Monday, December 27, 2021

Sleep issues of ICU workforce

 Q: ICU workforce at night can eliminate sleepiness by daytime sleep? 

A) True 

B) False 

Answer: B

Intensivists, mid-levels, nurses, respiratory therapists, pharmacists, and all other healthcare workers who work at night or on schedule with rotating day/night shifts struggle with sleep cycles. 

Unfortunately, daytime sleep does not fully eliminate sleepiness during the nocturnal hours. 

One effective trick is to take a short (power) nap either just before or during the shift. Nap is recommended to be restricted below an hour to avoid entering the deep-sleep phase and disorientation from sleep inertia. 

Coffee: Coffee helps! but should be limited to the early half of the night shift to avoid insomnia later in the day. One study showed that one single cup/dose of coffee/caffeine at the beginning of the night shift is better than the intermittent or divided doses throughout the shift 6. This prevents tolerance to caffeine. 

Wake-promoting agent i.e., modafinil or armodafinil has been suggested during the shift but should be monitored and prescribed by an experienced clinician.




1. Schweitzer PK, Randazzo AC, Stone K, et al. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Sleep 2006; 29:39. 

2. Sallinen M, Härmä M, Akerstedt T, et al. Promoting alertness with a short nap during a night shift. J Sleep Res 1998; 7:240. 

3. Purnell MT, Feyer AM, Herbison GP. The impact of a nap opportunity during the night shift on the performance and alertness of 12-h shift workers. J Sleep Res 2002; 11:219. 

4. Bonnefond A, Muzet A, Winter-Dill AS, et al. Innovative working schedule: introducing one short nap during the night shift. Ergonomics 2001; 44:937. 

5. Ker K, Edwards PJ, Felix LM, et al. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev 2010; :CD008508. 

6. Walsh JK, Muehlbach MJ, Schweitzer PK. Hypnotics and caffeine as countermeasures for shiftwork-related sleepiness and sleep disturbance. J Sleep Res 1995; 4:80.

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