The first time I took overnight call during my third-year clerkships, I was completely unprepared for how to transition back to a normal sleep schedule. After working around 24 hours with no call room sleeping time, I was, as expected, exhausted and fell asleep around 8 AM once I got home and settled. Next thing I knew, it was almost 3 PM.
Although I was ready to take on the day, I was wide awake and couldn't fall asleep again until almost 2 AM. With the lethal combination of having stayed up all night and sleeping in, this is not abnormal. The problem was that my alarm was to go off at 5 AM to begin a first call shift. From that experience, I decided it was probably best to figure out a better way to transition from 24-hour call shifts back to a normal sleep cycle.
The next 24-hour call shift I had 4 days later, I decided on a new method of attack. First and foremost, if I had the capability to get an hour or two of sleep in the call room, I would try to do that. Second, no caffeine after 3 AM; this would help me fall asleep quickly once my call was over. Third, I would only sleep for 3-4 hours after I got home around 8 AM, with no additional nap later in the day.
Was I drowsy? Sure. However, I was still able to accomplish studying, exercising, and making meals. I was also more than ready to go to sleep at a reasonable 9 pm rather than almost 2 AM. Though this is what works for me during 24-hour call, I know classmates who sleep as long as they feel they need and have no issue falling asleep at a decent time the next evening.
The 24- to 28-hour call is an entity in and of itself. Some specialties have night shifts or a night float system for an entire month. Although I haven't experienced a true month of night float just yet, I have experienced a string of 12-hour overnight shifts during my emergency medicine rotation.
My approach to transitioning to these rotations is quite different from my 24-hour call transition method. With 24-hour calls, I am focusing on recouping quickly, without compromising falling asleep at a normal time to function on a normal schedule for the 4-5 days to follow. However, with a 5-day string of night shifts, I want to be a night owl (which is totally abnormal for the morning person that I am).
For a string of night shifts, transitioning to nights involves three main things: caffeine, post-shift sleep, and pre-shift exercise and naps. Night 1 of 5, I will try my best to take a nap before a 7 PM shift begins. At the very least, I will have a coffee and a mid-shift energy drink ready to go. When the shift ends at 7 AM, I go home and sleep for as long as I'd like.
Unlike 24-hour call, I am not worried about staying up to late because my shifts are completely overnight for the next few days! After 6-7 hours of sleep, I'm ready to eat, study, and exercise and squeeze in a quick hour nap before my next night shift.
While this is the process that works for me, I know others find it helpful to try and stay awake as long as possible after the night shift and sleep all afternoon leading up to the next night shift (ie, sleeping noon to 6 PM, working 7 PM to 7 AM).
One thing I didn't expect from a string of 12-hour night shifts, which totally makes sense physiologically, is the shift in meal consumption — so be sure to pack enough food that would typically last you a day's shift!
I was clueless about how to structure my call and overnight shift sleep schedules when I began my clinical rotations but ultimately was able to figure out what would work best with my sleep requirements and study/exercise schedules! What sleep schedule transition works best for you?
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Cite this: Abigail Schirmer. Transitions of Sleep Cycle: Methods of Shifting Sleep Schedule for Variations in Shift Work - Medscape - Mar 24, 2022.
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