Night shifts and asthma

Was just wondering and seeking some advice form people that may work nite shifts and also have astham. I have just finsed my second night shift this is the first time i have done nights. I am on nights for a month. This morn about 7am in work towards end of spits I started to get really wheezey and I felt realy nauseaus (cant spell and not asthma related). Just wondering if there anything I can do apart form puff away on salbutamol to stop my ashtma flaring up. DOnt think i like nights my body is objecting already.

Thanks and tkae care al to those in costa

Love ehidi

14 Replies

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  • The dreaded night shifts...

    Hi Heidi,

    I also find night shifts a very major trigger for my asthma... I think mostly because I have a severe morning dip at about 5am and being up and about doing things during it does not suit at all. Also my night shifts have usually been 13 hours a night for 7 days and the long hours don't really suit either.

    When I was a PRHO I was banned from doing night shifts after ending up admitted to ITU and ventilated during one shift... not good for me and not good for the rest of the team either! Since then, I have managed to do them up until last year, as I had had three years of fairly good control, but I have always needed to up my oral steroids, or to go on a short course of oral steroids if I wasn't already on them. Also I used to need to neb fairly frequently throughout the shift.

    I can relate to the feelings of nausea as well, I used to feel permanently nauseous and headachy whilst on the shift, and never used to be able to eat very much. That and the fact that you never sleep as well during the day than you would at night contributes to the general feeling of yuckiness! Nights are just plain not good for you, asthma or no asthma.

    General advice for surviving night shifts:

    - make sure you eat a good balanced diet with a few treats; the temptation is to survive on snacks from the hospital vending machines which makes you feel worse not better! Be organised with healthy and tasty packed lunches. If you feel nauseous eat little and often. Try to eat the right meal at the right time, ie breakfast in the evening before you go to work, rather than a full meal which will make you sleepy, and then a big stodgy evening meal in the morning before you go to bed - this is difficult to do but force it down!

    - drink plenty, it's easier to get dehydrated on night shifts. Make sure you drink enough so that you are weeing regularly and your urine is clear. Cut back on the fluids in the last couple of hours of the shift though or your sleep will be disturbed by getting up to the loo.

    - make sure you sleep in bed rather than crashing out on the sofa in front of the telly when you get home. Make sure your curtains are thick enough to make the room really dark - I have blackout curtains under the proper ones! Get earplugs if you have neighbours that are doing DIY! Get the expensive earplugs not the cheap foam ones, they're more comfy.

    - when you finish your shift, try to expose yourself to the sun as little as possible, difficult in this weather! Bright sunlight just before you go to bed will stop your body clock from resetting itself to the new hours. Conversely, try to go out in the sun before the start of your night shift, to fool your body into thinking that it's morning.

    - a glass of wine before you go to sleep is not a bad idea, and will help you sleep, but resist the urge to drink too much; it will put you to sleep but it won't be good quality sleep (and ignore friends and relatives who frown at the idea of wine at 9am - it's the evening to you!)

    - similarly, resist the idea of sleeping pills unless the situation is really dire - I have friends who had to take them to get through the week of nights but they're best avoided if at all possible (and your GP may not be willing to prescribe them anyway!)

    - if you have a block of night shifts, then a couple of days off, then more night shifts, try to stick to the same sleep patterns on your days off - annoying for your social life but much easier than trying to adjust and then readjust!

    - depending on how long you are on night shifts for, plan at least a week at the end to get your body clock back in sync, and don't plan to do anything too tiring in that time

    Asthma advice:

    - you might have to increase your inhaled steroids/go on oral steroids/increase your oral steroids (depending what level of treatment you're on, obviously) while you are on night shifts - it's worth discussing with your GP. If you do go on pred, take it in the evening, ie your 'morning', just before you start work, rather than in the morning as usual, as it will help to reset your body clock if taken in the evening

    - don't ignore your symptoms if they're worsening - I did, five years ago, and ended up on ITU

    - speak to Occy Health - they might be able to take you off night shifts or arrange for you to do them in shorter batches. Occy Health at my first job were very accomodating once I had scared the hell out of all the staff, but hopefully they will do something for you without having to go to those lengths!

    - if you are worse at any particular time eg 5am, try and plan your break at that time so you are not running around madly at your worst time.

    - make sure your colleagues are aware of your asthma - difficult I know but better than them finding out the hard way!

    - if you can't go in you can't go in. Don't be a martyr!

    The night shift issue has been something I have struggled with throughout my career so far - it is the one thing at work (bar running to arrests) that I have really have problems with. I'm off work at the moment, but when I do go back I'm going to have to find a job that doesn't involve night shifts, as I can't see myself being able to do them for the forseeable future. I hope you have more luck than I have though and manage to find a way to get through them!

    Hope this helps, if you have any other questions feel free to PM me!

    Take care and don't let the (daytime) bed bugs bite!

    Em H

  • Thanks Em for your advice I have taken in all on board, it is very helpful. As you are a doc I may as well ask u this question too u prob be able to answer it for me.

    I am on singulair you should I carryo n tkaing this in the evening when I ually take it or take it in the morning before i go to bed which is now my new evening!? I am just so confused at the min. My body clock finding it hard to adjust keep waking up at 2pm hungry cos really havent been able to eat dinner beofre sleep bit as you said I will force my self.

    Also what not helping at the min is prob the fact that I have just started a course of erythromycin cos I have got an ear infection co amoxicalv didnt clear it up had it for nearly 3 weeks now dont think jetting of to sweden for a funeral helped either.

    I have a got a month of nights and really starting to feel already that I not going to cope with them all I am only about to start my 3rd one too I not usullay a wimp or afraid of hard work but i just want to cry. Cant even talk to fiends after work cos they at work and i so tired tired I cant even form sentences.

    Sorry for maoning and really appreciate the advice thanks again. and you take care look after your chest.

    Heidi xx

  • Heidi, don't worry about moaning! Night shifts are really really tough, don't underestimate the effect it will have on your body and your emotions. I am not usually the sort of person that cries easily and I always used to find I would get really tearful and emotional whilst on nights. You are right, it's not easy to maintain contact with friends either, and the social isolation doesn't help. I hate that feeling of just working and sleeping and nothing else! A month of nights is a lot, as well - I presume you do have some nights off in that time?

    Re: singular, I don't think it much matters when you take it, you may as well continue taking it in the evening; that way it might help to minimise the morning dip whilst you are at work. The important one is the steroids - we are normally advised to take them in the morning to mimic as closely as possible the diurnal rhythm of secretion of our body's own natural steroids, and to try to avoid steroid-induced insomnia, so it makes sense when on nights to take them in the evening to help the body clock to adjust. The erythromycin is not going to help your nausea, either; you'll probably find you feel a lot better after you've finished the course.

    Go easy on yourself, and remember, it does take time to adjust - the first couple of nights are often the hardest. You might well find that in a few nights time your body has adjusted and you are finding it a lot easier. Please, though, don't try to tough it out if you are really not managing; there's no shame in not managing nights, I know many many junior doctors, some with asthma, some with other problems, who can't cope with nights. It's much better for you and for the bosses to take some planned time out than to end up going off sick with a bad asthma attack during your shift!

    Look after yourself,

    Hugs

    Em H

  • Nothing more helpful to add really, as Emily has already said it all. Nights?? Bllleerrrrrrghhhhhhh!! Can totally identify with the four/five o'clock dips, allied to the zombie-like tiredness that only night shifts can induce, which really doesn't help when you are trying to do an important job. You have my utter sympathies for having to do a months' worth of nights, I hope they go as well as they can do and hopefully Emily's advice will see you through.

    Cathy

    xx

  • Heidi was wondering how u were doing. I am of no help re advice on night shifts...got it all to come in a few yrs time lovely! One thing tho...it doesn't matter when u take ure singulair...I am on double the recommended dose so i take it both morn and night.

    Good luck and keep us posted. Take care of yourself.

    Em x

  • Hi Em h, cathbear and em,

    Thanks for your support advice. It glad to know that someone is knowing how I feel at the min. Just sat here trying to force myself to eat some spagetti cabonara, then hopefully I wont wake up at 2pm with hunger pains and that i will be able to eat in the night at work.

    Tonight was a bad shift for me as someone died. I have had dealings with deaths on ward in past, but very emotional this time cos I have only just come back form sweden after buring my stepmother and of course i was tied and feeling very wheezey and SOB at 4am in the morn.

    After I have eaten my dinner I am off to check my pony still has 4 legs and just remind him who I am LOL!! I got one more nite then a day off the back to the grind stone.

    Once agaon thanks

    LOve and hugs

    Heidi xx

  • Heidi, sorry to hear that you had a bad shift. When a patient dies it is always difficult but it is often harder or more poignant when you yourself have recently suffered a loss (an experience I have unfortunately had twice all too recently). Look after yourself all the more over the next few days, be aware of your limitations and take five minutes or so if you need it to ""housekeep"" (as the president of the RCGP likes to call it).

    I always made sure I had a warm meal at some point during the day - usually a full cooked breakfast - then cereal when I got up in the evening, and took perhaps a sandwich plus lots of small easy (and not terribly healthy) snacks with me for the wee small hours, such as a small cake/pastry, apple, bag of crisps, Tracker bar etc. That way I didn't have to have a long stretch of time to sit down and eat a proper meal when I was trying to work.

    I hope your last shift (in the current stretch) goes slightly better and you have a good rest on your days off.

    Cathy

  • Heidi, enjoy your nights off and try not to spend the whole time worrying about your next stint on nights. It does get easier as you get more used to the different routine for sleeping, working and eating. Don't be hard on yourself I am sure everyone struggles when they first do nights - I know I did. I am now one of those strange morsels who really enjoys the night shift although my asthma is usually not too good between about 4 and 6am. I don't sleep that brilliantly day or night so end up with about the same amount of sleep whichever I do. I tend to eat my way through the night having a healthy meal as soon after midnight as possible then snack until about 4 am. I then try to have a cup of tea and toast at about 5.45 before the intense work at the start of the patients' day begins and then have cereals when I get home. THat way I tend not to get hungry during the day. i have a light meal when i wake up in the evening as i can never manage anything too heavy just after getting up. But I know i am different to most people. Having said what I do I am actually banned from working nights at the moment because my asthma is too unstable. I am a staff nurse in a community hospital and we only have 2 trained and 1 HCA covering the ward and MIU together. If i ended up with a problem the it would leave us with unsafe staffing levels with no way of getting help, never mind the other trained having to sort me out as well.

  • I just come back from my night shift. I don't realy have much more to add as all good advice has been given. I just hope it will get easier for you as you go on. It seems like you only do night this month which is great. Belive me there is nothing worse then a mixture of days and nights.

    Hopefuly your body clock will soon adapt to the new routine. Most people hate working nights and find it hard to adapt. I am the other way round. I love doing nights but early mornings are a killer for me. I think it would be better if they would let everyone choose their shifts and do not force nights on those who struggle (unfortunately as it seems that they are not to many people who fancy nights it will probably never work that way).

    What ward are you on? It seems to be pretty busy. I can usualy enjoy much more quite times and extra breaks on nights shifts on all wards apart of A&E and MAU, which are busy 24/7. Maybe you can arrange to split your break into 2 or 3 short bursts. Or maybe it will work better for you to make a good use of whole 1 hour break at the time when your peak flow is at its lowest. Try different things and hopefuly you will find a way to make it work for you.

    Make sure you ttalk with people on your shift and let them know when you struggle. Better be safe then sorry. I am sure they would rather let you take an extra 15 minutes break then deal with a major attack. If you think that your health suffers contact OH sunner then later. Maybe they will be able to get you of the night shifts.

    All together best of luck. I realy hope that it will get better for you.

  • I work on a respiratory ward, it not always too busy just got a few poorlies in at the minute. last nite was quite quiet which made it go slowly.

    Ashtma been really not too good today but I know it gets worse when i get tired and I am so tired at the min. Was going to have a chat with my ward manager to tell her i struggling with nites with my chest but she is not a very understanding or sypathetic person and she is quite unappraochable person. So I think I just leave it. Have been basicaly eating salbutamol today which isnt realy to good. I feel like I could do with a neb but dont have home nebs and I am not bad enough to go to a/e so will have to continue to eat salbutamol hopefullay by end of next week i will be used to night shifts.

    Take Care all

    Heidix

  • Heidi, please think about saying something to someone if you are struggling, if not your unsympathetic ward manager, then perhap another senior member of the nursing staff on the ward or someone from Occy Health. It's far better for you and for them to say something now rather than have to go off sick during a shift.

    It sounds like your salbutamol usage has gone up dramatically... not a good sign... have you thought about also visiting your GP to increase your treatment?

    Please don't just be brave and suffer in silence, it can make things so much worse!

    Take care

    Em H

  • Heidi, please think about saying something to someone if you are struggling, if not your unsympathetic ward manager, then perhap another senior member of the nursing staff on the ward or someone from Occy Health. It's far better for you and for them to say something now rather than have to go off sick during a shift.

    It sounds like your salbutamol usage has gone up dramatically... not a good sign... have you thought about also visiting your GP to increase your treatment?

    Please don't just be brave and suffer in silence, it can make things so much worse!

    Take care

    Em H

  • Heidi, If your asthma is really not good then perhaps you should go off-sick. i wouldn't normally suggest it but if you aren't up to par at work then are you actually safe working? How do you think you would cope in an emergency? I am not normally one for lecturing about health and work but i am kind of passing on all the lectures that i have had myself. Try seeing occi health when you finish shift or on your nights off to get their advice.

    Ange XX

  • Sorry to hear you are strugling so badly :(. Maybe it would be a good idea to get your meds changed a bit. Talk with your GP (working nights getting an apoitment may not be an easiest think to organise but I think it is worth the strugle). If you need so much of reliver maybe you need to increase your steroid. Otherwise, if you are not on it yet, maybe steping up your treatment with a long acting bronhodilator will do the trick.

    I would think that ward manager from respiratorry word would be more understanding but what do I know (I guess menagerr' is a key word here if you know what I mean). Maybe speak with the sister or some other senior staff.

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