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President’s Column: A to Zzz of Sleep

Jan 02, 2020

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I recently quizzed my children, "What is an acceptable reason to wake Mom from her precious sleep?" As a night-shift nurse, this is an essential refresher for my family.

My daughter, the older child, answered, "Only if there's a fire ..." As I let her answer hang there for a beat, my son, the younger child, clarified, "Only if the fire is uncontained."

The value of sleep is ingrained in my children. With both parents working opposite sides of the clock, they know what constitutes a good day or night of sleep.

Many years ago, I purchased an activity tracker, not to count my steps but to track my sleep. Much to my dismay, the gauged my sleep pattern as inconsistent and of poor quality. Although this sleep report was a rough estimate from a wrist device, my mind instantly went to how my erratic sleep might affect me as well as the patients I was caring for on a stretch of shifts.

It was evident that my sleep behavior needed changing. As a priority, I committed to each week mapping out my sleep without disruption. And I'm proud to say I still do.

In nursing school there was no course on managing work-life schedules or sleep strategies, although it certainly would have been valuable.

Although it seems obvious that sleep deprivation and circadian disruption are linked to night shifts, I question if it's unrelated to time of shift and equally challenging for those working seemingly normal hours. Often, a 12-hour shift stretches to 13, 14 or even 16 hours with the addition of a long commute.

Several studies across nursing and medical journals indicate that frequent 12-hour shifts (day or night), especially on multiple consecutive days, result in inadequate sleep between shifts. The data ranges from an average of five hours of sleep on workdays and nine hours of sleep on off days when nurses attempt to catch up. This degree of compounding loss of sleep can be associated with neurocognitive dysfunction and patient safety consequences. So, are we listening to what the data is telling us?

Our bodies demand and need recovery, yet that's influenced by how we manage our time at home. At this time of year, with many holidays, family events, end-of-year commitments and the typical high hospital census during winter, for many it can be especially difficult to navigate.

In the new year, I challenge us to be honest with ourselves — individually and collectively — and consider how we can truly make our optimal contribution by better managing the things that affect our sleep hygiene.

Have we considered measures to reduce shift length as an accepted norm, to reduce the number of consecutive shifts we work or prioritize sleep during our workweek? Our patients and co-workers count on us. Our own health is important too. There is only one solution to a lack of sleep, and that is to sleep!

Please share with me your ideas for good sleep hygiene and how you manage and mitigate fatigue at Unstoppable@aacn.org.