Doctors should nap during night shifts, conference hears

BMJ 2016; 355 doi: (Published 24 November 2016) Cite this as: BMJ 2016;355:i6255
  1. Abi Rimmer
  1. BMJ Careers

Researchers at a conference on the effect of sleep on fitness to work discussed how sleep deprivation can affect patient safety and doctors’ training. Abi Rimmer reports

Junior doctors working night shifts should be allowed to take regular short naps, says Jim Horne, a sleep neuroscientist and emeritus professor of psychophysiology at Loughborough University.

Horne was speaking at a conference held at the Royal Society of Medicine in London on 16 November about the effects of sleep deprivation on workers. He told the conference that a lack of sleep could affect a person’s ability to work and deal with emergencies.

Speaking to BMJ Careers, Horne said that “there’s absolutely no doubt” that junior doctors should be allowed to take short naps. He said, “It’s safer for everyone concerned; it makes the doctor safer to work, it improves patient safety, it reduces accidents, and doctors are happier because they think the organisation cares for them more.”

He added, “It’s been proven many times in other organisations that naps, roughly every four hours, ideally for about 15 minutes maybe with a cup of coffee beforehand, can be very effective indeed and highly recommended.”

Speaking to the conference, Horne explained that although sleep deprivation didn’t affect a person’s ability to carry out routine tasks—“something that you are pre-programmed to dealing with”—it did affect a person’s ability to deal with an unexpected emergency situation.

“Risk taking is a serious issue, because [sleep deprived] people start taking more risks,” Horne said. He added that sleep deprived people were also more easily distracted and struggled to focus. “Your language and communication skills become impaired . . . You’re more likely to talk in clichés than actually describe how the situation is changing,” he said.

He argued that organisations that employed shift workers needed to be aware of the potential effects of sleep deprivation and manage their staff accordingly. He said that staff who were sleep deprived should not be encouraged to say, “It’s my watch, I’ll carry on.” He said, “That’s very laudable but inadvisable, and really that person should be encouraged to seek help from others.”

Also speaking at the conference, Derk-Jan Dijk, professor of sleep and physiology at the University of Surrey, said that people who worked nights were very likely to be sleep deprived because they were working out of sync with their circadian rhythm. He said that night workers might not even be able to recover on their days off because of a combination of “acute desynchrony” with their circadian rhythm and chronic sleep loss.

One way that workers could reduce the effects of shift work, he said, was to maximise the amount of sleep they had before the night shift “or even during the night shift.”

Dijk also warned against 12 hour shifts. “From a theoretical perspective, which is based on data in the laboratory, 12 hour shifts probably will not result in a very good work performance at the end of those 12 hours,” he said. He added that if people were going to work 12 hour night shifts then their timing was important. “In our analysis the worst timing of the 12 hour shift would be from 7 pm to 7 am, because 7 am is the trough of the circadian cycle.

“From a circadian perspective it would probably make more sense to work from 4 am to 4 pm, because then the circadian trough would fall halfway through the shift, or to start a 12 hour shift at midnight.”

Another speaker at the conference was John Axelsson, associate professor at the Karolinska Institute in Stockholm. Commenting on the issue of junior doctors being able to learn during or after night shifts, he said that research had shown that sleep deprivation lowered people’s chance of remembering what they had been taught. “Sleep deprivation prior to doing something does affect learning. Also if you learn and then are sleep deprived afterwards you have reduced [memory] of the subject, because during sleep you transfer memories.

“So we know that sleep deprivation both prior and afterwards affects the capacity to learn things. I haven’t seen studies of medical doctors in these weeks [of long night shifts], but I’m pretty sure it’s going to be a blur for these people when you work 80 hours a week.”

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