Sleep smarter

Celeste: Welcome back to week three of the Nursing and Midwifery Health Program Victoria's podcast series; Wellness reimagined: How to thrive in stressful times. I'm Celeste Pinney, a Registered Midwife and Senior Clinician at the Nursing and Midwifery Health Program Victoria and host of the podcast, An,nd I'm joined by wellness speaker Mark Bunn. Welcome back, Mark.

Mark: Pleasure to be here Celeste.

Celeste: Great to have you here. This week's theme is sleep smarter. So let's dive in. For nurses and midwives who often work shift work, good sleep can seem elusive. We know sleep is fundamental to our mental, physical and emotional health, yet it can seem out of our control to obtain good, restful sleep. We know, we do hear from nurses and midwives that they can feel quite frustrated with the usual sleep hygiene recommendations, Mark, because it's not always possible to achieve for shift workers. Could you share with us what might be some strategies that nurses and midwives could use other than sleep hygiene to get good sleep?

Mark: Yeah, no, absolutely. And really want to just reinforce that point, that yeah, can be very frustrating, and so certainly not going to go into any of the science and research on sleep. I think we all have an inbuilt sort of understanding that sleep’s important, but for nurses and midwives, what I think is important is even the tips we're going to go through now. The idea is you're not going to have perfect eight hour sleep every night. The idea is, if we can get maybe a 10 or 15 or 20% improvement in their sleep, then that's, I think, a really good goal. So, to take a step back first, what I always like to do is just get a really good foundation of an understanding of sleep from both a modern and ancient perspective, just in a normal sleep cycle, because then we can best look at how we can address it or massage that to get the best sleep during a shift work cycle.

Celeste: Yeah that would be great.

Mark: Yeah so in my training, yeah, in Ayurvedic medicine, they have an understanding that there's the six four hour cycles that our bodies go through, and it's like a wave on the ocean where our bodies, physiologically are designed to do certain things, and the time for maximum sleep in terms of what we want sleep to do, which is all our detoxification and getting rid of impurities and fats and regenerating tissue, etc, etc, they say happens from around 10pm until 2am, they call that the nighttime rejuvenation cycle and so on a normal shift, or when nurses and midwives are on their holidays and they're not working at night, the basic premise is that we want to have a light dinner, and the main reason for that is if we're going to bed or sleep after our main meal of the day, which most people do in a western civilization, main meal of the day is dinner time, then they're sleeping on basically a heavy stomach, which not only disturbs digestion, but interferes with that important sleep cycle.

So even if we sleep well, inverted commas, we don't wake up fresh, clear, focused, and so the same principle we want to carry into shift work, and I'm going to use, let's say it's a 11pm till 7am shift. I know that's going to be different for different women and men listening, but just as that guide, so what we don't want to do where possible is to come off the shift at 6, 7am in the morning, and then have that main meal of our day. What we want to try and do is schedule the sleep portion first, and then the main meal after that sleep portion. So that's going to be, you know, might be 2, 3 o'clock in the afternoon, and then, and we'll get into this a little bit deeper through what we call a, what I call the shift acronym, which is S.H.I.F.T. S is for sleep, and it's very much this understanding of 10am to 2am being the peak cycle. But the H in the acronym is heavy food. H for heavy; so we want to try and avoid having our main calorie input or our heavier foods just before our sleep cycle.

And that applies whether we're on shift or we're not on shift. When we're on shift, even more important, because we're sleeping at a time when the body's not naturally designed to do that detoxification process. So we're compromised already a little bit. We don't want to magnify that. So coming off the shift, so prior to that, we're having maybe during the shift, if we're hungry, you know, light cup of soups or just some fruit, trying to keep things light so that we can maximise the sleep coming off the shift, and then have the main meal after that sleep cycle. And then we can, yeah, dig it deeper into the the acronym, if you like.

Celeste: Yeah, I think, seeing as you've started explaining, it'd be great to hear the rest. I’m curious!

Mark: Yes, well, after so heavy food, so we have that main meal after our sleep cycle, always then the I stands for illumination, and this one's really, really key, because even modern science over the last decade has really honed in on the fact that it's the cycles of light and darkness which is most important for our ability to get our bodies into a deep state of rest and sleep. In fact, Stanford University, just in the last 12 months or so, spoke about early morning sunlight through the eyes, 2 to 10 minutes, being absolutely critical to regulate our appropriate cortisol response and to synchronise our circadian rhythm. So, what we want to do on a shift work cycle, of course, is to reverse that. The challenge for nurses and midwives is, say, coming off shift at 6am, 7am of course, they're coming out into daylight, particularly now coming into mid spring and summer.

So what can we do to just minimise that. It's not going to be a perfect situation, by any means, and you might need to look a little bit weird compared to the rest of the population, but things like having dark tinted sunglasses or blue light glasses, particularly in the last few hours of the shift, if you drive to work and it's affordable, maybe even considering tinting the windows on your car, trying to avoid going and doing shopping and other activities out and about in the light before going home to sleep, trying to do those activities after the sleep cycle, even exploring and it's been a couple of years now since I look deeply into this, but there's now even say green light therapy, green glasses you can wear that actually are the opposite to the blue light that help affect the melatonin response and get us into a deep sleep state quicker.

If you've got a partner at home, and they're leaving for work, they're going or kids going to school, getting them to maybe put the air conditioning on in the house so it reduces the temperature. We know to drop off we need to cool off, have our body temperature low, closing the curtains, maybe getting night lights in the home. So if you are having to do activities around the home before you get into bed for sleep, you can have low light as much as possible. So there things are really important and just another really quick one as an aside to this illumination point is vitamin D, all nurses and midwives, hopefully most are already getting tested for vitamin D. We know how important that is for our health, but obviously working night shift regularly means that we're then having our main sleep portion during the daylight hours, and particularly in the middle of the day, when we get most of our vitamin D. So just maybe getting a blood test a little bit more regularly, or even if you haven't had a blood test for some months, really high priority to get one done may need to be some supplementation for vitamin D if there's regular night shifts. Celeste: It's really great to hear you talk about the light exposure, and I've seen a lot of that in the media in recent years, and I think it's becoming more well known about the importance of, you know, our circadian rhythm being governed by the light dark cycle. And it's, you know, for most people, I think probably can go outside, even if it's maybe not in winter, on a morning shift, you're going to miss some of the sun, but on your tea break, you know, if you can pop outside, even for just five minutes or so, can make a really big difference to your sleep that night, and just your sleep in general, as you go through your week.

Mark: Absolutely and not in just sleep, just our mental health, which we know is a big one they're actually talking about now that they don't actually so much talk about sleep health. They call it circadian health, because it's really so fundamental, this idea of light exposure that's really the key to sleep. And in fact, this link to mental health, Monash University, about two years ago, did a study through the UK Biobank-400,000 people, and what they showed very clearly is those people that got the most exposure to natural light, as opposed to just obviously artificial lighting indoors, significantly lower use of antidepressants, higher mood, just sort of more that positive outlook. So yeah, those little five minute breaks, as you said, we might not think it's much, but it makes such a big difference.

Celeste: I saw that study actually, very interesting. And would you say Mark that you really need to go outside for that light exposure? Indoor light wouldn't be strong enough. Is that the case?

Mark: Always ideal to get outside where possible, because we get other benefits as well. But yeah, everything's being practical of course. If we can't get that, we do the best we can. So, yeah.

Celeste: Fantastic, that's really good to know, all right. And what about the F in the shift acronym?

Mark: F is for fasting, and we don't want to alarm anyone by fasting we don't mean anything extended. But just coming back to this principle that when we're working night shift, reasonably regularly, there's that sub-optimal digestion, you know, rejuvenation, through sleep, etc, so where there's just that slightly greater risk of in Ayuveyda call it armour or undigested food. So the way to prevent that, or to balance that, is just intermittent fasting, if it's appropriate. We know it's not appropriate for everyone, but just an occasional might be once a week, or, you know, on your days off, you're having a bit of social activity, just maybe having that skipping that breakfast occasionally, or having, being really conscious of lightning up the evening meal when you're not on night shift, just to give the whole digestive system and the body as a whole a chance to get rid of those toxins and impurities so they don't build up knowing that our sleep cycles a little bit compromised, that we're not going to be able to facilitate that process as much when we're sleeping during the day.

And then T is what I call transcendence, and probably in each of the podcasts we're going to talk a little bit about meditation, but this understanding of those mental techniques of meditation to be able to just transcend and allow our mind to get that really deep state of rest. We know, when the mind is deeply rested, the body also gets deep rest, and this is the most profound way the body has to get rid of some of those deep stresses and both integrate mind and body, which really has a powerful effect on sleep Pageand a lot of the research on transcendence based meditation techniques shows really, really powerful benefits for both the quality of sleep, getting to sleep quicker, and being able to maintain deeper rest and sleep for longer periods, so quantity as well. So that's the shift.

Celeste: Great. I love that, easy one to remember for people, especially when you're a shift worker. Do you have any ideas for how to unwind after a late or night shift, just so people can get more restful sleep, given also considering that nurses and midwives often have not much time before bed, you know, they might be getting home at 10,10.30, at night, even later, depending on travel, is there any sort of quick little, you know, practices people can do that might just help bring them down a notch? Mark: Yeah, that's a great question. And I think with a lot of these, it's personal sort of preference. I think we all have our own sort of unique ways to unwind, so I certainly wouldn't suggest there's a perfect way. But I think walking, just, you know, those little 5-10, minute walks just really, really powerful a lot of us find. Meditation, I've touched on really, really powerful research showing it's the quickest way to get that switch off. We talk about, you know, that mind busy after a shift, we're still thinking of maybe what happened on shift. How do we get the mind to shift into that sort of more relaxed, calm state that's going to be more conducive for sleep.

Celeste: And Mark, would that also include mindfulness? Or

Mark: Absolutely?

Celeste: Yep, mindfulness meditation in that same category?

Mark: Yeah, absolutely meditations, a bit like that principle we just touched on, you know, finding what works for you individually. And there's so many practices out there and apps and so, yeah, mindfulness really, really powerful. Some even like journaling. You know, it's like 5 or 10 minutes of journaling just helps people to get those thoughts out of their head so that they can sort of move on to the next activity. And probably the final one, I would Pagesuggest, is using aromas. I think they're really underutilised. Basically, you know, you're getting home, you can put aromas on it. Or, again, that principle of, if you've got kids or a partner who's leaving for work an hour or two before you're getting home, or can put something on before you get home. Aromas are great, you know, because you can put ones that are relaxing, calming, there's a lot of roam is now specifically blended for sleep and promoting sleep. So you don't have to do anything. You know, it takes 20 seconds to put it on. But you not only get the effect in helping you unwind from the day or the night shift, but then, if they're in the bedroom, we get 7 or 8 hours of benefit physiologically without even doing anything. You know, it's working without us having to do it. So that's why I think aromas are really, really good too. Celeste: It's great. So something like love, I mean, I don't know much about them, but lavender, or one of the other more calming kind of scents for people, would be good. Mark: Absolutely yeah, and a lot of them now just label them, you know, deep sleep or restful slumber, or, you know, so they've already compiled the blends. But yeah, lavender certainly is a nice one for, for many people

Celeste: It's a nice, simple one people could try. And in terms of, for people who might be a little daunted by, say, meditation, mindfulness, not sure where to start, haven't done it before, or have tried it and have thought, oh, no, you know, this isn't for me I can't do it. Where would you just a quick suggestion about where people might start? Like, is there a, you know, an app or something guided that they could follow along with that might help them get into it?

Mark: Absolutely. Yeah. So there's the two types. So mindfulness, a number of really popular apps are Calm is one C.A.L.M. Head space, I hear often really good reports from those using Headspace. And then I think Insight Timer would be the third one

Celeste: Insight Timer, yeah, they've got huge selection of all different types of courses and meditations and mindfulness practices. So okay, that's good to know. PageMark: Mindfulness. Yeah. I mean, I do TM, which is more of a course. So people that like a course and go on a teacher face to face, highly recommend that, or other sort of transcending based type techniques. But, um, yeah, jumping online, talking to friends often, that's a really good way. You know, often other nurses or midwives or even just friends, we often don't talk about these sort of things, but you know, the next dinner party, asking people what they do, and often, you'll get really good tips or suggestions of other practices others use.

Celeste: Fantastic. Could you talk a little bit about how movement and stress affects sleep, and how nurses and midwives could improve their sleep by being more aware of stress levels and perhaps how much movement they're getting through the day? Mark: Yeah, I'm laughing because I, it's one of those sort of catch twenty two’s. We don't want to focus too much on being aware of our stress levels, because it can make us more stressed. But yeah, the movement is a really big one, and although I'm laughing, it's actually a good principle that I would tend to focus more on just getting more activity and movement in, rather than specifically focusing on dealing with the stress. Because, as we know, exercise is one of the most scientifically verified ways of reducing stress and directly promoting good sleep. So, and I know we're going to do a podcast on the whole exercise and movement piece, but just a quick tip would be to focus on the accumulation of activity within our day, rather than exercise per se. One of the biggest challenges I see people face is they have this perception of exercise, “oh, it's difficult”, you know, we need discipline. We always hear about got to get willpower. How do I get motivated to exercise? And I think a lot of it is we have this perception that it means getting changed, we've got to put runners on, we have to go to the gym, or go to the yoga class or but really, all the research suggests that it's the accumulation of activity throughout the day that's most important. If you look at all the traditional cultures through time, all the research on long living cultures, none of them go to the gym. None of them go to yoga or pilates. They just have lifestyles where they're more active during the day. So that would be my quick tip within a sleep framework. Is just, what can I do to move my body? You know, whether it's walking or, you know, the old things we all hear about, taking the stairs instead of the lift, those little 5-10, minute breaks we have, you know, walking around the block, maybe making some phone calls. You know, we often make phone calls during the day. Can you go outside and make 2 or 3 phone calls while you're walking rather than doing them? You know, sitting at the nurses station or in the car or whatever it is. Incidental exercise is the key there.

Celeste: Incidental exercise is the key there.

Mark: Yep

Celeste: Yeah, yeah, great. And just lastly, I'm curious to hear how you might think employers can help support nurses and midwives to get better sleep, particularly, say, around rostering.

Mark: Yeah, another really great question, probably easy for me to talk about you know, as I'm not directly involved, and I know it's tough for employees as well, but the thing that always comes to mind for me is just discussion, you know, just, it's a conversation I would as an employer, think of focus groups, you know, getting 10, 15, 20 nurses and midwives in, you know, giving them morning tea or afternoon tea, or coming off shift, and just finding out from them directly what would most be beneficial for them, and trying to structure as best they can around, around that, rather than trying to predict it themselves. The other aspect, I think, more from a research perspective, is just consistency. You know, there's always going to be challenges with shift work, but one of the biggest challenges physiologically for nurses and midwives is changing shifts. You know, going back from a day shift, night, night too regularly. So whatever the discussion the focus group brings out, and the rostering trying to keep that as consistent as possible, and not chopping and changing too much, that that would be my suggestion. PageCeleste: That's great, and I know with the new enterprise bargaining agreement that's come out through the union, then our employees will require 48 hours from the end of a night shift until the start of the next which I think is a great change, because it just gives people that rest and recovery time that's really needed.

Mark: Yep, yeah. I like it, nice.

Celeste: Yeah. That's great. And I just encourage people as well to think about really planning your roster out if you're not already, and hopefully you've got a good employer or good rostering person that you can work with. Get your requests in in advance and try to think about when you want, when you to do your night shift, and not doing too many night shifts in a row or too many late earlies in a week. They seem to be the killer for sleep the late earlies, because you really have that small window of opportunity for sleep. But you know, you can always call our service and talk to us if, if you want to go a little bit more deeply into getting some support around sleep. All right well, thank you so much for joining us today. Mark that was a really fruitful discussion on sleep. We appreciate your time, and we look forward to being with you next week for our next topic about movement.

Mark: Thanks Celeste. Look forward to it.

Celeste: Great. So for any nurse or midwife in need of support, you can call us on 9415 7551 to make an appointment with one of our nurse midwife clinicians, and we look forward to seeing you next week.