Jordan Ellis
Staying awake during long shifts is a common challenge faced by medical residents. With shifts lasting 20 to 40 hours, sometimes for several nights in a row, residents have to employ various strategies to stay alert. These include consuming caffeine and sugary snacks, engaging in physical activity, and listening to music. However, the use of caffeine is not recommended as a substitute for adequate sleep. In addition to residents, patients in hospitals also struggle with staying awake due to various factors such as noise, lighting, medication schedules, and vital sign checks. To address this issue, hospitals are re-evaluating their nighttime practices to minimise disruptions and improve patient sleep quality.
| Characteristics | Values |
|---|---|
| Noise | Staff voices, cleaning machines, roommates, hospital equipment, intercom announcements, food and medicine carts, people in the halls |
| Lighting | Bright fluorescent hallway light |
| Nighttime interruptions | Vitals checks, medication administration, blood draws, timed blood tests, breathing treatments |
| Pain | Ask for pain medicine at bedtime |
| Urination | Diuretic medication, IV fluids |
| Earplugs | Ask someone to bring earplugs |
| Door | Ask to have your door closed |
| Naps | Take naps earlier in the day and set an alarm to wake up after 30 minutes |
| Caffeine | Avoid caffeine after noon |
| Dinner | Finish dinner 3 hours before bedtime |
| Relaxation activities | Deep breathing exercises, listening to soothing music, reading a book, doing a crossword puzzle |
| Sleep medication | Take it between 9 pm and midnight |
| Light and sound | Lower blackout window shades, close curtains, turn off TV and computer screens, use an eye mask, silence cell phone after 10 pm, use headphones |
| Visitation management | Encourage daytime or early evening visits, set a visiting curfew around 8 pm |
| Sunlight exposure | Get sunlight during the day, open curtains in the morning, sit by the window |
| Physical activity | Walk, do exercises in your bed or chair, walk up and down stairs, go outside |
| Residents | Caffeine, candy, physical activity, music, micro-naps, conversation |
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What You'll Learn
Avoid caffeine after noon
Caffeine is a popular stimulant that many people rely on to stay awake and enhance their mood. It is found in many plants, including coffee beans, tea leaves, cacao pods, and kola nuts, as well as in medications and energy drinks. While it can be an effective tool to promote wakefulness, caffeine can also interfere with sleep, especially if consumed too late in the day.
To ensure a good night's rest, it is recommended to avoid caffeine after noon or at least eight hours before bedtime. Caffeine has a half-life of four to six hours, which means that half of the consumed caffeine is still present in the body within this timeframe, potentially keeping you alert and interfering with your sleep. The effects of caffeine vary from person to person, with some being more sensitive to it than others. If you find yourself feeling sleepy during the day despite consuming caffeine, it could be a symptom of a sleep disorder or an underlying medical issue, and you should consult your healthcare provider.
Additionally, caffeine consumption can have potential side effects, including jitteriness, headaches, nervousness, and insomnia. If you experience any of these side effects or sleep disturbances, it is advisable to reduce your daily caffeine intake and avoid it entirely after noon to improve your sleep quality.
By avoiding caffeine after noon, you can minimize the risk of caffeine interfering with your sleep and improve your overall sleep quality. This, in turn, can have a positive impact on your health and well-being, as adequate sleep is crucial for recovery and overall health.
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Take naps earlier in the day
If you're looking to stay awake at the hospital, it's important to consider the challenges that can make it difficult for patients to get a good night's rest. Hospitals are often noisy, with staff conversations, cleaning machines, and roommates all contributing to the disturbance. Additionally, patients may be woken up repeatedly for vital sign checks, medication administration, and blood draws. To counter this, it's advisable to take naps earlier in the day, preferably before 3 pm, to avoid disrupting your nighttime sleep. Here are some strategies to make the most of napping earlier in the day:
- Understand your body's natural sleep cycle: Our bodies follow a 24-hour circadian rhythm, with two peak periods of sleepiness: at night and in the early afternoon. Aim to take your nap during this afternoon dip to maximize its effectiveness.
- Create a comfortable nap environment: A good sleep environment is cool, quiet, and dark. If possible, lower the blackout window shades, close the curtains, and use an eye mask to block out any distracting lights. Earplugs or white noise can also help minimize noise interruptions.
- Set an alarm: Limit your nap to 20-30 minutes by setting an alarm. This will ensure you don't fall into a deep sleep, making it easier to wake up and reducing the risk of feeling groggy afterward.
- Adjust your medication schedule: Certain medications can make you sleepy during the day or keep you awake at night. Discuss with your doctor or nurse about adjusting your medication schedule to avoid daytime drowsiness and promote nighttime sleep.
- Avoid caffeine after noon: Caffeine has a long half-life and can stay in your system for many hours. Avoiding caffeine after lunchtime can help improve your sleep quality at night and make it easier to nap earlier in the day.
By incorporating these strategies, you can take advantage of the benefits of napping, such as reduced fatigue and improved alertness, without compromising your nighttime sleep. Remember to also practice good sleep hygiene, such as minimizing noise and light distractions at night, to ensure a restful stay in the hospital.
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Ask for medication schedules to be changed
Hospitals can be busy, noisy places, and it can be difficult to get a good night's sleep. There are many things about hospital routines that can make it challenging for patients to sleep well, such as medication schedules, vital sign checks, blood draws, and other treatments.
If you are in the hospital and want to stay awake, one strategy is to ask for your medication schedule to be changed. Here are some detailed instructions and considerations for doing so:
Understanding Medication Schedules
Before requesting any changes, it is important to understand why medications are given at specific intervals. Some medications, such as antibiotics, must be administered at particular times, and blood tests for antibiotic levels must be timed accordingly, which may result in middle-of-the-night interruptions. Additionally, certain conditions require vital signs to be checked every four hours, which can also disrupt sleep.
Communicating Your Concerns
If you find that your medication schedule is interrupting your sleep, it is essential to communicate your concerns to your healthcare team. Discuss your sleep difficulties with your doctor or nurse and request a change in the medication schedule to minimize nighttime interruptions. For example, you can ask if a medication ordered "every six hours" can be changed to "four times a day" or "every four hours while awake."
Alternative Scheduling Options
When discussing alternative scheduling options, consider the following:
- Six-Hour Intervals: Some antibiotics can be given at six-hour intervals instead of four-hour intervals, reducing the need for nighttime interruptions.
- Four Times a Day: Certain medications given every six hours can be adjusted to four times a day during your usual waking hours.
- Adjusting Timing: Request that your medications be administered during the day when you are typically awake. This may involve taking your last dose of the day earlier in the evening to avoid disrupting your sleep.
Patient-Centred Care
It is important to recognize that hospitals are increasingly focusing on patient-centred care, which includes improving patient sleep quality. Many hospitals are rethinking their nighttime practices and trying to better coordinate medicines to minimize interruptions. Your feedback is valuable, and hospitals do consider patient satisfaction and feedback when making changes.
Remember, it is always essential to consult with your healthcare provider before making any changes to your medication schedule. They will be able to assess your individual needs and make appropriate adjustments to ensure your well-being.
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Use earplugs and an eye mask
Hospitals can be noisy places, with staff voices, cleaning machines, and other patients all contributing to the din. The bright fluorescent lighting in hospital rooms can also make it difficult to get some rest. These environmental factors can reduce and fragment sleep, especially for those in intensive care units (ICUs).
Using earplugs and an eye mask can help to block out noise and light, improving your sleep quality. A study of 64 ICU patients found that those who used earplugs and an eye mask experienced a higher proportion of N3 sleep, which is the deep sleep stage, and fewer prolonged awakenings compared to those who did not use these tools. Another study of 60 patients with acute coronary syndrome showed a significant improvement in total sleep quality with the use of an eye mask from the second night of admission until discharge.
Earplugs and eye masks have also been shown to reduce anxiety and improve overall sleep perception. They can help you fall asleep faster and experience fewer arousals and awakenings. If you are in the hospital, you can ask someone to bring you earplugs, and you can use an eye mask to cover your eyes to block out any bright lights.
In addition to using earplugs and an eye mask, there are other things you can do to improve your sleep in the hospital. For example, you can ask to have your door closed to reduce noise, listen to soothing music, or try relaxation activities such as deep breathing exercises.
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Get sunlight during the day
Sunlight is a key regulator of our sleep-wake cycle, and getting some sun during the day can help you stay awake at the hospital. Morning sunlight suppresses melatonin, the sleep-inducing hormone, and increases cortisol, the stress hormone. While high cortisol levels can be detrimental, a small spike in the morning can actually lower stress levels for the rest of the day. This is called the cortisol-awakening response, and it helps us feel alert in the morning.
To get the benefits of morning sunlight, you don't need to spend hours in the sun. Even a short walk in the sun can be beneficial. If you're at the hospital, you can ask a family member or friend to join you for a walk in the morning. If you're unable to go outside, sitting by a window or in a well-lit room can also help. Try to get sunlight within 30 to 60 minutes of waking up.
In addition to improving alertness, morning sunlight has several other health benefits. It boosts serotonin levels, which improves sleep quality and enhances mood and mental health. Morning sunlight also provides essential vitamin D, strengthens the immune system, and supports healthy weight and metabolism.
If you're staying at the hospital for multiple days, try to stick to a regular schedule. Waking up at the same time every day and getting morning sunlight can help regulate your body's sleep-wake cycle. If you're unable to get morning sunlight, you can also get sunlight in the late afternoon. This can help trigger the release of melatonin before bedtime, further regulating your sleep-wake cycle.
While sunlight has many benefits, remember that too much direct exposure can be harmful. Limit your time in direct sunlight during peak hours, and wear proper protection, such as sunscreen and sunglasses.
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Frequently asked questions
Here are some tips to help you stay awake during long shifts at the hospital:
- Consume caffeine or caffeine mints.
- Eat snacks and candy to keep your energy levels up.
- Listen to music, preferably something upbeat.
- Hang out with the nurses and engage in conversation with them.
- Take micro-naps to recharge.
Here are some tips to help you get a good night's sleep during your hospital stay:
- Ask for a designated quiet time, during which non-essential tasks are minimised and lights and noise are lowered.
- Ask for earplugs to block out noise.
- Ask for the medication schedule to be changed so that you are not woken up during the night.
- Avoid caffeine after noon.
- Finish eating dinner 3 hours before you want to go to sleep.
If your child is staying awake for tests or other medical reasons, here are some tips to help them stay awake:
- Play games with them or read to them.
- Bring their favourite toys or books to keep them entertained.
- Take them for short walks around the hospital floor or garden, if possible.
