This is the the evidence-based, practical and effective protocol I designed as I entered a 12-week block of night shifts.

As a junior doctor, I earned my stripes working 12-hour shifts, 7 nights in a row, followed by 7-days off duty. I worked with 2 other doctors to care for over 450 patients across medical, surgical, paediatric and even psychiatry wards. Some nights were calm, others all hell broke loose. Lives were on the line, and the already risky business of doing no harm to the patients under my care were compounded by the dangers of sleep deprivation, altered mental performance, and fatigue.

Protocol objective:

To maintain peak performance under the stress of shifting sleep patterns, to reduce the risk of injuries and accidents to patients and myself. Further, be able to ‘switch out’ of night shift mode to be present and available in the off week for the activities and pleasures I value.

It is the quality of the 1/3rd of life spent sleeping that determines whether the other 2/3rds are worth living.

It was a privilege to take on this challenge as part of my duty of care to my patients. I used every ounce of knowledge I had about high performance and the sleep-wake cycle to not only ensure the highest standard of care and safety for my patients, but also for myself, so that I could drive home safely at the end of each shift, then flourish with my family and friends.

Transitioning into a night shift cycle

On day one of a week-long night shift cycle I have a power nap at around 5pm (max 1 hour), waking up at about 6pm (12 hours out of phase from my regular 6am wake up time, and use a Re-Timer for 30-50 minutes.

The average ‘day’ during night shift

Upon waking, I do my priming ‘morning ritual’. This usually involves meditation, a cold shower, Bulletproof coffee, reading, kettlebells, and mobility work. Sometimes it includes a Bikram Hot Yoga session (most exercise classes will be running at the time that is now your new ‘morning’ – a great way to kickstart your shifting body clock).

I get to work at the start of my shift at 10pm, clear the wards of jobs until 1am, and have my ‘breakfast’, or first meal of the ‘day’ (I practice a basic 16-8 intermittent fasting protocol, which I maintain during my night shifts – except 12 hours out of phase).

When possible, I have a power nap (max 20 minutes) half way through my shift, dramatically refreshing myself for the second half of the shift (I practice this power nap technique during my normal day hours, too).

The shift ends around 8am, when the sun is well and truly up. I then cautiously drive home, have a big, slow-carb meal, clean up, meditate, then hit the sack at around 9:30am.

Transitioning back to regular day cycle

On the final night (finishing on work Monday morning), I come home, stay awake for a few hours, then intentionally sleep for only 4 hours. I then wake up, go hard for the rest of the day with either a long session at the gym or in the surf, before going to bed around 9pm. Sleeping is easy at this stage, as by this time I’m physically and mentally drained, and get 8-10 hrs of sleep. This lets me wake up on the next day of my week off feeling completely refreshed and back into a regular wake cycle to enjoy a high quality of life with my friends and family.

This protocol allows me to be focused, energetic and at optimum performance during both the night shift cycle, and my time spent off duty.

Supplementary tools

The protocol is enhanced by some novel and innovative interventions I’ve researched and experimented with. The hacks below target the two biggest areas people struggle with during extended night shifts:

  1. Reversing the sleep-wake cycle, such that there is no mental lag or fatigue as you switch in or out of the night shift phase.
  2. Maintaining sleep quality when sleeping during sunlight hours.

The Re-Timer

Courtesy of Touch of Modern (www.touchofmodern.com)

This little gadget is worn like sunglasses, and emits a specific wavelength of light which shifts your internal body clock. It leverages the connection between the light absorbed by your eyes and the part of the brain called the suprachiasmic nucleus, which controls the bodily functions and feelings that make you feel alert when you should be awake, and sleepy when you should be, you know, asleep.

Courtesy of Re-Timer (re-timer.com)

You can hack your body clock by using the Re-Timer to reverse your sleep-wake cycle to enter a night shift phase, maintain that reversal, and then switch out when you ready to re-engage with the waking hours shared by the non-vampires of the world.

How to use the Re-Timer

  1. Use for 30-50 minutes it in the evening before you start your first night shift. This will tell your body it’s not time to start getting sleepy.
  2. If you have a break, use it for 20 minutes in the middle of your night shift. This will help you maintain your alertness, especially during the early stages of your night shift cycle.
  3. Use it immediately upon waking for 30-50 minutes. This will help your body know when ‘morning time’ is in your current routine.

By following this strategy, you’ll stop feeling fatigued and be as alert and focused during the night shifts as you are on a day shift. You can then quickly reset your body clock when exiting the night shift phase, such that no days off are wasted feeling groggy with ‘jet lag’.

Modafanil

After researching this drug extensively using medical databases, as well as collecting feedback from colleagues and peers from other industries on their experiences, I experimented with this nootropic. It has been shown in trials to be particularly effective in maintaining perceived alertness and mental cognition in individuals who were already under the influence of sleep deprivation or disturbance.

While I recommend that each individual take any supplement or drug with caution and commonsense, I found this to be a useful addition to the protocol for maintaining peak performance during night shifts. I used a derivative called armadafanil, which has a half life around 10-12 hours. This lasted the perfect length of time for my shifts, and ensured I had enough juice at the end of each shift to drive home safely.

Cautionary notes

Modafinil capsules typically come in 150 or 200mg tablets. Everyone responds differently, and some of us are more sensitive than others to its effects. Start with a small dose by cutting the tablet into quarters (this should not be taken on an empty stomach the first time) – for many, this is enough to have profound effects on mental performance and stamina. Gradually increase to find your optimal dose, and take no more than necessary to achieve the desired effect.

Environment

Sleep hygiene is important for all of us, though it becomes particularly important during a night shift cycle. Some easy sleep hacks that will improve your quality of sleep, especially whilst the sun is up, include:

  • Wearing ear plugs
  • Using black out curtains to ensure no sunlight is visible
  • Ensuring all LEDs in the bedroom are off
  • Using a face mask
  • Using air conditioning to keep your environment cool

Melatonin

Melatonin is an invaluable tool in helping me get to, and stay, asleep when the loud noises, bright lights and hotter temperatures associated with sleeping during the day did their best to wake me up. I, like most people, become a grizzly bear when I don’t get a solid sleep. Things become dangerous after prolonged sleep deprivation, with studies showing it to be the equivalent of having high blood alcohol levels – not something you want to experience when saving lives or driving a car.

Lifestyle

There are well documented studies demonstrating the negative effects of night shift work on physical health. It is important to continue following the same health protocols you use during your regular wake phase – this includes getting the same amount of sleep. For me, this meant maintaining my regular fasting and slow carb eating protocol, as well as doing some kind of high intensity exercise every day. This was complemented by adequate hydration, mediation, and regular doses of fun hanging out with my son, my girlfriend, my family, and my close friends. I also ensured I had awesome things to look forward to each day, which made it easier to get through the harder moments.

This protocol made what could have been a gruelling, trench-warfare style of medical rotation into something I enjoyed. I was exposed to medical emergencies and problems I would never have encountered at my level during daytime hours when the hospital was fully staffed, and I had the incredible opportunity to both extend my knowledge and skills in the challenging environment, and make a tangible difference to the lives of the patients I cared for during this time.

I hope this protocol lets you flourish in whatever night shift work you are facing.

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