Thread by @DrMikeFarquhar

I had a wee stint in our adult ICU team as part of COVID19 redeployment and, for some of that time, had an actigraph on

Actigraphy, worn like a watch, uses a number of sensors (mainly motion and light) to give an overall impression of sleep routine and pattern

Shift pattern was 3 long days/3 days off/3 nights/3 off, then repeat cycle

LOTS of caveats about this data:
- on shift, actigraph was in a scrubs pocket, often under PPE
- it isn’t directly measuring sleep
- one day I forgot to put it on at all...
- etc

But...it gives an idea

Some other points/caveats:
- black lines: motion/activity
- coloured lines: light exposure
- blue shading: sleep
- yellow: wake
- red: night shift
- purple: day shift
- I took some time to rest/recover on “off” days, but was generally doing “normal job” work on those days as well

My core sleep is around 7 hours, usually between ~2300-0600, and that’s usually relatively consistent

In as much as we can infer from actigrapy, my core sleep quality looks relatively good

Even when I’ve opportunity to sleep longer (eg a normal Saturday) I still generally wake up at same time

What I DO do then though is grab my iPad and spend an hour or two in bed scrolling through Twitter or playing games, which is the story the light/motion data is telling here

My normal average sleep time is just over 7 hours, and reasonable quality

While doing nights, I generally manage 4-5 hours of daytime sleep

Compare these two periods

On the left is sleep during a normal night; on the right, daytime sleep

You can see I’m much more active/restless during daytime sleep

(I was wearing a good quality eye mask for daytime sleep, so don’t worry about the light levels!)

What that boils down to is when sleeping in the day, I got less sleep, and less good quality sleep, than I normally would ...

... and then post-nights, I recover *some* of that sleep loss by sleeping significantly longer than I normally would

On the days after I finished a run of 3 nights, you can also see the shorter naps I took earlier in the day

However even during those long recovery sleep nights, I could still wake around 7am, go on my phone for about an hour, and then fall asleep again for another 90 minutes or so

Interestingly, there’s a suggestion I also slept longer for a couple of consecutive nights after doing 3 long days (which may just reflect the mental and physical increased effort of a paediatric sleep consultant reorientating their brain to adult critical care!)

How good am I at getting the basics of my sleep right?

Well, my core sleep routine is fairly consistent, which is good and at least some of the time I’m mindful about coming off screens a good hour or two before bedtime ...

... however on other nights, there is light exposure right up until bedtime 😳

(rumbled...)

You can also see some evidence of the reason why I’m a sleep consultant in the first place: I get relatively frequent episodes of sleep paralysis and hypnagogic hallucinations, and have done since I was a teenager

twitter.com/i/events/10548…

This was a particularly terrifying example of one

With a bad one, it always takes me a bit of time to relax/calm down again after (even though the physiology is fascinating)

For this one, I ended up distracting myself with my phone before going back to sleep (I know, I know...)

When my sleep is disrupted ... by working night shifts for example, the frequency of episodes tends to increase

Despite that though, one of my secret super powers is that I’m actually pretty good at adapting my sleep for night shifts (also means I don’t really get jet lag!)

As a sleep physician who spends a lot of time talking about supporting those who have to work shifts and nights, it was a really interesting experience to come back to this sort of work after not having done it for a while

ep.bmj.com/content/102/3/…

What was really great to see though was how seriously the whole @GSTT_ICU team took the issue of regular rest, breaks - and power naps on night shift - with excellent practice being modelled by consultants, senior nurses and senior registrars

For me it emphasises most important point: working at night is not physiologically natural

Even with all my knowledge and support, working nights had a huge effect on my sleep, that took time to recover

It’s why educating staff about sleep, and supporting them, is essential

... I didn’t actually mean for that Memoji picture to be in that tweet, but hey-ho...

Important extra: while recovery sleep is key to coping w/this sort of shift pattern, especially when doing intense work, not everyone is able to get it; it’s not uncommon, for example, for our night teams to also be toddler parents...

@LilDrSunshine

twitter.com/i/events/11018…