak [00:03:42] That makes me feel better ‘cause I wake up before my alarm and feel like I have a natural alarm clock. So, does that mean I have a good rhythm going?
Abbott [00:03:51] You probably do. And so, the best way to get good sleep is to keep the same schedule night after night, which as healthcare workers is really challenging. But we do have internal clocks, and the fact that you're waking up a little bit before your alarm probably means that you're on a good schedule and that your body is sort of anticipating the time that you should be waking up.
Masnari [00:04:10] Dr. Abbott, you specialize in circadian rhythm and shift work, correct?
Abbott [00:04:16] Among the other things I left out of my introduction, I am also the director of our circadian medicine clinic, and so my primary focus for the outpatient side is looking at circadian biology, treating shift workers and other circadian disorders.
Masnari [00:04:29] So why do you think that it's so much harder for shift workers to get adequate rest as compared to people who, like Alyssa said, work a regular nine-to-five?
Abbott [00:04:38] So, there are probably two factors to that. So one is that most people who are shift workers don't work the same shift every single night, or if they work nights, they still have family and friends who work days and so on their days off, they don't want to be following that same schedule. The reason it's so hard to sleep as a shift worker is that we have an internal clock that tells us what time of day it is. It's ideally designed so that when the sun comes up, we're prepared to do all of those daytime activities. Things like eating, being awake, being alert, and then when the sun goes down, we are prepared to do those nighttime activities, so be more likely to rest, less likely to eat. All of those things that should happen at night. When you're working shift work, you're flipping that whole schedule around and so you're trying to be alert at night when your body wants to be asleep. You're trying to sleep during the day when your body wants to be alert, and it's very hard to reverse those patterns because the sun still rises in sets and provides that daytime signal for you.
Masnari [00:05:38] We were talking about shift work, and you were talking about how when it's let out, your body wants to be awake and active, but our night shifters are sleeping during that time. I feel like in my meetings with my new nurses we talk about how they don't know when to eat or what to eat at what time, when they're done with their shift.
And at 7 am they want dinner, but it's breakfast time. What's the right thing to do in that situation? Is there a right thing to do?
Abbott [00:06:01] That's a really good question, and I think it's an area that there's a lot of really active research going on right now. We think that because of the fact that you still get that daily sunlight, your body probably doesn't flip and adapt to that night shift schedule. And so, because of that, all of your metabolic processes still are more active during the daytime. And so, there is at least one school of thought that we should do is still focus most of your meals during that daytime. And so, one way that you could approach this is eat a large meal. When you get home from night shift, sleep during the day, eat a large meal before you go on night shift and just have a snack in the middle of that overnight shift. So, you're still kind of shifting most of your food during the daytime. We think that that might be better for a couple of reasons. So one is that it may help avoid some of that dreaded weight gain that typically comes along with night working night shifts. But also, there's a little bit of data out there that it might actually make you more alert during the night shift. You — if you aren't having that kind of big food coma that happens in the middle of your shift, and so that's kind of how I advise my patients to structure it. There's still a lot of active research still ongoing, so I think in a couple years we'll have even more precise guidance for that.
Saklak [00:07:14] When I worked night shift and I wanted to be social the next day, or even, you know, if I worked two days in a row and then was off, one my go-to was to take a nap for a couple hours and then be social. And I think everyone kind of has a different practice around, you know, when you're trying to flip back to daytime schedule, is there any supportive research that can kind of help guide nurses into what would be best? I think some people, it almost feels like they're built for a night shift, and can do it for years. So, I'm curious, that napping piece, is there any evidence behind that of what works best?
Abbott [00:07:51] There are a couple of things to take out of your question there. So, in terms of how you adapt from going to a night shift to then being able to socialize, see your friends and family. People who aren't working night shifts, one of the recommendations is what we call a compromised phase. So, it's a fancy way of saying that when you're working night shifts, you're usually trying to sleep during the day, and then you usually have a couple days off. You may go back to night shift or you may not. But then the question is, what do you do with your sleep during that time? A lot of people try to completely flip backwards so that they're going back to sleeping at night and being awake during the day, and that's really hard for your body to do. You can imagine it's sort of like having the worst possible jet lag. You flew halfway around the world, and you're trying to shift your schedule to that. So instead, what we recommend is kind of finding somewhere in between. So as an example, if you are normally sleeping from like 8 am to 5 pm on your days off. Then you move that a little bit earlier. So maybe you sleep from, you know, like 3 am to noon. And the way you make that transition, like you said, that first day between doing nights to either being off or doing days, it does make sense to take a little bit of a nap. By that I mean, somewhere around four hours or so, just so you kind of get rid of that, what we call homeostatic drive, that makes you want to fall asleep so you can be up and then you can go to bed a little bit earlier the following night, to get at one of your other questions. That idea that some people are more built for night shifts than others. So, every single one of us falls somewhere on the spectrum between being a night owl and being an early bird.
It's part of your biology. It's not something that you're going to change. It's kind of like being short or being tall. It's who you are. People who are night owls obviously tend to do a little bit better with the second and third shift types of schedules. People who are early birds do not do well at all with the overnight shifts, but they do a lot better with the early morning shifts. And so, part of it, we all kind of have to go through some degree of shift work as we're going through our training, but recognizing who you are and trying to find the shift that fits best with your, what we call chronotype, is also going to benefit you in the long term.
Masnari [00:10:03] So, being a night owl, or being an early bird it's part of your makeup, like it's part of your DNA. It's part of like, it's built into you.
Abbott [00:10:10] Yes. So, there are lots of studies that have actually found people who are on the extreme ends of these. So, there are families full of early birds, there are families full of night owls. Basically, if you want to get into the biology of this, we have an internal clock that's basically in every single one of our cells.
It's this combination of genes that go through a process of transcription and translation, and essentially, they go through that whole cycle in about 24 hours. And if you have mutations that make you go through that cycle in shorter than 24 hours, you tend to be more early and more on that early bird end of the spectrum.
And if your particular genetic makeup makes you go through that cycle in a little bit longer than 24 hours, you tend to be more of a night owl. Most of us fall somewhere in the middle, but it's all part of your DNA.
Masnari [00:11:00] I think about our nurses or our team members that we work with who are also parents, but are also doing shift work, are responsible for someone else, a family member, a child, a parent, someone. And I think about how challenging that must be for them because not only are they doing shift work, but they're also responsible for caring someone when they should be trying to recover themselves.
Abbott [00:11:21] I think some people will choose the night shift because they're trying to split care responsibilities and trying to have somebody home during the daytime, not realizing that it is challenging to burn the candle at both ends, and sleep should not be something we consider optional in order to be able to take care of those responsibilities. And so, I think it's an important thing to recognize that you do need to prioritize some time for sleep and time for everything else.
Masnari [00:11:48] As a manager of an inpatient unit, what advice do you have for people who are trying to support other people who are in a position like that? How can I be the most, most supportive to my team members who are in this type of situation.
Abbott [00:11:58] That is a challenging question because I think the thing that I do not have and you do not have is the ability to add more hours to the day. And so, it is trying to find a way to balance work responsibilities, home responsibilities and your own personal health. And that's something that I spend a lot of time coaching my patients and walking through what their different responsibilities are and trying to figure out how we can find some happy medium where nothing gets neglected.
Saklak [00:12:26] The thing that popped into my head as we were talking about this, is all the other little hacks that we do. So, like melatonin, blackout curtains. You know, sleep sounds, I swear night, shift nurses can have a whole slew of things that they share with one another. Is there anything that stands out more in your research and experience that helps people to get better sleep?
Abbott [00:12:50] So, I think my number one thing would be the blackout curtains. It is a lot harder to sleep if you're getting light into your bedroom. I think my number two is a sign on your bedroom door that says “I am sleeping.” A lot of my patients, again, because they're home, the family members think, oh, well, I'm just going to go, you know, ask a quick question. I'm going to just do this one thing. You never do that in the middle of the night, but we forget because it's daytime and everybody else is awake. You may go in or the dog might come in, or the kids might come in and disrupt your sleep. So do not disturb sign is really helpful. And then I think either a good pair of earplugs or a white noise machine also can be really helpful because there's just a lot more noise during the daytime. It's harder to sleep through that. Those would be my top three.
Masnari [00:13:33] Are noise machines like habit forming? So, if I, I use a noise machine at night and then when I go on vacation, I feel like I can't sleep as well. Is that because I don't bring my noise machine with me or because I'm in a different environment? Is there anything to be said for the consistency of the physical environment and the temperature of the room that you're sleeping in?
Abbott [00:13:48] So, I don't think that they're habit forming per se, but you should talk to a bunch of sleep researchers when they ever go to a conference away. And all the little things that we have done to the hotel room is kind of insane. So, we're going around covering up alarm clocks, we're covering up lights, we are turning on the fan a 100% of the time, so you're not getting noise from the elevator. Once you figure out the routine that works for you, you definitely want to try to mimic that in any sleeping environment that you're in, because you just sort of get used to being able to sleep in that appropriate environment.
Masnari [00:14:20] What are your thoughts on the snooze alarm? How bad is that for me in the morning?
Abbott [00:14:24] Horrible idea. The idea is that you were sleeping, you disrupted that sleep, and then you are trying to go back to sleep and if you set the alarm starting at 6, but you didn't need to get up until 6:30. Just set it for 6:30 and get up instead of having half an hour of very interrupted, disrupted sleep at the very end of your night.
Masnari [00:14:44] It makes sense, but it's just so much better. Just five more minutes feels like I can take on the day, but it's not true. Mm-hmm. I just need to get up.
Abbott [00:14:51] You just need to get up.
Masnari [00:14:52] What about if I wake — like Alyssa wakes up a few minutes before her alarm. What if I wake up an hour before my alarm? Do I just get up or should I try to get that last hour?
Abbott [00:15:01] That's a tricky question. There's a delicate balance there. You don't want to spend a lot of time in bed if you're not sleeping because that can precipitate some degree of insomnia because your brain starts thinking, well, bed's a place where I lay awake and I plan my day and I think about everything that happened to me. Now within reason, we know that you're going to wake up during the night. So, if you're laying there and you're just going to try to fall back to sleep, and you're back to sleep in five to 10 minutes, great. If you find that you're laying there and you're just sitting there thinking about stuff, and 20 minutes have gone by and you know you're not going to fall back asleep before that alarm goes off, just get up.
Saklak [00:15:36] After a long 12-hour shift, whether it's days or night shift, it could be a very physical and mentally exciting day. A lot going on. And it can be really hard to unwind after a 12-hour day, but you're so exhausted. Is there a phenomenon that, that is kind of why that's happening, and what is your best advice for that event occurring? I, you know, I hear a lot of nurses talk about their mind as racing of the shift that happened or a code or, whatever events had happened that day. and it's almost like you can't fall asleep even though you're exhausted.
Abbott [00:16:10] Yeah, I think it's that, that kind of overtired feeling. And I just came off of two weeks of doing inpatient. I know where you're coming from. I certainly wasn't doing the hard 12 hours on a physical intense activity. But a lot of stuff happens on the inpatient side. A lot of, emotionally taxing things happen when we're caring for sick people, and I think we have to acknowledge that that's not just going to go away when you walk out the door. And so, taking some time to relax and decompress and think through what happened during the day. Don't think that you can just jump right from work and jump into bed and be fine, because you're going to sit there and you're going to think about stuff. You're going to process things. And so, there are two components of this. So, one is just giving yourself a little bit of time to relax and unwind before you go home and jump into bed. And you're going to find just the activity that works best for you, whether it's a little bit of stretching, some meditation, reading, something that's unrelated to work. Stay away from screen time because that's going to give you extra light exposure, is going to wake you up a little more. There's also a lot of just emotionally taxing things that can happen if you're either on social media or looking at the news.
And so, trying to get something that's going to put you more in that sleep state is going to be helpful. But then there's another component of this, which is in the behavioral sleep medicine side of things, we call this scheduled worry. But this idea of all of that stuff that you're sitting there trying to process when you're laying in bed at night, because it's the first time that things have been quiet. You're not getting pulled in a million directions. Move that out of the bedroom because you don't want bed to be the place where you process what happened during the day. That is going to lead to more difficulty sleeping. So set aside time at some point during the day outside of the bedroom, where you kind of think through and actually deal with all of the stuff that happened during your day, rather than using the bed for that.
Saklak [00:17:59] That is so helpful, and I will now schedule my worry at a different time and keep it out of the bed. Dr. Abbott, thank you so much for your insight and wisdom. This was so much fun, and I, I hope we answered a lot of the questions. I mean, the list can go on from nurses, so, might even have to do a part two down the line, but thank you so much.
Abbott [00:18:20] You're very welcome and I also, I am always happy to see people in clinic if you want to have an individual one-on-one discussion of how to manage and deal with your shift work. We are always happy to see you in clinic.
Masnari [00:18:30] Amazing. Thank you so much, Dr. Abbott. Thanks for tuning in.
Saklak [00:18:39] Better, RN is brought to you by The Woman's Board of Northwestern Memorial Hospital.