For many nurses, one of the biggest challenges presented by the profession is getting enough sleep. Night shifts, schedule changes and 12-hour workdays can all make it very difficult to get an adequate amount of sleep. This can wreak havoc on a nurse’s mental and physical well-being, lead to burnout and potentially to medical errors.
I recently spoke with renowned sleep expert Dr. Lois James, an assistant professor in the College of Nursing at Washington State University, on the Trusted Health podcast to talk about the intersection of sleep and nursing.
Dr. James’ recent research has delved into the role of sleep in performance, and in 2014, she worked with elite athletes who were traveling to Sochi, Russia for the winter Olympics on jet lag management. She has found that much of her work with athletes has takeaways for nurses, another group for whom peak performance is essential.
During our conversation, she shared some useful insights about how and why nurses should think differently about sleep, as well as some useful fatigue countermeasures. She also answered common questions like what is the ideal interval between shift rotations? Does splitting sleep work? How long is the ideal nap? What’s the difference between a power nap and a restorative nap?
I’ve included an excerpt of our conversation below. To listen to the full episode visit The Handoff’s website or search for us wherever you listen to podcasts.
Below, you can read a portion of my recent interview with Dr. Lois James herself.
Lois:
I'm a huge advocate of strategic and scheduled napping. And again, part of it is a huge cultural thing. The barriers around napping on duty for nurses are entirely cultural. Because there are plenty of other professional groups that not just allow, but encourage napping during downtime on shift. That's a part of it as well. And then of course there are other fatigue countermeasures that can certainly play in, in terms of just helping you through.
Dan:
So the large Starbucks and the humongous energy drink is probably not the best strategy there.
Lois:
Probably not. Caffeine when used strategically and when monitored in terms of your tolerance to it does remain one of the very useful fatigue countermeasures, but the big thing there is monitoring tolerance to it, many of us have some level of caffeine addiction. And so you have to be careful because you want to know that when you have your coffee, let's say at 1:30 AM anticipating that the 2:00 to 4:00 AM phase is going to be really, really rough. I mean, that's the ultimate low in our circadian rhythm. So knowing that when you have that coffee at 1:30 AM, it's actually going to have an effect.
Lois:
Another great fatigue countermeasure that isn't as widely known as caffeine and isn't used as often, but can be very effective is actually light therapy. So exposure to light when you want to feel alert and then avoidance of light when you want to wind down, that's a really useful one. And I know obviously that during a night shift exposure to sunlight is not an option. But that's why many hospitals and many groups are moving towards investing in light boxes, for example, where you can just have one at the nurses station and it can just give an alerting dose of life that can give you a bit of a boost.
Dan:
One of the questions that I've got from some of my colleagues in the ER is - is it better to stay on a shift, or is it better to rotate back and forth, whether that's in a week or over several weeks where you go day shift and night shifts back and forth. What are your thoughts on that?
Lois:
There's actually some really interesting findings around kind of looking at what's the optimal rotation schedule. And although there's a little bit of conflict in terms of the results, what we do know is the medium pace rotation. So, where you rotate every week or every couple of weeks, that seems to actually be the most damaging and the hardest to acclimate to. So most of the science at this point says to keep rotations longer term. So you rotate no quicker than every month or longer, which allows you to have a proper acclimation period. Or there's some research that shows forward rapid rotation can be quite effective.
Lois:
So in other words, you'd work a day, you'd work an evening, you'd work a night, then you'd have time off. You definitely want to avoid backward rapid rotation. So a night, an evening and a day, because that's harder for the body to adjust to. But forward rapid rotation, there has been some work that shows that that's actually pretty effective.
Dan:
As far as sleep goes, is it better to get eight good hours or 10 good hours, six good hours? Or could you consolidate sleep in spurts of two-hour blocks? I know one of the things that, as a night shift nurse, it was near impossible to sleep past 2:00 PM for me, after a shift, getting off at 7:00 AM, but I could take a nap maybe in-between 2:00 PM and my next shift starting at 7:00. So just wonder what the findings are related to that.
Lois:
Splitting sleep, especially for night shift workers, can be very, very effective because just like you said, I mean, the danger when you try and consolidate sleep is, let's say, you'll get off work, you'll get home, you'll get a couple of good hours. And then you'll limp along trying to sleep a bit more and then you'll call it good. And really you've only gotten, let's say, five hours or so, which is just insufficient sleep.
Lois:
So instead one option is to come home and sleep for as long as you comfortably can, which is usually anywhere between four and six hours, let's say, and then get a couple more hours before you go back out on shift. So that's a split sleep schedule that does work for a lot of people.
Dan:
And that's one of those fatigue countermeasures, which you've mentioned before. If you had to pick the one most effective fatigue countermeasure, what would it be?
Lois:
Definitely napping. If you think about it, napping is the only fatigue countermeasure that actually addresses the problem. Everything else is some kind of a bandaid. And just a quick point on naps. Because I get asked so frequently, "Well, when I nap, how long should I nap for?" There are actually two very distinctive different types of nap.
There's your restorative nap, an ideal time for that is about 90 minutes. And that's because that's about the amount of time it takes you to get through a sleep cycle or just a little bit shy of that. Or there's the power nap, which is about 20 minutes. And the timing of those is quite deliberate because what you want to avoid when you have a nap is being awakened from really deep slow-wave sleep.
For more sleep tips from Dr. James, as well as skincare tips from Renée Rouleau, check out their recent webinar with Trusted!
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