10 Fatigue and Sleep Hygiene Tips for Junior Docs
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Final year Monash University undergraduate medical school talk on how to manage fatigue
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10 Fatigue and Sleep Hygiene Tips for Junior Docs
- 1. Fatigue and Sleep Hygiene: PracticalTips Stuart Marshall @hypoxicchicken #HFsafety
- 2. WARNING: Failing to manage your fatigue can seriously damage your and your patients’ health
- 3. Fatigue is… • “Inability to perform work” • Acute Sleep Deprivation • Chronic Sleep Deprivation • Effects of recent activities (workload) • CircadianVariations
- 4. What’s the risk? • 30 hours without sleep = BAC 0.10% (Dawson, Nature 2007)
- 6. Ten tips for on-call and shift work
- 7. Question… A 15 minute nap can improve alertness? True or False? TRUE
- 8. 1. Naps are good • Most of the time • Short naps are useful • Have been proven to improve performance • Even as little as 10-15 mins can be useful for most people
- 9. Most naps are good but not all… THIS is the top Birmingham doctor being investigated for allegedly falling asleep during an operation, the Evening Mail can reveal today. Six separate hospital sources confirm the consultant in his 50s, from Bromsgrove, has been suspended after allegedly nodding off in the operating theatre during surgery last month.
- 10. 2. Beware sleep inertia • Sleep inertia is the inability to recover full (mental) capacity for 30 mins to 2 hours after waking • Sleeps over 1 hour may lead to sleep inertia • Work out your safe napping duration - consider an alarm if you need to be fully alert straight away
- 11. 3. On call rooms are not designed for sleeping • “Sleep Hygiene” is about modifying the environment to improve the ability to sleep • Check the room before going to work... – Choose a quiet room if possible – Heat / cool room – Remove distractions – Blackout the room
- 12. Which one of the following statements is true? • Most people can tell when they are too sleepy to drive or work? • You may have no warning before you lose consciousness through tiredness • The more tired you are the more accurate your perception of impairment is
- 13. Which one of the following statements is true? • Most people can tell when they are too sleepy to drive or work? • You may have no warning before you lose consciousness through tiredness • The more tired you are the more accurate your perception of impairment is
- 14. 4. Monitor your own fatigue
- 17. 5. Don’t get into (sleep) Debt
- 18. Chronic sleep debt is dangerous
- 19. Landrigan et al. NEJM 2004
- 21. 6. Driving • Six times increased risk of accidents after working overnight (Barger et al NEJM 2005) • Avoid driving if possible • Sleep for up to an hour before setting off • Consider caffeine if necessary
- 22. 7. Understand how to use caffeine
- 23. Place these in order of caffeine content • Tea • Plunger coffee (mug) • Espresso coffee • Instant coffee (mug) • Red Bull (250ml / 60ml shot) • V (350mls) • Berocca 5 (60mg) 2 (108mg) 4 (77mg) 6 (57mg) 3 (80mg) 1 (109mg) 7 (Nil)
- 24. The stimulant effect of caffeine lasts for: • 30 minutes • 1 to 2 hours • 3 to 5 hours • Up to 12 hours
- 25. The stimulant effect of caffeine lasts for: • 30 minutes • 1 to 2 hours • 3 to 5 hours • Up to 12 hours
- 27. 8. Alcohol doesn’t help. Exercise does • Alcohol inhibits normal sleeping patterns • Don’t use alcohol to get to sleep • Exercise helps reset the circadian rhythm • Avoid exercise within 3 hours of sleeping
- 28. 9. Be hygienic at home!
- 29. Sleep hygiene at home • Sleep hygiene is just as important at home • Maximise conditions: – Turn off or silence phones and electronics – Good curtains, heating / aircon – Earplugs and / or eyeshades – Tell flatmates your roster, organise another place to sleep if needed
- 30. 10. Get a GP • Shiftwork leads to an increase in physical and mental illness • Make sure you have a GP • Being ill is not a sign of weakness • Monitoring and recognising your limits is the sign of a responsible professional
- 31. Summary • Naps are good • Sleep inertia is bad • On call rooms are not made for sleeping • Monitor your fatigue • Take care driving home • Don’t get into sleep debt • Understand caffeine • Drink responsibly • Optimise sleep at home • See your GP
- 32. The positives… • Emergency and on call work is very rewarding • It’s the best clinical experience you can get • Enjoy it!
- 34. stuart.marshall@monash.edu WARNING: Failing to manage your fatigue can seriously damage your and your patients’ health
Editor's Notes
- Luckily few of you will be working excessive shifts - change in work to later years
- Down side to naps Most profound effect on performance of anything else (Large individual variation) Female ICU registrar forgot to get dressed when called to a cardiac arrest call
- Tip 3
- Mood is the first thing to be affected Beware you don’t snap at people Decision making and mundane tasks are next to be affected Skills are last to be affected – story about iv access.
- High percentage of junior medical staff are in debt “Sleep debt” is accumulated over time The only way to pay off a sleep debt... is to sleep! Take the opportunities you have to get the sleep you need
- High percentage of junior medical staff are in debt “Sleep debt” is accumulated over time The only way to pay off a sleep debt... is to sleep! Take the opportunities you have to get the sleep you need
- Dependant on rosters
- Driving after night shift Stanford story
- Addition of circadian low to fatigue
- Caffeine lasts for up to 6 hours - avoid at the end of a shift
- Caffeine lasts for up to 6 hours - avoid at the end of a shift
- Under NO circumstances self-prescribe hypnotics Occasional short acting sleeping tablets may be used under the supervision of a GP Melatonin has differential effects at different doses – use only under expert direction
- FInally