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Tips for night workers from an emergency department physician   

Al’ai Alvarez, MD, a nocturnist, explains how to take care of yourself when you’re on the overnight shift. 

In the latest issue of Stanford Medicine magazine, I penned a Q&A with Al'ai Alvarez, MD, a night shift doctor in the adult emergency department, about self-compassion. The Q&A includes how he cares for himself during difficult moments, why self-care is important as a physician and how it contributes to caring for other people.   

Alvarez has learned ways to be more alert and productive during the night shift -- after all, he's been doing it for over 10 years. He works many weekends from about 10 p.m. until 7 a.m.  

"Because we are in a service-oriented profession where we take care of other people often in distress, the reality is we have to take care of ourselves in order for us to be effective clinicians," said Alvarez, a Stanford School of Medicine clinical associate professor of emergency medicine.  

Despite the drastic adjustment, the night shift is, as you may not suspect, in high demand at Stanford Emergency Medicine. There are upsides -- such as fewer administrative complexities given the staffing difference at night -- and the teams who consistently choose night shifts develop camaraderie. For those who work nights or are considering working nights, Alvarez offers a few tips he uses:  

  • Stick with the same sleep schedule while you're on nighttime shifts. Alvarez goes to sleep about an hour after arriving home, waking up for about an hour or two at noon. He falls back asleep, then wakes again around 7 p.m. The biphasic sleep schedule enables him to attend meetings and get some creative work done when colleagues are awake. He returns to an active daytime schedule during the middle of the week when not preparing for a night shift. 
  • Maintain a dark, quiet and cold bedroom -- doing so signals to your brain that it's nighttime and prepares you for sleep. Consider the use of a cooling mask.  
  • Protect your sleep time -- don't attend meetings or events when you're usually sleeping unless they're absolutely essential.  He notes that this is a big challenge, even for him. 
  • Diet, water consumption and caffeine habits can make a difference: Drink plenty of water, but not immediately before bedtime; eat fewer carbohydrates and more protein; and have coffee or tea only during the first few hours of a shift.  
  • Practice the 4-7-8 relaxing breathing exercise: Inhale for four seconds, hold your breath for seven seconds and exhale for eight seconds.  
  • Wear blue-light-blocking goggles on your commute home to prepare yourself for the sleep ahead. Blue light keeps you awake and blocks melatonin production, which is essential for sleep.  
  • Practice a gratitude exercise highlighting three things you're grateful for that you observed that day.

Photo by Timothy Archibald

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