May 10, 2013

This guest post was written by Jasmin Zaman, a student at the Hunter-Bellevue School of Nursing and the Macaulay Honors College at the City University of New York. Last fall Jasmin took a course in narrative writing for nursing students at Hunter taught by CHMP senior fellows Joy Jacobson and Jim Stubenrauch.

11:46 PM … 12:45 AM … 3:30 AM …

Here we go again. As I toss and turn I lose my hopes of getting eight hours of sleep. It’s Tuesday night. That means tomorrow morning I have to meet my classmates at the lobby of the Hunter dorms to make it to our 7:55 AM meeting for clinicals next door. We have our psychiatric rotations at Bellevue, and I am desperate to catch up on as much sleep as I can.

I was against caffeine when I first entered college but on Tuesday morning I haul my fatigued body to the nearby caffeine watering hole—Dunkin Donuts. My mother always warned me about the evil grasp of coffee and energy drinks, as she believed they were the culprits of my unexplained heart palpitations.

Nursing student Jasmin Zaman and friend
Nursing student Jasmin Zaman and friend

Suffering from insomnia is something I have come to accept. I share this constant battle with my classmates, and it is comforting to know I am not alone. We become so consumed by the day’s activities and by tomorrow’s schedule that it is almost bizarre to just stop—and sleep. Not sleeping the day before clinical days, especially, is a recipe for disaster. An internal disaster. My body fights itself to understand the cause of this sleep deprivation. Without the stimulant effects of coffee my body shuts down. I have often caught myself dozing off on the floor. But if I move into the maintenance phase of caffeination with stimulants like Red Bull or other energy drinks, I’m contributing to my sleeplessness throughout the night.

Studies have shown that the classic theory of sleeping one-third of the day does not correlate with feeling well-rested. Factors such as age and lifestyle contribute to the quality of sleep and feeling rested. It does not matter how much sleep you get, but rather the quality of it. Quality over quantity is best. Rapid eye movement, or REM, sleep, considered one of the most crucial stages of the sleep cycle, is “the only phase of sleep during which the brain is as active as it is when we are fully conscious, and seems to offer our brains the best chance to come up with new ideas and hone recently acquired skills,” says David Randall in a an op-ed, “Rethinking Sleep.” 
Studies have shown that insomnia is related to decreased cognitive functioning, which leads to long term memory loss and decision making. It is during REM sleep that the body fully recovers and sorts out the knots of the day, often manifesting itself into dreams and nightmares. This may be a physiological way of coping with traumatic events and stress from the day. And with the rise of social media in our lives, it is hard to step away from the buzz when it is everywhere. Facebook, Instagram, Vine, Tumblr, Twitter, emails, phone calls: the ping of the smart phone can signal any of these, and it is enough to ruin sleep.

The theory of “split sleep,” getting however much sleep you can get at night and then sleeping in the daytime, may provide a model for preventing crash-and-burns. Napping in the daytime has been shown to increase awareness and decrease the chance of mistakes and errors throughout the day.

So would it be acceptable for night-shift nurses to take a 45-minute nap during their shift? A study done on Turkish nurses found that sleep quality negatively correlates with job satisfaction. This is a significant concern for me because new graduates are often hired to work the night shift.

Insomnia is expensive: it is associated with costly workplace accidents and errors, according to a recent study, and the researchers suggest that expanded screening and treatment of workers with insomnia might lower the costs for employers. Jeanne Geiger-Brown, co-author of an article called “Is it Time to Pull the Plug on 12-Hour Shifts?,” conducted a study of 393 nurses on 5,317 shifts that found “the odds of making errors by those who reported working more than 12 hours in shifts was three times greater than nurses who reported working 8.5-hour shifts.”

A blog commentator states: “Too many people think they can still operate like they did in college. This makes me want to ask every healthcare worker I interact with how many hours of sleep they’re getting a night! Long shifts just go against all common sense. And we wonder why we have people in this industry taking uppers to stay awake and downers to sleep. It’s a culture that’s hard to change.” As a future new nurse I find it hard to imagine getting through a day without caffeine. The idea of going to work with not enough sleep scares me, and I am sure many workers can relate. Instead of taking “downers” for sleep, maybe as we were taught in kindergarten, a little bit of naptime can make the world go round?