Advice needed...how to survive the night shift commute...literally.

[NeoPediRN]

I'm not sure if what I experience is normal or not. Over the past few years I've had a hard time staying awake in general behind the wheel if I'm driving for longer than 1/2 hour - 45 minutes. During the day it's easier, but even if I get a good night's sleep, I have to work on consciously reminding myself to stay awake. It only happens to me while driving.

I rotate day/nights 12 hour shifts and commuting after a night shift is extremely difficult. Taking a brief nap before heading home only makes it worse. I have tried: blasting the radio, singing along, eating ice, chewing gum, coffee 1/2 hour before my shift ends, rolling the windows down and sticking my head out, putting on the a/c, making myself freezing cold so that I'm too uncomfortable to want to drift off, eating breakfast in the car on the way home. I mean, you name it and I've tried it...and it makes no difference. I can literally feel sleep coming over me and a heaviness in my brain, and there's not much I can do about it. I drift off at red lights until a car behind me honks, I start falling asleep behind the wheel during the drive and my body jumps as I wake up quickly. I will also slam on the brakes in the middle of driving as I wake up thinking I'm about to hit something, but I'm nowhere near anything. Last year I fell asleep driving home after an overnight double and hit a snow bank 1/2 mile from my house. Thank God there was a blizzard and no one else on the road. I don't do overnight doubles anymore because of that, but it still doesn't solve the problem. I swerve at least once every morning, everything starts getting surreal, and often I don't remember driving home or I feel like the drive is a dream even though I know I'm awake, if that makes any sense. It's even started happening after day shifts, but nowhere near as bad as driving home after a night shift. The only thing that keeps me awake is if I come close to getting in an accident and I feel the adrenaline rush. That usually lasts long enough to get me close to home before it starts happening again. I'm so afraid I'm going to get seriously hurt or seriously hurt someone else. I live too far to use public transportation, and I've even thought about giving up the specialty I love to get any job close by, but there aren't many hospitals right near me and the ones that are, aren't hiring anyway.

Has anyone experienced this before or is there something wrong with me? Does it get better with time? I've been commuting after night shifts for about 18 months and it isn't getting better. Does anyone have other tips/tricks that have worked for them? I can't have a lot of caffeine or use energy drinks because I have a congenital heart condition. Thanks in advance, and please, no flames. I'm aware what I've shared is dangerous and I'm coming here for advice because I feel at a loss. I have to work, and commuting with someone else isn't an option, I live about 45 minutes northeast of my work and everyone lives in the city or south of.

[ukstudent]

If 8 hrs shift don't help then maybe you need all day shifts. Whatever it is, you need to change before you end up dead or having killed others.

I don't understand this concern for your license. Nurses work with a multitude of medical problems, some are on narcotics for pain issues, some are on psych meds. They are all good working nurses with licenses.

Get yourself to your doctor ans get this problem resolved.

[NeoPediRN]

I mean my driver's license, not my RN license. I'm afraid it'll get revoked since I could be seen as a danger behind the wheel, or because it's something that happens only while driving. Maybe I'll ask my doctor hypothetically so that I can back out of the conversation if she says she is obligated to report it to the RMV.

[CVmursenary]

I don't think doctors can report anything to the dmv nor any other agency accept abuse. They should be confidential with you.

[AggieD04]

I agree, your medical stuff is confidential. I think they would only have to report if you had actually committed a crime or something. I had this same problem and I ended up getting a job closer to home. The shorter drive makes all the difference. Right about the time I am ready to fall asleep I am pulling into my driveway. Good luck

[LouisVRN, RN]

Have you tried pulling over and like running around the car 10 times or doing squats or jumping jacks at the side of the road? Eating keeps me awake.

[Saysfaa]

I think this is beyond safely managing on your own. It could be relatively easy to fix, though, with the help of a sleep clinic.

[WalkieTalkie, RN]

I considered asking my doctor about Provigil since it's short acting, but I'm afraid of getting my license medically suspended. I have to be able to drive to be able to work. I also can't take anything that will speed up my heart. I was prescribed an allergy medicine with pseudoephedrine one time and even that gave me nasty tachyarrhythmias.

Some of the nurses I worked with at my old job have started taking Provigil, and they really like it! They told me it has helped their sleep/wake cycle immensely. These are all nurses who have been working nights for a long time and who still have problems with their sleep/wake cycle.

As for your heart rate, it's possible Provigil could speed it up. It certainly is a possible side effect. However, you won't know unless you try it. I take Adderall daily for AD/HD. It doesn't make me tachycardic unless I take multiple doses cuncurrently of something like pseudo or phenylepherine when I have a cold. You'll just have to be cognizant of this if you try it. I'd ask your doctor for a short script, like maybe a 7 day supply just to try it out.

As far as drug tests are concerned, modafanil is not included in a standard drug screen. In addition, it's generally ok to test positive for medications which you take for conditions such as AD/HD, sleep disorders (narcolepsy), and for other medical conditions being treated by your physician. If you are concerned about whether or not you can take a medication at work, contact your state's board of nursing. Personally speaking, since I do take Adderall, I obviously test positive for amphetamines on my drug screens. This has never been a problem for any of my employers. The nurse or physician responsible for the results will ensure that the script is legal, and it doesn't result in a problem for me personally, as the information is confidential in your employee health record.

I'd rather have a nurse who is awake than one who is halfway asleep, distracted, or otherwise unable to be completely alert!

[caliotter3]

I got so bad falling asleep behind the wheel that the highway patrol got my number and started to make my commute very, very "cozy". quote]

What do you mean by this? They called you during your commute, or you got pulled over frequently?

That also reminds me, I talk to my fiance on the way home sometimes to try to keep myself awake, but I still start to drift off and I'll start saying things that don't make sense, or start dreaming he's telling me something else and I'll respond out loud to that, and he'll yell at me to wake up.

I traveled on a long stretch of highway. I woke up one time while I was swerving across four lanes. The highway patrol began accompanying me every time I went to work, every day. It was obvious what they were doing and got annoying, but I certainly knew why they were doing it. It wasn't like I hadn't given them a reason to.

[canoehead, BSN, RN]

Can you take a short nap before leaving work, lie down in the break room, or in the backseat of your car?

If you are falling asleep in the car pull into a church or mall and take 15min of Zzzs. It really does make a difference.

[Music in My Heart]

I wonder if I can have a conversation with my doctor off the record, or if she would be obligated to put it in my medical file?

That's a question for your doctor. Mine will entertain off-the-record conversations.

[MassED, BSN, RN]

drinking an espresso on the way home? Or did you say you can't have anything caffeinated? What about talking to someone on the drive home, on your cell? Maybe not your boyfriend/fiance, but someone who can keep you awake and you'd be a bit more engaged in the conversation. I am super sleepy after 12 hour nights. I slap myself and turn on the a/c. Some mornings driving home are very dicey for me. I'm so tired I feel on the verge of hallucinating. I am very careful. I have fallen asleep while driving more than a few times, and it's so scary that my fear keeps me barely awake. I usually snack on some fruit or nuts also to keep me awake and busy doing something (chewing). I have a 45 minute commute.

[SlightlyMental_RN]

How about learning a foreign language CD's? Then, your brain would still be engaged.