Tuesday, December 18, 2012

Circadian rhythm and biological time clocks


How do doctors and nurses manage to work such crazy hours? 
The inside life of hospital doctors and nurses is far more complex than the majority of outsiders will ever know. There can be many reasons for this including patterns in work shifts, as well as balancing home life. 
For new doctors and nurses who have never worked in a hospital environment for any length of time, juggling home life with work can present numerous problems, particularly at first. For example, registered nurses and doctors have to contend with sleep disorders that involve shift work. At the same time, hospitals always function with doctors and nurses working a wide range of shifts. In fact, they come and go all day and night. 
Maintaining a healthy life style is very important for doctors and nurses, as well as their families. This means that doctors and nurses need to get sufficient sleep, in order to cope with their work, as well as their personal lives. 
Let us examine the topic of sleep disorders more closely because 'when' doctors and nurses sleep, does have a definite bearing on what happens in their personal lives. Sometimes what happens with regard to their sleep can be positive, while at other times, it may be negative. Understanding circadian rhythm and biological time clocks will help doctors and nurses who have problems adjusting to working shifts in hospital settings. Shift work can wreak havoc on the personal lives of doctors and nurses as well as their families, at any time, because it increases the level of stress that they are under. 

Disturbed sleep patterns affect their physical, mental, emotional and spiritual health. While shift work sleep disorder can bring about tremendous upheaval in the lives of doctors or nurses and affect their work, as well as their home lives, it does not necessarily have to do so. 

What is shift work sleep disorder?
"Circadian rhythm sleep disorders are a family of sleep disorders affecting, among other things the timing of sleep." (1) 
What happens to doctors and nurses who experience circadian rhythm sleep disorders? 
"People with circadian sleep disorders are unable to sleep and wake at the times required for normal work, school, and or social needs." (2)
Can working shift work at a hospital prove to be a positive thing for those who have circadian rhythm sleep disorders? In other words, can they still get enough sleep?
"They are generally able to get enough sleep if allowed to sleep and wake at the times dictated by their body clocks.  Unless they have another sleep disorder, their sleep is of normal quality." (3)
This suggests that when doctors or nurses understand their biological clocks, they may be able to work the hours of shift work that are most appropriate for them with respect to their normal sleep patterns. Thus, at times, shift work can prove to be a good thing for those who do understand and are able to meet their sleep needs.
Because every person has his or her unique biological clock, the family life of a doctor or nurse can suffer, if there are other members in the family who function on different circadian rhythms.
There are two kinds of circadian rhythm sleep disorders. There are those that are extrinsic and those that are intrinsic. Extrinsic sleep disorders include shift work sleep disorder and jet lag. Shift work sleep disorder affects those who work night shift or rotating shifts, while jet lag affects those who cross several time zones. (4)
Not all doctors and nurses work shift work, but many do and thus may suffer shift work sleep disorder. Both doctors and nurses tend to travel, so there will also be times when jet lag can be a problem too.
Intrinsic circadian rhythm disorders include delayed sleep phase syndrome, advanced sleep phase syndrome, non-24-hour sleep-wake syndrome and irregular sleep-wake pattern. (5)
Let us examine intrinsic circadian sleep rhythm disorders more closely because doctors and nurses, as well as other family members will benefit from becoming more aware of them. In fact, every person in a family may be able to adjust his or her hours of sleep, work and play around them, to some extent.
Delayed sleep phase syndrome (DSPS) "…causes a much later than normal timing of sleep onset and offset and a period of peak alertness in the middle of the night." (6)
These doctors and nurses tend to go to bed late and are often most active and productive in the middle of the night. Evening or night shift can work out perfectly for them especially when they have the opportunity to sleep during the day. Problems arise when others do not allow them to sleep in the daytime.
Advanced sleep phase syndrome (ASPS) "…causes difficulty staying awake in the evening and staying asleep in the morning." (7)
These doctors and nurses tend to go to sleep early in the evening and rise early in the morning, so they will function at their best when working day shift. They may frustrate spouses and others who insist on an active social life night and sleeping in.
Non-24 "…causes the affected individual's sleep to occur later and later each day, with the period of peak alertness also continuously moving around the clock from day to day." (8)
These doctors and nurses tend to be the ones whose constantly changing time of sleep, allows them to function on continually rotating shifts. Spouses and family members who insist on maintaining regular routines often have difficulty with those who have this kind of sleep pattern.
Irregular sleep-wake pattern "…presents as sleeping at very irregular times, and usually more than once per day (waking frequently during the night and taking naps during the day) but with total time asleep typical for the person's age." (9)
These doctors and nurses tend to be the ones who function well on any kind of work schedule, but they always need to take catnaps at work and at home. Taking catnaps at work can lead to dismissal. Taking catnaps at home all of the time often upsets other family members.
Still wondering about the inside life of hospital doctors and nurses? Perhaps their patterns in work shifts have far more to do with personal circadian rhythms and biological clocks than we are ever aware of, at any time.
Balancing home life and shift work becomes a lot easier when one begins to understand circadian rhythms. When a doctor or nurse can adjust his or her work or shift schedule to function in conjunction with his or her circadian rhythm, he or she will be able to obtain sufficient sleep. The doctor or nurse will become healthier and happier. His or her work and home life will improve 
There is an added bonus!
Circadian rhythms also "…affect body temperature, alertness, appetite, hormone secretion, etc." (10)
That means these doctors and nurses who follow their circadian rhythm feel great! No wonder doctors and nurses are able to work such crazy hours!
(2) Ibid.
(3) Ibid.
(4) Ibid.
(5) Ibid.
(6) Ibid.
(7) Ibid.
(8) Ibid.
(9) Ibid.
(10) Ibid.

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