October 14, 2022 • 24 mins
Emergencies can happen anytime, and ER doctors need to be ready and rested to treat everything from cardiac events to gunshot wounds or broken bones. Their work could mean life or death for the patients in their care. NYC ER doctor George Russo shares how he finds time to rest despite long days and constantly changing shifts in order to put patients first, while pulmonologist and sleep advocate Dr. Seema Khosla weighs in on the benefits of regular sleep for the wellbeing of both doctors and their patients.
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Speaker 1 (00:10):
No matter what time of day or night, the e
R is always awake, providing much needed support to patients
with any and every kind of ailment or injury. Dr
George Russo works in a New York hospital emergency room.
The margin for error in this line of work is
raised or thin, and since the e R never closes,
finding time to sleep and sleep properly is a daunting
(00:32):
challenge for George and his colleagues. There's no planned appointments.
It's whatever comes in comes in. Sometimes you're lucky enough
to get a notification over the phone from the e
M S, but that doesn't happen every time, so you
always gotta be ready to jump to it. It's a
fast paced environment, so you could be seeing somebody that's
having a heart attack or that is extremely sick with something,
(00:56):
and then you get a trauma notification and something's coming
in and now the wars and never closed. I wondered,
with all of the chaos and urgency of the e R,
how someone like George is thinking about sleep and how
it impacts his performance. So I asked him to recall
one of his more hectic shifts and what roles sleep
played in its success or obstacles all right. So it
(01:19):
was a Monday. It was Mayhem walked into a lot
of sign outs from the night prior because it was
a busy Sunday night already had to handle those, but
we also had new patients coming in for seven am sharp,
and then patients were coming in from the clinics as well,
because sometimes they have extremely high blood pressure, they get
dizzy and faint when they're getting blood taken, and I'm
(01:40):
dealing with all of those people. And then a stroke
alert comes in with E M S, so you have
to do the protocol for that because time is brain,
as they say. And then we had a stab wound
to the chest come in shortly after, so there was
a lot of things happening. And then there was also
COVID patient coming in, so they're taking up the isolation
(02:03):
rooms so you don't have exam rooms for the other patients,
and there was there was just a tremendous amount of
things going on, and we had to transfer patients for
some emergencies that our hospital didn't have the specialists for,
so you're on the phones as well, and it was
it was a day, and I think I was lucky
(02:24):
enough that I had had like a good eight hours
to sleep the night prior, Like I went to bed,
I don't know, probably ten pm. And since I was
there at seven, I woke up at six and I
felt pretty refreshed. And it wasn't one of those nights
where I had to split up my sleep or I
wasn't switching back and forth from days to nights. And uh,
(02:45):
I think it really helped me get through the day.
And then I tell you that night I certainly slept
well again because I was in bed I think at
nine thirty and I didn't wake up till the next
day at six. It was great. What role does our
sleep play in our long term health? How deep does
healthy sleep go into our biology? And how do you
(03:06):
get consistent rest and healthy sleep when your bedtime is
constantly in flux? Find out on this episode of Chasing
Sleep Urgent rest. Hi, I'm on a hut O'Connor and
this is Chasing Sleep and I heart radio production and
(03:28):
partnership with Mattress Firm. So there's definitely a stress, uh
that comes with the high stress environment that's very difficult
to wind down or to just leave at work. Everyone says,
don't take it home, but sometimes it's not possible. I mean,
(03:51):
when things are life and death, and when maybe there's
a bad outcome of something, it's gonna stay with you.
It just doesn't go away with the intensity. There must
be some payoff when things are life and death. The
downside is that when something goes wrong it can be
very grim, but when things go right, it must feel
pretty rewarding. The most rewarding part of what I do
(04:13):
is when family members or a patient feel better in
front of you, whether it's you give them antibiotics or
you give them something that helps bust a clot that
is causing a stroke in their brain, and you can
see them go from not being able to move one
side of their body to them being able to move
it within hours of them being in front of you,
(04:36):
and family members are crying so happy, the patients able
to talk to you afterwards. That's happened a couple of times,
and it's extremely rewarding when you can actually change somebody's
life in a matter of minutes to hours. From bustling
cities to sparsely populated rural areas, emergency medical care is
a NonStop job. Hospital staff are on their feet hour
(04:58):
after hour without respite because accidents and injuries don't follow
a schedule. Yeah, the physical aspect of the job, especially
after a twelve hour shift, wear and tear is absolutely there.
I mean there was there's muscle aches that felt like
I was back playing sports. It's very difficult to find
time to work out after twelve hour shift, especially if
(05:19):
you have a commute, and sometimes these twelve hour shifts
go to fourteen hours of something terrible comes in right
before the end of it, and it was just it
was exhausting. I mean, it was very difficult to get
in a good rhythm of things as things were changing
so often throughout the pandemic, and also just to get
a good routine at home, to get to bed at
(05:41):
a normal hour, to also find a way to eat
in there and watch a show with your your loved one,
or if you have kids, to find time to be
with them because they were home all day too. It's hard,
it's grueling, it's fast paced, it's long days, long nights,
and the schedule is constantly changing and all of that
does a number on our mental functions. It's difficult enough
(06:04):
working when you're exhausted, it becomes even more challenging when
the stakes are as high as they are an emergency medicine.
I wanted to learn more about what's happening inside our
bodies when our sleep schedules change, and what the impact
is on medical professionals. So I called up Dr Sema Cosla.
I'm Dr Sema Cosla, and I sleep medicine physician and
(06:26):
the medical director of the North Dakota Center for Sleep
and Fargo. So you have a really extensive background in sleep,
and first off, I think sleep is really challenging for
a lot of people. So I wanted to get your
thoughts on what do you think actually constitutes healthy sleep.
So there's you know, when we think about healthy sleep,
(06:48):
we have to consider quality, quantity, and timing, and so
we want to make sure that we're getting enough good
quality sleep at the right time. Seema emphasizes the importance
of consistent schedules for shift workers, and she's even gone
as far as to petition hospitals to provide consistent shift
(07:09):
schedules for their employees. There are so many people who
have no choice but to have these unusual sleep schedules.
You know, like our study subject today, George, who is
an e R doctor, and he and others like him
have no choice but to work the night shift at times.
How common is this And do you see a lot
(07:29):
of patients who have to work these unusual sleep schedules
And what are some of the common complaints that you
get from these patients? Yeah, so you're right. In the
medical field, also manufacturing, you know, we see a lot
of overnight workers. I think the challenge about an e
R shift is that it's not consistent. You know, sometimes
they'll be kind enough to give you, you know, a
(07:49):
week of days and then a week of nights, but
oftentimes it isn't like that, so you're constantly switching. And
so a consistent shift, even if as night shift, is
better than a variable shift, right, because at least you
can give your body some semblance of a circadian rhythm, right.
I was wondering about that. Yeah, yeah, And so I've
(08:11):
written letters before just asking can you please, like pick
a shift. We don't care what the shift is, to
make it consistent, please, But picking a shift is easier
said than done, especially in a field where your day
changes wildly with no control over what might walk through
the hospital doors. So the schedule of an e R
doctor is not the average schedule. It is not a
(08:34):
Monday through Friday, it is not a nine to five.
So the average gr doctor does about twelve to fifteen
shifts a month, and they can be anywhere from eight
to twelve hour shifts. Some in rural places do twenty
four hour shifts and even thirty hour shifts depending on
the amount of patients that the hospital sees. And these
(08:56):
shifts can be the morning swing shift or they be
the overnight shift. Night to day shift is when it
becomes more difficult to get to bed and normal hour
because if you go to bed at the same hour
that you did when you had to wake up at
seven am, you wake up around seven and then you
don't work again until seven pm. So I would find
(09:16):
myself trying to push myself and stay up a little later,
maybe until midnight two in the morning, as if it
was a Saturday night. Frequently, changing schedules, while necessary and
feels like this one, makes for challenging sleep. So the
switch back and forth from day to night is never
easy with sleep and sleep, especially in the emergency medicine world.
(09:38):
Did we tend to be the most sleep deprived or
have the most issues with sleep because of the shift
work and jumping around in the schedule. UH with twelve
hour shifts, found that it was difficult sometimes to keep
a nice sleep routine because my significant other, she would
get home later and I would want to stay up
to see her. But then that would affect my work
(10:01):
or my sleep pattern because I would be up till
midnight and then have to wake up again the next
day at six am. I found out pretty quickly that
that wasn't sustainable. And then switching over to nights. We
all have our different ways of trying to normalize it,
but you're always going to feel kind of awful when
you switched over to nights or when you switch back today.
It's because it's just like jet lag. It's like we flew,
(10:21):
but you didn't even get the nice Franci vacation out
of it. Nurses and doctors are so vulnerable to life
their ning mistakes. When their sleep is jeopardized, a tired
doctor in an e er or an operating room becomes
a danger to a patient. My sister in law is
a doctor in London, and I was quizzing her about,
(10:41):
you know how she gets through this, you know, working
these night shifts and go back to regular shift, and
she mentioned that at her hospital they actually won't let
the doctors perform any complex procedures or surgeries overnight unless
it's an emergency. If someone comes in with the gunshot
or you know, a stab wound, then they have to
do some thing. But if it's a surgery that they
(11:02):
can push off until the morning or daytime, you know,
they will try to do that rather than operate on
someone in the middle of the night, just because of
the risks involved. So I think it's important to recognize
that some people do great at night. That's sort of
where they really perform well, and they're just naturally better
at night, and some people don't. So my background is
(11:23):
pulmonary and critical care, and so that when I would
go into the i c U in the middle of
the night, you write a little adrenaline so to kind
of combat the sleepiness that occurs, and you have to
be sharp, and I think you push yourself to be sharp,
if that makes sense. You know, people in these fields
are usually high achievers, high performers, and they put a
(11:45):
lot of demands, like I'm sure you know in the
e er that adrenaline also helps you, right, And there's
been a lot of research on this topic of sleep
deprivation among healthcare workers. So, for example, I saw that
the British Journal of Anesthesia published a study that found
more than ten increase in life threatening events that happened
(12:07):
in surgeries that were performed at night. Yeah. Well, and
it's at its risk of operator error, but also support
in a hospital if something goes bad, you're minimally staffed
at night. And so we used to have this lore
in the world of pulmonary that if you have fluid
around your lungs, it needs to be taken out before
(12:27):
the sun sets. Was kind of what we were always taught.
And then it turns out if you start doing these
things at nine o'clock at night or ten o'clock at night,
when no one else is in the hospital, that's not
great for patients. Yeah, because then you may convert it
into an emergency procedure or something like that and calling
people in from sleep, right, calling people in from their
(12:49):
beds to help you. And so I applaud where your
sister works that they recognize this. We'll be right back
after a brief message from our partners at Mattress Firm,
(13:10):
and now back to chasing sleep throughout our series. So far,
I've learned a lot about how sleep impacts our physical
and mental performance and our endurance. I've deepened my understanding
of how stress and anxiety can adversely impact our sleep
as well. But speaking with George and Seema gave me
(13:31):
a completely new perspective on just how much sleep impacts
our overall and long term health. You know, it's so funny.
We we talk a good game in our world of sleep,
right we're saying, yep, you should be in bed at
the same time every night and get seven to nine
hours of good restorative sleep. And so what we what
we've seen over the years is sometimes people who are
(13:53):
night owls, we call them delayed sleep phase coronotype. So
just meaning that you're just biologically right. You you like
to say up late, and you like to sleep in um.
Sometimes they will find themselves in a night shift position
just because it sort of fits with their circadian rhythm.
But not always. We do see that there is a
higher risk of cancer in night shift workers. They did
(14:16):
a study of nurses, for example, and they had a
higher incidence of breast cancer. And so it's really it's
kind of amazing. I remember years ago we were giving
this conference, and I reached out to a cancer researcher
and I wanted to talk to her about, you know,
how we think sleep is super important for you know,
for cancer and and that sort of thing, and she
(14:36):
kind of laughed at me. She was very kind, but
I thought we were so smart thinking about this, and
she's like, oh, yeah, we've considered poor sleep a carcinogen
for decades, So yeah, they were way ahead of us.
As Seema says, poor sleep is a carcinogen, a mood destabilizer,
(14:58):
and it causes many other issues and diseases. I wanted
to learn more about the ways sleep is constantly affecting
our health, so I asked Seema to explain the biology
of sleep and everything that's happening inside us as we snooze.
So REM is important for mood regulation, right, slow wave
(15:18):
sleep or delta sleep. This is this lovely slow wave sleep.
Kids get tons of this. This is where they where
they grow, and where they you know, sleepwalk, do all
of those things. Um, that's probably important for us to
download short term memory into long term memory, and then
REM is important for us to organize and edit those memories.
(15:41):
That's just in the mind and so if you can
imagine the brain has write all those little ups and
downs and on a cellular level, if you imagine it,
and I'm going to borrow this from one of my colleagues,
Dr Chuck Seisler. He was the the expert witness at
the Michael Jackson trial, and this is how he described it.
So if you picture it like a big city like
(16:02):
New York City, right, You've got these big, huge, tall buildings,
and then you've got these alleys, and all day long,
the garbage truck is, you know, cleaning debris out of
the alleys, right, and people are tossing stuff out of
the windows. And so when you sleep, the buildings shrink
and the alleys get really wide, and so all of
(16:24):
that debris gets swept away much more efficiently. And when
you analyze that debris, it is beta amyloid, which is
one of the things that builds up in Alzheimer's. And
so sleep is really really important to that, you know,
for all of that. So to your point about you know,
why does sleep impact cancer growth and why does it
(16:45):
impact ourselves? You know, we we know it's important for immunity.
We learned a lot with the pandemic right. We know
that if you're well rested the night before your your
vaccine and the day before that, you had better vaccine responsiveness.
Um and probably just because every thing needs to recover,
so it's not just the long term, it's these immediate
effects have an impact on your response to a vaccine.
(17:09):
Fascinating analogy. So when we sleep and we have our
very own sanitation department clearing the streets in our brains,
think about what that debris entails. It's imperative that George
has time to clear out those beta amyloid proteins in
his brain so that he can get back to work
and be on top of his game, saving lives and
helping people when they need it the most. With so
(17:36):
much of our health riding on sleep, I was curious
about the unique obstacles that e er workers like George
face when they're trying to get adequate sleep. Battling this
newze button for an early morning shift is one thing.
Coming home when the sun rises, and trying to get
healthy sleep in the middle of the day is an
entirely different challenge. So it's actually easier to get more
(17:56):
sleep during the winter. During the summer is when it
said it's artists, and I have to keep the sunglasses
on after an overnight shift. Actually, that's one of the
big things. On the way home. If I forget my sunglasses,
I get really messed up because my circadian rhythm wants
to be awake. So you've got to keep it dark.
And if you can get out at a time where
the sun still hasn't come up, I try and rush
(18:17):
home as if I'm a vampire or something like. I
have to get there before the sun comes up, because
it can absolutely throw you for a loop once the
sun comes up. You know, our impetus to sleep is
driven by a couple of things. So one is that
circadian rhythm right when we're biologically programmed to be awake
and to fall asleep. But the other is what's called
sleep pressure. So sleep pressure builds up from the minute
(18:41):
you wake up until you go to bed. So if
you are at your typical sleep schedule, they both peak
to push you to sleep. But now when we're asking
people to work night shift, these work against each other, right,
and so then we have to accommodate. We need to
drill just say okay, well, how can we make sure
(19:02):
that the sleep you're getting is as good as we
can make it, and so we really focus on the
sleep environment, make sure the room is cool and dark
especially and quiet, so especially with these ever changing shift
schedules and the on the job stresses that are the
(19:23):
norm in the e R George, what other tools are
there besides caffeine? Can Strategic napping for example, helped to
bridge the gap to getting rest went on twenty four
our shifts. Now, we don't necessarily do this in the
e R s everywhere, but some more rural places do
have to do twenty four our plus shifts. During residency,
(19:43):
I had to do. I see you rotations that did
have twenty four to twenty seven hours shifts. It doesn't
sound possible, and I didn't think it was, but somehow
you make it through it. Now, one of the main
ways was after the whole day to day was done,
when everyone else had left his own the you and
somebody else, and you would try and take shifts where
you could get to nap or sometimes even get to
(20:05):
sleep like four hours, and it really helps because you
had already been up since six am, and then it
was about whether it was eight pm ten pm. You
got to even sleep for two hours it was lovely
because at that time bed feels the best and you
just want to lay down. It's sometimes it's a little
more difficult to kind of wind down, and then you
end up staring at the ceiling for a while. But
(20:27):
to get that rest and again step away from everything,
it's it was so necessary. I don't I'm sure there
was sometimes that people couldn't do it because it's just
too busy for those twenty four hours. But the exhaustion
really takes a toll. And so now let's say for
like a health care professional who maybe works in a
(20:47):
rural area and it's working overnight shift pretty consistently, what
can napping do for them? Oh, so this is a
really important strategy. You know, if they are on call
twenty four hours a day, they can't count on being
able to sleep at night, can they, And so it's
important to have a strategy where if they do have
(21:09):
some downtime, perhaps they will be able to nap. Now,
normally a shorter nap is better, meaning twenty to thirty minutes,
just because you don't go into all of the sleep stages, right,
But that's for people who are able to sleep at night, right,
(21:29):
But for our e er colleagues that work those twenty
four hour shifts. Probably the single most important thing is
that they have a place where they can sleep that
is away from the e R. Not far enough away
that they can't jump up and help, but it is
dark and cool and quiet. Right Like when I would
(21:52):
leave the I c U, I'd be like, Okay, I'm
gonna go and try and sleep. Please let me know
what you need now you know I'm gonna go. I'll
be back in ten minutes, like, don't page me all right, um,
And and a lot of the time the nursing staff
was really protective of that time. You know, they wouldn't
wake the dock up unless they needed something. And so
twenty four hours of duty is a long time, and
(22:13):
so it has to be protected as much as you
can absolutely, you know, with parameters of only wake me
up if you know X, Y and Z occur, and
then that is devoted time, okay, And so you want
to set your alarm potentially to make sure you're not
going past thirty minutes. It sounds like, well the thirty
minutes isn't necessarily for this scenario. This would be we
wanted to sleep whatever you can capture as much sleep
(22:35):
as you can, because ideally, if we can get seven
hours in that twenty four period, that would be amazing.
You know, the realities that you may not, and so
then a lot of the time they just they truly
go without sleep for twenty four hours. And so if
you have, it's a little bit like the advice we
give new parents, right sleep when you can. That's all
(23:00):
for this episode. Join me again next week when we
learn about the global stage of professional video gaming, where
around the clock gameplay feels high stakes tournaments and gaming
content on streaming services. To our brains, these developers and
these games are so good that they create real experience,
like you feel like you were in the deserted compound
(23:25):
surrounded by zombies trying to figure out how to kill
them and get to this next place where all the
other players are like when in fact, no, you're just
sitting in a chair in your bedroom looking at a
box of light. We want to hear from you. Leave
a rating or review for our show on your podcast
player of choice. You can find me on Twitter at
(23:46):
on at O'Connor. Until next time, Hoping you're living your
best while sleeping your best, chasing sleep is a production
of I Heart Radio in partnership with Matches Firm. Our
executive producer is Molly Sosha. Our EP of Post is
James Foster. Our supervising producer is Kia Swinton. Our producer
is Sierra Kaiser. This episode was written and researched by
(24:09):
Erik Lesia and Jess Kapadia. Our show was hosted by
me on a hot O'Connor
No matter what time of day or night, the e
R is always awake, providing much needed support to patients
with any and every kind of ailment or injury. Dr
George Russo works in a New York hospital emergency room.
The margin for error in this line of work is
raised or thin, and since the e R never closes,
finding time to sleep and sleep properly is a daunting
(00:32):
challenge for George and his colleagues. There's no planned appointments.
It's whatever comes in comes in. Sometimes you're lucky enough
to get a notification over the phone from the e
M S, but that doesn't happen every time, so you
always gotta be ready to jump to it. It's a
fast paced environment, so you could be seeing somebody that's
having a heart attack or that is extremely sick with something,
(00:56):
and then you get a trauma notification and something's coming
in and now the wars and never closed. I wondered,
with all of the chaos and urgency of the e R,
how someone like George is thinking about sleep and how
it impacts his performance. So I asked him to recall
one of his more hectic shifts and what roles sleep
played in its success or obstacles all right. So it
(01:19):
was a Monday. It was Mayhem walked into a lot
of sign outs from the night prior because it was
a busy Sunday night already had to handle those, but
we also had new patients coming in for seven am sharp,
and then patients were coming in from the clinics as well,
because sometimes they have extremely high blood pressure, they get
dizzy and faint when they're getting blood taken, and I'm
(01:40):
dealing with all of those people. And then a stroke
alert comes in with E M S, so you have
to do the protocol for that because time is brain,
as they say. And then we had a stab wound
to the chest come in shortly after, so there was
a lot of things happening. And then there was also
COVID patient coming in, so they're taking up the isolation
(02:03):
rooms so you don't have exam rooms for the other patients,
and there was there was just a tremendous amount of
things going on, and we had to transfer patients for
some emergencies that our hospital didn't have the specialists for,
so you're on the phones as well, and it was
it was a day, and I think I was lucky
(02:24):
enough that I had had like a good eight hours
to sleep the night prior, Like I went to bed,
I don't know, probably ten pm. And since I was
there at seven, I woke up at six and I
felt pretty refreshed. And it wasn't one of those nights
where I had to split up my sleep or I
wasn't switching back and forth from days to nights. And uh,
(02:45):
I think it really helped me get through the day.
And then I tell you that night I certainly slept
well again because I was in bed I think at
nine thirty and I didn't wake up till the next
day at six. It was great. What role does our
sleep play in our long term health? How deep does
healthy sleep go into our biology? And how do you
(03:06):
get consistent rest and healthy sleep when your bedtime is
constantly in flux? Find out on this episode of Chasing
Sleep Urgent rest. Hi, I'm on a hut O'Connor and
this is Chasing Sleep and I heart radio production and
(03:28):
partnership with Mattress Firm. So there's definitely a stress, uh
that comes with the high stress environment that's very difficult
to wind down or to just leave at work. Everyone says,
don't take it home, but sometimes it's not possible. I mean,
(03:51):
when things are life and death, and when maybe there's
a bad outcome of something, it's gonna stay with you.
It just doesn't go away with the intensity. There must
be some payoff when things are life and death. The
downside is that when something goes wrong it can be
very grim, but when things go right, it must feel
pretty rewarding. The most rewarding part of what I do
(04:13):
is when family members or a patient feel better in
front of you, whether it's you give them antibiotics or
you give them something that helps bust a clot that
is causing a stroke in their brain, and you can
see them go from not being able to move one
side of their body to them being able to move
it within hours of them being in front of you,
(04:36):
and family members are crying so happy, the patients able
to talk to you afterwards. That's happened a couple of times,
and it's extremely rewarding when you can actually change somebody's
life in a matter of minutes to hours. From bustling
cities to sparsely populated rural areas, emergency medical care is
a NonStop job. Hospital staff are on their feet hour
(04:58):
after hour without respite because accidents and injuries don't follow
a schedule. Yeah, the physical aspect of the job, especially
after a twelve hour shift, wear and tear is absolutely there.
I mean there was there's muscle aches that felt like
I was back playing sports. It's very difficult to find
time to work out after twelve hour shift, especially if
(05:19):
you have a commute, and sometimes these twelve hour shifts
go to fourteen hours of something terrible comes in right
before the end of it, and it was just it
was exhausting. I mean, it was very difficult to get
in a good rhythm of things as things were changing
so often throughout the pandemic, and also just to get
a good routine at home, to get to bed at
(05:41):
a normal hour, to also find a way to eat
in there and watch a show with your your loved one,
or if you have kids, to find time to be
with them because they were home all day too. It's hard,
it's grueling, it's fast paced, it's long days, long nights,
and the schedule is constantly changing and all of that
does a number on our mental functions. It's difficult enough
(06:04):
working when you're exhausted, it becomes even more challenging when
the stakes are as high as they are an emergency medicine.
I wanted to learn more about what's happening inside our
bodies when our sleep schedules change, and what the impact
is on medical professionals. So I called up Dr Sema Cosla.
I'm Dr Sema Cosla, and I sleep medicine physician and
(06:26):
the medical director of the North Dakota Center for Sleep
and Fargo. So you have a really extensive background in sleep,
and first off, I think sleep is really challenging for
a lot of people. So I wanted to get your
thoughts on what do you think actually constitutes healthy sleep.
So there's you know, when we think about healthy sleep,
(06:48):
we have to consider quality, quantity, and timing, and so
we want to make sure that we're getting enough good
quality sleep at the right time. Seema emphasizes the importance
of consistent schedules for shift workers, and she's even gone
as far as to petition hospitals to provide consistent shift
(07:09):
schedules for their employees. There are so many people who
have no choice but to have these unusual sleep schedules.
You know, like our study subject today, George, who is
an e R doctor, and he and others like him
have no choice but to work the night shift at times.
How common is this And do you see a lot
(07:29):
of patients who have to work these unusual sleep schedules
And what are some of the common complaints that you
get from these patients? Yeah, so you're right. In the
medical field, also manufacturing, you know, we see a lot
of overnight workers. I think the challenge about an e
R shift is that it's not consistent. You know, sometimes
they'll be kind enough to give you, you know, a
(07:49):
week of days and then a week of nights, but
oftentimes it isn't like that, so you're constantly switching. And
so a consistent shift, even if as night shift, is
better than a variable shift, right, because at least you
can give your body some semblance of a circadian rhythm, right.
I was wondering about that. Yeah, yeah, And so I've
(08:11):
written letters before just asking can you please, like pick
a shift. We don't care what the shift is, to
make it consistent, please, But picking a shift is easier
said than done, especially in a field where your day
changes wildly with no control over what might walk through
the hospital doors. So the schedule of an e R
doctor is not the average schedule. It is not a
(08:34):
Monday through Friday, it is not a nine to five.
So the average gr doctor does about twelve to fifteen
shifts a month, and they can be anywhere from eight
to twelve hour shifts. Some in rural places do twenty
four hour shifts and even thirty hour shifts depending on
the amount of patients that the hospital sees. And these
(08:56):
shifts can be the morning swing shift or they be
the overnight shift. Night to day shift is when it
becomes more difficult to get to bed and normal hour
because if you go to bed at the same hour
that you did when you had to wake up at
seven am, you wake up around seven and then you
don't work again until seven pm. So I would find
(09:16):
myself trying to push myself and stay up a little later,
maybe until midnight two in the morning, as if it
was a Saturday night. Frequently, changing schedules, while necessary and
feels like this one, makes for challenging sleep. So the
switch back and forth from day to night is never
easy with sleep and sleep, especially in the emergency medicine world.
(09:38):
Did we tend to be the most sleep deprived or
have the most issues with sleep because of the shift
work and jumping around in the schedule. UH with twelve
hour shifts, found that it was difficult sometimes to keep
a nice sleep routine because my significant other, she would
get home later and I would want to stay up
to see her. But then that would affect my work
(10:01):
or my sleep pattern because I would be up till
midnight and then have to wake up again the next
day at six am. I found out pretty quickly that
that wasn't sustainable. And then switching over to nights. We
all have our different ways of trying to normalize it,
but you're always going to feel kind of awful when
you switched over to nights or when you switch back today.
It's because it's just like jet lag. It's like we flew,
(10:21):
but you didn't even get the nice Franci vacation out
of it. Nurses and doctors are so vulnerable to life
their ning mistakes. When their sleep is jeopardized, a tired
doctor in an e er or an operating room becomes
a danger to a patient. My sister in law is
a doctor in London, and I was quizzing her about,
(10:41):
you know how she gets through this, you know, working
these night shifts and go back to regular shift, and
she mentioned that at her hospital they actually won't let
the doctors perform any complex procedures or surgeries overnight unless
it's an emergency. If someone comes in with the gunshot
or you know, a stab wound, then they have to
do some thing. But if it's a surgery that they
(11:02):
can push off until the morning or daytime, you know,
they will try to do that rather than operate on
someone in the middle of the night, just because of
the risks involved. So I think it's important to recognize
that some people do great at night. That's sort of
where they really perform well, and they're just naturally better
at night, and some people don't. So my background is
(11:23):
pulmonary and critical care, and so that when I would
go into the i c U in the middle of
the night, you write a little adrenaline so to kind
of combat the sleepiness that occurs, and you have to
be sharp, and I think you push yourself to be sharp,
if that makes sense. You know, people in these fields
are usually high achievers, high performers, and they put a
(11:45):
lot of demands, like I'm sure you know in the
e er that adrenaline also helps you, right, And there's
been a lot of research on this topic of sleep
deprivation among healthcare workers. So, for example, I saw that
the British Journal of Anesthesia published a study that found
more than ten increase in life threatening events that happened
(12:07):
in surgeries that were performed at night. Yeah. Well, and
it's at its risk of operator error, but also support
in a hospital if something goes bad, you're minimally staffed
at night. And so we used to have this lore
in the world of pulmonary that if you have fluid
around your lungs, it needs to be taken out before
(12:27):
the sun sets. Was kind of what we were always taught.
And then it turns out if you start doing these
things at nine o'clock at night or ten o'clock at night,
when no one else is in the hospital, that's not
great for patients. Yeah, because then you may convert it
into an emergency procedure or something like that and calling
people in from sleep, right, calling people in from their
(12:49):
beds to help you. And so I applaud where your
sister works that they recognize this. We'll be right back
after a brief message from our partners at Mattress Firm,
(13:10):
and now back to chasing sleep throughout our series. So far,
I've learned a lot about how sleep impacts our physical
and mental performance and our endurance. I've deepened my understanding
of how stress and anxiety can adversely impact our sleep
as well. But speaking with George and Seema gave me
(13:31):
a completely new perspective on just how much sleep impacts
our overall and long term health. You know, it's so funny.
We we talk a good game in our world of sleep,
right we're saying, yep, you should be in bed at
the same time every night and get seven to nine
hours of good restorative sleep. And so what we what
we've seen over the years is sometimes people who are
(13:53):
night owls, we call them delayed sleep phase coronotype. So
just meaning that you're just biologically right. You you like
to say up late, and you like to sleep in um.
Sometimes they will find themselves in a night shift position
just because it sort of fits with their circadian rhythm.
But not always. We do see that there is a
higher risk of cancer in night shift workers. They did
(14:16):
a study of nurses, for example, and they had a
higher incidence of breast cancer. And so it's really it's
kind of amazing. I remember years ago we were giving
this conference, and I reached out to a cancer researcher
and I wanted to talk to her about, you know,
how we think sleep is super important for you know,
for cancer and and that sort of thing, and she
(14:36):
kind of laughed at me. She was very kind, but
I thought we were so smart thinking about this, and
she's like, oh, yeah, we've considered poor sleep a carcinogen
for decades, So yeah, they were way ahead of us.
As Seema says, poor sleep is a carcinogen, a mood destabilizer,
(14:58):
and it causes many other issues and diseases. I wanted
to learn more about the ways sleep is constantly affecting
our health, so I asked Seema to explain the biology
of sleep and everything that's happening inside us as we snooze.
So REM is important for mood regulation, right, slow wave
(15:18):
sleep or delta sleep. This is this lovely slow wave sleep.
Kids get tons of this. This is where they where
they grow, and where they you know, sleepwalk, do all
of those things. Um, that's probably important for us to
download short term memory into long term memory, and then
REM is important for us to organize and edit those memories.
(15:41):
That's just in the mind and so if you can
imagine the brain has write all those little ups and
downs and on a cellular level, if you imagine it,
and I'm going to borrow this from one of my colleagues,
Dr Chuck Seisler. He was the the expert witness at
the Michael Jackson trial, and this is how he described it.
So if you picture it like a big city like
(16:02):
New York City, right, You've got these big, huge, tall buildings,
and then you've got these alleys, and all day long,
the garbage truck is, you know, cleaning debris out of
the alleys, right, and people are tossing stuff out of
the windows. And so when you sleep, the buildings shrink
and the alleys get really wide, and so all of
(16:24):
that debris gets swept away much more efficiently. And when
you analyze that debris, it is beta amyloid, which is
one of the things that builds up in Alzheimer's. And
so sleep is really really important to that, you know,
for all of that. So to your point about you know,
why does sleep impact cancer growth and why does it
(16:45):
impact ourselves? You know, we we know it's important for immunity.
We learned a lot with the pandemic right. We know
that if you're well rested the night before your your
vaccine and the day before that, you had better vaccine responsiveness.
Um and probably just because every thing needs to recover,
so it's not just the long term, it's these immediate
effects have an impact on your response to a vaccine.
(17:09):
Fascinating analogy. So when we sleep and we have our
very own sanitation department clearing the streets in our brains,
think about what that debris entails. It's imperative that George
has time to clear out those beta amyloid proteins in
his brain so that he can get back to work
and be on top of his game, saving lives and
helping people when they need it the most. With so
(17:36):
much of our health riding on sleep, I was curious
about the unique obstacles that e er workers like George
face when they're trying to get adequate sleep. Battling this
newze button for an early morning shift is one thing.
Coming home when the sun rises, and trying to get
healthy sleep in the middle of the day is an
entirely different challenge. So it's actually easier to get more
(17:56):
sleep during the winter. During the summer is when it
said it's artists, and I have to keep the sunglasses
on after an overnight shift. Actually, that's one of the
big things. On the way home. If I forget my sunglasses,
I get really messed up because my circadian rhythm wants
to be awake. So you've got to keep it dark.
And if you can get out at a time where
the sun still hasn't come up, I try and rush
(18:17):
home as if I'm a vampire or something like. I
have to get there before the sun comes up, because
it can absolutely throw you for a loop once the
sun comes up. You know, our impetus to sleep is
driven by a couple of things. So one is that
circadian rhythm right when we're biologically programmed to be awake
and to fall asleep. But the other is what's called
sleep pressure. So sleep pressure builds up from the minute
(18:41):
you wake up until you go to bed. So if
you are at your typical sleep schedule, they both peak
to push you to sleep. But now when we're asking
people to work night shift, these work against each other, right,
and so then we have to accommodate. We need to
drill just say okay, well, how can we make sure
(19:02):
that the sleep you're getting is as good as we
can make it, and so we really focus on the
sleep environment, make sure the room is cool and dark
especially and quiet, so especially with these ever changing shift
schedules and the on the job stresses that are the
(19:23):
norm in the e R George, what other tools are
there besides caffeine? Can Strategic napping for example, helped to
bridge the gap to getting rest went on twenty four
our shifts. Now, we don't necessarily do this in the
e R s everywhere, but some more rural places do
have to do twenty four our plus shifts. During residency,
(19:43):
I had to do. I see you rotations that did
have twenty four to twenty seven hours shifts. It doesn't
sound possible, and I didn't think it was, but somehow
you make it through it. Now, one of the main
ways was after the whole day to day was done,
when everyone else had left his own the you and
somebody else, and you would try and take shifts where
you could get to nap or sometimes even get to
(20:05):
sleep like four hours, and it really helps because you
had already been up since six am, and then it
was about whether it was eight pm ten pm. You
got to even sleep for two hours it was lovely
because at that time bed feels the best and you
just want to lay down. It's sometimes it's a little
more difficult to kind of wind down, and then you
end up staring at the ceiling for a while. But
(20:27):
to get that rest and again step away from everything,
it's it was so necessary. I don't I'm sure there
was sometimes that people couldn't do it because it's just
too busy for those twenty four hours. But the exhaustion
really takes a toll. And so now let's say for
like a health care professional who maybe works in a
(20:47):
rural area and it's working overnight shift pretty consistently, what
can napping do for them? Oh, so this is a
really important strategy. You know, if they are on call
twenty four hours a day, they can't count on being
able to sleep at night, can they, And so it's
important to have a strategy where if they do have
(21:09):
some downtime, perhaps they will be able to nap. Now,
normally a shorter nap is better, meaning twenty to thirty minutes,
just because you don't go into all of the sleep stages, right,
But that's for people who are able to sleep at night, right,
(21:29):
But for our e er colleagues that work those twenty
four hour shifts. Probably the single most important thing is
that they have a place where they can sleep that
is away from the e R. Not far enough away
that they can't jump up and help, but it is
dark and cool and quiet. Right Like when I would
(21:52):
leave the I c U, I'd be like, Okay, I'm
gonna go and try and sleep. Please let me know
what you need now you know I'm gonna go. I'll
be back in ten minutes, like, don't page me all right, um,
And and a lot of the time the nursing staff
was really protective of that time. You know, they wouldn't
wake the dock up unless they needed something. And so
twenty four hours of duty is a long time, and
(22:13):
so it has to be protected as much as you
can absolutely, you know, with parameters of only wake me
up if you know X, Y and Z occur, and
then that is devoted time, okay, And so you want
to set your alarm potentially to make sure you're not
going past thirty minutes. It sounds like, well the thirty
minutes isn't necessarily for this scenario. This would be we
wanted to sleep whatever you can capture as much sleep
(22:35):
as you can, because ideally, if we can get seven
hours in that twenty four period, that would be amazing.
You know, the realities that you may not, and so
then a lot of the time they just they truly
go without sleep for twenty four hours. And so if
you have, it's a little bit like the advice we
give new parents, right sleep when you can. That's all
(23:00):
for this episode. Join me again next week when we
learn about the global stage of professional video gaming, where
around the clock gameplay feels high stakes tournaments and gaming
content on streaming services. To our brains, these developers and
these games are so good that they create real experience,
like you feel like you were in the deserted compound
(23:25):
surrounded by zombies trying to figure out how to kill
them and get to this next place where all the
other players are like when in fact, no, you're just
sitting in a chair in your bedroom looking at a
box of light. We want to hear from you. Leave
a rating or review for our show on your podcast
player of choice. You can find me on Twitter at
(23:46):
on at O'Connor. Until next time, Hoping you're living your
best while sleeping your best, chasing sleep is a production
of I Heart Radio in partnership with Matches Firm. Our
executive producer is Molly Sosha. Our EP of Post is
James Foster. Our supervising producer is Kia Swinton. Our producer
is Sierra Kaiser. This episode was written and researched by
(24:09):
Erik Lesia and Jess Kapadia. Our show was hosted by
me on a hot O'Connor
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