Dr Michael Farquhar, consultant in children’s sleep medicine at Evelina London Children's Hospital talks in this blog about the importance of sleep, and the positive impact effective sleep can have on our working lives, especially for shift workers.
Sleep is essential to health. We spend about a third of our lives asleep, performing a nightly personal MOT making sure our brains and bodies function at their best.
When we don’t get enough sleep, or our sleep is poor quality, we suffer the short and long-term consequences of sleep deprivation and fatigue - we are more irritable, less patient and less empathic. Our thinking is slower, more sluggish and we are less able to cope with the unexpected. When we work as part of close-knit teams, fatigue makes it more difficult for us to work together. Over time our risk of diseases such as obesity, type 2 diabetes mellitus, cardiovascular disease, anxiety, depression and Alzheimer’s disease increase.
Without sleep, we can’t function at our best.
Those who work around the clock are used to dealing with fatigue. Night-shift workers generally sleep less, and have poorer quality sleep, when sleeping in the daytime. To stay awake at night, night-shift workers must fight against their circadian rhythm, the internal body clock insisting that they should be asleep. As more night shifts are worked, most people build up increasing levels of fatigue, as they fight against the twin effects of work jet lag and sleep deprivation.
Many industries have strict mandatory rules about rest and breaks, to manage the fatigue of their staff, for one very simple reason - tiredness kills.
We aren't as good at thinking like this in the NHS.
The NHS never stops - it continues to treat all those who need it, regardless of the time of day. To do that safely, the impact that fatigue has on the health of the people who deliver that care, but also their ability to deliver care safely, effectively and efficiently, must be acknowledged. Momentary losses of concentration, simple errors, can rapidly lead to significant consequences for the patients we are there for.
Rest and breaks are essential to combat fatigue. Airports close runways rather than allow air traffic controllers to work without breaks, because anything less is simply not safe. The NHS’ runways must always stay open - but that means we must think even more about how we support our staff to do so safely.
It’s all too easy to think that when it’s busy, breaks become less important. The truth is, the busier it is, the more important it is that you make sure you get your breaks and rest - the more pressured the work is, the more you need to be at your best to deal with it.
For many people a short, 15 to 20-minute nap can help to reduce the impact of fatigue on their ability to function, especially at night. Power naps are enough to give a ‘boost’ of sleep that can leave you feeling more alert and less sluggish when you wake. Work done by NASA looking at how to reduce the impact of employee fatigue demonstrated improvements in performance of about 34 per cent and alertness by 54 per cent following an in-shift power nap.
But more sleep in a nap is not necessarily better. If we sleep longer than 15-20 minutes, we are more likely to enter the deeper stages of sleep, if this happens, we are often groggy and disorientated for a few minutes, which can make a critical difference if woken suddenly to deal with an emergency.
Power naps don’t work for everyone but it’s worth experimenting to find the right amount of nap sleep that works for you.
Power napping is a skill that can be learnt over time. For a good nap, there needs to be a quiet, dark, comfortable space where sleep is possible. A comfy reclining chair or a camping mat can work, though it does need to be a space away from the noise and activity of the ward. The discipline of simply lying back, shutting your eyes and relaxing in the quiet for 15 to 20 minutes has its own benefits and, as so often with sleep, the trick is not to worry about whether you fall asleep or not - if it happens, it happens. Practicing techniques like mindfulness or breathing exercises can help, both to encourage sleep, but also to help to relax. Don’t forget to set an alarm, or ask a colleague, to wake you though!
If you drink caffeinated drinks through the night, another useful trick is to take a shot of caffeine just as you put your head down to nap. Caffeine takes about 15 to 20 minutes to kick in - which means as you wake at the end of your nap, you get a double boost from both the sleep and the caffeine.
As the pressure on the NHS grows ever stronger, it becomes even more important that strategies to support the staff delivering care are put in place. Organisations need to understand the essential role of fatigue management and look after their staff so that they can provide safe, effective and efficient patient care.