Fatigue and Sleep Hygiene:Practical Tips

Stuart Marshall

@hypoxicchicken #HFsafety

WARNING: Failing to manage your fatigue can seriously damage your and your patients’ health

Fatigue is…

• “Inability to perform work”• Acute Sleep Deprivation• Chronic Sleep Deprivation• Effects of recent activities (workload)• Circadian Variations

What’s the risk?

• 30 hours without sleep = BAC 0.10%(Dawson, Nature 2007)

Ten tips for on-call and shift work

Question…

A 15 minute nap can improve alertness?

True or False?TRUE

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

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.

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

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

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

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

4. Monitor your own fatigue

5. Don’t get into (sleep) Debt

Chronic sleep debt is dangerous

Landrigan et al. NEJM 2004

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

7. Understand how to use caffeine

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)

The stimulant effect of caffeine lasts for:

• 30 minutes• 1 to 2 hours• 3 to 5 hours• Up to 12 hours

The stimulant effect of caffeine lasts for:

• 30 minutes• 1 to 2 hours• 3 to 5 hours• Up to 12 hours

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

9. Be hygienic at home!

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

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

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

The positives…

• Emergency and on call work is very rewarding

• It’s the best clinical experience you can get

• Enjoy it!

stuart.marshall@monash.edu

WARNING: Failing to manage your fatigue can seriously damage your and your patients’ health