Education
  • Rest to Be Your Best: Simple Steps to Improve Your Sleep Hygiene

    We as nurse anesthetists and students, with our busy work, on-call, and class schedules, know first-hand the effects of sleep deprivation on our health and performance.1 The importance of obtaining at least seven hours of sleep per night is crucial for our overall physical, mental and emotional health, as lack of sleep is correlated with many health risks such as weight gain, decreased mental acuity and focus, diabetes, and high blood pressure.2,3 A study by Biddle et al.4 reported that “large numbers of CRNAs experience sleep disturbances, regularly self-medicate to produce sleep, medicate within proximity to patient contact, have daytime somnolence and fatigue, and report a wide range of workplace and personal misadventures that maybe linked to inadequate off-duty sleep.”

    Standard V of the AANA Standards for Nurse Anesthesia Practice emphasizes that continuous clinical observation and vigilance are the foundation of safe anesthesia care.5 Nurse anesthetists are on the frontline of providing safe anesthesia care and fatigue and sleep deprivation can have a deleterious impact on patient safety. In one study, “almost one-third [of providers] reported committing an error in patient care because of fatigue.” 6 Improving sleep hygiene prepares us for our mission to provide the safe patient care. Here are some simple steps you can take to improve your sleep health.

    Develop a set of habits that prepare you for sleep7,8

    • Prepare for sleep about an hour before bedtime.
    • Set an alarm to shut off social media, email, and other stressors. Amber glasses can also block out blue light on screens.9
    • Journal or write down stressors.
    • Relax by taking a warm shower, meditating, aromatherapy, or other relaxation techniques.10
    • Keep the same habits on weekends and holidays, and go to bed within 20 minutes of your set bedtime. Maintaining consistency will restore your body’s sleep/wake cycle and keep your hormones balanced.

    Create a sleep environment that is cool, dark, and quiet3

    • Recommended temperature is between 64-68°11
    • Put away cell phones and other electronics.
    • Cover LED lights, including cable boxes and11 fire detectors.
    • Turn clocks away from your sleeping position.
    • Cover windows with blackout curtains, and use a sleep mask when traveling or if you cannot get your room dark enough. Darkness stimulates your body to release melatonin.
    • Use ear plugs or white noise to keep the space quiet.10

    Avoid going to bed hungry or full

    • Finish eating and drinking four-six hours prior to bed, and stop caffeine after 12 noon to prevent stimulation.
    • Avoid alcohol four-six hours prior to bedtime.
    • Limit fluids to avoid night trips to the bathroom.

    Change it up

    • If you are unable to fall asleep within 20 minutes or wake up in the middle of the night, get up and move to another room.
    • Engage in relaxing activities such as reading or listening to soothing music.12
    • Wait until you are sleepy to return to bed.

    Naps and exercise are good… but use with caution

    • Napping too late in the day decreases your sleep drive, which prevents you from falling asleep or staying asleep.
    • Limit it to 20 minutes and avoid napping fewer than four hours before your bedtime.7
    • If possible, complete exercise by 2 p.m., or at least two hours before bedtime or three hours before bedtime if you engage in high-intensity exercise.  Exercise increases cortisol, causing difficulty falling asleep.1,12,13

    Resources are available

    The AANA offers practice documents, podcasts, and checklists to help improve sleep.
    Visit www.aana.com/fatigue.

    Build your sleep hygiene as a step-wise process, and you’re more likely to have success than if you try to do it all at once.7 Wellness is the foundation of safe anesthesia practice, and CRNAs should maintain familiarity with strategies that prevent and mitigate fatigue. Changing habits is never easy, but we owe it to ourselves to stay healthy to provide the best possible anesthesia care to our patients.

    References

    1. Patient Safety Fatigue Sleep and Work Schedule Effects. Park Ridge, IL: American Association of Nurse Anesthetists; 2015.

    2. Mayo Clinic. Sleep tips: 6 steps to better sleep. https:// www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/ art-20048379. Accessed May 11, 2018.

    3. Mayo Clinic. Sleep: The foundation for healthy habits. https:// www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep-the- foundation-for-healthy-habits/art-20270117. Accessed May 11, 2018.

    4. Biddle C, Aker J. The national study of sleep-related behaviors of nurse anesthetists: Personal and professional implications. Vol 792011.

    5. Standards for Nurse Anesthesia Practice. Park Ridge, IL: American Association of Nurse Anesthetists; 2013.

    6. Domen R, Connelly CD, Spence D. Call-shift fatigue and use of countermeasures and avoidance strategies by certified registered nurse anesthetists: a national survey. AANA J. 2015; 83(2):123-131.

    7. Optimal Wellness Labs. Sleep Hygiene: Checklist for Good Sleep – You Can Sleep Like a Baby! https://optimalwellnesslabs.com/ sleep-hygiene-checklist-for-good-sleep-you-can-sleep-like-a-baby Accessed May 11, 2018.

    8. How to Sleep Like the Dead with Dr. Kirk Parsley [Internet]; 2016. Podcast. Available from: https://www.youtube.com/ watch?v=-6_Zbl7laXI

    9. The Most Overlooked Factor in Health and Longevity [Internet]: TheIHMC; 2016. Podcast. Available from: https://www.youtube. com/watch?v=dnGACHPr1nM

    10. What is Sleep Hygiene? . https://sleep.org/articles/sleep-hygiene/. Accessed May 11, 2018.

    11. Sleep to Win [Internet]; 2017. Podcast. Available from: https:// www.youtube.com/watch?v=1QbQbHs84OY

    12. Division of Sleep Medicine at Harvard Medical School. Twelve Simple Tips to Improve Your Sleep. http://healthysleep.med. harvard.edu/healthy/getting/overcoming/tips.
    Accessed May 8, 2018.

    13. American Sleep Association. Sleep Hygiene Tips. https://www. sleepassociation.org/about-sleep/sleep-hygiene-tips/. Accessed May 11, 2018.

    Please find a PDF of this article here.