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PED-EM-L  February 1998

PED-EM-L February 1998

Subject:

Re: Circadian Dis-stress

From:

Ronnie Waldrop <[log in to unmask]>

Reply-To:

Ronnie Waldrop <[log in to unmask]>

Date:

Wed, 11 Feb 1998 12:04:46 -0500

Content-Type:

text/plain

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Parts/Attachments

text/plain (63 lines)

I did circadian neuroendocrine research for many years prior to my
emergency medicine career so I can comment with some expertise on this
subject.  Unfortunately, there are but a handful of useful articles on
shift work. To summarize briefly, humans as all vertebrates are born with
genetic tendencies toward various circadian neuroendocrine characteristics.
In other words, while almost everyone has a roughly 24 hour rhythm of
sleep-wake, activity, food ingestion, etc. based on neuroendocrine
variations and synchronized by typical social cues (i.e. lights on, alarms,
noise, social expectations), there appear to be categories of individuals
with various degrees of "circadian flexibility".  People in general fit
into 3 categories - those who easily switch work cycles between night and
day without much maladaptation in personality and basic function, those who
are literally incapacitated by these switches, and those in between.  It is
important to decide your category and adapt your life since difficulty in
adapting to these cycle changes is thought to be the core problem in many
if not all psychiatric disturbances and social maladaptation (i.e. seasonal
affective disorder).  We have all seen EM physicians who suffer great
psychiatric shifts with night work.  It is my opinion that burnout in
emergency medicine has as much to do with circadian disorganization as the
work itself.  In addition, it is clear now that circadian flexibility
decreases with age leading to the old adage that EM physicians hit the wall
between age 40-50 leading to career changes.  As far as schedules, the
healthiest is one which phase shifts forward - Day 1 AM, Day 2 Swing 1, Day
3 Swing 2, Day 4 night, then 4 days off for example.  Next would be blocks
of time - 5 nights on 5 nights off.  Finally, the worst is scatter
scheduling - night, off, day, night, swing, etc. due to no consistent
circadian shifts or recovery period.  As for myself, I am fortunate at 40
to be still flexible - all nights 7 PM - 5 AM, 5 on, 5 off, 2 on, 2 off.
Exercise of my legs( bike)and weigh training, creatine tabs (1/day), and a
megadose multivitamin keeps my fatigue to a minimum.  The day after the
last night I sleep little and do some physicial activity in order to phase
shift the next night and wake up in the AM refreshed.  I occasionally take
1 tsp of phergan DM as a mild sleep aid.  I must admit though there are few
out there this flexible at age 40-50 but it is best for my family.
 
                                 Ron D. Waldrop MD, FAAP, FACEP
 
 
 
 
 
------------------ Reply Separator --------------------
Originally From: Dale Steele <[log in to unmask]>
Subject:  Circadian Dis-stress
Date: 02/10/98 04:19pm
 
 
What helpful strategies have list members found for working a mix of shifts
which includes days, "evenings" and overnights while remaining sane,
married with children who recognize you, and at least some productivity in
academic, teaching and administrative realms?
 
How is this influenced by number of clinical hours? age beyond 35? length
of shifts? blocks of nights? Sleep strategies? Drugs?
 
Dale Steele, MD
PEM, Hasbro Children's Hospital
Providence, RI
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

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