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Third speaker @AAGBI Facing Fatigue #covid19webinar.
Dr Roopa McCrossan. @RooMccrossan (Ooooh excellent a speaker with a Twitter handle hi Roo!)
Practical steps to improve sleep and manage shift work.
Dr Roopa McCrossan. @RooMccrossan (Ooooh excellent a speaker with a Twitter handle hi Roo!)
Practical steps to improve sleep and manage shift work.
Fatigue and anaesthetists.
Our job is tiring, we are an acute speciality and we can never eliminate overnight working. Working at night is never the same as working during the day. We are supposed to be asleep at night. Given this - how do we make working at night safer?
Our job is tiring, we are an acute speciality and we can never eliminate overnight working. Working at night is never the same as working during the day. We are supposed to be asleep at night. Given this - how do we make working at night safer?
What can we do about fatigue?
Improve our core sleep - usual sleep during usual shifts.
How to manage night working - preparation, how to work at night, recovery
Take our breaks (so important even 5 minutes, not good at this historically)
Learning to ask for help (normalise it)
Improve our core sleep - usual sleep during usual shifts.
How to manage night working - preparation, how to work at night, recovery
Take our breaks (so important even 5 minutes, not good at this historically)
Learning to ask for help (normalise it)
Improve core sleep
Sleep patterns are individualised
What is right for you?
Do you wake up refreshed?
How much is your optimum? avg = 8
Natural pattern - lark or owl?
Plan when you need to go to bed.
Sleep in a way that works for you (even if a night waker).
Sleep patterns are individualised
What is right for you?
Do you wake up refreshed?
How much is your optimum? avg = 8
Natural pattern - lark or owl?
Plan when you need to go to bed.
Sleep in a way that works for you (even if a night waker).
Consider setting an alarm to tell you when it's time to go to bed, to avoid staying up too late for you.
Sleep diary can help you answer what your sleep should be.
https://www.nhs.uk/livewell/insomnia/documents/sleepdiary.pdf
Sleep diary can help you answer what your sleep should be.
https://www.nhs.uk/livewell/insomnia/documents/sleepdiary.pdf
Sleepio app is a digital version of the NHS sleep diary pdf - is currently free for NHS staff.
Helps you work out your ideal sleep patterns. https://www.sleepio.com
Helps you work out your ideal sleep patterns. https://www.sleepio.com
Improving core sleep
Max natural light exposure during the day. (ugh theatres with no windows - even go outside for 5 mins if you can)
Avoid caffeine for at least 4 hours before bed.
Mindful of alcohol - helps get to sleep, but disturbs later
Avoid big meal before bed.
Max natural light exposure during the day. (ugh theatres with no windows - even go outside for 5 mins if you can)
Avoid caffeine for at least 4 hours before bed.
Mindful of alcohol - helps get to sleep, but disturbs later
Avoid big meal before bed.
Improving core sleep
Regular exercise, even mild, but not 2 hrs before bed (wakes up instead of winds down)
Bath before bed (warm, vasodilates, helps you lose heat which aids sleep)
Limit blue light exposure (I guess that means no tweeting)
Invest in an alarm clock (not phone)
Regular exercise, even mild, but not 2 hrs before bed (wakes up instead of winds down)
Bath before bed (warm, vasodilates, helps you lose heat which aids sleep)
Limit blue light exposure (I guess that means no tweeting)
Invest in an alarm clock (not phone)
Put your phone on night mode (limits blue light).
Avoid phone in room unless on call - blue light, plus tempted to look at it.
Avoid phone in room unless on call - blue light, plus tempted to look at it.
Improving core sleep
Dark room - invest in black out blinds, curtains, eye mask (esp when day sleeping)
Quiet - ear plugs, play white noise (geez would someone tell #GongPuppy Honey)
Bed comfortable and warm (1/3 of life!)
Room cool (suggest 18deg)
Mental relaxation
Dark room - invest in black out blinds, curtains, eye mask (esp when day sleeping)
Quiet - ear plugs, play white noise (geez would someone tell #GongPuppy Honey)
Bed comfortable and warm (1/3 of life!)
Room cool (suggest 18deg)
Mental relaxation
Mental relaxation before bed:
Put your worries aside.
Headspace app.
Pen and paper next to bed to write down ideas to limit them going around and around in head.
Put your worries aside.
Headspace app.
Pen and paper next to bed to write down ideas to limit them going around and around in head.
Working the night shift.
Pre nights -
preparation day not a day off (switch the mindset)
get extra sleep before shift eg lie in but afternoon nap better (decr continuous time awake)
plan how to get home, ?options other than driving
will I need a rest before driving home?
Pre nights -
preparation day not a day off (switch the mindset)
get extra sleep before shift eg lie in but afternoon nap better (decr continuous time awake)
plan how to get home, ?options other than driving
will I need a rest before driving home?
Working through the night
Well hydrated, healthy snacks
Avoid eating midnight to 6 am (WHAT!?)
Calories on nights count (WHAT!?)
Work as a team to take breaks
Power nap
Be wary at 4 am - physiological dip
Be aware of effects of fatigue on performance - check and double check
Well hydrated, healthy snacks
Avoid eating midnight to 6 am (WHAT!?)
Calories on nights count (WHAT!?)
Work as a team to take breaks
Power nap
Be wary at 4 am - physiological dip
Be aware of effects of fatigue on performance - check and double check
Power naps
Pilot study showed that PNs overnight prevent microsleeps, routine for long haul pilots (short 20mins, but need 15m to fall asleep)
Longer nap leads to sleep inertia
Can have caffeinated nap to avoid this - caffeine takes effect as wake from nap
Pilot study showed that PNs overnight prevent microsleeps, routine for long haul pilots (short 20mins, but need 15m to fall asleep)
Longer nap leads to sleep inertia
Can have caffeinated nap to avoid this - caffeine takes effect as wake from nap
However, power naps don't prevent negative effects of sleep deprivation - emotional stability, complex reasoning, decision making, learning.
Between shifts
Nap before leaving work if too tired.
Wear sunglasses on drive home to decrease stimulus (avoid if driving)
Have food before bed (don't want to wake hungry)
Go to bed ASAP to max sleep before next shift
Nap before leaving work if too tired.
Wear sunglasses on drive home to decrease stimulus (avoid if driving)
Have food before bed (don't want to wake hungry)
Go to bed ASAP to max sleep before next shift
Recovery after nights
Reset into normal pattern ASAP
Short sleep in morning, then get up
Go to bed at normal time for you
Avoid long lie the next day (get up and find some sunlight)
Need 2 normal nights sleep to recover from sleep debt
Reset into normal pattern ASAP
Short sleep in morning, then get up
Go to bed at normal time for you
Avoid long lie the next day (get up and find some sunlight)
Need 2 normal nights sleep to recover from sleep debt
Fatigue resources available on @AAGBI website, including infographics and downloadables.
https://anaesthetists.org/fatigue
https://anaesthetists.org/fatigue
